University of Oulu

Paukkunen, M., Ala-Mursula, L., Öberg, B., Karppinen, J., Sjögren, T., Riska, H., Nikander, R., & Abbott, A. (2023). Measuring the determinants of implementation behavior in multiprofessional rehabilitation. European Journal of Physical and Rehabilitation Medicine, 59(4).

Measuring the determinants of implementation behavior in multiprofessional rehabilitation

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Author: Paukkunen, Maija1,2; Ala-Mursula, Leena3; Öberg, Birgitta1;
Organizations: 1Institution for Health, Medicine and Caring Sciences, University of Linköping, Linköping, Sweden
2Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
3Research Unit of Population Health, University of Oulu, Oulu, Finland
4Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
5Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
6Central Hospital of Central Finland, Jyväskylä, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
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Language: English
Published: Edizioni Minerva Medica, 2023
Publish Date: 2023-10-24


Background: The Determinants of Implementation Behavior Questionnaire (DIBQ) measures facilitators or barriers of healthcare professionals’ implementation behaviors based on the current implementation research on practice and policy. The DIBQ covers 18 domains of the Theoretical Domains Framework and consists of 93 items. A previously tailored version (DIBQ-t) covering 10 domains and 28 items focuses on implementing best-practice low back pain care.

Aim: To tailor a shortened version of DIBQ to multiprofessional rehabilitation context with cross-cultural adaptation to Finnish language.

Design: A two-round Delphi study.

Setting: National-level online survey.

Population: Purposively recruited experts in multiprofessional rehabilitation (N.=25).

Methods: Cross-cultural translation of DIBQ to Finnish was followed by a two-round Delphi survey involving diverse experts in rehabilitation (physicians, physiotherapists, occupational therapists, psychologists, nursing scientists, social scientists). In total, 25 experts in Round 1, and 21 in Round 2 evaluated the importance of DIBQ items in changing professionals’ implementation behavior by rating on a 5-point Likert Scale (1 = Strongly Disagree, 5 = Strongly Agree) of including each item in the final scale. Consensus to include an item was defined as a mean score of ≥4 by ≥75% of Delphi participants. Open comments were analyzed using inductive content analysis. Items with agreement of ≤74% were either directly excluded or reconsidered and modified depending on qualitative judgements, amended with experts’ suggestions. After completing an analogous second-round, a comparison with DIBQ-t was performed. Lastly, the relevance of each item was indexed using content validity index on item-level (I-CVI) and scale-level (S-CVI/Ave).

Results: After Round 1, 17 items were included and 48 excluded by consensus whereas 28 items were reconsidered, and 20 items added for Round 2. The open comments were categorized as: 1) ”modifying”; 2) ”supportive”; and 3) ”critical”. After Round 2, consensus was reached regarding all items, to include 21 items. After comparison with DIBQ-t, the final multiprofessional DIBQ (DIBQ-mp) covers 11 TDF domains and 21 items with I-CVIs of ≥0.78 and S-CVI/Ave of 0.93.

Conclusions: A Delphi study condensed a DIBQ-mp with excellent content validity for multiprofessional rehabilitation context.

Clinical rehabilitation impact: A potential tool for evaluating determinants in implementing evidence-based multiprofessional rehabilitation interventions.

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Series: European journal of physical and rehabilitation medicine
ISSN: 1973-9087
ISSN-E: 1973-9095
ISSN-L: 1973-9087
Volume: 59
Issue: 4
Pages: 488 - 501
DOI: 10.23736/S1973-9087.23.07857-7
Type of Publication: A1 Journal article – refereed
Field of Science: 3141 Health care science
Copyright information: © 2023 THE AUTHORS. This is an open access article distributed under the terms of the CC BY-NC-ND 4.0 license which allows users to copy and distribute the manuscript, as long as this is not done for commercial purposes and further does not permit distribution of the manuscript if it is changed or edited in any way, and as long as the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI) and provides a link to the license.