Measuring determinants of implementation behavior: psychometric properties of a questionnaire based on the theoretical domains framework

BACKGROUND: To be able to design effective strategies to improve healthcare professionals’ implementation behaviors, a valid and reliable questionnaire is needed to assess potential implementation determinants. The present study describes the development of the Determinants of Implementation Behavior Questionnaire (DIBQ) and investigates the reliability and validity of this Theoretical Domains Framework (TDF)-based questionnaire. METHODS: The DIBQ was developed to measure the potential behavioral determinants of the 12-domain version of the TDF (Michie et al., 2005). We identified existing questionnaires including items assessing constructs within TDF domains and developed new items where needed. Confirmatory factor analysis was used to examine whether the predefined structure of the TDF-based questionnaire was supported by the data. Cronbach’s alpha was calculated to assess internal consistency reliability of the questionnaire, and domains’ discriminant validity was investigated. RESULTS: We developed an initial questionnaire containing 100 items assessing 12 domains. Results obtained from confirmatory factor analysis and Cronbach’s alpha resulted in the final questionnaire consisting of 93 items assessing 18 domains, explaining 63.3% of the variance, and internal consistency reliability values ranging from .68 to .93. Domains demonstrated good discriminant validity, although the domains ‘Knowledge’ and ‘Skills’ and the domains ‘Skills’ and ‘Social/professional role and identity’ were highly correlated. CONCLUSIONS: We have developed a valid and reliable questionnaire that can be used to assess potential determinants of healthcare professional implementation behavior following the theoretical domains of the TDF. The DIBQ can be used by researchers and practitioners who are interested in identifying determinants of implementation behaviors in order to be able to develop effective strategies to improve healthcare professionals’ implementation behaviors. Furthermore, the findings provide a novel validation of the TDF and indicate that the domain ‘Environmental context and resources’ might be divided into several environment-related domains

Unravelling the factors decisive to the implementation of EPODE-derived community approaches targeting childhood obesity: a longitudinal, multiple case study

Abstract Background Implementation of intersectoral community approaches often fails due to a translational gap between the approach as intended and the approach as implemented in practice. Knowledge about the implementation determinants of such approaches is needed to facilitate future implementation processes. Methods The implementation of five EPODE-derived intersectoral community approaches was studied longitudinally. Semi-structured interviews were held with 189 community stakeholders from four sectors to elucidate which determinants influenced implementation, and if an to which extent determinants differed across communities, sectors and over time. A framework approach was used to analyze our data. Results Twenty-two key determinants of implementation were identified. Facilitators named were mostly proximal (stakeholder level), and barriers were mostly distal (context level). Key determinants varied greatly across sectors and over time, especially between the educational & health care sector and the private, welfare & sports sector. Only ‘perceived importance of IACO goals’ was identified as an universal implementation facilitator. Conclusions Striking differences in determinants were found across sectors and over time. Also, stakeholders expressed that possibilities to adapt the approach to the local context were needed to improve implementation. We therefore propose to develop sector- and time specific leads for implementation, which should be approved and amended (over time) by stakeholders. This so-called ‘mutual adaptation’ allows for the use of both scientific insights and practice-based knowledge, enabling program management and community stakeholders to collaboratively improve their implementation efforts

Comparing three short questionnaires to detect psychosocial problems among 3 to 4-year olds

Background: Validated questionnaires help community pediatric services to identify psychosocial problems. Our aim was to assess which of three short questionnaires was most suitable for this identification among pre-school children. Methods: We included 1,650 children (response 64 %) aged 3-4 years undergoing routine well-child health assessments in 18 services across the Netherlands. Child healthcare professionals (CHPs) interviewed and examined children and parents. Parents were randomized regarding filling out the Strengths and Difficulties Questionnaire (SDQ) or the KIPPPI, a Dutch-origin questionnaire. In addition, all filled out the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) and the Child Behavior Checklist (CBCL). We assessed the internal consistency and validity of each questionnaire, with CBCL and treatment status as criteria, and the degree to which each questionnaire could improve identification based solely on clinical assessment. Results: The internal consistency of the total problems scale of each questionnaire was satisfactory, Cronbach's alphas varied between 0.75 and 0.98. Only the SDQ discriminated sufficiently between children with and without problems as measured by the CBCL (sensitivity = 0.76 at a cut-off point with specificity = 0.90), in contrast to the other two questionnaires (with sensitivity indices varying between 0.51-0.63). Similar results were found for the treatment status criterion, although sensitivity was lower for all questionnaires. The SDQ seemed to add most to the identification of psychosocial problems by CHPs, but the differences between the SDQ and the ASQ: SE were not statistically significant. Conclusions: The SDQ is the best tool for the identification of psychosocial problems in pre-school children by community paediatric services

Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research

BACKGROUND: To improve the implementation of innovations in healthcare settings, it is important to understand factors influencing healthcare professionals’ behaviors. We aimed to develop a generic questionnaire in English and in Dutch assessing the 14 domains of behavioral determinants from the revised TDF (Cane et al., 2012) that can be tailored to suit different targets, actions, contexts, and times of interest, and to investigate questionnaire items’ discriminant content validity. METHODS: We identified existing questionnaires including items assessing constructs within TDF domains and developed new items where needed. Nineteen judges allocated 79 items to one or more TDF domains. One-sample t-tests were used to examine the discriminant content validity of each item, i.e., whether items measured intended domains or whether items measured a combination of domains. RESULTS: We identified items judged to discriminately measure 11 out of 14 domains. Items measuring the domains Reinforcement, Goals, and Behavioral regulation were judged to measure a combination of domains. CONCLUSIONS: We have developed a questionnaire in English and in Dutch able to discriminately assess the majority of TDF domains. The results partly support Cane et al.’s (2012) 14-domain validation of the TDF and suggest that Michie et al.’s (2005) 12-domain original version might be more applicable in developing a TDF-based questionnaire. The identified items provide a robust basis for developing a questionnaire to measure TDF-based determinants of healthcare professionals’ implementation behaviors to suit different targets, actions, contexts, and times. Future research should investigate the concurrent and predictive validity and reliability of such a questionnaire in practice

Identifying Anticipated Challenges when Implementing Group Care: Context-analyses Across Seven Countries to Develop an Anticipated Challenges Framework

Problem Despite increasing interest in Group Care worldwide, implementation is challenging. Background Group Care is an evidence-based perinatal care model including three core components: health assessment, interactive learning, and community building. It has several advantages for service users and providers compared to individual perinatal care. Aim We aimed to identify anticipated challenges when implementing Group Care, and to develop a supporting tool based on these challenges. Methods Context analyses through Rapid Qualitative Inquiries were conducted in 26 sites in seven countries to gain insight into the anticipated challenges when implementing Group Care. Data triangulation and investigator triangulation were applied. The context analyses generated 330 semi-structured interviews with service users and other stakeholders, 10 focus group discussions, and 56 review meetings with the research teams. Findings We identified six surface structure anticipated challenges categories (content, materials, facilitators, timing, location, group composition), and five deep structure anticipated challenges categories (health assessment, scheduling Group Care into regular care, enrolment, (possible) partner organisations, financials) occurring in all participating sites, leading to the development of the Anticipated Challenges Framework. Conclusion Completing the Anticipated Challenges Framework raises awareness of anticipated challenges if sustainable Group Care implementation is to succeed and encourages the initiation of a concrete action plan to tackle these challenges. Application of the framework may offer important insights to health systems administrators and other key stakeholders before implementing Group Care. In the medium- and long-term, insights gained may lead to greater possibilities for sustainability and to the most cost-effective approaches for implementing Group Care

Hydrothermally-induced melt lens cooling and segmentation along the axis of fast- and intermediate-spreading centers

Author Posting. © American Geophysical Union, 2011. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geophysical Research Letters 38 (2011): L14307, doi:10.1029/2011GL047798.The heat output and thermal regime of fast and intermediate spreading centers are strongly controlled by boundary layer processes between the hydrothermal system and the underlying crustal magma chamber (AMC), which remain to be fully understood. Here, we model the interactions between a shallow two-dimensional cellular hydrothermal system at temperatures <700°C, and a deeper AMC at temperatures up to 1200°C. We show that hydrothermal cooling can freeze the AMC in years to decades, unless melt injections occur on commensurate timescales. Moreover, the differential cooling between upflow and downflow zones can segment the AMC into mush and melt regions that alternate on sub-kilometric length scales. These predictions are consistent with along-axis variations in AMC roof depth observed in ophiolites and oceanic settings. In this respect, fine-scale geophysical investigations of the structure of AMCs may help constrain hydrothermal recharge locations associated with active hydrothermal sites

Belonging: a meta-theme analysis of women’s community-making in group antenatal and postnatal care

Health care systems are social institutions simulating microcosms of wider societies where unequal distribution of power and resources translate into inequities in health outcomes, experiences and access to services. Growing research on participatory women’s groups positively highlights the influence of group-based care on health and wellbeing for women, their infants, families and wider communities across different countries. With similarities in ethos and philosophies, group care combines relational, group-based facilitation and clinical care, uniquely offering an opportunity to examine the intersections of health and social care. With collated data from Group Care for the First 1000 Days (GC_1000), we conducted a qualitative meta-thematic analysis of women’s experiences of group antenatal and postnatal care in Belgium, Ghana, Kosovo, The Netherlands, South Africa, Suriname and The United Kingdom to better understand how and to what extent community-making engenders a sense of belonging amongst group care participants and how these experiences may address social well-being and health. Results from this analysis expose that women actively participate in community building in group care in three key ways: (1) Collective agreements, (2) Boundary setting and (3) Care Gestures, orchestrated via socio-spatial building embedded in key pillars of the model. This analysis also illustrates how a sense of belonging derived from group care can mobilise women to support and care for the wider community through communal building of health literacy which builds from individual to communal empowerment: (1) Individual Health, (2) Community Health, (3) Partner Involvement, (4) Social Care and (5) Including Wider Community in Group Care. This research study builds upon existing evidence from both group care and participatory women’s group literature, showcasing the potential of group-based care to holistically address women’s needs. This research further illustrates the ways women create a sense of belonging in the context of group care and highlights why belonging may be an integral component of the model’s facilitation of improved health and well-being for individuals as well as their wider communities. More research is needed to understand the link between belonging and community mobilisation in the context of group care and how it may address the needs of underserved communities