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

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

Prevalence of passive smoking in infancy in the Netherlands

The objective of the study was to assess the prevalence of passive smoking in infancy. This was done by self-report questionnaires completed by parents who attended the well-baby clinic in the period February-May 1996. A total of 2720 questionnaires were spread among parents with babies between 1 and 14 months: smoking and non-smoking parents. The questionnaires contained questions on smoking habits, smoking at home, smoking in presence of the baby. A total of 1702 parents filled in and returned the questionnaire (63%); 24% of the mothers and 33% of their partners smoked. In 44% of the families, one or more persons smoked; 22% of the mothers and 26% of the partners smoked at home. In 39% of the families, one or both parents smoked at home; 42% of the babies were exposed to tobacco smoke in the living-room, 8% were exposed in the car, and 4% during feeding. In cases where only the mother smoked, 13% of the infants were exposed to tobacco smoke during feeding. In the families where only the partner smoked, the babies were predominantly exposed to smoke in the car (18%). If both parents smoked, the child was most frequently exposed to tobacco smoke in the living-room (73%). It can be concluded that health workers, nurses, pediatricians and family physicians should be advised to inform parents systematically of the harmful effects of passive smoking in infancy. If parents are unable or unwilling to stop smoking, it is important to advise them to refrain from smoking in the presence of the baby. Copyright (C) 2000 Elsevier Science Ireland Ltd. Chemicals/CAS: Tobacco Smoke Pollutio

"She is a Mother, but still Childish". Exploring Adult Caregivers' Perspectives on Adolescent Parenting

The adolescent-adult caregiver relationship is arguably one of the strongest influences on adolescent parents' development and parenting abilities. In Cape Town, South Africa, an evaluation of a parenting programme targeting school-going adolescent parents, considered the intervention effects on parenting and adolescent wellbeing, in three low-income communities. Adolescent parents resided with their adult caregivers. This paper draws on seventeen qualitative interviews with the caregivers of these adolescent parents. The qualitative interviews formed part of a wider parenting programme evaluation. This study explored the nature of the adolescent-caregiver relationship, and the potential effects of these relationships on adolescents' wellbeing and parenting competencies. The findings suggest that while caregivers played co-parenting roles, they were often not emotionally supportive, placed multiple demands on the adolescents, and portrayed authoritarian approaches. The adolescent-caregiver relationships were often complex, hierarchical, and reflected negative parenting. Caregiver behaviours possibly left adolescents feeling unsupported, restricted in their parental autonomy, and undermined. Caregivers reported adolescents' use of harsh discipline measures with their children. The findings highlight the indelible imprint that older generations, particularly those upholding traditional values, have on adolescent parents and their parenting. The authors conclude that caregiving environments that lack supportive interactions may lead to an elevated risk of compromised mental health and lowered parental competency for adolescent parents. Caregiver-adolescent relationship quality should be considered in interventions targeting adolescent parents. Interventions should be inclusive of adolescents' caregivers, emphasising that support relationships should nurture both the adolescent and their young children

Expert Consensus on Multilevel Implementation Hypotheses to Promote the Uptake of Youth Care Guidelines: A Delphi Study

Background: The implementation of youth care guidelines remains a complex process. Several evidence–based frameworks aid the identification and specification of implementation determinants and strategies. However, how certain determinants are influenced by specific strategies remains unclear. Therefore, we need to clarify which active ingredients of strategies, called behaviour change techniques (BCTs), elicit behaviour change and improve implementation outcomes. With this knowledge, we are able to formulate evidence–based implementation hypotheses. An implementation hypothesis details how determinants and in turn, implementation outcomes might be influenced by specific implementation strategies and their BCTs. We aimed to identify 1) determinants relevant to the implementation of youth care guidelines and 2) feasible and potentially effective implementation hypotheses. Methods: A four–round online modified Delphi study was conducted. In the first round, experts rated the implementation determinants based on their relevance. In the second stage, the experts formulated implementation hypotheses by connecting BCTs and implementation strategies to determinants. Next, they were asked to provide a rationale for their choices. In Round 3, the experts reconsidered and finalised their hypotheses based on an anonymous overview of the hypotheses formulated by all the experts, including the substantiations of these hypotheses. Finally, the experts were asked to rate the implementation hypotheses based on their potential effectiveness and feasibility. Results: A total of 14 experts completed the first, second, and third rounds, and 11 completed the final round. Guideline promotion, mandatory education, presence of an implementation leader, poor management support, knowledge regarding guideline use, and a lack of communication skills were reported as most relevant. In total, 46 hypotheses were formulated, ranging from 6 to 9 different hypotheses per determinant. For each determinant, we provide an overview of the implementation hypotheses most often considered feasible and potentially effective. Conclusion: Determinants related to engagement and to knowledge and skills were found to be relevant to youth care guideline implementation. This study offers a set of hypotheses that could help organisations, policymakers, and professionals guide the implementation process of youth care guidelines to ultimately improve implementation outcomes. The effectiveness of these hypotheses in practice remains to be assessed