The Determinants of Implementation Behavior Questionnaire in multiprofessional rehabilitation context (DIBQ-mp): A mixed methods tailoring study with Finnish cross-cultural adaptation

Background: The Determinants of Implementation Behavior Questionnaire (DIBQ) identifies factors that are facilitators of or barriers to professionals´ change of behavior after evidence-based training. The original English DIBQ consists of 93 items covering 18 domains. The DIBQ is built upon the Theoretical Domains Framework and the Behavioral Change Wheel. The purpose of the study is to tailor the DIBQ to the multiprofessional rehabilitation context as well as cross-culturally adapt it to the Finnish context. Methods: Cross-cultural translation followed by a two round, Delphi method involving experts in rehabilitation with diversity of professions (physicians, physiotherapists, occupational therapists, psychologists, nursing scientists, social scientists and health care policymakers) was conducted, 25 experts participated in Round 1, and 21 in Round 2. Participants evaluated the importance of each DIBQ item in changing professionals´ implementation behavior. Consensus to include items was defined as a mean score of ≥4 on a Likert scale (1 = Strongly Disagree, 2 = Disagree, 3 = Neither Agree nor Disagree, 4 = Agree, 5 = Strongly Agree) by ≥75% of Delphi participants. Items rated at agreement of ≤74% were either excluded or reviewed depending on qualitative judgements. The relevance of each item was indexed using content validity index (CVI). A second-round survey followed the same process. Comparison with tailored versions of Danish and Swedish (DIBQ-t) was also performed before reaching the consensus of the results.Results: The final validated multiprofessional DIBQ (DIBQ-mp) consists of 23 questions. Twenty-nine percent (n = 27) of the Round 1 questions did not reach acceptable agreement. Second-round survey was developed based on the results of the first round. In all, 4% (n=2) of the Round 2 questions did not reach acceptable agreement. Agreement was achieved on all items after Round 2 in comparison with DIBQ-t, and the Delphi process was concluded. The final DIBQ-mp has evidence of excellent content validity with 0.93 average item-level CVI.Conclusions: The study resulted in the Determinants of Implementation Behavior Questionnaire tailored to the multiprofessional rehabilitation context as well as a Finnish cross-culturally adapted version.