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Cited by 385Health Policy Implementation ScienceHealth Education and ValidationBehavioral Health and Interventions

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

Open access
Huijg, Johanna M, Gebhardt, Winifred A, Crone, Mathilde R, Dusseldorp, Elise, Presseau, Justin·2014·Implementation Science
DOI 10.1186/1748-5908-9-11PMC PMC3896680
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Abstract

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.

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Written from the paper’s full text.

TL;DR

This study developed a generic English and Dutch Theoretical Domains Framework (TDF) questionnaire and tested the discriminant content validity of its items using expert judges. Of 79 items, 32 were judged to discriminately measure 11 of the 14 revised TDF domains, while items for Reinforcement, Goals, and Behavioral regulation were not.

Key findings

  • Nineteen judges allocated 79 items to TDF domains; 32 items were classified as measuring their intended domain, covering 11 of 14 domains: Knowledge, Skills, Social/professional role and identity, Beliefs about capabilities, Optimism, Beliefs about consequences, Intentions, Memory/attention/decision processes, Environmental context and resources, Social influences, and Emotion.
  • Items intended to measure Reinforcement, Goals, and Behavioral regulation were not classified to their intended domains and were excluded from the final questionnaire.
  • Inter-rater agreement was moderate for all 79 items (Light’s κ = .56, 95% CI .50–.62) and almost perfect for the final 32 items (κ = .82, 95% CI .79–.85).
  • The authors conclude the results partly support Cane et al.’s 14-domain TDF and suggest Michie et al.’s original 12-domain version might be more applicable for developing a TDF-based questionnaire.

Methods

  • The authors developed a questionnaire with 79 items assessing the 14 revised TDF domains, using existing validated items where available and newly developed items where needed; items used a generic “[action] in [context, time] with [target]” TACT construction and were developed in English, translated to Dutch, and back-translated.
  • Fifty-eight academics were approached and 19 participated (33% response rate); they rated their expertise on each domain and allocated each item to up to three TDF domains, rating confidence in each allocation from 0% to 100%.
  • Discriminant content validity was tested with one-sample one-tailed t-tests on confidence-weighted judgments, with false discovery rate correction; Light’s kappa assessed inter-rater agreement.

Limitations

  • The authors state the DCV task was challenging because judges allocated 79 items across 14 domains; a larger number of judges and a less complex task might have provided more information, and validity as perceived by an academic audience may differ from “real life.”
  • The authors state the final questionnaire requires refinement: most domains need more items (at least three per domain), Environmental context and resources items were framed only in socio-political terms, Emotion items assessed general Stress rather than behavior-specific Affect, and Knowledge could be improved with additional items.
  • Evident from the text: the final questionnaire contains no items for Reinforcement, Goals, or Behavioral regulation and only two items for several domains, and concurrent validity, predictive validity, and reliability were not tested in this study; the authors call for future research on these properties.

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Integrity signals

Registry

Crossref · 10.1186/1748-5908-9-11

Cites

78 of 78 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 92 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Items judged to discriminately measure 11 out of 14 TDF domains were identified.

    “We identified items judged to discriminately measure 11 out of 14 domains.”
    Quote in the paperSubstantial claim
  • Findingown data

    Items measuring the domain Goals were judged to measure a combination of domains.

    “Items measuring the domains Reinforcement, Goals, and Behavioral regulation were judged to measure a combination of domains.”
    Quote in the paperSubstantial claim
  • Findingown data

    Items measuring the domain Reinforcement were judged to measure a combination of domains.

    “Items measuring the domains Reinforcement, Goals, and Behavioral regulation were judged to measure a combination of domains.”
    Quote in the paperSubstantial claim
  • Findingown data

    Items measuring the domain Behavioral regulation were judged to measure a combination of domains.

    “Items measuring the domains Reinforcement, Goals, and Behavioral regulation were judged to measure a combination of domains.”
    Quote in the paperSubstantial claim
  • Findingown data

    Forty-seven items were allocated to more than one domain.

    “Forty-seven items were allocated to more than one domain, of which 39 items were allocated to the intended domain as well as additional domains, while eight items were classified as measuring a domain other than the item aimed to measure.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 37
  • Classified as probably not a substantial claim. 35

  • May combine two claims.

    Findingown data

    Of the six Knowledge items included in the DCV exercise, four items were classified as measuring the domain Knowledge and were included in the final questionnaire.

    “Of the six Knowledge items included in the DCV exercise, four items were classified as measuring the domain Knowledge (Table 4) and were included in the final questionnaire.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    All four Social/professional role and identity items included in the DCV were classified as measuring the intended domain and were included in the final questionnaire.

    “All four Social/professional role and identity items included in the DCV were classified as measuring the intended domain (Table 3) and were included in the final questionnaire.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Neither judges' expertise with TDF domains nor their academic level was related to their performance on the classification of items to domains.

    “Neither judges’ expertise with TDF domains nor their academic level (i.e., PhD student, PhD, Professor) was related to their performance on the classification of items to domains calculated as the number of 'matches’.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Three out of four Skills items included in the DCV were classified as measuring the intended domain and were included in the final questionnaire.

    “Three out of four Skills items included in the DCV were classified as measuring the intended domain (Table 3) and were included in the final questionnaire.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Only three judges indicated to be a layman on, respectively, one, two, and seven domains.

    “Only three judges indicated to be a layman on, respectively, one, two, and seven domains.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The three Beliefs about capabilities items containing the word 'confident' were classified as measuring the intended domain and were included in the final questionnaire.

    “The three items containing the word 'confident’ were classified as measuring the intended domain (Table 3) and were included in the final questionnaire.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    On average, judges rated that they had most expertise on the domains Intentions and Goals, whereas lowest expertise ratings were given to the domains Social/professional role and identity, and Memory, attention, and decision processes.

    “On average, judges rated that they had most expertise on the domains Intentions and Goals, whereas lowest expertise ratings were given to the domains Social/professional role and identity, and Memory, attention, and decision processes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The item 'How much control do you have over...' was allocated to the intended domain, but also to the domains Skills and Behavioral regulation.

    “The item 'How much control do you have over…’ was allocated to the intended domain, but also to the domains Skills and Behavioral regulation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Two out of six Optimism items included in the DCV were classified as measuring the domain Optimism and were included in the final questionnaire.

    “Two out of six Optimism items included in the DCV were classified as measuring the domain Optimism (Table 3). These were included in the final questionnaire.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The Beliefs about capabilities items measuring the difficulty and possibility of [action] in [context, time] with [target] were allocated to more than one domain, often including Skills.

    “The items measuring the difficulty and possibility of [action] in [context, time] with [target] were allocated to more than one domain. In addition to the domain Beliefs about capabilities, they were often allocated to the domain Skills.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Eight Goals items were included in the DCV exercise, but none of them were classified to the right domain and thus Goals items were not included in the final questionnaire.

    “Eight Goals items were included in the DCV exercise. None of them were classified to the right domain (Table 3) and thus Goals items were not included in the final questionnaire.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Items measuring the domain Emotion were adapted from previously published questionnaires.

    “items measuring the domain Emotion were adapted from previously published questionnaires”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Eight items were included in the DCV exercise to measure the domain Memory, attention, and decision processes; four of these items were classified to measure the intended domain and were included in the final questionnaire.

    “Eight items were included in the DCV exercise to measure the domain Memory, attention, and decision processes. Four of these items were classified to measure the intended domain (Table 3) and were included in the final questionnaire.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The DCV exercise included three items intended to measure Reinforcement, but none of them was classified as measuring the domain and so none was included in the final questionnaire.

    “The DCV exercise included three items intended to measure Reinforcement, but none of them was classified as measuring the domain (Table 3) and so none of them was included in the final questionnaire.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Items intended to measure Reinforcement, Goals, and Behavioral regulation were allocated to multiple domains or classified to a domain other than the intended one.

    “Items intended to measure these domains were allocated to multiple domains or classified to a domain other than the item intended to measure.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The four items measuring the construct Action planning were included in the DCV as measuring both the domain Goals and Behavioral regulation, but they were not classified as measuring these two domains because they were also often allocated to the domain Intentions.

    “The four items measuring the construct Action planning were included in the DCV as measuring both the domain Goals and Behavioral regulation. They were not classified as measuring these two domains, because they were also often allocated to the domain Intentions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The item '...I feel like I am making a difference' was classified as measuring the domain Beliefs about consequences.

    “The item '…I get recognition from professionals who are important to me’ was classified as measuring the domain Social influences and the item '…I feel like I am making a difference’ was classified as measuring the domain Beliefs about consequences.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Five, three, and two judges did not allocate any of the items to, respectively, the domains Reinforcement, Goals, and Behavioral regulation.

    “five, three, and two judges did not allocate any of the items to, respectively, the domains Reinforcement, Goals, and Behavioral regulation”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Of the four Emotion items included in the DCV exercise, the two items measuring the construct Stress were classified as measuring the intended domain and were included in the final questionnaire.

    “Of the four Emotion items included in the DCV exercise, the two items measuring the construct Stress were classified as measuring the intended domain (Table 3). These items were included in the final questionnaire.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Items measuring the domains Goals, Intentions, and Behavioral regulation were allocated to all three domains and are not able to discriminately measure them.

    “the items measuring these domains were allocated to all three domains, and thus are not able to discriminately measure them”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Eight items were included in the DCV to measure the Environmental context and resources domain, while only two items were classified as measuring the domain and therefore could be included in the final questionnaire.

    “Eight items were included in the DCV to measure this domain, while only two items were classified as measuring the domain (Table 3) and therefore could be included in the final questionnaire.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Ten items, including Action planning items also aimed to measure the domain Goals, were included in the DCV to measure Behavioral regulation, but none of them were classified to the right domain and therefore Behavioral regulation items were not included in the final questionnaire.

    “Ten items, including Action planning items also aimed to measure the domain Goals, were included in the DCV to measure Behavioral regulation. None of them were classified to the right domain (Table 3) and therefore Behavioral regulation items were not included in the final questionnaire.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    All four items included in the DCV to measure Intentions were classified as measuring the domain and included in the final questionnaire.

    “All four items included in the DCV to measure Intentions were classified as measuring the domain (Table 3) and included in the final questionnaire.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Items measuring the construct Stress demonstrated to be able to discriminately assess the domain Emotions, while Affect items did not.

    “Items measuring the construct Stress demonstrated to be able to discriminately assess the domain Emotions, while Affect items did not.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Two Memory, attention, and decision processes items were allocated to more than one domain, and two items measuring the construct Memory were classified as measuring a domain other than they were intended to measure (i.e., Knowledge and Beliefs about capabilities).

    “Two items were allocated to more than one domain and two items measuring the construct Memory were classified as measuring a domain other than they were intended to measure (i.e., Knowledge and Beliefs about capabilities).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Primary care-based interventions for increasing physical activity are effective.

    “primary care-based interventions for increasing physical activity (PA) are effective [4-7]”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [4] Eakin EG, Glasgow RE, Riley KM: Review of primary care-based physical activity intervention studies. J Fam Practice. 2000, 49: 158-168.

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    Premisecitation

    Improving the adoption and implementation of evidence-based interventions into routine practice involves changes in healthcare professionals' behaviors that may be influenced by a range of individual, organizational, and social factors.

    “Improving the adoption and implementation of evidence-based interventions into routine practice involves changes in healthcare professionals’ behaviors that may be influenced by a range of individual, organizational, and social factors [16-20].”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [16] Fleuren M, Wiefferink K, Paulussen T: Determinants of innovation within health care organizations: literature review and Delphi study. Int J Qual Health C. 2004, 16: 107-123. 10.1093/intqhc/mzh030. source

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    • cites [17] Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004, 82: 581-629. 10.1111/j.0887-378X.2004.00325.x. source

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    • cites [18] Grol R, Wensing M, Eccles M: Improving Patient Care: The Implementation of Change in Clinical Practice. 2005, Oxford: Elsevier

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      Not checked in the free run.

    • cites [20] Rogers EM: Diffusion of Innovations. 1983, New York: The Free Press

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  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Identifying the key factors associated with healthcare professional behavior can provide a basis for developing interventions to help healthcare professionals to use research findings more effectively.

    “Identifying the key factors associated with healthcare professional behavior can provide a basis for developing interventions to help healthcare professionals to use research findings more effectively [14].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Foy R, Eccles M, Grimshaw J: Why does primary care need more implementation research?. Fam Pract. 2001, 18: 353-355. 10.1093/fampra/18.4.353. source

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    Premisecitation

    The gap between research and practice reduces the impact that effective behavior change interventions can have on public health.

    “This gap between research and practice reduces the impact that effective behavior change interventions can have on public health [12,13].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [12] Glasgow RE, Bull SS, Gilette C, Klesges LM, Dzewaltowski DA: Behavior change intervention research in healthcare settings: a review of recent reports with emphasis on external validity. Am J Prev Med. 2002, 23: 62-69. 10.1016/S0749-3797(02)00437-3. source

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    Premisecitation

    Many advocate the use of theory to guide the selection of factors to investigate.

    “many advocate the use of theory to guide the selection of factors to investigate [15,21-23].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [15] Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N: Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. J Clin Epidemiol. 2005, 58: 107-112. 10.1016/j.jclinepi.2004.09.002. source

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    • cites [21] Francis JJ, Tinmouth A, Stanworth SJ, Grimshaw JM, Johnston M, Hyde C, Stockton C, Brehaut JC, Fergusson D, Eccles MP: Using theories of behaviour to understand transfusion prescribing in three clinical contexts in two countries: development work for an implementation trial. Implement Sci. 2009, 4: 70-10.1186/1748-5908-4-70. source

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    • cites [22] Grol RPTM, Bosch MC, Hulscher MEJL, Eccles MP, Wensing M: Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Q. 2007, 85: 93-138. 10.1111/j.1468-0009.2007.00478.x. source

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    • cites [23] Michie S, Johnston M, Francis J, Hardeman W, Eccles M: From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol. 2008, 57: 660-680. 10.1111/j.1464-0597.2008.00341.x. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The UK Medical Research Council guidance on developing and evaluating complex interventions recommends the use of theory in the intervention development phase.

    “the UK Medical Research Council guidance on developing and evaluating complex interventions recommends the use of theory in the intervention development phase [24].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M: Developing and evaluationg complex interventions: the new medical research council guidance. BMJ. 2008, 337: a1655-10.1136/bmj.a1655. source

      Not checked in the free run.

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    Premisecitation

    The TDF has been used in a number of studies.

    “The framework has been used in a number of studies and was demonstrated to be useful for the development of qualitative [32,33] and quantitative [34-36] measurement tools to assess potential implementation behavior determinants.”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [32] Patey AM, Islam R, Francis JJ, Bryson GL, Grimshaw JM: Anesthesiologists’ And surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the theoretical domains framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests. Implement Sci. 2012, 7: 52-10.1186/1748-5908-7-52. source

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    • cites [33] McSherry LA, Dombrowski SU, Francis JJ, Murphy J, Martin CM, O’Leary JJ, Sharp L, ATHENS Group: 'It’s a can of worms’: understanding primary care practitioners’ behaviours in relation to HPV using the theoretical domains framework. Implement Sci. 2012, 7: 73-10.1186/1748-5908-7-73. source

      Not checked in the free run.

    • cites [34] Amemori M, Michie S, Korhonen T, Murtomaa H, Kinnunen TH: Assessing implementation difficulties in tobacco use prevention and cessation counselling among dental providers. Implement Sci. 2011, 6: 50-10.1186/1748-5908-6-50. source

      Not checked in the free run.

    • cites [35] Beenstock J, Sniehotta FF, White M, Bell R, Milne EM, Araujo-Soares V: What helps and hinders midwives in engaging with pregnant women about stopping smoking? A cross-sectional survey of perceived implementation difficulties among midwives in the northeast of England. Implement Sci. 2012, 7: 36-10.1186/1748-5908-7-36. source

      Not checked in the free run.

    • cites [36] Taylor N, Parveen S, Robins V, Slater B, Lawton R: Development and initial validation of the Influences on Patient Safety Behaviours Questionnaire. Implement Sci. 2013, 8: 81-10.1186/1748-5908-8-81. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The questionnaire was developed in English, then translated to Dutch and back-translated to English by an independent translator.

    “The questionnaire was developed in English, then translated to Dutch and back-translated to English by an independent translator.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The authors have developed a TDF-based questionnaire in both English and Dutch that is able to discriminately assess the majority of domains.

    “We have developed a TDF-based questionnaire in both English and Dutch able to discriminately assess the majority of domains.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The sample size of 19 participants was based on estimates of between three and 20 participants as adequate for judgment tasks.

    “The sample size was based on estimates of between three and 20 participants as adequate for judgment tasks [39,40].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [39] Lynn MR: Determination and quantification of content validity. Nurs Res. 1986, 35: 382-385. source

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    • cites [40] Rubio DM, Berg-Weger M, Tebb SS, Lee ES, Rauch S: Objectifying content validity: conducting a content validity study in social work research. Soc Work Res. 2003, 27: 94-104. 10.1093/swr/27.2.94. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Theoretical Domains Framework (TDF) was developed as an integrative framework of theories of behavior change to overcome these challenges.

    “The Theoretical Domains Framework (TDF) [31] was developed as an integrative framework of theories of behavior change to overcome these challenges.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A: Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005, 14: 26-33. 10.1136/qshc.2004.011155. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    A generalization of Cohen's kappa (Light's Kappa) was calculated to assess agreement between judges across their allocation of all items to domains.

    “A generalization of Cohen’s kappa (i.e., Light’s Kappa [59]) was calculated to assess agreement between judges across their allocation of all items to domains.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [59] Conger A: Integration and generalization of kappas for multiple raters. Psychol Bull. 1980, 88: 322-328. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The consensus study that produced the TDF has been validated, leading to Cane et al.'s refined TDF.

    “Since its original development, the consensus study that produced the TDF [31] has been validated, leading to Cane et al.’s [37] refined TDF.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [31] Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A: Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005, 14: 26-33. 10.1136/qshc.2004.011155. source

      Not checked in the free run.

    • cites [37] Cane J, O’Connor D, Michie S: Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012, 7: 37-10.1186/1748-5908-7-37. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Internal consistency reliability of the TDF-based questionnaires was low or could be improved.

    “and internal consistency reliability was low [34] or could be improved [35,36].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [34] Amemori M, Michie S, Korhonen T, Murtomaa H, Kinnunen TH: Assessing implementation difficulties in tobacco use prevention and cessation counselling among dental providers. Implement Sci. 2011, 6: 50-10.1186/1748-5908-6-50. source

      Not checked in the free run.

    • cites [35] Beenstock J, Sniehotta FF, White M, Bell R, Milne EM, Araujo-Soares V: What helps and hinders midwives in engaging with pregnant women about stopping smoking? A cross-sectional survey of perceived implementation difficulties among midwives in the northeast of England. Implement Sci. 2012, 7: 36-10.1186/1748-5908-7-36. source

      Not checked in the free run.

    • cites [36] Taylor N, Parveen S, Robins V, Slater B, Lawton R: Development and initial validation of the Influences on Patient Safety Behaviours Questionnaire. Implement Sci. 2013, 8: 81-10.1186/1748-5908-8-81. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The findings provide an additional level of validation for the content of the TDF: judges agree about the constructs within each domain and the domain structure as demonstrated by Cane et al., and the majority of TDF domains have now been shown to be largely discriminately measurable.

    “Our findings provide an additional level of validation for the content of the TDF: not only do judges agree about the constructs within each domain and the domain structure as demonstrated by Cane et al.[37], but the majority of TDF domains have now been shown to be largely discriminately measurable.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Cane et al.[37] Cane J, O’Connor D, Michie S: Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012, 7: 37-10.1186/1748-5908-7-37. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The items of the questionnaire were listed in a random order.

    “The items of the questionnaire were listed below the definitions, in a random order.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The TDF includes 12 theoretical domains of potential behavioral determinants.

    “The framework includes 12 theoretical domains of potential behavioral determinants and provides exemplar questions for the theoretical assessment of implementation problems.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A: Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005, 14: 26-33. 10.1136/qshc.2004.011155. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The false discovery rate controlling procedure was used to correct for multiple tests.

    “The false discovery rate controlling procedure [57] was used to correct for multiple tests.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [57] Benjamini Y, Hochberg Y: Controlling the false discovery rate: a practical and powerful approach to multiple testing. J Roy Stat Soc B Met. 1995, 57: 289-300. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The refined TDF extends the original TDF to include 14 domains: Knowledge; Skills; Social/professional role and identity; Beliefs about capabilities; Optimism; Beliefs about consequences; Reinforcement; Intentions; Goals; Memory, attention and decision processes; Environmental context and resources; Social influences; Emotions; and Behavioral regulation.

    “It extends the original TDF to include the following 14 domains: Knowledge; Skills; Social/professional role and identity; Beliefs about capabilities; Optimism; Beliefs about consequences; Reinforcement; Intentions; Goals; Memory, attention and decision processes; Environmental context and resources; Social influences; Emotions; and Behavioral regulation.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] Cane J, O’Connor D, Michie S: Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012, 7: 37-10.1186/1748-5908-7-37. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The development of the questionnaire provides important evidence of content validity and is a first step towards the development of a valid and reliable questionnaire to measure TDF-based factors underlying healthcare professionals' specific implementation behaviors.

    “In summary, the development of our questionnaire provides important evidence of content validity and is a first step towards the development of a valid and reliable questionnaire to measure TDF-based factors underlying healthcare professionals’ specific implementation behaviors.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The TDF was demonstrated to be useful for the development of qualitative and quantitative measurement tools to assess potential implementation behavior determinants.

    “The framework has been used in a number of studies and was demonstrated to be useful for the development of qualitative [32,33] and quantitative [34-36] measurement tools to assess potential implementation behavior determinants.”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [32] Patey AM, Islam R, Francis JJ, Bryson GL, Grimshaw JM: Anesthesiologists’ And surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the theoretical domains framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests. Implement Sci. 2012, 7: 52-10.1186/1748-5908-7-52. source

      Not checked in the free run.

    • cites [33] McSherry LA, Dombrowski SU, Francis JJ, Murphy J, Martin CM, O’Leary JJ, Sharp L, ATHENS Group: 'It’s a can of worms’: understanding primary care practitioners’ behaviours in relation to HPV using the theoretical domains framework. Implement Sci. 2012, 7: 73-10.1186/1748-5908-7-73. source

      Not checked in the free run.

    • cites [34] Amemori M, Michie S, Korhonen T, Murtomaa H, Kinnunen TH: Assessing implementation difficulties in tobacco use prevention and cessation counselling among dental providers. Implement Sci. 2011, 6: 50-10.1186/1748-5908-6-50. source

      Not checked in the free run.

    • cites [35] Beenstock J, Sniehotta FF, White M, Bell R, Milne EM, Araujo-Soares V: What helps and hinders midwives in engaging with pregnant women about stopping smoking? A cross-sectional survey of perceived implementation difficulties among midwives in the northeast of England. Implement Sci. 2012, 7: 36-10.1186/1748-5908-7-36. source

      Not checked in the free run.

    • cites [36] Taylor N, Parveen S, Robins V, Slater B, Lawton R: Development and initial validation of the Influences on Patient Safety Behaviours Questionnaire. Implement Sci. 2013, 8: 81-10.1186/1748-5908-8-81. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    While Taylor et al. used specific items, the present items are generic and allow for application within a range of different contexts in which implementation research takes place.

    “While Taylor et al.[36,63] used specific items (i.e., related to a specific application), our items are generic and allow for application within a range of different contexts in which implementation research takes place.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Taylor et al.[36,63]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    WAG and MRC supervised the development of the questionnaire and reviewed items' face validity.

    “WAG and MRC supervised the development of the questionnaire and reviewed items’ face validity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The domain Reinforcement is a refinement of the Beliefs about consequences domain and was originally included within the latter domain in the original TDF.

    “the domain Reinforcement is a refinement of the Beliefs about consequences domain and was originally included within the latter domain in the original TDF [31]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A: Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005, 14: 26-33. 10.1136/qshc.2004.011155. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Items measuring the construct Affect were based on the Positive and Negative Affect Schedule and Stress items were based on the General Health Questionnaire.

    “items measuring the construct Affect were based on the Positive and Negative Affect Schedule [49] and Stress items were based on the General Health Questionnaire [48]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [49] Thompson ER: Development and Validation of an Internationally Reliable Short-Form of the Positive and Negative Affect Schedule (PANAS). J Cross Cult Psychol. 2007, 38: 227-242. 10.1177/0022022106297301. source

      Not checked in the free run.

    • cites [48] Goldberg DP, Blackwell B: Psychiatric illness in general practice: a detailed study using a new method of case identification. Brit Med J. 1970, 1: 439-443. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The TDF domains are potential behavioral determinants, instead of factors proven to influence implementation behavior.

    “the TDF domains are potential behavioral determinants, instead of factors proven to influence implementation behavior”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Francis JJ, Stockton C, Eccles MP, Johnston M, Cuthbertson BH, Grimshaw JM, Hyde C, Tinmouth A, Stanworth SJ: Evidence-based selection of theories for designing behaviour change interventions: using methods based on theoretical construct domains to understand clinicians’ blood transfusion behaviour. Brit J Health Psychol. 2009, 14: 625-646. 10.1348/135910708X397025. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    At least three items with a loading above .80 will give a reliable component.

    “at least three items with a loading above .80 will give a reliable component [64]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [64] Stevens J: Applied Multivariate Statistics for the Social Sciences. 1992, Hillsdale: Lawrence Erlbaum

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Emotions in relation to performing a specific behavior have been found to be linked to implementation behaviors in previous research.

    “items assessing emotions in relation to performing a specific behavior should also be taken into account as these have been found to be linked to implementation behaviors in previous research [65-67]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [65] Taylor N, Lawton R, Slater B, Foy R: The demonstration of a theory-based approach to the design of localized patient safety interventions. Implement Sci. 2013, 8: 123-10.1186/1748-5908-8-123. source

      Not checked in the free run.

    • cites [66] Dyson J, Lawton R, Jackson C, Cheater F: Development of a theory-based instrument to identify barriers and levers to best hand hygiene practice among healthcare practitioners. Implement Sci. 2013, 8: 111-10.1186/1748-5908-8-111. source

      Not checked in the free run.

    • cites [67] Dyson J, Lawton R, Jackson C, Cheater F: Does the use of a theoretical approach tell us more about hand hygiene behavior? The barriers and levers to hand hygiene. J Infect Prev. 2011, 12: 17-24. 10.1177/1757177410384300. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Major strengths of this study include the sample of academics with expertise on TDF domains and the formulation of items using the 'TACT principle'.

    “Major strengths of this study include the sample of academics with expertise on TDF domains and the formulation of items using the 'TACT principle’ [38]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Fishbein M: Attitude and the Prediction of Behavior. Readings in Atttiude Theory and Measurement. Edited by: Fishbein M. 1967, New York: Wiley, 477-492.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The operationalization and validation of the domains of the TDF are limited to these specific methods.

    “the operationalization and validation of the domains of the TDF are limited to these specific methods”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Research on the development of a generic TDF questionnaire will improve our understanding of factors influencing healthcare professionals' implementation and advance theory and methods in implementation research.

    “research on the development of a generic TDF questionnaire will improve our understanding of factors influencing healthcare professionals’ implementation and advance theory and methods in implementation research.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The TDF framework does not specify relationships between domains.

    “the framework does not specify relationships between domains [30]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Francis JJ, Stockton C, Eccles MP, Johnston M, Cuthbertson BH, Grimshaw JM, Hyde C, Tinmouth A, Stanworth SJ: Evidence-based selection of theories for designing behaviour change interventions: using methods based on theoretical construct domains to understand clinicians’ blood transfusion behaviour. Brit J Health Psychol. 2009, 14: 625-646. 10.1348/135910708X397025. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    This study is the first to develop a generic TDF-based questionnaire in both English and Dutch including items which are able to discriminately measure a majority of the domains.

    “this study is the first to develop a generic (i.e., formulation of items following the 'TACT principle’ [38]) TDF-based questionnaire in both English and Dutch including items which are able to discriminately measure a majority of the domains”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [38] Fishbein M: Attitude and the Prediction of Behavior. Readings in Atttiude Theory and Measurement. Edited by: Fishbein M. 1967, New York: Wiley, 477-492.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Premisecitation

    A valid TDF-based questionnaire will increase the use of theory in the assessment of barriers and facilitators for implementation problems, which can inform the selection of possible techniques that can be used to change healthcare professionals' behaviors.

    “a valid TDF-based questionnaire will increase the use of theory in the assessment of barriers and facilitators for implementation problems [31,69,70], which can inform the selection of possible techniques that can be used to change healthcare professionals’ behaviors [15,23,26]”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [31] Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A: Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005, 14: 26-33. 10.1136/qshc.2004.011155. source

      Not checked in the free run.

    • cites [69] Davies P, Walker AE, Grimshaw JM: A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations. Implement Sci. 2010, 5: 14-10.1186/1748-5908-5-14. source

      Not checked in the free run.

    • cites [70] Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004, 8: 1-72. source

      Not checked in the free run.

    • cites [15] Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N: Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. J Clin Epidemiol. 2005, 58: 107-112. 10.1016/j.jclinepi.2004.09.002. source

      Not checked in the free run.

    • cites [23] Michie S, Johnston M, Francis J, Hardeman W, Eccles M: From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol. 2008, 57: 660-680. 10.1111/j.1464-0597.2008.00341.x. source

      Not checked in the free run.

    • cites [26] French SD, Green SE, O’Connor DA, McKenzie JE, Francis JJ, Michie S, Buchbinder R, Schattner P, Spike N, Grimshaw JM: Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework. Implement Sci. 2012, 7: 38-10.1186/1748-5908-7-38. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    This study represents an important first step in the thorough development of a questionnaire to measure TDF-based factors underlying healthcare professionals' implementation behaviors.

    “this study represents an important first step in the thorough development of a questionnaire to measure TDF-based factors underlying healthcare professionals’ implementation behaviors”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    This DCV approach is a degree of magnitude more challenging than how DCVs have typically been applied in the past.

    “This approach is a degree of magnitude more challenging than how DCVs have typically been applied in the past (to a much smaller number of constructs).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The results partly support Cane et al.'s validation of the TDF and suggest that the 12-domain version might be more applicable in developing a TDF-based questionnaire.

    “The results partly support Cane et al.’s validation of the TDF [37] and suggest that the 12-domain version [31] might be more applicable in developing a TDF-based questionnaire.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [37] Cane J, O’Connor D, Michie S: Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012, 7: 37-10.1186/1748-5908-7-37. source

      Not checked in the free run.

    • cites [31] Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A: Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005, 14: 26-33. 10.1136/qshc.2004.011155. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The DCV exercise of allocating 79 items to 14 domains was a challenging task for judges, requiring consideration of multiple possible definitions.

    “The DCV exercise of allocating 79 items to 14 domains was a challenging task for judges, requiring consideration of multiple possible definitions.”
    Quote in the paperNot a substantial claim
63 of 63

  • The paper relies on this without support.

    The content of the TDF had not yet been validated at item level.

    “Although the framework is suggested to be useful for the development of theory-based questionnaires for use in implementation research, the content of the TDF has not yet been validated on item level.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • There are three published validated questionnaire measures of the TDF to identify influences on health care professionals' patient safety behaviours, physical activity in the general population, and generic health professional behaviours.

    “There are three published validated questionnaire measures of the TDF to identify influences on the following behaviours: health care professionals' patient safety behaviours [48], physical activity in the general population [20] and generic health professional behaviours [49].”

    From A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems (2017) · cites this paper as [49]

    The Discussion describes this paper’s generic TDF questionnaire as having evidence of discriminant content validity for most domains. But it calls that evidence a first step toward a valid and reliable measure, and the Conclusions say reliability and predictive validity still require investigation. Thus the source supports the identification of a generic measure, but not its description as a fully validated questionnaire. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Huijg and colleagues developed a TDF-based questionnaire that could be tailored to study under-explored barriers and assess their importance.

    “Huijg and colleagues developed a TDF-based questionnaire [118] that could be tailored to study these under-explored barriers and assess their importance.”

    From Factors influencing the implementation of screening and brief interventions for alcohol use in primary care practices: a systematic review using the COM-B system and Theoretical Domains Framework (2021) · cites this paper as [118]

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. Eakin EG, Glasgow RE, Riley KM: Review of primary care-based physical activity intervention studies. J Fam Practice. 2000, 49: 158-168.
  2. Huijg JM, van der Zouwe N, Gebhardt WA, Crone MR, Verheijden MW, Middelkoop BJC: Introducing physical activity interventions in primary health care: a qualitative study of perceived facilitators and barriers [abstract]. Int J Behav Med. 2012, 19: S1-S341.
  3. Maes S, Karoly P, de Gucht V, Ruehlman LS, Heiser W: The self regulation skills battery. 2006, Leiden/Phoenix: Leiden University/Arizona State University
  4. IBM Corp: IBM SPSS statistics for windows, version 19.0. 2010, Armonk, NY: IBM Corp
  5. Falissard B: Psy: Various Procedures Used in Psychometry. 2012, : R Package Version 1.1

Cited by

Sorted by citations

Related

Authors
Huijg, J. M., Gebhardt, W. A., Crone, M. R., Dusseldorp, E., & Presseau, J.
Affiliations
  • Leiden University (NL)
  • Leiden University Medical Center (NL)
  • Netherlands Organisation for Applied Scientific Research (NL)
  • Newcastle University (GB)
Corresponding author
Huijg, Johanna M
ORCID
Venue
Implementation Science
Publisher
Springer Science and Business Media LLC
Published
2014-01-15
Volume
9
Issue
1
Pages
11-11
ISSN
1748-5908 (ISSN-L)
DOI
10.1186/1748-5908-9-11
PMC
PMC3896680
OpenAlex
W2130770431
Semantic Scholar
d4ff79d66f85c061e8af489063ba90d48fbc076a
Cited by
385
References
78
Citations by year
2026: 27 · 2025: 34 · 2024: 44 · 2023: 47 · 2022: 65 · 2021: 59 · 2020: 32 · 2019: 22 · 2018: 15 · 2017: 15 · 2016: 12 · 2015: 9 · 2014: 3
FWCI
23.48
Type
journal article
Language
en
Open access
Licence
Locations
  • Implementation Science (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Leiden Repository (Leiden University) (submittedVersion)
  • TNO Repository (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Newcastle University ePrints (Newcastle Univesity) (cc-by)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Social Sciences › Education › Health Education and Validation
  • Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Keywords
Theoretical Domains Framework, questionnaire development, behavioral factors, healthcare workers, reinforcement, goals, behavioral regulation, Dutch translation, English translation
MeSH terms
Attitude of Health Personnel, Diffusion of Innovation, Environment, Health Knowledge, Attitudes, Practice, Language, Models, Theoretical, Motivation, Surveys and Questionnaires, Reproducibility of Results, Evidence-Based Medicine, Self Efficacy, Professional Role, Translational Research, Biomedical

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