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

The DOI matches its Crossref record; 78 of the 78 references it cites were found in a registry or an index; 5 of the 92 sources its claims cite were checked for support.

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

Open access

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.

Overview

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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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Registry

Crossref · 10.1186/1748-5908-9-11

Cites

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  • Probably not a substantial claim. 35
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  • 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.”
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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

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Metadata

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
Venue
Implementation Science
Published
2014-01-15
Volume
9
Issue
1
Pages
11-11
ISSN
1748-5908 (ISSN-L)
OpenAlex
W2130770431
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
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
  • Health Sciences › Nursing › Research and Theory › 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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