Tailoring the Determinants of Implementation Behaviour Questionnaire (DIBQ) to best-practice low back pain primary care program implementation: a mixed-methods validity-testing in Sweden and Denmark

Abstract Background: Best-practice low back pain (LBP) primary care programs have been developed based on evidence-based clinical guidelines and are implemented in Sweden and Denmark. The Theoretical Domains Framework and its linkage to The Behavioural Change Wheel has been utilised in the design of the implementation object and its implementation strategy. Based on the Theoretical Domains Framework domains, the Determinants of Implementation Behaviour Questionnaire (DIBQ) has been developed to evaluate implementation determinants but its feasibility and validity needs to be tested and adapted to study specific contexts while maintaining its linkage to the Behavioural Change Wheel. The aim of this study was to tailor the DIBQ for evaluation of the implementation processes for best-practice LBP primary care programs in Sweden and Denmark. More specifically, the objectives were to i) Translate the DIBQ into Swedish and Danish, ii) Adapt the DIBQ into DIBQ-tailored (DIBQ-t) to study content validity, iii) Test the DIBQ-t for feasibility and iv) Perform initial validity testing of DIBQ-t. Methods: A mixed methods design with a four-step process was used. First, forward translation of the DIBQ, then adaptation into DIBQ-t using qualitative face validity assessed by the project group followed by quantitative content validity assessment by an expert group. Finally, primary care clinicians completed the DIBQ-t directly after participation in a 2-day educational course prior to the implementation of the program to determine feasibility and construct validity using confirmatory factor analyses. Results: In total 598 clinicians out of 609 responded, with only 2% of the items missing. The final DIBQ-t included 28 items describing 10 of the original 18 TDF domains and was considered feasible. The confirmatory factor analyses showed good fit after removing items 4 and 13 with the lowest domain loading. The DIBQ-t maintained linkage to all domains of the Capability–Opportunity-Motivation-Behaviour model within the Behavioural Change Wheel. The clinicians´ expectations according to the DIBQ-t indicate facilitating determinants outweighing barriers at the initiation of implementation processes. Conclusions: The study resulted in a tailored version of the DIBQ, DIBQ-t, which is feasible and valid for evaluating clinicians’ expectations regarding implementation determinants of best-practice LBP primary care programs.