Development of a universal healthcare professionals’ implementation- needs questionnaire and its validation among Ukrainian family doctors

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Existing questionnaires mainly assess general competencies, knowledge, or the presence of barriers and facilitators, but rarely capture the specific, individualised needs of healthcare professionals for implementing particular methods. A standardised, universal instrument that identifies these needs could support more effective and tailored implementation strategies. The aim of this paper is to develop a universal questionnaire to assess healthcare professionals’ implementation needs and to evaluate its content and face validity among family doctors in Ukraine. Methods: The Healthcare Professionals’ Implementation-needs Questionnaire (HPIQ) was developed by selecting determinants from the Determinants of Implementation Behavior Questionnaire (DIBQ) that could be considered as healthcare professionals’ needs. These determinants were then used to create HPIQ items that capture the importance of each need and provide details on how it can be addressed. Content validity was assessed in two rounds, by 12 and 10 experts respectively. Face validity was evaluated by 25 family doctors. Quantitative measures (Content Validity Ratio (CVR), Content Validity Index (CVI), Item Impact Score (IIS)) and qualitative feedback guided item refinement. The version validated among family doctors is referred to as HPIQ-FD. Results: We developed an initial pool of 31 items (12 Likert-scale, 19 open-ended). After evaluation, 14 items (6 Likert-scale, 8 open-ended) met all thresholds for content (CVR ≥0.62, CVI ≥0.79) and face validity (IIS ≥1.5) and were retained. These items reflect key needs, such as clear instructions, practical skills, additional time, financial motivation, access to resources, organisational support, and other factors affecting successful implementation. The edited final version of the questionnaire appeared to be concise, practical and structured for use in primary care. Conclusions: The HPIQ was developed as a universal instrument to assess healthcare professionals’ implementation needs. Its initial validation among family doctors (HPIQ-FD) confirmed content and face validity in this context. The questionnaire supports systematic and personalised identification of critical needs, enables tailored implementation strategies, and could be adapted for other specialties and clinical settings to promote effective, sustainable evidence-based practice. Health Care Professionals Family Doctors Primary Care Implementation Science Questionnaire Design Validation Study Ukraine. Background Implementation science has emerged as a distinct field to bridge the gap between evidence and clinical practice. Its mission is to ensure that proven practices are effectively adopted into the daily work routine of healthcare professionals [ 1 ]. Research has shown that the success of healthcare change processes depends not only on the effectiveness of the practices themselves, but also on the context and participation of those who will implement them [ 2 ]. In the process of analysing the implementation of new practices, numerous facilitators and barriers, known as determinants, have been identified that influence the implementation behaviour of healthcare professionals [ 3 ]. At the same time, methods for their detection require further improvement and evaluation of effectiveness [ 4 ]. In this regard, there is a growing need for standardised tools that can assess the factors that influence the implementation of changes in the clinical environment. The development of such tools is considered as one of the ways to prevent the formation of the so-called secondary gap between research and its application in practice [ 5 ]. Many international recommendations emphasise the need to involve healthcare professionals in decision-making regarding changes in clinical activities, particularly in the field of primary health care[ 6 – 9 ]. Individualised approaches to implementation have been shown to provide higher effectiveness than one-size-fits-all strategies [ 4 ] The literature describes a significant number of questionnaires aimed at assessing the knowledge, skills, attitudes and training needs of health professionals in the context of evidence-based practice. The Evidence-Based Practice Inventory (EBPI) [ 10 ], the Evidence-Based Practice Confidence (EPIC) scale[ 11 ], Health Sciences-Evidence-Based Practice (HS-EBP)[ 12 ], Evidence-Based Practice Questionnaire (EBPQ) [ 13 ] and Noor Evidence-Based Medicine Questionnaire [ 14 ] are used to assess knowledge, skills, attitudes, readiness and motivation relating to various aspects of evidence-based medicine. The Developing Evidence-Based Practice Questionnaire (DEBPQ) has been developed to identify barriers, sources of knowledge, and attitudes toward evidence-based practice [ 15 ], while the Hennessy-Hicks Training Needs Analysis (TNA) has been used as a universal tool to identify training needs across countries and professional contexts [ 16 ]. A common feature of most tools is their focus on general competencies and training needs rather than on the needs of healthcare professionals when implementing specific practices. Some questionnaires are focused on assessing motivational or organisational factors in narrow areas, such as telemedicine [ 16 ] or the use of medical devices [ 17 ]. However, these tools do not allow for a systematic assessment of the specific needs of employees for the implementation of individual methods. In addition, only a limited number of questionnaires have the flexibility to adapt to a specific method or area of medicine while maintaining validity. In this context, the Theoretical Domains Framework (TDF) is particularly valuable: it provides a sufficiently universal structure that has been widely applied in numerous implementation-focused questionnaires in healthcare, capturing behavioural, motivational, and organisational determinants. Most TDF-based questionnaires to date have primarily been qualitative in nature, focusing on interviews or focus groups rather than structured survey instruments [ 18 ]. Despite the versatility of the TDF, there are relatively few questionnaires that are both structured and truly universal, capable of being applied across different clinical areas and healthcare contexts, explicitly designed around TDF determinants [ 19 ]. Among the universal instruments, the most common are the Determinants of Implementation Behavior Questionnaire (DIBQ), based on TDF determinants [ 20 ] and the Clinician Guideline Determinants Questionnaire (CGDQ) [ 21 ]. They cover a wide range of determinants that influence on the implementation, but do not focus on an individualised assessment of the needs of employees as active participants in change. The DIBQ does not provide detailed answers or suggestions for meeting needs, and the CGDQ consists mainly of closed questions, while a limited number of general open-ended questions only partially detail the conditions necessary for the implementation of innovations. Given these limitations, there is a need to create a universal questionnaire for different areas of medicine that can identify the personal needs of medical professionals in the process of implementing specific methods, assess the individual significance of each need, and elicit suggestions on ways to meet them. The use of such a tool could become the basis for making informed management decisions that consider the real needs of medical professionals and thereby contribute to a more effective and sustainable implementation of evidence-based methods in practice. The study aimed (1) to develop a questionnaire assessing medical professionals’ needs for implementing evidence-based methods and guidelines in clinical practice, and (2) to evaluate its validity among family doctors in Ukraine. Methods Selection of DIBQ determinants for the formation of the Healthcare Professionals’ Implementation-needs Questionnaire (HPIQ) We used a structured approach based on the existing DIBQ instrument to develop a HPIQ [20]. Items from the original questionnaire were selected according to the following pre-defined inclusion criteria, with only those items that met all these criteria being included in the final list: represented something that healthcare workers may need to be able to implement a specific method or evidence-based recommendation in practice in today’s environment; related to needs that can be potentially addressed by the medical institution’s management team; covered needs that would only be encountered by healthcare professionals after the implementation process has begun; were universal and could be applied to the implementation of any evidence-based medical intervention or recommendation; were formulated as clearly, simply and unambiguously as possible; did not duplicate the main idea of other items (if there were other items similar in content, only the option that best reflected it, was retained); Formation of new questionnaire items Based on the selected determinants from the DIBQ, we wrote new items that allowed us to assess the level of importance of the needs in each of the domains. Each new item: was formulated according to one of the domains of the original DIBQ; was transformed to reflect the need itself, not just the presence of a facilitator or barrier; met the selection criteria above. All closed questions had the same initial formula: “To implement [method/evidence-based recommendations] in my practice, I definitely need…”, where the name of the specific method or clinical recommendation being implemented may be inserted in square brackets. Each question was rated on a Likert scale: 1 – strongly disagree, 2 – disagree, 3 – uncertain, 4 – agree, 5 – strongly agree. The key wording “definitely need” in the question template was chosen to make the scale easier to interpret: respondents who selected 5 (strongly agree) indicated that the need was truly essential, whereas those selecting 1 (strongly disagree) indicated that it was not needed at all. This wording was designed to clearly distinguish the extremes of the scale and reduce ambiguity. For each Likert-scale question, an open question was added if the respondent had chosen a score of 4 or 5. The open-ended questions were designed to clarify the specific aspects of the identified needs during implementation, for example what instructions or resources are required, how they should be delivered, and whether additional needs of healthcare workers exist. Content validity Content validity assessment procedure To assess the content validity of the developed questionnaire, we created an online form using the Google Forms platform. An expert panel for content validity assessment was formed through purposeful selection of experts among staff members of the Departments of Family Medicine at Uzhhorod National University and Bukovinian State Medical University in Ukraine. These panellists were eligible if they met the following criteria: clinical experience in both family medicine and other specialties, involvement in research activities, experience working at medical university departments, and participation in the development of questionnaires. During the piloting phase, the evaluation form was tested by three experts from this panel to check the ease of completion, the clarity of the wording, and the logic of the design. Based on the results of the piloting, we clarified the wording of the tasks and improved the visual presentation of the validation form. In the direct content validity assessment round, twelve different experts from the panel received an improved version of the form for quantitative content validity assessment of 31 items in the HPIQ. Before this assessment began, we informed the experts of the two main objectives of the questionnaire: Objective #1, for closed questions with a Likert scale: to assess how critical (necessary) each need was for implementing a specific method or recommendation; Objective #2, for open-ended questions: to identify what specifically was needed for each item. We asked the experts to evaluate each item based on three criteria: essentialness, relevance, and clarity for the respondent. Essentialness. Experts were requested to assess how essential each item was for the study. After each item with a Likert scale, we included this question: “Please rate how essential this item is for the study in terms of objective #1”. After each item with open-ended question, we included this question: “Please rate how essential this item is for the study in terms of objective #2”. The experts were asked to rate their assessments on a 3-point scale: 1 – not necessary, 2 – useful but not essential, 3 – essential. Relevance. For items with a Likert scale, we asked experts the question: “Please rate how relevant this item is to the questionnaire objective #1?” For items with open-ended questions, the question was: “Please rate how relevant this item is to the questionnaire objective #2” The relevance of each item was assessed on a 4-point scale: 1 – not at all relevant, 2 – not relevant, 3 – relevant, 4 – very relevant. Clarity for the respondent. The task of the experts was to assess the clarity of each item for healthcare professionals. After each item, we asked the following question: “Please rate how clear this item is for the healthcare professional being surveyed.” Clarity was assessed on a 4-point scale: 1 – not at all clear, 2 – not clear, 3 – clear, 4 – very clear. In addition to quantitative evaluation, we asked experts asked to provide comments and suggestions for each item, if necessary, in the format: "Write your suggestions for improving this item, if any." Content validity data analysis For each item, the content validity ratio (CVR) was calculated using the formula: CVR=(Ne-(N/2))/(N/2), where N is the total number of experts, Nₑ is the number of experts who rated the item as essential (3 points). According to Lawshe criteria, with the participation of 10 or more experts, CVR ≥ 0.62 is considered sufficient [22]. Based on the relevance and clarity criteria, the item-level content validity index (I-CVI) was calculated using the formula: I-CVI = number of experts who rated the item as relevant or clear (3-4 points) / total number of experts. The I-CVI reflects the proportion of experts who agree that a particular item is appropriate in terms of its relevance or clarity and is used to determine whether each individual item should be retained, revised, or removed. Interpretation of CVI results was carried out according to generally accepted thresholds: CVI > 0.79 — sufficient level, CVI 0.70–0.79 — requires revision, CVI < 0.70 — item deletion is recommended. To evaluate the overall content validity of the questionnaire, the Scale-Level Content Validity Index (S-CVI) was calculated separately for relevance and clarity of the items. The S-CVI summarizes the level of agreement among experts across all items in the scale. Two complementary approaches were applied: S-CVI Universal Agreement (S-CVI/UA) and S-CVI Average Agreement (S-CVI/Ave). S-CVI/UA represents the proportion of items that achieved full agreement among experts, meaning that all experts rated the item as either 3 or 4 on a 4-point scale. It was computed separately for relevance and for clarity using the formula: S-CVI/UA = number of items with I-CVI = 1 / total number of items. S-CVI/Ave reflects the average of the item-level CVIs (I-CVIs) across all items and indicates the overall agreement on item quality rather than complete consensus. It was calculated using the formula: S-CVI/Ave = ΣI-CVIi / total number of items. Higher S-CVI values indicate stronger agreement among experts regarding the relevance or clarity of the items. An S-CVI value of 0.80 or higher was considered sufficient when assessing the content validity of the scale [23]. The research team analyzed the CVR, CVI, and expert comments. Based on the results of the analysis, changes were made to the wording of the questions, retaining only items with confirmed validity, and reformulating controversial ones in accordance with the comments. Given the significant number of edits and new versions of questions, the content validity assessment procedure for the updated questionnaire was fully repeated in Round 2. Face validity Face validity assessment procedure At the face validity stage, the HPIQ was evaluated among family doctors. This group was selected for the initial face validity assessment because family physicians work across a wide range of clinical contexts and practice settings, which is consistent with the concept of a universal questionnaire. As a result of this stage, the version of the instrument validated for family doctors is referred to as HPIQ-FD. To assess the face validity of the developed instrument, 25 general practitioners (family medicine physicians) were involved. The main inclusion criterion was professional practice in the field of general practice/family medicine. Participants were recruited through professional online chats of family physicians from the Zakarpattia region and Uzhhorod, via personal contacts, and by applying the snowball sampling method, whereby participating physicians recruited other colleagues. Additional recruitment was conducted through online groups and chats associated with previous training sessions held for family doctors. Each of them was sent an online form to assess the importance of the questionnaire items. After reviewing each item, respondents were asked: “How important is it to include this question for healthcare professionals to understand their needs when implementing changes in clinical practice?” Responses were provided on a 5-point scale: 1 – not at all important, 2 – not important, 3 – uncertain, 4 – important, 5 – very important. We also invited respondents to provide suggestions in an open-ended format: “Please write your suggestions for improving this item, if any,” in order to identify potential ambiguities or unclear wording and to refine item content. Face validity data analysis Based on the responses received, we calculated the item impact score (IIS) for each item using the formula: IIS = (proportion of respondents who rated the item as 4 or 5) × (mean item score). The IIS indicator was used to quantitatively assess face validity: if IIS ≥ 1.5 , the item was considered sufficiently significant and was retained in the final version of the questionnaire; if IIS < 1.5 , the face validity was determined to be insufficient, the corresponding item was subject to exclusion or revision with subsequent re-evaluation . [24] The qualitative comments were analysed to refine item content and improve the clarity and precision of the questionnaire. We used Microsoft Excel for data entry, tabulation, and calculation of CVR, CVI (for content validity), IIS (for face validity), and for organizing qualitative comments from experts/respondents. Results Questionnaire development: As a result of checking 93 items of the original DIBQ questionnaire for compliance with the predefined inclusion criteria, we created the first version of the new HPIQ. It included 12 mandatory items in the format of closed questions covering the main types of needs, the importance of which is assessed on a five-point Likert scale of agreement (1 - "strongly disagree", 2 - "disagree", 3 - "uncertain", 4 - "agree", 5 - "strongly agree"). For each Likert scale question, open questions (a total of 19) were developed, the purpose of which was to clarify the content of the needs, identify possible ways to meet them and detect additional, not yet considered needs. The first version of the HPIQ, including the original DIBQ items and their adapted form, is presented in Table 1 . Table 1 Development of the HPIQ from DIBQ items. DIBQ Domains, constructs (and item numbers) Original DIBQ items used Items after adaptation for HPIQ Knowledge Knowledge (1) I know how to deliver [PA intervention] following the guidelines. 1.1. To implement [method/evidence-based recommendations] in my practice, I definitely need clearer instructions than I currently have. 1.2. If you need clearer instructions, please specify which ones? 1.3. If you need clearer instructions, please indicate how you would like them provided? Skills Skills (3) I have the skills to deliver [PA intervention] following the guidelines. 2.1. To implement [method/evidence-based recommendations] in my practice, I definitely need more practical skills. 2.2. If you need more practical skills, please specify which ones ? 2.3. If you need more practical skills, please indicate what you need to develop them ? Beliefs about consequences Outcome expectancies (5) If I deliver [PA intervention] following the Guidelines, it will help participants to be more physically active. 3.1. To implement [method/evidence-based recommendations] in my practice, I definitely need a greater understanding of what benefits it has for my patients. 3.2. If you have doubts about the usefulness of [method/evidence-based recommendations], please describe them. Innovation Innovation characteristics (5) [PA intervention] is simple to deliver. 4.1. To implement [method/evidence-based recommendations] in my practice, I definitely need the performing process to be simpler than it is now. 4.2. If you need to simplify the performing process, please specify what is needed for this? Innovation Innovation characteristics (3/5) [PA intervention] costs little time to deliver. 5.1. To implement [method/evidence-based recommendations] into my practice, I will definitely need more time than I have now to perform it. 5.2. If you need more time to perform [method/evidence recommendations], please indicate how much? 5.3. If you need more time to perform [method/evidence-based recommendations], please specify what is required for this? Reinforcement (1/3) When I deliver [PA intervention] following the guidelines, I get financial reimbursement. 6.1. To implement [method/evidence-based recommendations] into my practice, I definitely need additional financial compensation. 6.2. If you require additional financial compensation, please indicate the amount. 6.3. If you require other compensation, please describe it. Organization Organizational resources and support (1/4) In the organization I work, all necessary resources are available to deliver [PA intervention]. 7.1. To implement [method/evidence-based recommendations] in my practice, I definitely need more resources (materials, equipment) than I currently have. 7.2. If you need more materials or equipment, please specify which ones. Organization Organizational resources and support (2/4) I can count on support from the management of the organization I work in, when things get tough guidelines. 8.1. To implement [method/evidence-based recommendations] in my practice, I definitely need more support from the medical institution’s management team than I currently have. 8.2. If you need more support from the medical institution’s management team, please specify in what situations? 8.3. If you need more support from the medical institution’s management team, please specify what kind? Social influences Social support (1/3) I can count on support from professionals with whom I deliver [PA intervention] when things get tough around delivering [PA intervention] following the guidelines. 9.1. I definitely need more support from colleagues to implement [method/evidence-based recommendations] in my practice. 9.2. If you need more support from colleagues, please specify in what situations? 9.3. If you need more support from colleagues, please specify what kind? Behavioral regulation Memory (2/2) Delivering [PA intervention] following the guidelines is something I often forget. 10.1. To implement [method/evidence-based recommendations] in my practice, I definitely need a better reminder system to follow [method/evidence-based recommendations]. 10.2. If you need to improve the reminder system, please indicate in what format you would like to receive them? Reinforcement (2/3) When I deliver [PA intervention] following the guidelines, I get recognition from the work context. 11.1. To implement [method/evidence-based recommendations] in my practice, I definitely need more recognition from the medical institution’s management team than I currently have. 11.2. If you need more recognition from the medical institution’s management team, please indicate in what format you would like to receive it? Reinforcement (3/3) When I deliver [PA intervention] following the guidelines, I get recognition from participants. 12.1. To implement [method/evidence-based recommendations] in my practice, I definitely need more recognition from patients than I currently have. 12.2. If you need more recognition from patients, please indicate in what format you would like to receive it? `New general item: 13. What else can help you implement [method/evidence-based recommendations] in practice? The selected items covered key determinants of implementation that can be considered as needs of healthcare professionals in the context of applying any evidence-based methods or clinical guidelines. Table 1 . Development of the HPIQ from DIBQ items. Based on the defined criteria, we excluded items that did not meet the predetermined selection criteria from the first version of HPIQ. One of the key reasons for their exclusion was that they could not be conceptualised as healthcare professionals’ needs. In particular, constructs such as making an intervention part of one’s professional duties or a priority, the intention to carry it out, expectations of significant others, as well as confidence in performing the intervention under unfavorable conditions (when other professionals do not implement it, when there is a lack of time, or when patients are not motivated), reflect the level of readiness or social influence, but do not constitute independent, clearly defined needs. Items reflecting domains such as optimism, patients’ motivation, and healthcare providers’ positive or negative emotions were excluded because these factors cannot be directly influenced or addressed through managerial actions within a medical institution. We also excluded itemsif they could not be applied to the implementation of any evidence-based medical intervention or recommendation, duplicated the core concept of other HPIQ items, or were considered overly complex, too broad, or ambiguous in their wording. The detailed reasons for excluding specific items from the preliminary version of the HPIQ are given in Appendix 2. Content validity assessment The content validity assessment of the HPIQ was carried out in two rounds with the involvement of qualified experts. The first round began after testing the assessment form by three experts to check the ease of filling in, the clarity of the task formulations, and the logic of the design. Based on the results of the testing, the formulation of the tasks was clarified and the visual presentation of the online form was improved. The first round involved twelve experts with research experience (one assistant professor of the department, six PhD students and five PhDs). Each of the experts taught at departments of medical universities of Ukraine, had experience in developing questionnaires, as well as clinical experience in the field of family medicine and/or other specialties at the same time and/or involvement in the administration of medical institutions. In the first round, twelve experts performed a quantitative assessment of 31 items contained in the first version of the questionnaire. Based on the experts’ ratings, the Scale-Level Content Validity Index (S-CVI) was calculated separately for relevance and clarity. For relevance, S-CVI(UA) was 0.16 (insufficient) and S-CVI(Ave) was 0.89 (sufficient). For clarity, S-CVI(UA) reached 0.32 (insufficient) and S-CVI(Ave) was 0.91 (sufficient), according to the generally accepted criterion of 0.80 for adequate content validity. For each item, CVR was calculated, as well as two I-CVI, which related to the relevance and clarity. According to the experts' assessments, only 12 items (5 closed and 6 open) reached all three thresholds of validity (CVR ≥ 0.62; both I-CVI ≥ 0.79). At the same time, changes were proposed to six of them. The remaining items demonstrated insufficient values according to at least one of the three criteria. In total, 16 items were removed, another 11 underwent substantive changes, and 4 were left unchanged for further assessment in the second round. The results from Round 1 of the content validity assessment, along with experts’ comments and the authors’ decisions for each item, are presented in Appendix 3. The general suggestions of experts received during the first round of content validity assessment suggested that the HPIQ should begin with a mandatory preamble form, in which the potential researcher will be able to indicate the main data: who is conducting the survey, the purpose of the study, the approximate time for completion and guarantees of confidentiality, and also express gratitude to the respondent for participation. The structure of the preamble form of the questionnaire is presented in the HPIQ final version, validated among family doctors (HPIQ-FD) ( Appendix 1 ), supplemented by the researcher with information about the method or recommendation being implemented. Experts also recommended including instructions for the researcher that emphasise including the name and description of the essence of the method or recommendation being implemented, indicating the scientific justification and practical benefit for healthcare professionals. We provided the instructions for researchers planning a survey to implement a specific method or evidence-based recommendation in the questionnaire final version, validated among family doctors (HPIQ-FD) (see Appendix 1 ). To improve comprehension and accuracy of data collection, experts recommended highlighting in bold the main concepts or terms in each item, and providing a list of possible answer options in parentheses under some open-ended questions. In the second round, 10 experts (two were unable to participate) rated the updated version, which included 15 items: 6 closed and 9 open-ended. Based on expert evaluations, S-CVI demonstrated high levels of agreement for both relevance and clarity (threshold ≥ 0.80). For relevance, S-CVI(UA) was 0.93 and S-CVI(Ave) was 0.99, while for clarity, S-CVI(UA) reached 0.93 and S-CVI(Ave) was 0.99. One item, “If you need more help from the medical institution’s management team to overcome difficulties associated with [using the method/evidence-based recommendations], describe your difficulties?” was removed due to insufficient specificity (CVR < 0.62) and experts’ comments about content overlap with the following question: “If you need more help from the medical institution’s management team to overcome difficulties associated with [using the method/evidence-based recommendations], indicate what actions management team can take to help.” The removal avoided duplication of information and increased the accuracy of data collection while maintaining the completeness of the assessment of respondents’ needs. After the removal of this item, the S-CVI reached 1.00 under all calculation methods. All other 14 items met the content validity criteria of essentiality (CVR ≥ 0.62), relevance and clarity for respondents (I-CVI ≥ 0.79). The results from Round 2 of the content validity assessment are presented in Table 2 . Table 2 Results of Round 2 of Content Validity AssessmentTable 3. Results of face validity assessment. Questionnaire items (Closed questions are rated on a 5-point Likert scale (1 - "strongly disagree", 2 - "disagree", 3 - "uncertain", 4 - "agree", 5 - "strongly agree"). Answers to open-ended questions are provided in the form of extended text) In the questionnaire items, the words ‘[method/evidence-based recommendation]’ are replaced with the name of the specific method or recommendation, focusing on the needs of healthcare professionals in its implementation. CVR I-CVI (relevance) I-CVI (clarity) Authors' decision on the point To implement [method/evidence-based recommendations] in my practice, I definitely need clearer instructions than I currently have on [using the method/evidence-based recommendations]. 0.8 1 1 Saved If you need clearer instructions, please indicate what exactly in the instructions needs clarification or more detailed explanation? 1 1 1 Saved To implement [method/evidence-based recommendations] in my practice, I definitely need more practical skills to [use the method/evidence-based recommendations] than I currently have. 1 1 1 Saved If you need more practical skills for [using the method/evidence-based recommendations], please specify which ones? 1 1 1 Saved If you need more practical skills for [using the method/evidence-based recommendations], please specify what you need to develop them? (training with practical work, supervision meetings with experts, mentoring, video, online course, other - specify what) 0.8 1 1 Saved To implement [method/evidence-based recommendations] into my practice, I will definitely need more time than I have now to do it. 0.8 1 1 Saved If you need more time, please indicate what could help free up time for [use of method/evidence-based recommendations]? (increasing the duration of the consultation, additional paid hours, time management training, hiring an assistant, other - specify what). 1 1 1 Saved To implement [method/evidence-based recommendations] in my practice, I definitely need additional financial motivation. 0.8 1 1 Saved If you need additional financial motivation, what amount would you consider sufficient [for amount of work completed]* [for the amount of work completed] is established by the person conducting the survey of healthcare professionals and is indicated in the questionnaire instead of square brackets (e.g., “per hour of using the method” or “per procedure performed”), depending on the method or recommendation. 0.8 1 1 Saved To implement [method/evidence-based recommendations] in my practice, I definitely need more resources (materials, equipment) than I currently have. 1 1 1 Saved If you need more materials or equipment , please specify which ones? 1 1 1 Saved To implement [method/evidence-based recommendations] in my practice, I will definitely need more help from the medical institution’s management team than I currently have in overcoming the difficulties associated with [using the method/evidence-based recommendations] 0.8 1 1 Saved If you need more help from the medical institution’s management team in overcoming difficulties related to [using the method/evidence recommendations], describe your difficulties. 0.4 0.9 0.9 Removed If you need more help from the medical institution’s management team in overcoming difficulties related to [use of the method/evidence-based recommendations], please indicate what actions management team can take to help ? (discussion at meetings, personal advice, psychological support, specific administrative decisions, other - specify what) 1 1 1 Saved What else can help you implement [method/evidence-based recommendations] in practice? 1 1 1 Saved Thus, based on a two-round expert assessment, a final version of the HPIQ was formed, which included only items with confirmed content validity. Table 2 . Results of Round 2 of Content Validity Assessment Face validity assessment. We assessed face validity using a sample of family doctors, chosen as a group representing a wide range of clinical contexts in practice. A total of 25 general practitioners – family medicine doctors (20 women, 5 men) working in urban (n = 18) and rural (n = 7) healthcare institutions across different regions of Ukraine participated. Among the participants, 4 were interns, 11 had 1–5 years of experience, 6–6–10 years, 2–11–20 years, 1–20–25 years and 1–26–30 years. This distribution ensured the representation of different experience and conditions of practical work. According to the results of calculating the IIS indicator, all items of the questionnaire demonstrated a sufficient level of significance (IIS ≥ 1.5), therefore they were retained in the final version of the questionnaire. In qualitative comments, respondents emphasised the relevance of the proposed statements, especially in connection with the need for practical skills, time allocation for training, financial motivation, resource provision and support from the medical institution’s management team. The importance of various learning formats (training, mentoring, supervision, online courses) and creating conditions for combining them with professional activities was also noted. Detailed results of the face validity assessment, including Item Impact Scores (IIS) and respondents` comments for each item, are presented in Table 3 . Table 3 Results of face validity assessment. Questionnaire items (Closed questions are rated on a 5-point Likert scale (1 - "strongly disagree", 2 - "disagree", 3 - "uncertain", 4 - "agree", 5 - "strongly agree"). Answers to open-ended questions are provided in the form of extended text) In the questionnaire items, the words ‘[method/evidence-based recommendation]’ are replaced with the name of the specific method or recommendation, focusing on the needs of healthcare professionals in its implementation. IIS Comments from respondents assessing face validity To implement [method/evidence-based recommendations] in my practice, I definitely need clearer instructions than I currently have on [using the method/evidence-based recommendations]. 4.4 “Continuous audit is needed” “It is important for healthcare workers to understand the goals, implementation methods…” If you need clearer instructions, please indicate what exactly in the instructions needs clarification or more detailed explanation? 4.2 “Many people simply do not understand their clear job responsibilities” “Everyone can understand what they read in their own way. And when there are clear explanations, they don’t overthink things.” “For me, the question is not entirely complete, however, I believe that there are some gaps in our system regarding evidence-based information updated according to the latest research/standards. In order to always be up to date, you need to search for information yourself, follow up, take certain courses and training (which are not always free), since the information is not updated immediately. Perhaps healthcare institutions should be more interested in updating the knowledge of their employees, and raise these issues more openly among medical workers.” To implement [method/evidence-based recommendations] in my practice, I definitely need ...more than I currently have the practical skills needed to [use the method/evidence-based recommendations] 4.2 “Without working out, it is practically difficult to talk about correct results” "Very relevant, practical skills will always be the basis for more confident use of theoretical knowledge, which can still be found. This is relevant both for doctors/nurses at the beginning of their work, and for everyone who seeks to keep up with the pace and develop with the development of medicine." If you need more practical skills for [using the method/evidence-based recommendations], please specify which ones? 4.4 “We need to motivate employees for continuous improvement” “An important question, this way we will be able to understand which educational projects need to be implemented” If you need more practical skills for [using the method/evidence-based recommendations], please specify what you need to develop them? (training with practical work, supervision meetings with experts, mentoring, video, online course, other - specify what) 4.2 “Everyone chooses the most convenient way for them to practice practical skills” “I consider trainings to be the most effective (it is the format that allows you to use knowledge in practice), as well as mentoring (when you have that person who can help with questions and difficult cases, so that you can know that you are not alone and that they will support you and help you choose the right path). Video and online courses are now common, but still not as effective (for me personally), although in today's reality it helps a lot.” “Creating centers in every region of Ukraine so that such a development system works and has wide coverage” To implement [method/evidence-based recommendations] into my practice, I will definitely need more time than I have now to do it. 3.9 “It’s cool to specify the real need for time, because everyone has different schedules and it’s great that management team could allocate time within working hours to gain new knowledge” “Time for learning always becomes less when you start working, the demands on the work of a primary care physician and other specialists are great, but there is not much time (considering that there are also other areas of life). You may need to allocate special time in your work schedule for learning (this will help not only to have the opportunity to learn, but also to switch jobs)” If you need more time, please indicate what could help free up time for [use of method/evidence-based recommendations]? (increasing the duration of the consultation, additional paid hours, time management training, hiring an assistant, other - specify what). 4.1 “Currently, doctors are often overloaded with paperwork, the amount of which has not decreased with the introduction of digitalization. Often, because they simply have to duplicate everything. The doctor has no time for patients or for development” “I already added in the previous answer, but having an assistant helps to complete administrative aspects that take a lot of time faster, thereby freeing up space for "trainings".” To implement [method/evidence-based recommendations] in my practice, I definitely need additional financial motivation . 3.6 “Everyone wants to receive financial motivation” “I put 1, but I consider this issue important. However, it requires discussion and the creation of a model that will eliminate corruption risks as much as possible, while encouraging doctors to develop and implement evidence-based methods in clinical practice.” “Financial motivation is always relevant, because now it is no less important issue, which affects the motivation to work in the field of medicine in general, where you invest a lot physically, morally (the work requires a lot of time spent on studying in general, and in itself is psychologically difficult), but expectations do not correspond to reality, and often there is no strength or desire to develop. Maybe this would help. The work of a doctor is evaluated quite low.” If you need additional financial motivation, what amount would you consider sufficient [for amount of work completed]* [for the amount of work completed] is established by the person conducting the survey of healthcare professionals and is indicated in the questionnaire instead of square brackets (e.g., “per hour of using the method” or “per procedure performed”), depending on the method or recommendation. 3.9 “The reward should provide tangible opportunities and not necessarily be in the form of money, it can be preferences, which ones and in what context - this is a question for brainstorming. If we talk purely about financial reward - it should be adjusted according to the cost of goods and services in Ukraine, and not according to the humiliating salaries that doctors receive.” “Service provided - clearly negotiated price for it” To implement [method/evidence-based recommendations] in my practice, I definitely need more resources (materials, equipment) than I currently have. 4.7 “Support Indicator” “The resource must be accessible” “In order to implement something, there must be conditions, but everything must start with a person motivated to develop and implement innovations. No super equipment will have an effect without a person who is not only trained to work with it but also motivated + support from management team, not a "spokesman"” “The question is important, you can find out what exactly employees need…” If you need more materials or equipment , please specify which ones? 4.9 “there must be specifics, that’s why it’s very important” “...and add a link to buy them” To implement [method/evidence-based recommendations] in my practice, I will definitely need more support from the medical institution’s management team than I currently have in overcoming the difficulties associated with [using the method/evidence-based recommendations] 2.9 “It is important to have a mentor who can help with some clinical issues where there is uncertainty” “open communication and the introduction of a horizontal management model where possible will promote effective interaction” “The issue is important in itself, management team should first of all be interested in improving the work and overcoming difficulties in the work of its employees, be a mentor and support” If you need more help from the medical institution’s management team in overcoming difficulties related to [use of the method/evidence-based recommendations], please indicate what actions management team can take to help ? (discussion at meetings, personal advice, psychological support, specific administrative decisions, other - specify what) 4.0 “in continuation of the previous comment: the problem should be viewed from both the bottom and the top, then communication, assessment of opportunities and decision-making, appointment of specific responsible persons” What else can help you implement [method/evidence-based recommendations] in practice? 4.5 “Everyone has their own barriers and it is important to hear from each employee to make it work effectively” “A question provides an opportunity to “recall” what may have been missed and provides an opportunity for deeper reflection.” As a result, a version validated for family doctors (HPIQ-FD) was established (see Appendix 1 ). Table 3 . Results of face validity assessment Discussion Summary of the questionnaire development and structure The initial version of the HPIQ, which consisted of 93 items based on the original DIBQ, has been substantially reduced and transformed into 14 valid items (6 closed and 8 open) that cover the main needs of healthcare professionals in the process of implementing evidence-based methods and recommendations into clinical practice. The final version, validated among family doctors (HPIQ-FD), identifies needs related to clear instructions, practical skills, additional time, financial motivation, resource provision, management team assistance in difficult situations, as well as other factors that can contribute to the successful implementation of methods or recommendations into practice. Interpretation of the results The results indicate that the developed HPIQ is a universal tool with potential applicability across a variety of clinical contexts. The version for family doctors (HPIQ-FD) has undergone content and face validity assessment in Ukraine and is capable of assessing the personalized implementation needs of Ukrainian general practitioners across a wide range of evidence-based methods and recommendations. Comparison with existing literature Some existing universal questionnaires, in particular the DIBQ and the CGDQ, are focused on assessing the determinants of clinical guideline implementation. Both instruments focus on the presence or absence of factors, without taking into account their subjective importance for the respondent in the implementation context. The DIBQ does not provide open-ended questions at all, so it does not allow the elaboration of individual needs [ 20 ]. The CGDQ partially eliminates this limitation by including an open-ended question about the key factor that facilitates implementation (“What is the single most important factor that does/will enable your use of this guideline?”). At the same time, other CGDQ questions address the factors without assessing their relative importance for each individual respondent and without providing respondents the opportunity to clarify their needs in open-ended questions [ 21 ]. Similar limitations are evident in other tools that primarily capture the presence of barriers or facilitators but do not consider the individual weight of each. Some questionnaires include questions about helpful strategies, but the responses are limited to yes/no, without assessing the significance of the need, and without the ability to elaborate in open formats [25]. The HPIQ is focused on a different approach. In it, each determinant is formulated as a personalized need (“to implement the method or evidence-based recommendations, I definitely need…”), which allows to determine the critically necessary factors for a medical worker. The use of a 5-point Likert scale provides a quantitative assessment of the importance of each need, and open-ended clarifying questions reveal their content, possible ways of satisfaction, and identify additional needs not taken into account in other questions. The development process of the HPIQ, together with the validation among family doctors (HPIQ-FD), ensured that the questionnaire is as simple as possible, with a balanced length of 14 valid items that allow comprehensive assessment while remaining practical for routine use. Practical and Research Implications We have made a transition from assessing the presence of determinants (barriers or facilitators) to analyzing the personalised needs of healthcare professionals using the HPIQ. This opens up the possibility of adapting implementation strategies to different categories of healthcare professionals and creates the basis for more individualized support with optimal use of resources, since the focus is not on providing all missing determinants as equivalent, but only on those that are really critically necessary for the implementation of innovations by healthcare professionals. Such an approach can increase the effectiveness of the implementation of methods and recommendations in family medicine already at the current stage using HPIQ-FD, and in other specialties after conducting additional validity studies, which in the future will allow assessing the universality of the HPIQ and its practical value in different areas of healthcare. From a research perspective, this tool can be useful for studying the relative importance of implementation needs and testing the effectiveness of tailored interventions targeting the most critical requirements of healthcare professionals in different clinical settings. Strengths and limitations The key stages of the HPIQ development methodology — from the structured selection of DIBQ determinants, through transformation into personalized needs, to the design of a comprehensive questionnaire — ensured the practical relevance of the tool, avoided duplication and excessive length, and created conditions for obtaining contextually meaningful data. The wording “definitely need” in the scaled items of the HPIQ helps make the questions clear by highlighting its extremes: high agreement indicates an essential need, and low agreement indicates it is not necessary. However, while the phrase is easy to understand, it may sound somewhat leading. Future versions of the HPIQ could consider more neutral wording to maintain clarity while reducing potential response bias. For the initial assessment of content validity, experts were selected who combined the experience of family doctors and specialists from other fields, as well as academic researchers, educators, and managers of healthcare institutions. For the initial assessment of face validity, family doctors were chosen because they represent a wide range of clinical contexts and practice settings, making them suitable for evaluating the clarity and relevance of items in a universal questionnaire. Content and face validity were assessed using CVR, CVI, IIS, and respondent comments, resulting in a version validated for family doctors (HPIQ-FD). Since the validity assessment was limited to family doctors and did not include professionals from all medical fields, further evaluation among physicians of other specialties, as well as physical therapists, mental health professionals, nurses, paramedics and other healthcare workers, is warranted. At the stage of face validity, there was an unequal distribution of respondents by work experience, with the majority of participants having had five or less years of experience. This may affect the generalisation of conclusions regarding the needs and priorities of specialists with different levels of experience, which requires further verification. There is a need for an assessment of reliability in terms of the form of stability and internal consistency of the items. The study was geographically limited to Ukraine. The majority of respondents came from the Zakarpattia Oblast, which was easier to achieve in the wartime conditions, and it may be that there needs to be a separate validation in other regions. The instrument was created in Ukrainian, and its adaptation for international use would require validation by backward translation and cross-cultural adaptation. Conclusion We developed the HPIQ to systematically assess the personalised needs of healthcare providers in implementing evidence-based methods and recommendations. In the present study, the questionnaire was evaluated for content and face validity among family doctors in Ukraine, resulting in a validated version for this group (HPIQ-FD). The tool enables the systematic identification of specific implementation needs, supporting individually tailored strategies to improve clinical practice. While HPIQ-FD reflects the validated version for family doctors, the HPIQ is designed as a universal instrument that could be adapted for other medical specialties and international contexts, contributing to a more effective and sustainable integration of evidence-based practice. Abbreviations HPIQ The Healthcare Professionals’ Implementation-needs Questionnaire HPIQ-FD The Healthcare Professionals’ Implementation-needs Questionnaire for family doctors TDF Theoretical Domains Framework DIBQ Determinants of Implementation Behavior Questionnaire CGDQ Clinician Guideline Determinants Questionnaire PhD Doctor of Philosophy CVR Content validity ratio CVI Content validity index I-CVI Item content validity index S-CVI Scale content validity index IIS Item impact score EGPRN European General Practice Research Network Declarations Ethics approval and consent to participate: The study was approved by the Bioethics Committee of Uzhhorod National University, Ukraine (Protocol No. 8/4, 30 September 2025). By completing the questionnaire, participants provided their informed consent to take part in the study. Consent for Publication: Participants consented to the publication of the collected data in anonymized form. Availability of data and materials The original data with participant names redacted is available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding This study was funded by the MiMIND project, supported by GAMIAN-Europe. Author contributions Andrii Kolesnyk: Conceptualisation, Data curation, Formal analysis, Investigation, Methodology, Project administration, Validation, Visualisation, Writing - original draft, Writing - review & editing. Pavlo Kolesnyk: Funding acquisition, Resources, Supervision, Conceptualisation, Investigation, Methodology, Validation, Visualization, Writing - original draft, Writing - review & editing. Michael Harris: Supervision, Formal analysis, Investigation, Methodology, Visualisation, Writing - original draft, Writing - review & editing. Acknowledgements The authors sincerely thank Drs. Johanna M. Huijg and Winifred A. Gebhardt for granting permission to use the DIBQ determinants as a basis for the HP-IQ. We also thank the experts from the European General Practice Research Network (EGPRN) — Shlomo Vinker, Mehmet Ungan, Sabine Bayen and Ana Clavería — for their valuable comments, suggestions, and references. In addition, we express our gratitude to the academics and PhD students from the Department of Family Medicine and Outpatient Care, Medical Faculty #2, Uzhhorod National University, and from the Family Medicine Department, Bukovinian State Medical University, as well as to Ukrainian doctors who participated in the validation process. Their contributions were invaluable to the development and evaluation of the questionnaire. References Westerlund A, Sundberg L, Nilsen P. Implementation of Implementation Science Knowledge: The Research-Practice Gap Paradox. Worldviews Evid Based Nurs. 2019;16:332–4. https://doi.org/10.1111/wvn.12403. Tucker S, McNett M, Mazurek Melnyk B, Hanrahan K, Hunter SC, Kim B, et al. Implementation Science: Application of Evidence-Based Practice Models to Improve Healthcare Quality. Worldviews Evid Based Nurs. 2021;18:76–84. https://doi.org/10.1111/wvn.12495. van Tuijl AAC, Wollersheim HC, Fluit CRMG, van Gurp PJ, Calsbeek H. Development of a tool for identifying and addressing prioritised determinants of quality improvement initiatives led by healthcare professionals: a mixed-methods study. Implement Sci Commun. 2020;1:92-. https://doi.org/10.1186/s43058-020-00082-w. Powell BJ, Fernandez ME, Williams NJ, Aarons GA, Beidas RS, Lewis CC, et al. Enhancing the impact of implementation strategies in healthcare: A research agenda. Front Public Health. 2019;7 JAN:431063. https://doi.org/10.3389/fpubh.2019.00003. McNett MM, Tucker SJ, Juckett LA, Bunger AC. Advancing Implementation Practice: Supplemental Tools to Aid in Selection of Implementation Strategies and Outcomes for Healthcare Practitioners. Global Implementation Research and Applications 2024 4:3. 2024;4:286–95. https://doi.org/10.1007/s43477-024-00122-w. WHO. Handbook for national quality policy and strategy. A practical approach for developing policy and strategy to improve quality of care. 2018. https://www.who.int/publications/i/item/9789241565561. Accessed 13 Feb 2026. NICE. Shared decision making NICE guideline. 2021. www.nice.org.uk/guidance/ng197. Accessed 16 Feb 2026. Ministry of Health of Ukraine. Recommendations for building a quality management system in a healthcare facility. 2022. https://moz.gov.ua/uploads/ckeditor/Бібліотека%20проектів%20USAID/Рекомендації_final_new.pdf. Accessed 13 Feb 2026. Hurzhyi P. Quality management of healthcare services in healthcare institutions. Entrepreneurship and Innovation. 2024;:95–9. https://doi.org/10.32782/2415-3583/33.16. Kaper NM, Swennen MHJ, Van Wijk AJ, Kalkman CJ, Van Rheenen N, Van Der Graaf Y, et al. The “evidence-based practice inventory”: reliability and validity was demonstrated for a novel instrument to identify barriers and facilitators for Evidence Based Practice in health care. J Clin Epidemiol. 2015;68:1261–9. https://doi.org/10.1016/j.jclinepi.2015.06.002. Salbach NM, Jaglal SB. Creation and validation of the evidence-based practice confidence scale for health care professionals. J Eval Clin Pract. 2011;17:794–800. https://doi.org/10.1111/j.1365-2753.2010.01478.x. Fernández-Domínguez JC, De Pedro-Gómez JE, Morales-Asencio JM, Bennasar-Veny M, Sastre-Fullana P, Sesé-Abad A. Health Sciences-Evidence Based Practice questionnaire (HS-EBP) for measuring transprofessional evidence-based practice: Creation, development and psychometric validation. PLoS One. 2017;12:e0177172. https://doi.org/10.1371/journal.pone.0177172. Upton D, Upton P. Development of an evidence-based practice questionnaire for nurses. J Adv Nurs. 2006;53:454–8. https://doi.org/10.1111/j.1365-2648.2006.03739.x. Norhayati MN, Nawi ZM. Validity and reliability of the Noor Evidence-Based Medicine Questionnaire: A cross-sectional study. PLoS One. 2021;16:e0249660. https://doi.org/10.1371/journal.pone.0249660. Zabaleta-del-Olmo E, Subirana-Casacuberta M, Ara-Pérez A, Escuredo-Rodríguez B, Ríos-Rodríguez MÁ, Carrés-Esteve L, et al. Developing Evidence-Based Practice questionnaire for community health nurses: reliability and validity of a Spanish adaptation. J Clin Nurs. 2016;25:505–17. https://doi.org/10.1111/jocn.13078. Markaki A, Malhotra S, Billings R, Theus L. Training needs assessment: tool utilization and global impact. BMC Med Educ. 2021;21:310. https://doi.org/10.1186/s12909-021-02748-y. Hatz MHM, Sonnenschein T, Blankart CR. The PMA Scale: A Measure of Physicians’ Motivation to Adopt Medical Devices. Value in Health. 2017;20:533–41. https://doi.org/10.1016/j.jval.2016.12.002. Wong E, Mavondo F, Horvat L, McKinlay L, Fisher J. Healthcare professionals’ perspective on delivering personalised and holistic care: using the Theoretical Domains Framework. BMC Health Serv Res. 2022;22:281. https://doi.org/10.1186/s12913-022-07630-1. Zhou Y, Huang Y, Wang Y, Xu X, Yu Z, Gu Y. Theoretical Domains Framework: A Bibliometric and Visualization Analysis from 2005-2023. J Multidiscip Healthc. 2024;17:4055–69. https://doi.org/10.2147/jmdh.s470223. Huijg JM, Gebhardt WA, Dusseldorp E, Verheijden MW, van der Zouwe N, Middelkoop BJC, et al. Measuring determinants of implementation behavior: psychometric properties of a questionnaire based on the theoretical domains framework. Implement Sci. 2014;9:33. https://doi.org/10.1186/1748-5908-9-33. Gagliardi AR, Armstrong MJ, Bernhardsson S, Fleuren M, Pardo-Hernandez H, Vernooij RWM, et al. The Clinician Guideline Determinants Questionnaire was developed and validated to support tailored implementation planning. J Clin Epidemiol. 2019;113:129–36. https://doi.org/10.1016/j.jclinepi.2019.05.024. Additional Declarations No competing interests reported. Supplementary Files Appendix1.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 03 May, 2026 Reviewers invited by journal 21 Apr, 2026 Editor invited by journal 23 Mar, 2026 Editor assigned by journal 20 Mar, 2026 Submission checks completed at journal 20 Mar, 2026 First submitted to journal 20 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9177115","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":631998586,"identity":"6135dfa7-1294-414c-af13-88f5f7cf5213","order_by":0,"name":"Andrii Kolesnyk","email":"","orcid":"","institution":"Uzhhorod National University","correspondingAuthor":false,"prefix":"","firstName":"Andrii","middleName":"","lastName":"Kolesnyk","suffix":""},{"id":631998587,"identity":"c1272d2c-664c-4e8c-a44d-3591dc662d23","order_by":1,"name":"Pavlo Kolesnyk","email":"","orcid":"","institution":"Uzhhorod National University","correspondingAuthor":false,"prefix":"","firstName":"Pavlo","middleName":"","lastName":"Kolesnyk","suffix":""},{"id":631998591,"identity":"b7c7068b-0955-432d-bee1-51351d30e5e1","order_by":2,"name":"Michael Harris","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwUlEQVRIiWNgGAWjYLCCygabBAYGHghHgigtZxvSEhjYSNRymAQturPbn244uON8Hv/83gMMP2oYEmc2ENBidueM2Y2DZ24XSxzjS2DsOcaQOJuQLWY3cthuf2y7ndhwjMeAgbeBIXEeYS3pz24cbDuXOB+ohfEvcVoSgA5rO5C4AaiFGWQLYYeB/dKWXGx4LMfgsMwxCWPC3r/dDnKYXZ7c4TOGD9/U2MjOOEDIGuRoOEBcRBIX2aNgFIyCUTCiAQDyf0pJ2AqDowAAAABJRU5ErkJggg==","orcid":"","institution":"University of Bath","correspondingAuthor":true,"prefix":"","firstName":"Michael","middleName":"","lastName":"Harris","suffix":""}],"badges":[],"createdAt":"2026-03-20 09:08:46","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9177115/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9177115/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108803960,"identity":"a7099334-01c0-4538-ba15-ab1ec1b2d2d4","added_by":"auto","created_at":"2026-05-08 15:12:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":423907,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9177115/v1/c5b1c3a7-931f-4b01-99ce-5875735f6fb2.pdf"},{"id":108247282,"identity":"ef491a4c-2fb4-4121-b450-4352ad7c0879","added_by":"auto","created_at":"2026-05-01 00:41:01","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":46776,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1.docx","url":"https://assets-eu.researchsquare.com/files/rs-9177115/v1/e00965d516a7f8e075c0b2c1.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development of a universal healthcare professionals’ implementation- needs questionnaire and its validation among Ukrainian family doctors","fulltext":[{"header":"Background","content":"\u003cp\u003eImplementation science has emerged as a distinct field to bridge the gap between evidence and clinical practice. Its mission is to ensure that proven practices are effectively adopted into the daily work routine of healthcare professionals [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Research has shown that the success of healthcare change processes depends not only on the effectiveness of the practices themselves, but also on the context and participation of those who will implement them [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In the process of analysing the implementation of new practices, numerous facilitators and barriers, known as determinants, have been identified that influence the implementation behaviour of healthcare professionals [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. At the same time, methods for their detection require further improvement and evaluation of effectiveness [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this regard, there is a growing need for standardised tools that can assess the factors that influence the implementation of changes in the clinical environment. The development of such tools is considered as one of the ways to prevent the formation of the so-called secondary gap between research and its application in practice [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Many international recommendations emphasise the need to involve healthcare professionals in decision-making regarding changes in clinical activities, particularly in the field of primary health care[\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Individualised approaches to implementation have been shown to provide higher effectiveness than one-size-fits-all strategies [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe literature describes a significant number of questionnaires aimed at assessing the knowledge, skills, attitudes and training needs of health professionals in the context of evidence-based practice. The Evidence-Based Practice Inventory (EBPI) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], the Evidence-Based Practice Confidence (EPIC) scale[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], Health Sciences-Evidence-Based Practice (HS-EBP)[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], Evidence-Based Practice Questionnaire (EBPQ) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and Noor Evidence-Based Medicine Questionnaire [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] are used to assess knowledge, skills, attitudes, readiness and motivation relating to various aspects of evidence-based medicine. The Developing Evidence-Based Practice Questionnaire (DEBPQ) has been developed to identify barriers, sources of knowledge, and attitudes toward evidence-based practice [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], while the Hennessy-Hicks Training Needs Analysis (TNA) has been used as a universal tool to identify training needs across countries and professional contexts [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. A common feature of most tools is their focus on general competencies and training needs rather than on the needs of healthcare professionals when implementing specific practices.\u003c/p\u003e \u003cp\u003eSome questionnaires are focused on assessing motivational or organisational factors in narrow areas, such as telemedicine [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] or the use of medical devices [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, these tools do not allow for a systematic assessment of the specific needs of employees for the implementation of individual methods. In addition, only a limited number of questionnaires have the flexibility to adapt to a specific method or area of medicine while maintaining validity.\u003c/p\u003e \u003cp\u003eIn this context, the Theoretical Domains Framework (TDF) is particularly valuable: it provides a sufficiently universal structure that has been widely applied in numerous implementation-focused questionnaires in healthcare, capturing behavioural, motivational, and organisational determinants. Most TDF-based questionnaires to date have primarily been qualitative in nature, focusing on interviews or focus groups rather than structured survey instruments [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Despite the versatility of the TDF, there are relatively few questionnaires that are both structured and truly universal, capable of being applied across different clinical areas and healthcare contexts, explicitly designed around TDF determinants [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong the universal instruments, the most common are the Determinants of Implementation Behavior Questionnaire (DIBQ), based on TDF determinants [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and the Clinician Guideline Determinants Questionnaire (CGDQ) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. They cover a wide range of determinants that influence on the implementation, but do not focus on an individualised assessment of the needs of employees as active participants in change. The DIBQ does not provide detailed answers or suggestions for meeting needs, and the CGDQ consists mainly of closed questions, while a limited number of general open-ended questions only partially detail the conditions necessary for the implementation of innovations.\u003c/p\u003e \u003cp\u003eGiven these limitations, there is a need to create a universal questionnaire for different areas of medicine that can identify the personal needs of medical professionals in the process of implementing specific methods, assess the individual significance of each need, and elicit suggestions on ways to meet them. The use of such a tool could become the basis for making informed management decisions that consider the real needs of medical professionals and thereby contribute to a more effective and sustainable implementation of evidence-based methods in practice.\u003c/p\u003e \u003cp\u003e\u003cb\u003eThe study aimed\u003c/b\u003e (1) to develop a questionnaire assessing medical professionals\u0026rsquo; needs for implementing evidence-based methods and guidelines in clinical practice, and (2) to evaluate its validity among family doctors in Ukraine.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eSelection of DIBQ determinants for the formation of the Healthcare Professionals\u0026rsquo; Implementation-needs Questionnaire (HPIQ)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe used a structured approach based on the existing DIBQ instrument to develop a HPIQ [20].\u003c/p\u003e\n\u003cp\u003eItems from the original questionnaire were selected according to the following pre-defined inclusion criteria, with only those items that met all these criteria being included in the final list:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003erepresented something that healthcare workers may need to be able to implement a specific method or evidence-based recommendation in practice in today\u0026rsquo;s environment;\u003c/li\u003e\n \u003cli\u003erelated to needs that can be potentially addressed by the medical institution\u0026rsquo;s management team;\u003c/li\u003e\n \u003cli\u003ecovered needs that would only be encountered by healthcare professionals after the implementation process has begun;\u003c/li\u003e\n \u003cli\u003ewere universal and could be applied to the implementation of any evidence-based medical intervention or recommendation;\u003c/li\u003e\n \u003cli\u003ewere formulated as clearly, simply and unambiguously as possible;\u003c/li\u003e\n \u003cli\u003edid not duplicate the main idea of other items (if there were other items similar in content, only the option that best reflected it, was retained);\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eFormation of new questionnaire items\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the selected determinants from the DIBQ, we wrote new items that allowed us to assess the level of importance of the needs in each of the domains. Each new item:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003ewas formulated according to one of the domains of the original DIBQ;\u003c/li\u003e\n \u003cli\u003ewas transformed to reflect the need itself, not just the presence of a facilitator or barrier;\u003c/li\u003e\n \u003cli\u003emet the selection criteria above.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAll closed questions had the same initial formula:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;To implement [method/evidence-based recommendations] in my practice, I definitely need\u0026hellip;\u0026rdquo;, where the name of the specific method or clinical recommendation being implemented may be inserted in square brackets.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEach question was rated on a Likert scale: 1 \u0026ndash; strongly disagree, 2 \u0026ndash; disagree, 3 \u0026ndash; uncertain, 4 \u0026ndash; agree, 5 \u0026ndash; strongly agree.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe key wording \u0026ldquo;definitely need\u0026rdquo; in the question template was chosen to make the scale easier to interpret: respondents who selected 5 (strongly agree) indicated that the need was truly essential, whereas those selecting 1 (strongly disagree) indicated that it was not needed at all. This wording was designed to clearly distinguish the extremes of the scale and reduce ambiguity.\u003c/p\u003e\n\u003cp\u003eFor each Likert-scale question, an open question was added if the respondent had chosen a score of 4 or 5. The open-ended questions were designed to clarify the specific aspects of the identified needs during implementation, for example what instructions or resources are required, how they should be delivered, and whether additional needs of healthcare workers exist.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContent validity\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContent validity assessment procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo assess the content validity of the developed questionnaire, we created an online form using the Google Forms platform. An expert panel for content validity assessment was formed through purposeful selection of experts among staff members of the Departments of Family Medicine at Uzhhorod National University and Bukovinian State Medical University in Ukraine. These panellists were eligible if they met the following criteria: clinical experience in both family medicine and other specialties, involvement in research activities, experience working at medical university departments, and participation in the development of questionnaires.\u003c/p\u003e\n\u003cp\u003eDuring the piloting phase, the evaluation form was tested by three experts from this panel to check the ease of completion, the clarity of the wording, and the logic of the design. Based on the results of the piloting, we clarified the wording of the tasks and improved the visual presentation of the validation form.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the direct content validity assessment round, twelve different experts from the panel received an improved version of the form for quantitative content validity assessment of 31 items in the HPIQ. Before this assessment began, we informed the experts of the two main objectives of the questionnaire:\u003c/p\u003e\n\u003cp\u003eObjective #1, for closed questions with a Likert scale: to assess how critical (necessary) each need was for implementing a specific method or recommendation;\u003c/p\u003e\n\u003cp\u003eObjective #2, for open-ended questions: to identify what specifically was needed for each item.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe asked the experts to evaluate each item based on three criteria: essentialness, relevance, and clarity for the respondent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEssentialness.\u0026nbsp;\u003c/em\u003eExperts were requested to assess how essential each item was for the study. After each item with a Likert scale, we included this question: \u0026ldquo;Please rate how essential this item is for the study in terms of objective #1\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eAfter each item with open-ended question, we included this question: \u0026ldquo;Please rate how essential this item is for the study in terms of objective #2\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eThe experts were asked to rate their assessments on a 3-point scale: 1 \u0026ndash; not necessary, 2 \u0026ndash; useful but not essential, 3 \u0026ndash; essential.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRelevance.\u0026nbsp;\u003c/em\u003eFor items with a Likert scale, we asked experts the question: \u0026ldquo;Please rate how relevant this item is to the questionnaire objective #1?\u0026rdquo; For items with open-ended questions, the question was: \u0026ldquo;Please rate how relevant this item is to the questionnaire objective #2\u0026rdquo; The relevance of each item was assessed on a 4-point scale: 1 \u0026ndash; not at all relevant, 2 \u0026ndash; not relevant, 3 \u0026ndash; relevant, 4 \u0026ndash; very relevant.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eClarity for the respondent.\u0026nbsp;\u003c/em\u003eThe task of the experts was to assess the clarity of each item for healthcare professionals. After each item, we asked the following question: \u0026ldquo;Please rate how clear this item is for the healthcare professional being surveyed.\u0026rdquo; Clarity was assessed on a 4-point scale: 1 \u0026ndash; not at all clear, 2 \u0026ndash; not clear, 3 \u0026ndash; clear, 4 \u0026ndash; very clear.\u003c/p\u003e\n\u003cp\u003eIn addition to quantitative evaluation, we asked experts asked to provide comments and suggestions for each item, if necessary, in the format: \u0026quot;Write your suggestions for improving this item, if any.\u0026quot;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContent validity data analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor each item, the content validity ratio (CVR) was calculated using the formula:\u003cbr\u003e\u003cem\u003eCVR=(Ne-(N/2))/(N/2),\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/em\u003ewhere \u003cem\u003eN\u0026nbsp;\u003c/em\u003eis the total number of experts,\u0026nbsp;\u003cem\u003eNₑ\u0026nbsp;\u003c/em\u003eis the number of experts who rated the item as essential (3 points). According to Lawshe criteria, with the participation of 10 or more experts, CVR \u0026ge; 0.62 is considered sufficient\u0026nbsp;[22].\u0026nbsp;Based on the relevance and clarity criteria, the item-level content validity index (I-CVI) was calculated using the formula:\u003cbr\u003e\u003cem\u003eI-CVI = number of experts who rated the item as relevant or clear (3-4 points) / total number of experts.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe I-CVI reflects the proportion of experts who agree that a particular item is appropriate in terms of its relevance or clarity and is used to determine whether each individual item should be retained, revised, or removed. Interpretation of CVI results was carried out according to generally accepted thresholds: CVI \u0026gt; 0.79 \u0026mdash; sufficient level, CVI 0.70\u0026ndash;0.79 \u0026mdash; requires revision, CVI \u0026lt; 0.70 \u0026mdash; item deletion is recommended.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo evaluate the overall content validity of the questionnaire, the Scale-Level Content Validity Index (S-CVI) was calculated separately for relevance and clarity of the items. The S-CVI summarizes the level of agreement among experts across all items in the scale. Two complementary approaches were applied: S-CVI Universal Agreement (S-CVI/UA) and S-CVI Average Agreement (S-CVI/Ave).\u003c/p\u003e\n\u003cp\u003eS-CVI/UA represents the proportion of items that achieved full agreement among experts, meaning that all experts rated the item as either 3 or 4 on a 4-point scale. It was computed separately for relevance and for clarity using the formula:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;S-CVI/UA = number of items with I-CVI = 1 / total number of items.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eS-CVI/Ave reflects the average of the item-level CVIs (I-CVIs) across all items and indicates the overall agreement on item quality rather than complete consensus. It was calculated using\u003cem\u003e\u0026nbsp;\u003c/em\u003ethe formula:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eS-CVI/Ave = \u0026Sigma;I-CVIi / total number of items.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eHigher S-CVI values indicate stronger agreement among experts regarding the relevance or clarity of the items. An S-CVI value of 0.80 or higher was considered sufficient when assessing the content validity of the scale [23].\u003c/p\u003e\n\u003cp\u003eThe research team analyzed the CVR, CVI, and expert comments. Based on the results of the analysis, changes were made to the wording of the questions, retaining only items with confirmed validity, and reformulating controversial ones in accordance with the comments.\u003c/p\u003e\n\u003cp\u003eGiven the significant number of edits and new versions of questions, the content validity assessment procedure for the updated questionnaire was fully repeated in Round 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFace validity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFace validity assessment procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt the face validity stage, the HPIQ was evaluated among family doctors. This group was selected for the initial face validity assessment because family physicians work across a wide range of clinical contexts and practice settings, which is consistent with the concept of a universal questionnaire. As a result of this stage, the version of the instrument validated for family doctors is referred to as HPIQ-FD.\u003c/p\u003e\n\u003cp\u003eTo assess the face validity of the developed instrument, 25 general practitioners (family medicine physicians) were involved. The main inclusion criterion was professional practice in the field of general practice/family medicine. Participants were recruited through professional online chats of family physicians from the Zakarpattia region and Uzhhorod, via personal contacts, and by applying the snowball sampling method, whereby participating physicians recruited other colleagues. Additional recruitment was conducted through online groups and chats associated with previous training sessions held for family doctors. Each of them was sent an online form to assess the importance of the questionnaire items.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAfter reviewing each item, respondents were asked: \u003cem\u003e\u0026ldquo;How important is it to include this question for healthcare professionals to understand their needs when implementing changes in clinical practice?\u0026rdquo;\u003c/em\u003e Responses were provided on a 5-point scale: 1 \u0026ndash; not at all important, 2 \u0026ndash; not important, 3 \u0026ndash; uncertain, 4 \u0026ndash; important, 5 \u0026ndash; very important.\u003c/p\u003e\n\u003cp\u003eWe also invited respondents to provide suggestions in an open-ended format: \u0026ldquo;Please write your suggestions for improving this item, if any,\u0026rdquo; in order to identify potential ambiguities or unclear wording and to refine item content.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFace validity data analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the responses received, we calculated the item impact score (IIS) for each item using the formula:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIIS = (proportion of respondents who rated the item as 4 or 5) \u0026times; (mean item score).\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe IIS indicator was used to quantitatively assess face validity: if IIS \u0026ge; 1.5 , the item was considered sufficiently significant and was retained in the final version of the questionnaire; if IIS \u0026lt; 1.5 , the face validity was determined to be insufficient, the corresponding item was subject to exclusion or revision with subsequent re-evaluation\u003cem\u003e.\u003c/em\u003e [24]\u003c/p\u003e\n\u003cp\u003eThe qualitative comments were analysed to refine item content and improve the clarity and precision of the questionnaire.\u003c/p\u003e\n\u003cp\u003eWe used Microsoft Excel for data entry, tabulation, and calculation of CVR, CVI (for content validity), IIS (for face validity), and for organizing qualitative comments from experts/respondents.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eQuestionnaire development:\u003c/h2\u003e \u003cp\u003eAs a result of checking 93 items of the original DIBQ questionnaire for compliance with the predefined inclusion criteria, we created the first version of the new HPIQ. It included 12 mandatory items in the format of closed questions covering the main types of needs, the importance of which is assessed on a five-point Likert scale of agreement (1 - \"strongly disagree\", 2 - \"disagree\", 3 - \"uncertain\", 4 - \"agree\", 5 - \"strongly agree\"). For each Likert scale question, open questions (a total of 19) were developed, the purpose of which was to clarify the content of the needs, identify possible ways to meet them and detect additional, not yet considered needs. The first version of the HPIQ, including the original DIBQ items and their adapted form, is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDevelopment of the HPIQ from DIBQ items.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDIBQ Domains, constructs (and item numbers)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOriginal DIBQ items used\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eItems after adaptation for HPIQ\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003cp\u003eKnowledge (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI know how to deliver [PA intervention] following the guidelines.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1. To implement [method/evidence-based recommendations] in my practice, I definitely need clearer instructions than I currently have.\u003c/p\u003e \u003cp\u003e1.2. If you need clearer instructions, please specify which ones?\u003c/p\u003e \u003cp\u003e1.3. If you need clearer instructions, please indicate how you would like them provided?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkills\u003c/p\u003e \u003cp\u003eSkills (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI have the skills to deliver [PA intervention] following the guidelines.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.1. To implement [method/evidence-based recommendations] in my practice, I definitely need more practical skills.\u003c/p\u003e \u003cp\u003e2.2. If you need more practical skills, please specify which ones ?\u003c/p\u003e \u003cp\u003e2.3. If you need more practical skills, please indicate what you need to develop them ?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBeliefs about consequences\u003c/p\u003e \u003cp\u003eOutcome expectancies (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIf I deliver [PA intervention] following the Guidelines, it will help participants to be more physically active.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.1. To implement [method/evidence-based recommendations] in my practice, I definitely need a greater understanding of what benefits it has for my patients.\u003c/p\u003e \u003cp\u003e3.2. If you have doubts about the usefulness of [method/evidence-based recommendations], please describe them.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInnovation\u003c/p\u003e \u003cp\u003eInnovation characteristics (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[PA intervention] is simple to deliver.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.1. To implement [method/evidence-based recommendations] in my practice, I definitely need the performing process to be simpler than it is now.\u003c/p\u003e \u003cp\u003e4.2. If you need to simplify the performing process, please specify what is needed for this?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInnovation\u003c/p\u003e \u003cp\u003eInnovation characteristics (3/5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[PA intervention] costs little time to deliver.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.1. To implement [method/evidence-based recommendations] into my practice, I will definitely need more time than I have now to perform it.\u003c/p\u003e \u003cp\u003e5.2. If you need more time to perform [method/evidence recommendations], please indicate how much?\u003c/p\u003e \u003cp\u003e5.3. If you need more time to perform [method/evidence-based recommendations], please specify what is required for this?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReinforcement (1/3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhen I deliver [PA intervention] following the guidelines, I get financial reimbursement.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.1. To implement [method/evidence-based recommendations] into my practice, I definitely need additional financial compensation.\u003c/p\u003e \u003cp\u003e6.2. If you require additional financial compensation, please indicate the amount.\u003c/p\u003e \u003cp\u003e6.3. If you require other compensation, please describe it.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrganization\u003c/p\u003e \u003cp\u003eOrganizational resources and support (1/4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn the organization I work, all necessary resources are available to deliver [PA intervention].\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.1. To implement [method/evidence-based recommendations] in my practice, I definitely need more resources (materials, equipment) than I currently have.\u003c/p\u003e \u003cp\u003e7.2. If you need more materials or equipment, please specify which ones.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrganization\u003c/p\u003e \u003cp\u003eOrganizational resources and support (2/4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI can count on support from the management of the organization I work in, when things get tough guidelines.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.1. To implement [method/evidence-based recommendations] in my practice, I definitely need more support from the medical institution\u0026rsquo;s management team than I currently have.\u003c/p\u003e \u003cp\u003e8.2. If you need more support from the medical institution\u0026rsquo;s management team, please specify in what situations?\u003c/p\u003e \u003cp\u003e8.3. If you need more support from the medical institution\u0026rsquo;s management team, please specify what kind?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial influences\u003c/p\u003e \u003cp\u003eSocial support (1/3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI can count on support from professionals with whom I deliver [PA intervention] when things get tough around delivering [PA intervention] following the guidelines.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.1. I definitely need more support from colleagues to implement [method/evidence-based recommendations] in my practice.\u003c/p\u003e \u003cp\u003e9.2. If you need more support from colleagues, please specify in what situations?\u003c/p\u003e \u003cp\u003e9.3. If you need more support from colleagues, please specify what kind?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBehavioral regulation Memory (2/2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDelivering [PA intervention] following the guidelines is something I often forget.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.1. To implement [method/evidence-based recommendations] in my practice, I definitely need a better reminder system to follow [method/evidence-based recommendations].\u003c/p\u003e \u003cp\u003e10.2. If you need to improve the reminder system, please indicate in what format you would like to receive them?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReinforcement (2/3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhen I deliver [PA intervention] following the guidelines, I get recognition from the work context.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.1. To implement [method/evidence-based recommendations] in my practice, I definitely need more recognition from the medical institution\u0026rsquo;s management team than I currently have.\u003c/p\u003e \u003cp\u003e11.2. If you need more recognition from the medical institution\u0026rsquo;s management team, please indicate in what format you would like to receive it?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReinforcement (3/3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhen I deliver [PA intervention] following the guidelines, I get recognition from participants.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.1. To implement [method/evidence-based recommendations] in my practice, I definitely need more recognition from patients than I currently have.\u003c/p\u003e \u003cp\u003e12.2. If you need more recognition from patients, please indicate in what format you would like to receive it?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e`New general item:\u003c/p\u003e \u003cp\u003e13. What else can help you implement [method/evidence-based recommendations] in practice?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e The selected items covered key determinants of implementation that can be considered as needs of healthcare professionals in the context of applying any evidence-based methods or clinical guidelines.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Development of the HPIQ from DIBQ items.\u003c/p\u003e \u003cp\u003eBased on the defined criteria, we excluded items that did not meet the predetermined selection criteria from the first version of HPIQ.\u003c/p\u003e \u003cp\u003eOne of the key reasons for their exclusion was that they could not be conceptualised as healthcare professionals\u0026rsquo; needs. In particular, constructs such as making an intervention part of one\u0026rsquo;s professional duties or a priority, the intention to carry it out, expectations of significant others, as well as confidence in performing the intervention under unfavorable conditions (when other professionals do not implement it, when there is a lack of time, or when patients are not motivated), reflect the level of readiness or social influence, but do not constitute independent, clearly defined needs.\u003c/p\u003e \u003cp\u003eItems reflecting domains such as optimism, patients\u0026rsquo; motivation, and healthcare providers\u0026rsquo; positive or negative emotions were excluded because these factors cannot be directly influenced or addressed through managerial actions within a medical institution.\u003c/p\u003e \u003cp\u003eWe also excluded itemsif they could not be applied to the implementation of any evidence-based medical intervention or recommendation, duplicated the core concept of other HPIQ items, or were considered overly complex, too broad, or ambiguous in their wording.\u003c/p\u003e \u003cp\u003eThe detailed reasons for excluding specific items from the preliminary version of the HPIQ are given in Appendix 2.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eContent validity assessment\u003c/h2\u003e \u003cp\u003eThe content validity assessment of the HPIQ was carried out in two rounds with the involvement of qualified experts. The first round began after testing the assessment form by three experts to check the ease of filling in, the clarity of the task formulations, and the logic of the design. Based on the results of the testing, the formulation of the tasks was clarified and the visual presentation of the online form was improved.\u003c/p\u003e \u003cp\u003eThe first round involved twelve experts with research experience (one assistant professor of the department, six PhD students and five PhDs). Each of the experts taught at departments of medical universities of Ukraine, had experience in developing questionnaires, as well as clinical experience in the field of family medicine and/or other specialties at the same time and/or involvement in the administration of medical institutions.\u003c/p\u003e \u003cp\u003eIn the first round, twelve experts performed a quantitative assessment of 31 items contained in the first version of the questionnaire.\u003c/p\u003e \u003cp\u003eBased on the experts\u0026rsquo; ratings, the Scale-Level Content Validity Index (S-CVI) was calculated separately for relevance and clarity. For relevance, S-CVI(UA) was 0.16 (insufficient) and S-CVI(Ave) was 0.89 (sufficient). For clarity, S-CVI(UA) reached 0.32 (insufficient) and S-CVI(Ave) was 0.91 (sufficient), according to the generally accepted criterion of 0.80 for adequate content validity.\u003c/p\u003e \u003cp\u003eFor each item, CVR was calculated, as well as two I-CVI, which related to the relevance and clarity. According to the experts' assessments, only 12 items (5 closed and 6 open) reached all three thresholds of validity (CVR\u0026thinsp;\u0026ge;\u0026thinsp;0.62; both I-CVI\u0026thinsp;\u0026ge;\u0026thinsp;0.79). At the same time, changes were proposed to six of them. The remaining items demonstrated insufficient values according to at least one of the three criteria. In total, 16 items were removed, another 11 underwent substantive changes, and 4 were left unchanged for further assessment in the second round.\u003c/p\u003e \u003cp\u003eThe results from Round 1 of the content validity assessment, along with experts\u0026rsquo; comments and the authors\u0026rsquo; decisions for each item, are presented in Appendix 3.\u003c/p\u003e \u003cp\u003eThe general suggestions of experts received during the first round of content validity assessment suggested that the HPIQ should begin with a mandatory preamble form, in which the potential researcher will be able to indicate the main data: who is conducting the survey, the purpose of the study, the approximate time for completion and guarantees of confidentiality, and also express gratitude to the respondent for participation.\u003c/p\u003e \u003cp\u003eThe structure of the preamble form of the questionnaire is presented in the HPIQ final version, validated among family doctors (HPIQ-FD) (\u003cspan refid=\"Sec21\" class=\"InternalRef\"\u003eAppendix 1\u003c/span\u003e), supplemented by the researcher with information about the method or recommendation being implemented.\u003c/p\u003e \u003cp\u003eExperts also recommended including instructions for the researcher that emphasise including the name and description of the essence of the method or recommendation being implemented, indicating the scientific justification and practical benefit for healthcare professionals.\u003c/p\u003e \u003cp\u003eWe provided the instructions for researchers planning a survey to implement a specific method or evidence-based recommendation in the questionnaire final version, validated among family doctors (HPIQ-FD) (see \u003cspan refid=\"Sec21\" class=\"InternalRef\"\u003eAppendix 1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo improve comprehension and accuracy of data collection, experts recommended highlighting in bold the main concepts or terms in each item, and providing a list of possible answer options in parentheses under some open-ended questions.\u003c/p\u003e \u003cp\u003eIn the second round, 10 experts (two were unable to participate) rated the updated version, which included 15 items: 6 closed and 9 open-ended. Based on expert evaluations, S-CVI demonstrated high levels of agreement for both relevance and clarity (threshold\u0026thinsp;\u0026ge;\u0026thinsp;0.80). For relevance, S-CVI(UA) was 0.93 and S-CVI(Ave) was 0.99, while for clarity, S-CVI(UA) reached 0.93 and S-CVI(Ave) was 0.99.\u003c/p\u003e \u003cp\u003eOne item, \u0026ldquo;If you need more help from the medical institution\u0026rsquo;s management team to overcome difficulties associated with [using the method/evidence-based recommendations], describe your difficulties?\u0026rdquo; was removed due to insufficient specificity (CVR\u0026thinsp;\u0026lt;\u0026thinsp;0.62) and experts\u0026rsquo; comments about content overlap with the following question: \u0026ldquo;If you need more help from the medical institution\u0026rsquo;s management team to overcome difficulties associated with [using the method/evidence-based recommendations], indicate what actions management team can take to help.\u0026rdquo; The removal avoided duplication of information and increased the accuracy of data collection while maintaining the completeness of the assessment of respondents\u0026rsquo; needs. After the removal of this item, the S-CVI reached 1.00 under all calculation methods.\u003c/p\u003e \u003cp\u003eAll other 14 items met the content validity criteria of essentiality (CVR\u0026thinsp;\u0026ge;\u0026thinsp;0.62), relevance and clarity for respondents (I-CVI\u0026thinsp;\u0026ge;\u0026thinsp;0.79).\u003c/p\u003e \u003cp\u003eThe results from Round 2 of the content validity assessment are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of Round 2 of Content Validity AssessmentTable 3. Results of face validity assessment.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestionnaire items\u003c/p\u003e \u003cp\u003e(Closed questions are rated on a 5-point Likert scale (1 - \"strongly disagree\", 2 - \"disagree\", 3 - \"uncertain\", 4 - \"agree\", 5 - \"strongly agree\").\u003c/p\u003e \u003cp\u003eAnswers to open-ended questions are provided in the form of extended text)\u003c/p\u003e \u003cp\u003eIn the questionnaire items, the words \u0026lsquo;[method/evidence-based recommendation]\u0026rsquo; are replaced with the name of the specific method or recommendation, focusing on the needs of healthcare professionals in its implementation.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCVR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI-CVI (relevance)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eI-CVI (clarity)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAuthors' decision on the point\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo implement [method/evidence-based recommendations] in my practice, I definitely need clearer \u003cb\u003einstructions than I currently have\u003c/b\u003e on [using the method/evidence-based recommendations].\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSaved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf you need clearer instructions, please indicate \u003cb\u003ewhat exactly in the instructions needs clarification or more detailed explanation?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSaved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo implement [method/evidence-based recommendations] in my practice, I definitely need more \u003cb\u003epractical skills\u003c/b\u003e to [use the method/evidence-based recommendations] than I currently have.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSaved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf you need more practical skills for [using the method/evidence-based recommendations], please specify \u003cb\u003ewhich ones?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSaved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf you need more practical skills for [using the method/evidence-based recommendations], please specify \u003cb\u003ewhat you need to develop them?\u003c/b\u003e \u003cem\u003e(training with practical work, supervision meetings with experts, mentoring, video, online course, other - specify what)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSaved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo implement [method/evidence-based recommendations] into my practice, I will definitely need \u003cb\u003emore time\u003c/b\u003e than I have now to do it.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSaved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf you need more time, please indicate \u003cb\u003ewhat could help free up time\u003c/b\u003e for [use of method/evidence-based recommendations]? \u003cem\u003e(increasing the duration of the consultation, additional paid hours, time management training, hiring an assistant, other - specify what).\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSaved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo implement [method/evidence-based recommendations] in my practice, I definitely need additional \u003cb\u003efinancial motivation.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSaved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf you need additional \u003cb\u003efinancial motivation, what amount\u003c/b\u003e would you consider sufficient [for amount of work completed]* \u003cem\u003e[for the amount of work completed] is established by the person conducting the survey of healthcare professionals and is indicated in the questionnaire instead of square brackets (e.g., \u0026ldquo;per hour of using the method\u0026rdquo; or \u0026ldquo;per procedure performed\u0026rdquo;), depending on the method or recommendation.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSaved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo implement [method/evidence-based recommendations] in my practice, I definitely need more \u003cb\u003eresources (materials, equipment) than I currently have.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSaved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf you need more \u003cb\u003ematerials or equipment\u003c/b\u003e, please specify \u003cb\u003ewhich ones?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSaved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo implement [method/evidence-based recommendations] in my practice, I will definitely need \u003cb\u003emore help from\u003c/b\u003e the medical institution\u0026rsquo;s \u003cb\u003emanagement team\u003c/b\u003e than I currently have in overcoming the difficulties associated with [using the method/evidence-based recommendations]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSaved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf you need more help from the medical institution\u0026rsquo;s management team in overcoming difficulties related to [using the method/evidence recommendations], describe \u003cb\u003eyour difficulties.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRemoved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf you need more help from the medical institution\u0026rsquo;s management team in overcoming difficulties related to [use of the method/evidence-based recommendations], please indicate \u003cb\u003ewhat actions management team can take to help\u003c/b\u003e ? \u003cem\u003e(discussion at meetings, personal advice, psychological support, specific administrative decisions, other - specify what)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSaved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat else\u003c/b\u003e can help you implement [method/evidence-based recommendations] in practice?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSaved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThus, based on a two-round expert assessment, a final version of the HPIQ was formed, which included only items with confirmed content validity.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Results of Round 2 of Content Validity Assessment\u003c/p\u003e \u003cp\u003e \u003cb\u003eFace validity assessment.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eWe assessed face validity using a sample of family doctors, chosen as a group representing a wide range of clinical contexts in practice. A total of 25 general practitioners \u0026ndash; family medicine doctors (20 women, 5 men) working in urban (n\u0026thinsp;=\u0026thinsp;18) and rural (n\u0026thinsp;=\u0026thinsp;7) healthcare institutions across different regions of Ukraine participated. Among the participants, 4 were interns, 11 had 1\u0026ndash;5 years of experience, 6\u0026ndash;6\u0026ndash;10 years, 2\u0026ndash;11\u0026ndash;20 years, 1\u0026ndash;20\u0026ndash;25 years and 1\u0026ndash;26\u0026ndash;30 years. This distribution ensured the representation of different experience and conditions of practical work. According to the results of calculating the IIS indicator, all items of the questionnaire demonstrated a sufficient level of significance (IIS\u0026thinsp;\u0026ge;\u0026thinsp;1.5), therefore they were retained in the final version of the questionnaire. In qualitative comments, respondents emphasised the relevance of the proposed statements, especially in connection with the need for practical skills, time allocation for training, financial motivation, resource provision and support from the medical institution\u0026rsquo;s management team. The importance of various learning formats (training, mentoring, supervision, online courses) and creating conditions for combining them with professional activities was also noted. Detailed results of the face validity assessment, including Item Impact Scores (IIS) and respondents` comments for each item, are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of face validity assessment.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestionnaire items\u003c/p\u003e \u003cp\u003e(Closed questions are rated on a 5-point Likert scale (1 - \"strongly disagree\", 2 - \"disagree\", 3 - \"uncertain\", 4 - \"agree\", 5 - \"strongly agree\").\u003c/p\u003e \u003cp\u003eAnswers to open-ended questions are provided in the form of extended text)\u003c/p\u003e \u003cp\u003eIn the questionnaire items, the words \u0026lsquo;[method/evidence-based recommendation]\u0026rsquo; are replaced with the name of the specific method or recommendation, focusing on the needs of healthcare professionals in its implementation.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIIS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eComments from respondents assessing face validity\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo implement [method/evidence-based recommendations] in my practice, I definitely need clearer \u003cb\u003einstructions than I currently have\u003c/b\u003e on [using the method/evidence-based recommendations].\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;Continuous audit is needed\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;It is important for healthcare workers to understand the goals, implementation methods\u0026hellip;\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf you need clearer instructions, please indicate \u003cb\u003ewhat exactly in the instructions needs clarification or more detailed explanation?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;Many people simply do not understand their clear job responsibilities\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;Everyone can understand what they read in their own way. And when there are clear explanations, they don\u0026rsquo;t overthink things.\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;For me, the question is not entirely complete, however, I believe that there are some gaps in our system regarding evidence-based information updated according to the latest research/standards. In order to always be up to date, you need to search for information yourself, follow up, take certain courses and training (which are not always free), since the information is not updated immediately. Perhaps healthcare institutions should be more interested in updating the knowledge of their employees, and raise these issues more openly among medical workers.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo implement [method/evidence-based recommendations] in my practice, I definitely need ...more than I currently \u003cb\u003ehave the practical skills\u003c/b\u003e needed to [use the method/evidence-based recommendations]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;Without working out, it is practically difficult to talk about correct results\u0026rdquo;\u003c/p\u003e \u003cp\u003e\"Very relevant, practical skills will always be the basis for more confident use of theoretical knowledge, which can still be found. This is relevant both for doctors/nurses at the beginning of their work, and for everyone who seeks to keep up with the pace and develop with the development of medicine.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf you need more \u003cb\u003epractical skills\u003c/b\u003e for [using the method/evidence-based recommendations], please specify \u003cb\u003ewhich ones?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;We need to motivate employees for continuous improvement\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;An important question, this way we will be able to understand which educational projects need to be implemented\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf you need more practical skills for [using the method/evidence-based recommendations], please specify \u003cb\u003ewhat you need to develop them?\u003c/b\u003e \u003cem\u003e(training with practical work, supervision meetings with experts, mentoring, video, online course, other - specify what)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;Everyone chooses the most convenient way for them to practice practical skills\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;I consider trainings to be the most effective (it is the format that allows you to use knowledge in practice), as well as mentoring (when you have that person who can help with questions and difficult cases, so that you can know that you are not alone and that they will support you and help you choose the right path). Video and online courses are now common, but still not as effective (for me personally), although in today's reality it helps a lot.\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;Creating centers in every region of Ukraine so that such a development system works and has wide coverage\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo implement [method/evidence-based recommendations] into my practice, I will definitely need \u003cb\u003emore time\u003c/b\u003e than I have now to do it.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;It\u0026rsquo;s cool to specify the real need for time, because everyone has different schedules and it\u0026rsquo;s great that management team could allocate time within working hours to gain new knowledge\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;Time for learning always becomes less when you start working, the demands on the work of a primary care physician and other specialists are great, but there is not much time (considering that there are also other areas of life). You may need to allocate special time in your work schedule for learning (this will help not only to have the opportunity to learn, but also to switch jobs)\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf you need more time, please indicate \u003cb\u003ewhat could help free up time\u003c/b\u003e for [use of method/evidence-based recommendations]? \u003cem\u003e(increasing the duration of the consultation, additional paid hours, time management training, hiring an assistant, other - specify what).\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;Currently, doctors are often overloaded with paperwork, the amount of which has not decreased with the introduction of digitalization. Often, because they simply have to duplicate everything. The doctor has no time for patients or for development\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;I already added in the previous answer, but having an assistant helps to complete administrative aspects that take a lot of time faster, thereby freeing up space for \"trainings\".\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo implement [method/evidence-based recommendations] in my practice, I definitely need additional \u003cb\u003efinancial motivation\u003c/b\u003e .\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;Everyone wants to receive financial motivation\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;I put 1, but I consider this issue important. However, it requires discussion and the creation of a model that will eliminate corruption risks as much as possible, while encouraging doctors to develop and implement evidence-based methods in clinical practice.\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;Financial motivation is always relevant, because now it is no less important issue, which affects the motivation to work in the field of medicine in general, where you invest a lot physically, morally (the work requires a lot of time spent on studying in general, and in itself is psychologically difficult), but expectations do not correspond to reality, and often there is no strength or desire to develop. Maybe this would help. The work of a doctor is evaluated quite low.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf you need \u003cb\u003eadditional financial motivation, what amount\u003c/b\u003e would you consider sufficient [for amount of work completed]* \u003cem\u003e[for the amount of work completed] is established by the person conducting the survey of healthcare professionals and is indicated in the questionnaire instead of square brackets (e.g., \u0026ldquo;per hour of using the method\u0026rdquo; or \u0026ldquo;per procedure performed\u0026rdquo;), depending on the method or recommendation.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;The reward should provide tangible opportunities and not necessarily be in the form of money, it can be preferences, which ones and in what context - this is a question for brainstorming. If we talk purely about financial reward - it should be adjusted according to the cost of goods and services in Ukraine, and not according to the humiliating salaries that doctors receive.\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;Service provided - clearly negotiated price for it\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo implement [method/evidence-based recommendations] in my practice, I definitely need more \u003cb\u003eresources (materials, equipment) than I currently have.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;Support Indicator\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;The resource must be accessible\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;In order to implement something, there must be conditions, but everything must start with a person motivated to develop and implement innovations. No super equipment will have an effect without a person who is not only trained to work with it but also motivated\u0026thinsp;+\u0026thinsp;support from management team, not a \"spokesman\"\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;The question is important, you can find out what exactly employees need\u0026hellip;\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf you need more \u003cb\u003ematerials or equipment\u003c/b\u003e, please specify \u003cb\u003ewhich ones?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;there must be specifics, that\u0026rsquo;s why it\u0026rsquo;s very important\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;...and add a link to buy them\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo implement [method/evidence-based recommendations] in my practice, I will definitely need more support from the medical institution\u0026rsquo;s management team than I currently have \u003cb\u003ein overcoming the difficulties\u003c/b\u003e associated with [using the method/evidence-based recommendations]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;It is important to have a mentor who can help with some clinical issues where there is uncertainty\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;open communication and the introduction of a horizontal management model where possible will promote effective interaction\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;The issue is important in itself, management team should first of all be interested in improving the work and overcoming difficulties in the work of its employees, be a mentor and support\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf you need more help from the medical institution\u0026rsquo;s management team in overcoming difficulties related to [use of the method/evidence-based recommendations], please indicate \u003cb\u003ewhat actions management team can take to help\u003c/b\u003e ? \u003cem\u003e(discussion at meetings, personal advice, psychological support, specific administrative decisions, other - specify what)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;in continuation of the previous comment: the problem should be viewed from both the bottom and the top, then communication, assessment of opportunities and decision-making, appointment of specific responsible persons\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat else\u003c/b\u003e can help you implement [method/evidence-based recommendations] in practice?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;Everyone has their own barriers and it is important to hear from each employee to make it work effectively\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;A question provides an opportunity to \u0026ldquo;recall\u0026rdquo; what may have been missed and provides an opportunity for deeper reflection.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs a result, a version validated for family doctors (HPIQ-FD) was established (see \u003cspan refid=\"Sec21\" class=\"InternalRef\"\u003eAppendix 1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Results of face validity assessment\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSummary of the questionnaire development and structure\u003c/h2\u003e \u003cp\u003eThe initial version of the HPIQ, which consisted of 93 items based on the original DIBQ, has been substantially reduced and transformed into 14 valid items (6 closed and 8 open) that cover the main needs of healthcare professionals in the process of implementing evidence-based methods and recommendations into clinical practice. The final version, validated among family doctors (HPIQ-FD), identifies needs related to clear instructions, practical skills, additional time, financial motivation, resource provision, management team assistance in difficult situations, as well as other factors that can contribute to the successful implementation of methods or recommendations into practice.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eInterpretation of the results\u003c/h2\u003e \u003cp\u003eThe results indicate that the developed HPIQ is a universal tool with potential applicability across a variety of clinical contexts. The version for family doctors (HPIQ-FD) has undergone content and face validity assessment in Ukraine and is capable of assessing the personalized implementation needs of Ukrainian general practitioners across a wide range of evidence-based methods and recommendations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eComparison with existing literature\u003c/h2\u003e \u003cp\u003e Some existing universal questionnaires, in particular the DIBQ and the CGDQ, are focused on assessing the determinants of clinical guideline implementation. Both instruments focus on the presence or absence of factors, without taking into account their subjective importance for the respondent in the implementation context. The DIBQ does not provide open-ended questions at all, so it does not allow the elaboration of individual needs [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e The CGDQ partially eliminates this limitation by including an open-ended question about the key factor that facilitates implementation (\u0026ldquo;What is the single most important factor that does/will enable your use of this guideline?\u0026rdquo;). At the same time, other CGDQ questions address the factors without assessing their relative importance for each individual respondent and without providing respondents the opportunity to clarify their needs in open-ended questions [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSimilar limitations are evident in other tools that primarily capture the presence of barriers or facilitators but do not consider the individual weight of each. Some questionnaires include questions about helpful strategies, but the responses are limited to yes/no, without assessing the significance of the need, and without the ability to elaborate in open formats [25].\u003c/p\u003e \u003cp\u003eThe HPIQ is focused on a different approach. In it, each determinant is formulated as a personalized need (\u0026ldquo;to implement the method or evidence-based recommendations, I definitely need\u0026hellip;\u0026rdquo;), which allows to determine the critically necessary factors for a medical worker. The use of a 5-point Likert scale provides a quantitative assessment of the importance of each need, and open-ended clarifying questions reveal their content, possible ways of satisfaction, and identify additional needs not taken into account in other questions.\u003c/p\u003e \u003cp\u003eThe development process of the HPIQ, together with the validation among family doctors (HPIQ-FD), ensured that the questionnaire is as simple as possible, with a balanced length of 14 valid items that allow comprehensive assessment while remaining practical for routine use.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003ePractical and Research Implications\u003c/h2\u003e \u003cp\u003eWe have made a transition from assessing the presence of determinants (barriers or facilitators) to analyzing the personalised needs of healthcare professionals using the HPIQ. This opens up the possibility of adapting implementation strategies to different categories of healthcare professionals and creates the basis for more individualized support with optimal use of resources, since the focus is not on providing all missing determinants as equivalent, but only on those that are really critically necessary for the implementation of innovations by healthcare professionals. Such an approach can increase the effectiveness of the implementation of methods and recommendations in family medicine already at the current stage using HPIQ-FD, and in other specialties after conducting additional validity studies, which in the future will allow assessing the universality of the HPIQ and its practical value in different areas of healthcare. From a research perspective, this tool can be useful for studying the relative importance of implementation needs and testing the effectiveness of tailored interventions targeting the most critical requirements of healthcare professionals in different clinical settings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eThe key stages of the HPIQ development methodology \u0026mdash; from the structured selection of DIBQ determinants, through transformation into personalized needs, to the design of a comprehensive questionnaire \u0026mdash; ensured the practical relevance of the tool, avoided duplication and excessive length, and created conditions for obtaining contextually meaningful data.\u003c/p\u003e \u003cp\u003eThe wording \u003cem\u003e\u0026ldquo;definitely need\u0026rdquo;\u003c/em\u003e in the scaled items of the HPIQ helps make the questions clear by highlighting its extremes: high agreement indicates an essential need, and low agreement indicates it is not necessary. However, while the phrase is easy to understand, it may sound somewhat leading. Future versions of the HPIQ could consider more neutral wording to maintain clarity while reducing potential response bias.\u003c/p\u003e \u003cp\u003eFor the initial assessment of content validity, experts were selected who combined the experience of family doctors and specialists from other fields, as well as academic researchers, educators, and managers of healthcare institutions. For the initial assessment of face validity, family doctors were chosen because they represent a wide range of clinical contexts and practice settings, making them suitable for evaluating the clarity and relevance of items in a universal questionnaire. Content and face validity were assessed using CVR, CVI, IIS, and respondent comments, resulting in a version validated for family doctors (HPIQ-FD).\u003c/p\u003e \u003cp\u003eSince the validity assessment was limited to family doctors and did not include professionals from all medical fields, further evaluation among physicians of other specialties, as well as physical therapists, mental health professionals, nurses, paramedics and other healthcare workers, is warranted.\u003c/p\u003e \u003cp\u003eAt the stage of face validity, there was an unequal distribution of respondents by work experience, with the majority of participants having had five or less years of experience. This may affect the generalisation of conclusions regarding the needs and priorities of specialists with different levels of experience, which requires further verification. There is a need for an assessment of reliability in terms of the form of stability and internal consistency of the items. The study was geographically limited to Ukraine. The majority of respondents came from the Zakarpattia Oblast, which was easier to achieve in the wartime conditions, and it may be that there needs to be a separate validation in other regions. The instrument was created in Ukrainian, and its adaptation for international use would require validation by backward translation and cross-cultural adaptation.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe developed the HPIQ to systematically assess the personalised needs of healthcare providers in implementing evidence-based methods and recommendations. In the present study, the questionnaire was evaluated for content and face validity among family doctors in Ukraine, resulting in a validated version for this group (HPIQ-FD). The tool enables the systematic identification of specific implementation needs, supporting individually tailored strategies to improve clinical practice. While HPIQ-FD reflects the validated version for family doctors, the HPIQ is designed as a universal instrument that could be adapted for other medical specialties and international contexts, contributing to a more effective and sustainable integration of evidence-based practice.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eHPIQ The Healthcare Professionals\u0026rsquo; Implementation-needs Questionnaire\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHPIQ-FD The Healthcare Professionals\u0026rsquo; Implementation-needs Questionnaire for family doctors\u003c/p\u003e\n\u003cp\u003eTDF Theoretical Domains Framework\u003c/p\u003e\n\u003cp\u003eDIBQ Determinants of Implementation Behavior Questionnaire\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCGDQ Clinician Guideline Determinants Questionnaire\u003c/p\u003e\n\u003cp\u003ePhD Doctor of Philosophy\u003c/p\u003e\n\u003cp\u003eCVR Content validity ratio\u003c/p\u003e\n\u003cp\u003eCVI Content validity index\u003c/p\u003e\n\u003cp\u003eI-CVI Item content validity index\u003c/p\u003e\n\u003cp\u003eS-CVI Scale content validity index\u003c/p\u003e\n\u003cp\u003eIIS Item impact score\u003c/p\u003e\n\u003cp\u003eEGPRN European General Practice Research Network\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Bioethics Committee of Uzhhorod National University, Ukraine (Protocol No. 8/4, 30 September 2025). By completing the questionnaire, participants provided their informed consent to take part in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants consented to the publication of the collected data in anonymized form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original data with participant names redacted is available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was funded by the MiMIND project, supported by GAMIAN-Europe.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAndrii Kolesnyk:\u003c/strong\u003e Conceptualisation, Data curation, Formal analysis, Investigation, Methodology, Project administration, Validation, Visualisation, Writing - original draft, Writing - review \u0026amp; editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePavlo Kolesnyk:\u0026nbsp;\u003c/strong\u003eFunding acquisition, Resources, Supervision, Conceptualisation, Investigation, Methodology, Validation, Visualization, Writing - original draft, Writing - review \u0026amp; editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMichael Harris:\u0026nbsp;\u003c/strong\u003eSupervision, Formal analysis, Investigation, Methodology, Visualisation, Writing - original draft, Writing - review \u0026amp; editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors sincerely thank Drs. Johanna M. Huijg and Winifred A. Gebhardt for granting permission to use the DIBQ determinants as a basis for the HP-IQ. We also thank the experts from the European General Practice Research Network (EGPRN) \u0026mdash; Shlomo Vinker, Mehmet Ungan, Sabine Bayen and Ana Claver\u0026iacute;a \u0026mdash; for their valuable comments, suggestions, and references. In addition, we express our gratitude to the academics and PhD students from the Department of Family Medicine and Outpatient Care, Medical Faculty #2, Uzhhorod National University, and from the Family Medicine Department, Bukovinian State Medical University, as well as to Ukrainian doctors who participated in the validation process. Their contributions were invaluable to the development and evaluation of the questionnaire.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWesterlund A, Sundberg L, Nilsen P. Implementation of Implementation Science Knowledge: The Research-Practice Gap Paradox. 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Value in Health. 2017;20:533\u0026ndash;41. https://doi.org/10.1016/j.jval.2016.12.002.\u003c/li\u003e\n\u003cli\u003eWong E, Mavondo F, Horvat L, McKinlay L, Fisher J. Healthcare professionals\u0026rsquo; perspective on delivering personalised and holistic care: using the Theoretical Domains Framework. BMC Health Serv Res. 2022;22:281. https://doi.org/10.1186/s12913-022-07630-1.\u003c/li\u003e\n\u003cli\u003eZhou Y, Huang Y, Wang Y, Xu X, Yu Z, Gu Y. Theoretical Domains Framework: A Bibliometric and Visualization Analysis from 2005-2023. J Multidiscip Healthc. 2024;17:4055\u0026ndash;69. https://doi.org/10.2147/jmdh.s470223.\u003c/li\u003e\n\u003cli\u003eHuijg JM, Gebhardt WA, Dusseldorp E, Verheijden MW, van der Zouwe N, Middelkoop BJC, et al. Measuring determinants of implementation behavior: psychometric properties of a questionnaire based on the theoretical domains framework. Implement Sci. 2014;9:33. https://doi.org/10.1186/1748-5908-9-33.\u003c/li\u003e\n\u003cli\u003eGagliardi AR, Armstrong MJ, Bernhardsson S, Fleuren M, Pardo-Hernandez H, Vernooij RWM, et al. The Clinician Guideline Determinants Questionnaire was developed and validated to support tailored implementation planning. J Clin Epidemiol. 2019;113:129\u0026ndash;36. https://doi.org/10.1016/j.jclinepi.2019.05.024.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Health Care Professionals, Family Doctors, Primary Care, Implementation Science, Questionnaire Design, Validation Study, Ukraine.","lastPublishedDoi":"10.21203/rs.3.rs-9177115/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9177115/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eImplementation of evidence-based practice often fails when interventions are not adapted to real-world clinical settings. Existing questionnaires mainly assess general competencies, knowledge, or the presence of barriers and facilitators, but rarely capture the specific, individualised needs of healthcare professionals for implementing particular methods. A standardised, universal instrument that identifies these needs could support more effective and tailored implementation strategies.\u003c/p\u003e\n\u003cp\u003eThe aim of this paper is to develop a universal questionnaire to assess healthcare professionals’ implementation needs and to evaluate its content and face validity among family doctors in Ukraine.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003cbr\u003e\n \u003c/strong\u003eThe Healthcare Professionals’ Implementation-needs Questionnaire (HPIQ) was developed by selecting determinants from the Determinants of Implementation Behavior Questionnaire (DIBQ) that could be considered as healthcare professionals’ needs. These determinants were then used to create HPIQ items that capture the importance of each need and provide details on how it can be addressed. Content validity was assessed in two rounds, by 12 and 10 experts respectively. Face validity was evaluated by 25 family doctors. Quantitative measures (Content Validity Ratio (CVR), Content Validity Index (CVI), Item Impact Score (IIS)) and qualitative feedback guided item refinement. The version validated among family doctors is referred to as HPIQ-FD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003cbr\u003e\n \u003c/strong\u003eWe developed an initial pool of 31 items (12 Likert-scale, 19 open-ended). After \u0026nbsp;evaluation, 14 items (6 Likert-scale, 8 open-ended) met all thresholds for \u0026nbsp;content (CVR ≥0.62, CVI ≥0.79) and face validity (IIS ≥1.5) and were retained. \u0026nbsp;These items reflect key needs, such as clear instructions, practical skills, \u0026nbsp;additional time, financial motivation, access to resources, organisational \u0026nbsp;support, and other factors affecting successful implementation. The edited \u0026nbsp;final version of the questionnaire appeared to be concise, practical and \u0026nbsp;structured for use in primary care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003cbr\u003e\n \u003c/strong\u003eThe HPIQ was developed as a universal instrument to assess healthcare professionals’ implementation needs. Its initial validation among family doctors (HPIQ-FD) confirmed content and face validity in this context. The questionnaire supports systematic and personalised identification of critical needs, enables tailored implementation strategies, and could be adapted for other specialties and clinical settings to promote effective, sustainable evidence-based practice.\u003c/p\u003e","manuscriptTitle":"Development of a universal healthcare professionals’ implementation- needs questionnaire and its validation among Ukrainian family doctors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-01 00:40:57","doi":"10.21203/rs.3.rs-9177115/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"280239071332083890583167139246021150624","date":"2026-05-03T16:46:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-21T19:27:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-23T05:58:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-20T12:30:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-20T12:30:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Primary Care","date":"2026-03-20T08:55:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2cb65738-e152-4b3b-8085-0961ffd10dd6","owner":[],"postedDate":"May 1st, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"280239071332083890583167139246021150624","date":"2026-05-03T16:46:50+00:00","index":76,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-01T00:40:57+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-01 00:40:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9177115","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9177115","identity":"rs-9177115","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}