Development and validation of a generic questionnaire for the implementation of complex medical interventions

Implementation outcome instruments for use in physical healthcare settings: a systematic review

BACKGROUND

Implementation research aims to facilitate the timely and routine implementation and sustainment of evidence-based interventions and services. A glaring gap in this endeavour is the capability of researchers, healthcare practitioners and managers to quantitatively evaluate implementation efforts using psychometrically sound instruments. To encourage and support the use of precise and accurate implementation outcome measures, this systematic review aimed to identify and appraise studies that assess the measurement properties of quantitative implementation outcome instruments used in physical healthcare settings.

METHOD

The following data sources were searched from inception to March 2019, with no language restrictions: MEDLINE, EMBASE, PsycINFO, HMIC, CINAHL and the Cochrane library. Studies that evaluated the measurement properties of implementation outcome instruments in physical healthcare settings were eligible for inclusion. Proctor et al.'s taxonomy of implementation outcomes was used to guide the inclusion of implementation outcomes: acceptability, appropriateness, feasibility, adoption, penetration, implementation cost and sustainability. Methodological quality of the included studies was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Psychometric quality of the included instruments was assessed using the Contemporary Psychometrics checklist (ConPsy). Usability was determined by number of items per instrument.

RESULTS

Fifty-eight publications reporting on the measurement properties of 55 implementation outcome instruments (65 scales) were identified. The majority of instruments assessed acceptability (n = 33), followed by appropriateness (n = 7), adoption (n = 4), feasibility (n = 4), penetration (n = 4) and sustainability (n = 3) of evidence-based practice. The methodological quality of individual scales was low, with few studies rated as 'excellent' for reliability (6/62) and validity (7/63), and both studies that assessed responsiveness rated as 'poor' (2/2). The psychometric quality of the scales was also low, with 12/65 scales scoring 7 or more out of 22, indicating greater psychometric strength. Six scales (6/65) rated as 'excellent' for usability.

CONCLUSION

Investigators assessing implementation outcomes quantitatively should select instruments based on their methodological and psychometric quality to promote consistent and comparable implementation evaluations. Rather than developing ad hoc instruments, we encourage further psychometric testing of instruments with promising methodological and psychometric evidence.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2017 CRD42017065348.

Social and Behavioral Theories and Physician’s Prescription Behavior

The efficacy, safety, and cost of medication are the major concerns for a patient; thus, this research addresses factors that influence the physician’s prescription behavior. The objective of the undertaken study is the empirical testing of a novel conceptual model that was newly developed by the previous literature, which is based on behavioral and social theories. The considered model explains the association between marketing efforts, pharmacist factors, patient characteristics, and the physician’s decision to prescribe a drug. This unique model also includes the influence of cost and benefit ratio, drug characteristics, physician’s persistence, and trustworthiness as moderating variables. This model is useful for analyzing the prospects of marketing. We have collected 984 physicians’ responses from the urban centers of Pakistan through a structured questionnaire. We have used Structural equation modelling (SEM) based multivariate techniques such as exploratory and confirmatory factor analysis, and conditional process modelling to explore the direct and indirect relationship amongst the exogenous, moderating, and endogenous variables. The findings of the study demonstrated that marketing efforts, patient’s characteristics, and pharmacist factors have a positive and significant influence on the physician’s decision to prescribe medicines. The moderation analysis exhibited the significant effect of drug characteristics, cost–benefit ratio, physician’s persistence, and trustworthiness in a relationship between exogenous and endogenous variables. The results of the undertaken study are helpful for the marketers of the pharmaceutical industry to save wasteful marketing expenditures for the product portfolios, and measured variables may help to make meaningful marketing strategies for the physician’s prescription that provide optimum Returns on Investment (ROI) of their investments.

Psychometric Properties of a Theory of Planned Behavior Questionnaire for Assessing the Midwives' Intention to Provide Planned Home Birth Services in Nigeria

We developed and psychometrically tested a Theory of Planned Behavior (TPB) questionnaire which focused on assessing the midwives' intention to provide planned home birth (PHB) services. This is a quantitative, cross-sectional survey, conducted among 226 midwives working in ten participating health facilities. The reliability and validity of the theoretical constructs were assessed. The Cronbach's alpha values were >0.8 for all scales, suggesting satisfactory internal consistency. Confirmatory factor analysis revealed sufficient convergent validity (the average variance extracted was >0.5 for each construct) and discriminant validity. The study gathered an evidence of the usefulness of TPB in the specific context of PHB.

German language questionnaires for assessing implementation constructs and outcomes of psychosocial and health-related interventions: a systematic review

Background

Over the past years, implementation science has gained more and more importance in German-speaking countries. Reliable and valid questionnaires are needed for evaluating the implementation of evidence-based practices. On an international level, several initiatives focused on the identification of questionnaires used in English-speaking countries but limited their search processes to mental health and public health settings. Our aim was to identify questionnaires used in German-speaking countries measuring the implementation of interventions in public health and health care settings in general and to assess their psychometric properties.

Methods

We searched five different bibliographic databases (from 1985 to August 2017) and used several other search strategies (e.g., reference lists, forward citation) to obtain our data. We assessed the instruments, which were identified in an independent dual review process, using 12 psychometric rating criteria. Finally, we mapped the instruments’ scales and subscales in regard to the constructs of the Consolidated Framework for Implementation Research (CFIR) and the Implementation Outcome Framework (IOF).

Results

We identified 31 unique instruments available for the assessment of implementation science constructs. Hospitals and other health care settings were the ones most often investigated (23 instruments), while education and childcare settings, workplace settings, and community settings lacked published instruments. Internal consistency, face and content validity, usability, and structural validity were the aspects most often described. However, most studies did not report on test-retest reliability, known-groups validity, predictive criterion validity, or responsiveness. Overall, the majority of studies did not reveal high-quality instruments, especially regarding the psychometric criteria internal consistency, structural validity, and criterion validity. In addition, we seldom detected instruments operationalizing the CFIR domains intervention characteristics, outer setting, and process, and the IOF constructs adoption, fidelity, penetration, and sustainability.

Conclusions

Overall, a sustained and continuous effort is needed to improve the reliability and validity of existing instruments to new ones. Instruments applicable to the assessment of implementation constructs in public health and community settings are urgently needed.

Trial registration

The systematic review protocol was registered in PROSPERO on October 19, 2017, under the following number: CRD42017075208.

Electronic supplementary material

The online version of this article (10.1186/s13012-018-0837-3) contains supplementary material, which is available to authorized users.

Models and theories of prescribing decisions: A review and suggested a new model

To date, research on the prescribing decisions of physician lacks sound theoretical foundations. In fact, drug prescribing by doctors is a complex phenomenon influenced by various factors. Most of the existing studies in the area of drug prescription explain the process of decision-making by physicians via the exploratory approach rather than theoretical. Therefore, this review is an attempt to suggest a value conceptual model that explains the theoretical linkages existing between marketing efforts, patient and pharmacist and physician decision to prescribe the drugs. The paper follows an inclusive review approach and applies the previous theoretical models of prescribing behaviour to identify the relational factors. More specifically, the report identifies and uses several valuable perspectives such as the ‘persuasion theory - elaboration likelihood model’, the stimuli–response marketing model’, the ‘agency theory’, the theory of planned behaviour,’ and ‘social power theory,’ in developing an innovative conceptual paradigm. Based on the combination of existing methods and previous models, this paper suggests a new conceptual model of the physician decision-making process. This unique model has the potential for use in further research.