Creation of a questionnaire using a theory-guided process to explore clinician’s self-reported barriers and facilitators to delivering person-centred care


Patient beliefs and expectations are key factors associated with patient-rated outcomes for the physiotherapy management of musculoskeletal problems (Chester 2019, DeBaets 2019). These are integral to the biopsychosocial (BPS) model and person-centred care (PCC). However, despite recognising the importance of the BPS model and PCC, physiotherapists report a range of barriers and facilitators to exploring patient’s health beliefs and expectations (Sweeting 2020, Holopainen et al 2020; Driver et al 2020). Whilst there are common themes, some factors differ between individual physiotherapists and context. A self-report questionnaire would assist physiotherapists identify where the care they deliver is likely to be sub-optimal and the type of support that would help them to deliver PCC and a BPS approach more effectively. There are no validated questionnaires currently available for this purpose. The main objective of this study was therefore to develop a questionnaire to explore physiotherapist’s perceived confidence, opportunity and motivation for using the BPS model and provide PCC in a musculoskeletal outpatient setting


The framework for item generation and wording for the questionnaire was based on recommendations by Boynton and Greenhalgh (2004), Rattray (2006) and Meadows (2003). Step 1: Items were initially generated based on barriers and facilitators identified from i) our review of the literature, and ii) our own survey of proposed respondents (Daniell, 2018; Sweeting, 2020). Step 2: All barriers and facilitators were mapped onto i) the three constructs of the COM-B model of behaviour, a core component of the Behaviour Change Wheel (Michie, 2014): capability, opportunity and motivation and ii) the fourteen constructs of the Theoretical Domains Framework (Atkins, 2017). This ensured all potential influences on behaviours were included. Step 3: The first draft of the questionnaire (48 items) was piloted on a group of 47 physiotherapists for feedback. Endorsement of some items was received. Problem items were identified regarding: likely high floor and ceiling effects; clarity and definitions; and the sensitivity and potentially contentious nature of the subject. Step 4: Two workshops including experts in psychometrics, psychology of behaviour change, and physiotherapists delivering health coaching discussed the extent to which items represented the proposed domains and constructs (content validity).


Results: We generated a 65 item questionnaire covering all 14 domains of the TDF. This is now ready for scale and response formatting, item analysis in the form of Cronbach’s Alpha which will in turn lead to item elimination, followed by exploratory factor analysis.

Conclusion(s): Reflection on this process has highlighted these learning points: -Importance of a theoretical framework to inform and structure item generation. -Using target responders to inform item generation at an early stage. -The sensitivity of the topic regarding commonality of language and interpretation. -The value of feedback from a range of representatives.

Cost and savings

Research Capability Funding received for Helena Daniell's time to work one day a week for a year with the team


The questionnaire will inform physiotherapists of their strengths and areas for delivering BPS and PCC and help prioritise learning and education. Following further development, the questionnaire will be used as a self-reported outcome measure of the effectiveness of training programmes aimed at improving physiotherapist’s confidence in providing BPS and Person-Centred Care

Top three learning points

No further information. 

Funding acknowledgements

Research Capability Funding granted by Norfolk and Norwich University Hospital for Helena Daniell