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

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).