We developed a questionnaire that initially included 100 items assessing each of the domains through their related key constructs (see Additional file 1 ). First, constructs within domains were selected based on:
1. Their conceptual relatedness to the content of the domain (i.e., Knowledge, Skills, Professional role, and Memory);
2. Their inclusion in relevant theories frequently used in the field of behavior change (and thus ready access to existing items): the Theory of Planned Behavior [41 (link)] (i.e., Perceived behavioral control, Attitude, Subjective norm, and Intention) and Social Cognitive Theory [42 (link)] (i.e., Self-efficacy, Outcome expectancies, and Social support);
3. The existence of validated scales to measure constructs (i.e., Role clarity, Optimism, Emotions, Action planning, Coping planning, Automaticity); and/or
4. Constructs’ relevance to the implementation of PA intervention in routine healthcare by mapping factors resulting from previous research [13 (link),43 (link)] onto the TDF domains (i.e., Reinforcement, Priority, Characteristics of the innovation, Characteristics of the socio-political context, Characteristics of the organization, Characteristics of the participants, Characteristics of the innovation strategy, Descriptive norm).
Second, for each domain a minimum of two and a maximum of 24 items were developed, with an average of 4 items for each construct. Items were related to the target behavior ‘delivering PA interventions following the guidelines’. Items measuring the constructs within the domains ‘Knowledge’, ‘Beliefs about capabilities’, ‘Social influences’, ‘Emotion’, ‘Behavioral regulation’, and ‘Nature of the behaviors’ [37 (link),41 (link),42 (link),44 -49 ] were adapted from previously published questionnaires. The content of these items was based on previous research on factors influencing the implementation of PA intervention in routine healthcare [13 (link),43 (link)]. For instance, items measuring the constructs Self-efficacy [41 (link)] and Coping planning [47 (link)] were developed so that they included HCPs’ barriers of lack of time and patient motivation. Items measuring constructs within the domains ‘Skills’, ‘Social/professional role and identity’, ‘Memory, attention, and decision processes’ were based on results of the discriminant content validity study [40 (link)]. With regard to the domain ‘Beliefs about consequences’, items measuring the constructs Attitude [41 (link)] and Outcome expectancies [42 (link)] were adapted from previously published questionnaires, whereas items measuring the construct Reinforcement were newly developed (as none could be located in the literature). Regarding the domain ‘Motivation and goals’, items measuring the construct Intention were adapted from a previously published questionnaire [41 (link)], while items were newly developed for the construct Priority. Furthermore, new items were created for the domain ‘Environmental context and resources’. New items were developed based on discussions between WAG, MRC, and JMH. These discussions were informed by the academic literature on the concept and definition of specific domains and constructs, questions to identify behavior change processes as formulated by Michie et al. [28 (link)], and themes emerging from interviews on the implementation of PA interventions [43 (link)]. Finally, the questionnaire was piloted among five colleague researchers and a sample of eight physical therapists. Piloting indicated that the questionnaire was easily understood and well received by the respondents.
1. Their conceptual relatedness to the content of the domain (i.e., Knowledge, Skills, Professional role, and Memory);
2. Their inclusion in relevant theories frequently used in the field of behavior change (and thus ready access to existing items): the Theory of Planned Behavior [41 (link)] (i.e., Perceived behavioral control, Attitude, Subjective norm, and Intention) and Social Cognitive Theory [42 (link)] (i.e., Self-efficacy, Outcome expectancies, and Social support);
3. The existence of validated scales to measure constructs (i.e., Role clarity, Optimism, Emotions, Action planning, Coping planning, Automaticity); and/or
4. Constructs’ relevance to the implementation of PA intervention in routine healthcare by mapping factors resulting from previous research [13 (link),43 (link)] onto the TDF domains (i.e., Reinforcement, Priority, Characteristics of the innovation, Characteristics of the socio-political context, Characteristics of the organization, Characteristics of the participants, Characteristics of the innovation strategy, Descriptive norm).
Second, for each domain a minimum of two and a maximum of 24 items were developed, with an average of 4 items for each construct. Items were related to the target behavior ‘delivering PA interventions following the guidelines’. Items measuring the constructs within the domains ‘Knowledge’, ‘Beliefs about capabilities’, ‘Social influences’, ‘Emotion’, ‘Behavioral regulation’, and ‘Nature of the behaviors’ [37 (link),41 (link),42 (link),44 -49 ] were adapted from previously published questionnaires. The content of these items was based on previous research on factors influencing the implementation of PA intervention in routine healthcare [13 (link),43 (link)]. For instance, items measuring the constructs Self-efficacy [41 (link)] and Coping planning [47 (link)] were developed so that they included HCPs’ barriers of lack of time and patient motivation. Items measuring constructs within the domains ‘Skills’, ‘Social/professional role and identity’, ‘Memory, attention, and decision processes’ were based on results of the discriminant content validity study [40 (link)]. With regard to the domain ‘Beliefs about consequences’, items measuring the constructs Attitude [41 (link)] and Outcome expectancies [42 (link)] were adapted from previously published questionnaires, whereas items measuring the construct Reinforcement were newly developed (as none could be located in the literature). Regarding the domain ‘Motivation and goals’, items measuring the construct Intention were adapted from a previously published questionnaire [41 (link)], while items were newly developed for the construct Priority. Furthermore, new items were created for the domain ‘Environmental context and resources’. New items were developed based on discussions between WAG, MRC, and JMH. These discussions were informed by the academic literature on the concept and definition of specific domains and constructs, questions to identify behavior change processes as formulated by Michie et al. [28 (link)], and themes emerging from interviews on the implementation of PA interventions [43 (link)]. Finally, the questionnaire was piloted among five colleague researchers and a sample of eight physical therapists. Piloting indicated that the questionnaire was easily understood and well received by the respondents.
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