Development and validation of a questionnaire to identify barriers to the implementation of the Clinical Practice Guidelines for lower limb amputees in a middle-income country

Aim

To develop and validate a questionnaire to identify the perceived barriers in the implementation of the Clinical Practice Guidelines for the lower limb amputee (CPG-AMP).

Study Design and Setting

The study consisted of two stages: first, the development of the questionnaire based on a meta-review of the literature and interviews with patients and health providers (mixed-methods research). Second, the evaluation of its psychometric properties was performed. Participants included health providers from hospitals and clinics, prosthetic workshops and academic institutions in Colombia.

Results

A total of 90 items were obtained from the literature review and interviews. The validation of a preliminary 66-item questionnaire was performed with 545 participants. After the factorial analysis, a 25-item questionnaire with four domains was developed. Internal consistency was adequate in all domains, with Cronbach's α values between 0.76 and 0.83. Test–retest reliability in 58 participants yielded intraclass correlation coefficients between 0.51 and 0.59.

Conclusions

A 25-item questionnaire with four domains (health system, guideline, institutional and individual) was proposed to measure the perception of barriers to the CPG-AMP. The conceptual framework and the questionnaire can be used to identify barriers of other CPGs and to help design strategies aimed at improving its implementation.