2.9 Process of instrument development
Established principles of survey design were applied.18 The steps taken to develop and validate the survey instrument are outlined in Table 1.
[Place Table 1 here]
2.9.1 Step 1: Item generation
Before developing the questions, the constructs that we intended to measure required identification and definition. These included KAP, as well as demographic questions. A database search was undertaken to identify aspects of OBP and KAP that should be included in the questionnaire. Electronic searches of CINAHL (Cumulative Index to Nursing and Allied Health Literature) via EBSCOhost, Pubmed and Google Scholar were conducted between July 2017 and March 2018 using the search string hand therap* AND (occupation* OR occupation based practice* OR occupation based intervention OR occupation as a means and occupation as an end). These keywords were chosen based on the different operational definitions for the concept of OBP used in previous studies. Papers had to be in English and published from 2000 onwards. A total of 26 papers were retrieved during the database search and used in the development of the survey items.
As no existing questionnaires measuring KAP related to OBP in hand therapy had been identified in the first database search, studies investigating KAP as single constructs in hand therapy literature, or in related areas, were sought, and relevant items were identified. Key points were extracted from the definitions of each construct, and relevant items were identified and extracted8,9,20,21,22,23,24 (see Table 2). As the literature on occupation-based hand therapy predominantly focussed on barriers and facilitators,21,24,25 these aspects were included in the questionnaire to obtain information on practice influences that could be compared across other studies. Table 2 outlines the questionnaire constructs with the key points extracted from their definitions, and the studies from which the information was obtained.
[Place Table 2 here]
A table of specifications was developed by listing each construct (KAP and influences) with all related key points on the vertical axis and applicable themes related to OBP on the horizontal axis. Each cell was then summarised by a draft question/statement that linked with an aspect of the construct (on the vertical axis) with the theme (on the horizontal axis). Statement wording was additionally informed through personal and professional experience, until saturation was reached.18 Survey items were then generated from the items listed in the table of specifications.