Development Of A Questionnaire On Influencing Factors Of Early Postoperative Ambulation In Patients With Hepatobiliary And Pancreatic Diseases Based On Theoretical Domains Framework

Objective:In this study,the Department of Hepatobiliary and Pancreatic Surgery of a tertiary hospital in Chengdu was selected as the study site to explore the barriers and facilitators of early postoperative bed activity in surgical patients using a theoretical domain framework.Also,based on the exploration of the influencing factors,a questionnaire on the influencing factors of early postoperative bed activity was developed to provide a measurement tool to facilitate the development of interventions by linking behavioral theories.Methods1 Literature research methodThrough the school library,relying on databases such as CNKI and Pub Med to understand the application status of the theoretical domain framework and early postoperative out-of-bed activities,and analyze the influencing factors and existing problems of early postoperative out-of-bed activities in China’s accelerated rehabilitation surgery pathway.2 Semi-structured interviewsAn interview outline was developed based on the Theoretical Domains Framework（TDF）,and 13 postoperative patients were selected for semi-structured interviews by purposive sampling,and deductive content analysis was used to comprehensively identify the influencing factors that might hinder and promote early postoperative ambulation.3 Questionnaire survey methodAn interview-based questionnaire was administered to patients in the department through a self-designed early postoperative bed activity questionnaire,and the number of questionnaires was collected in a ratio of 1:5 to 10 for the ratio of entries to questionnaires.After screening,156 questionnaires were finally included.4 Statistical AnalysisThe Cronbach’sαcoefficient method was used to test the reliability of each factor of the questionnaire as well as the questionnaire as a whole.After item analysis,exploratory factor analysis and confirmatory factor analysis were used to evaluate the validity of the questionnaire.Results1 Identification of influencing factorsThe interview results were analyzed using deductive content analysis and using TDF for topic classification.Barriers and enablers were found to be most prevalent in six areas（listed by percentage of total code）:Environmental context and resources（22.45%）,Beliefs about capabilities（8.98%）,Intentions（8.98%）,social influence（8.98%）,Memory,attention and decision processes（8.03%）,and Social/professional role and identity（7.77%）.Overall,92.40%of the topics fit the 10 theoretical domains highlighted.2 Questionnaire development and validationThe initial questionnaire of the factors of early postoperative ambulation included 9dimensions and 30 items.The statistical results of project analysis show that there is no need to delete entries.The overall Cronbach’sαcoefficient of the questionnaire was 0.959,and the range of Cronbach’sαcoefficients for each dimension was 0.696 to 0.873,with good internal consistency.Main fitting indexes of confirmatory factor analysis of the initial questionnaireχ2/df,RMSEA,CFI,TLI,and SRMR were 2.98,0.113,0.789,0.751,and0.078,respectively,suggesting that the model was poorly fitted.The exploratory factor analysis found that the fitting index of the five-factor model was the best,1.90,0.076,0.916,0.876,0.034,and was named model T₁.The main fitting index of the confirmatory factor analysis on model T₁was 2.38,0.094,0.843,0.827,0.069,and the fitting index of the modified model T₆is 1.98,0.079,0.891,0.877,0.064,indicating that the data and model fitting were acceptable.ConclusionThe questionnaire developed in this study has good reliability and validity,including five dimensions:（1）Emotion and Decision-making;（2）Knowledge and Results;（3）Environmental context and resources;（4）Beliefs about capabilities;（5）Social influence,which can effectively and objectively evaluate the influencing factors of patients’health behavior changes,and can be used as a tool of fast link theory.