Validating a Theory of Planned Behaviour Questionnaire for Assessing Changes in Professional Behaviours of Medical Students Provisionally Accepted

Shaista S. Guraya^1* Eric Clarke² Asil Sadeq² Mary Smith² Sinead Hand² Frank Doyle² Grainne Kearney³ Mark Harbinson³ Aine Ryan² Fiona Boland² Abdelsalam B. Saaud² Salman Yousuf Guraya⁴ Denis W. Harkin²

• ¹Royal College of Surgeons in Ireland (Bahrain), Bahrain
• ²Royal College of Surgeons in Ireland, Ireland
• ³Queen's University Belfast, United Kingdom
• ⁴University of Sharjah, United Arab Emirates

Introduction: Teaching professionalism is a fundamental aspect of medical undergraduate education, delivering important domains of professional attitudes, ethics and behaviours. The effects of educational interventions can be assessed by measuring the change in such domains, but validated assessment tools for these professionalism domains are lacking. In this study, we constructed and conducted expert validation of a modified Theory of Planned Behaviour (TPB) questionnaire to assess changes in professional behaviours (PBs) in medical students. Methods: To validate that, we modified an existing TPB questionnaire, and an 18-item questionnaire was subjected to expert-panel evaluation using the content validation method. The clarity and relevance of items were assessed using a four-point rating scale (i.e., 1 = not relevant to 4 = highly relevant). Experts' ratings and free-text comments were analysed. Quantitative evaluation of relevance and clarity was undertaken through analyses of the Item-level Content Validity Index (I-CVI) and Scale-level Content Validity Index (S-CVI). A qualitative assessment of experts' comments was conducted to refine items, any disagreements were discussed, and a consensus decision was developed among authors for item changes. Results: Quantitative evaluation of Item Content Validity (I-CVI) scored 0.9-1 for relevance and 0.7-1 for clarity. Qualitative evaluation resulted in (i) changes to the items' wording (e.g., choices such as "worthless/ worthwhile" were replaced with "not important/important"); and (ii) suggestion of the addition of social media in the construct of subjective norms. Discussion: The proposed tool exhibits content validity and can assess TPB constructs in professionalism education. This study of content validity may help to ensure the modified TPB questionnaire accurately measures the TPB constructs, ensuring its effectiveness in accurately measuring the TPB constructs for PB in diversified educational medical institutions.