Development and validation of the Behavioral Determinants of Deprescribing Questionnaire (BDDQ)

Abstract Background Deprescribing is a strategy to optimize medication use. While health behaviour can successfully be predicted by health behavior theories, the literature on deprescribing relies almost exclusively on questionnaires that measure attitudes only, such as the Beliefs about Medicines Questionnaire and the Patients Attitudes Towards Deprescribing, resulting in poor predictive validity. The aim of this study was to develop a new tool to measure the psychological determinants of deprescribing among people aged over 60, based on concepts derived from health behaviour theories. Methods A draft self-report questionnaire was developed consisting of 64 questions measuring 11 dimensions representing determinants of deprescribing. As well as previous deprescribing experience, current deprescribing behaviour and willingness to deprescribe. Face validity was assessed by asking 10 health professionals and 13 of older people to complete the questionnaire and comment in a small group discussion, resulting in the removal of 18 items. Construct validity was assessed on a sample of 103 participants aged over 60, using exploratory factor analysis (EFA). Internal consistency was assessed via Cronbach’s alpha. Results The EFA could confirm 11 dimensions explaining 70,5% of the total variance, but revealed poor loadings for several items and inadequate alphas (<.50) for two factors. Removal of items and these two dimensions resulted in 26 items measuring 9 dimensions, all showing acceptable internal consistencies (between .52 and .77): perceived risk; relatives’ involvement; deprescribing concerns; attitudes; medication beliefs; healthcare support; perceived difficulties; motivation to comply; communication accessibility. Conclusions This study produced a conceptually based and psychometrically validated questionnaire to assess behavioural determinants of deprescribing. It provides for a more comprehensive investigation of deprescribing intentions and behaviour of older adults. Key messages • A conceptually sound, psychometrically validated questionnaire (BDDQ) was developed. • BDDQ can be used for a more comprehensive study of de-prescribing in older people.