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.