Translation, cultural adaptation, and psychometric evaluation of the Danish version of the Provider Attitudes Toward Cardiac Rehabilitation and Referral – Revised (PACRR-R) questionnaire

Background Provider attitudes are key determinants of referral to cardiac rehabilitation (CR). The Provider Attitudes toward Cardiac Rehabilitation and Referral – Revised (PACRR-R) scale was developed to assess these attitudes, but no Danish version exists. This study translated, culturally adapted, and validated the PACRR-R in a Danish setting. Methods Translation and cultural adaptation followed Beaton’s six-step method, including forward and backward translation, expert review, and cognitive interviews (n = 4). Following the two rounds of cognitive interviews, minor linguistic and conceptual adjustments were incorporated into the final Danish version. The final version was evaluated in a national cross-sectional survey of 75 healthcare professionals involved in the care and referral of patients with heart failure (HF). Psychometric evaluation included internal consistency, item analysis, principal component analysis, and convergent construct validity assessed through six predefined hypotheses. Results The cognitive interviews supported the face validity of the Danish PACRR-R, with participants generally perceiving the items as relevant, understandable, and applicable in a Danish clinical context; only minor linguistic and conceptual clarifications were required. The Danish PACRR-R demonstrated acceptable internal consistency, with a Cronbach’s alpha of 0.70, and item–total correlations were modest, with no meaningful improvement observed by item removal. A four-component exploratory PCA, pre-specified based on the structure reported in previous validation studies, explained 55.0% of the total variance (overall KMO = 0.69). Four of six predefined hypotheses were supported: no statistically significant differences were detected by gender or profession, a moderate positive association was found with years of experience in cardiology, and an overall difference was found across regions. The hypotheses concerning CR-related training and a moderate association with years since authorisation were not supported. Conclusion The Danish version of the PACRR-R demonstrates acceptable reliability and initial evidence of validity among healthcare professionals involved in HF care. It may be useful for identifying provider-related attitudes and perceived barriers to CR referral in Danish clinical settings, although further validation in larger samples and across other cardiac populations and referral pathways is needed.