Translation, cultural adaptation, and psychometric evaluation of the danish version of the provider attitudes toward cardiac rehabilitation and referral - revised (PACRR-R) questionnaire

Abstract Background Cardiac rehabilitation is an evidence-based intervention that improves survival, functional capacity, and quality of life in patients with heart failure. Despite these benefits, referral rates remain suboptimal and vary across healthcare settings. Healthcare professionals’ attitudes, beliefs, and perceived organisational factors are known to influence referral decisions. A validated instrument to assess these determinants in a Danish context has been lacking. Purpose To translate and culturally adapt a scale measuring healthcare professionals’ attitude toward cardiac rehabilitation referral and to evaluate its psychometric properties among professionals involved in referral of patients with heart failure. Methods The instrument was translated and culturally adapted into Danish using a standard cross-cultural adaptation framework, including forward translation, expert review, back-translation, and pretesting. A national cross-sectional survey was conducted among healthcare professionals involved in referral of patients with heart failure (n = 75). Internal consistency was assessed using Cronbach’s alpha and item total correlations. Construct validity was examined using six predefined hypotheses based on expected associations with professional characteristics and clinical experience. Results The Danish version demonstrated acceptable internal consistency (Cronbach’s alpha = 0.70). Item total correlations showed some variation across items, but most were within an acceptable range, and removal of individual items did not meaningfully improve internal consistency. Four of six predefined hypotheses assessing construct validity were supported, including positive associations with cardiology experience and years since professional authorisation, as well as overall differences across regions. Furthermore, health care professionals found the adapted scale comprehensible and relevant. Conclusion The Danish version of the instrument demonstrates acceptable reliability and evidence of construct validity for assessing healthcare professionals’ attitudes toward cardiac rehabilitation referral in patients with heart failure. The scale may be useful for research and quality improvement initiatives aimed at strengthening referral practices in clinical settings.