Strides in Development of Medical Education

Document Type : Original Article


1 Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Semnan University of Medical Sciences, Semnan, Iran


Objectives The present study was conducted with the aim of psychometric evaluation of a tool measuring behavioral intention in relation to interprofessional shared decision-making based on the theory of planned behavior and its assessment among medical and nursing students. Methods This descriptive study was carried out in two stages. In the first stage, the psychometric properties of the interprofessional shared decision-making (IP-SDM) tool were evaluated based on experts’ opinions. In the second stage, the participants’ behavioral intention was evaluated using the mentioned questionnaire. The questionnaire consisted of five domains of cognitive attitude (2 items), emotional attitude (2 items), subjective norms (3 items), perceived behavioral control (3 items), and intention to use interprofessional shared decision-making (3 items). Content validity of the questionnaire was evaluated qualitatively and quantitatively (using the content validity ratio (CVR) and content validity index (CVI)). Cronbach’s alpha coefficient and interclass correlation coefficient (ICC) were used to determine the reliability of the questionnaire. In the second stage, the data were analyzed using descriptive statistics (mean and standard deviation) and Pearson’s correlation test in SPSS software. Results Qualitative and quantitative content validity of the questionnaire was confirmed based on experts’ opinions. The internal consistency of the tool, based on the Cronbach’s alpha coefficient, was 0.92, and the tool’s repeatability was calculated at 0.84 using ICC. Participants in the study intended to participate in interprofessional shared decision-making. Conclusions The behavioral intention measurement tool in relation to interprofessional shared decision-making based on the theory of planned behavior has good validity and reliability in Iran. Regarding the participants’ behavioral intention to participate in shared decision-making, it is suggested that a suitable platform for shared decision-making and teamwork between health team members be provided in educational systems.


  1. Guerrier M, Legare F, Turcotte S, Labrecque M, Rivest LP. Shared decision making does not influence physicians against clinical practice guidelines. PLoS One. 2013;8(4). e62537. doi:10.1371/journal.pone.0062537. [PubMed: 23638111]. [PubMed Central: PMC3634782].
  2. Barratt A. Evidence based medicine and shared decision making: The challenge of getting both evidence and preferences into health care. Patient Educ Couns. 2008;73(3):407–12. doi:10.1016/j.pec.2008.07.054. [PubMed: 18845414].
  3. Reeves S, Zwarenstein M, Goldman J, Barr H, Freeth D, Hammick M, et al. Interprofessional education: Effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2008;(1). CD002213.doi: 10.1002/14651858.CD002213.pub2. [PubMed: 18254002].
  4. Legare F, Stacey D, Briere N, Fraser K, Desroches S, Dumont S, et al. Healthcare providers’ intentions to engage in an interprofessional approach to shared decision-making in home care programs: A mixed methods study. J Interprof Care. 2013;27(3):214–22. doi:10.3109/13561820.2013.763777. [PubMed:23394265]. [PubMed Central:PMC3665231].
  5. Harden RM. Effective multiprofessional education: A threedimensional perspective. Med Teach. 2009;20(5):402–8. doi:10.1080/01421599880472.
  6. World Health Organization; Department of Human Resources for Health. Health professions networks, nursing and midwifery. Framework for action on interprofessional education and collaborative practice. Geneva, Switzerland: WHO; 2010.
  7. Towle A, Godolphin W. Framework for teaching and learning informed shared decision making. BMJ. 1999;319(7212):766–71. [PubMed:10488010]. [PubMed Central: PMC1116602].
  8. Interprofessional Education Collaborative Expert Panel. Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, USA: Interprofessional Education Collaborative;2011.
  9. Makoul G, Clayman ML. An integrative model of shared decision making in medical encounters. Patient Educ Couns. 2006;60(3):301–12. doi:10.1016/j.pec.2005.06.010. [PubMed: 16051459].
  10. Legare F, Stacey D, Pouliot S, Gauvin FP, Desroches S, Kryworuchko J, et al. Interprofessionalism and shared decision-making in primary care: A stepwise approach towards a new model. J Interprof Care. 2011;25(1):18–25. doi: 10.3109/13561820.2010.490502. [PubMed:20795835]. [PubMed Central:PMC3018136].
  11. Word Health Organization. Learning together to work together for health. Geneva; 1998, [cited 2011 Mar 2]. cited 2011 Mar 2. Available from:
  12. Canadian Interprofessional Health Collaborative. Interprofessional education and core competencies, literature review. [cited 2007 Jun 6]. cited 2007 Jun 6. Available from:
  13. Reeves S, Fletcher S, Barr H, Birch I, Boet S, Davies N, et al. A BEME systematic review of the effects of interprofessional education: BEME Guide No. 39. Med Teach. 2016;38(7):656–68. doi:10.3109/0142159X.2016.1173663. [PubMed: 27146438].
  14. Glanz K, Rimer BK, Viswanath K. Health behavior and health education: Theory, research, and practice. 4th ed. San Francisco: Jossey-Bass press;2008.
  15. Legare F, Stacey D, Briere N, Robitaille H, Lord MC, Desroches S, et al. An interprofessional approach to shared decision making: An exploratory case study with family caregivers of one IP home care team. BMC Geriatr. 2014;14:83. doi: 10.1186/1471-2318-14-83. [PubMed:24985335]. [PubMed Central:PMC4105553].
  16. Stacey D, Samant R, Pratt M, Legare F. Feasibility of training oncology residents in shared decision making: A pilot study. J Cancer Educ. 2012;27(3):456–62. doi: 10.1007/s13187-012-0371-y. [PubMed:22539055].
  17. Lawshe CH. A quantitative approach to content validity. Pers Psychol. 1975;28(4):563–75. doi:10.1111/j.1744-6570.1975.tb01393.x.
  18. Polit DF, Beck CT. The content validity index: Are you sure you know what’s being reported? Critique and recommendations. Res Nurs Health. 2006;29(5):489–97. doi: 10.1002/nur.20147. [PubMed:16977646].
  19. Khan KS, Chien PF. Evaluation of a clinical test. I: Assessment of reliability. BJOG. 2001;108(6):562–7. [PubMed: 11426888].
  20. Mandrekar JN. Measures of interrater agreement. J Thorac Oncol. 2011;6(1):6–7. doi:10.1097/JTO.0b013e318200f983. [PubMed: 21178713].
  21. Barry MJ, Edgman-Levitan S. Shared decision making–pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780–1. doi: 10.1056/NEJMp1109283. [PubMed: 22375967].
  22. Pellerin MA, Elwyn G, Rousseau M, Stacey D, Robitaille H, Legare F. Toward shared decision making: Using the OPTION scale to analyze resident-patient consultations in family medicine. Acad Med. 2011; 86(8): 1010–8. doi: 10.1097/ACM.0b013e31822220c5. [PubMed:21694569].
  23. Deschenes SM, Gagnon MP, Legare F, Lapointe A, Turcotte S, Desroches S. Psychosocial factors of dietitians’ intentions to adopt shared decision making behaviours: A cross-sectional survey. PLoS One. 2013;8(5).e64523. doi: 10.1371/journal.pone.0064523. [PubMed: 23700484]. [PubMed Central:PMC3659101].