# The doing, being, becoming, and belonging (DB3) scale: Development and initial content validity in an Australian context

## TL;DR

The DB3 scale is a new tool to measure how people feel about their daily activities, identity, growth, and connections, and it shows promise for use in occupational therapy.

## Contribution

The DB3 scale is the first outcome measure exclusively addressing occupational being, based on the Pan Occupational Paradigm.

## Key findings

- The DB3 scale demonstrated adequate content validity with most items rated as relevant and comprehensible.
- Occupational therapy experts and consumers found the scale applicable to clinical practice, research, and education.
- Feedback from participants led to minor improvements in the final version of the scale.

## Abstract

Occupational being emerges from interactions between the dimensions of occupation—doing, being, becoming, and belonging. It is a key concept in occupational therapy practice and is also influenced by available resources and opportunities. This study aimed to reflect on the development of a new outcome measure of occupational being—the doing, being, becoming, and belonging (or DB3) scale—and to describe preliminary evidence of its validity and application to occupational therapy, based on content validity testing with occupational therapy academics in Australia and Aotearoa New Zealand and consumers from an Australian health service.

Applying a descriptive mixed method, this study recruited occupational therapy academics and consumers to complete a single online survey. Content validity was assessed through participants' perceptions of the DB3 scale's applicability, relevance, comprehensiveness, and comprehensibility. Data were analysed using descriptive statistics and Lawshe's content validity ratio, complemented by qualitative data about potential applications to practice.

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Findings indicate that the DB3 scale possesses adequate content validity. All but two of the scale items met the criterion for relevance, and all met the criterion for comprehensibility. The DB3 was perceived by occupational therapy academics as applicable to clinical practice, research, education, and direct service provision with consumers. It was also generally perceived by both groups as comprehensive, although participants recommended some changes which have been incorporated into the final version.

The DB3 scale meets a previously identified need for a tool to translate the core concepts of the Pan Occupational Paradigm (POP) into occupational therapy practice and is the first outcome measure exclusively addressing occupational being. This study underscores its potential utility and applicability across a wide range of settings. Future directions should focus on expanded psychometric evaluation beyond the initial Australian context, exploring cross‐cultural applicability and wider implementation of the DB3 into clinical practice, research, and education.

The doing, being, becoming, and belonging (DB3) scale is a new tool. It measures how people feel about their daily tasks, who they are, how they grow and their connections with others. These four areas make up “occupational being.” This idea is the key in occupational therapy. It shows how what we do every day helps build a life that feels good and full of meaning. The DB3 scale asks simple questions. People rate how happy they are with these parts of life. It takes only 5–10 minutes to complete.

We tested the scale with occupational therapy experts in Australia and Aotearoa New Zealand and with everyday people from the community in Australia. We wanted to see if the questions were clear, useful, and easy to answer. The results were positive. Everyone agreed the scale makes sense and works well. It helps show how people join in activities that matter to them. Experts and community members gave helpful feedback. We made a few small changes to create the final version.

Occupational therapists can use the DB3 scale in several ways. They can set goals with clients, track changes over time, and plan treatments that fit each person's needs and wishes. A big strength of the scale is that it comes straight from occupational therapy ideas. It was also built with help from both experts and real people. One limit is that we tested it with a small group. More studies with larger and more varied groups, including people in other countries and cultural contexts, are needed to show how well it works over time. Overall, the DB3 scale is a helpful new way to understand daily life better. It can guide therapists and may shape future therapy practices and rules.