The Manchester driving behavior questionnaire (DBQ) integrating health and technology factors: The DBQ 2025 update with translations in 11 languages

The Manchester Driving Behavior Questionnaire is a widely-used instrument to assess driving behavior but has become outdated, omitting items addressing modern communication technologies and health-related issues that impact today's drivers. This study updated the original instrument with relevant health and technology items. The instrument updating process involved 5 steps. First, a literature review identified new and relevant items from existing instruments. Second, an international team with expertise in driving behavior, including the original instrument developer, reviewed and suggested revisions, assessed face validity, and recommend changes iteratively. Third, content validity was evaluated via computation of a content validity index (CVI) and content validity ratios (CVR). Fourth, the updated English version was translated into 11 languages by a global team. Finally, reliability of the Persian version was assessed via Cronbach's alpha and intra-class correlation coefficient. The literature review led to new items addressing topics such as smartphone use and health conditions that may impact safe driving. Experts refined these items iteratively, creating an updated MDBQ with the 27 original items and 12 newly-developed ones. Content validity was assessed, yielding average CVIs of 0.95 and CVRs of 0.87. The questionnaire was then translated into 11 languages (Arabic, Azerbaijani Turkish, Chinese, French, German, Italian, Persian, Spanish, Swedish, Tagalog, and Turkish) according to standardized methods. The updated instrument retained all components of the original MDBQ, preserving comparability with existing data while also assessing contemporary topics. It provides a comprehensive instrument to assess driving behaviors and is recommended for use in research, policy, public health, and intervention development.