Validering av Alberta Context Tool (ACT) för bruk inom svensk kommunal äldrevård : Ett verktyg för implementering av evidensbaserad vård

The aim of this study was to conduct an instrument test of the Canadian questionnaire Alberta Context Tool (ACT) version Long-Term care for Swedish conditions. ACT is designed in order to measure the context in the care environment and different behaviours related to the changes in clinical practice. In total, 159 Licensed Practical Nurses (LPNs) and Registered Nurses (RNs) within municipality care of the elderly were included in the survey. The test included the instrument's reliability and face validity.The reliability test was implemented through calculation of Cronbach´s Alpha, and showed internal consistency for five of the scales of the ACT-instrument with Cronbach´s Alpha values ranging between 0,728 and 0,873. However, three dimensions got lower values (0,558 - 0,683).The analysis was carried out with content analysis and carried out for LPNs and RNs in separate groups. The majority of LPNs expressed that it was easy to respond to the questions (56%), while nine percent considered it as difficult. Eleven comments were given about questions that were perceived to be unclear, complicated or contained difficult words. In the RN group only 30 percent considered that the questions were easy to respond to. One third of the RNs considered that part of the questions were unclear, and six RNs expressed also which questions they experienced as unclear. In general, the questions in the ACT were perceived as relevant. The instrument's relevance as a tool to measure contextual factors that influence the implementation of evidence based nursing can also be considered to be determined. By modifying the content in the questionnaire in accordance with what appeared in this survey and to implement yet another test, the instrument should be considered to be relevant for use within Swedish municipality care of the elderly. ACT can be used both as a tool in the work on improvement of clinical practice and as a tool for further research about implementation of evidence based nursing.

Är organisationen mogen för evidensbaserad vård? : översättning och validering av Alberta Context Tool och beskrivning av sjuksköterskors skattning av kontextuella faktorer inom ortopedisk vård

Syftet med denna studie var att reliabilitetstesta Alberta Context Tool (ACT) i svensk hälso- och sjukvård och beskriva ortopedsjuksköterskors skattning av kontextuella faktorer såsom ledarskap, arbetskultur, återkoppling, utvecklingsmöjligheter och forskningsanvändning, som kan påverka möjligheten att omsätta forskningsresultat i vårdarbetet. Urvalet bestod av 119 sjuksköterskor som arbetade på ortopediska vårdavdelningar på sex olika sjukhus i mellersta Sverige. ACT är ett frågeformulär framtaget utifrån de senaste årens forskning om vilka faktorer i kontexten som har betydelse för sjuksköterskors forskningsanvändning. Reliabilitetstest gjordes enligt analys med Chronbach`s Alpa och innehållsvaliditet. Resultatet visade att ACT var relevant att användas för sjuksköterskor som arbetar på ortopedisk vårdavdelning i Sverige. Reliabilitetstesten med Chronbach´s Alpa gav värden nära 0,7 för de åtta frågeområden som behandlar kontexten.Sjuksköterskorna rapporterade att det fanns brister i många av de delar av kontexten som enligt forskning visat sig ha betydelse för möjligheten att implementera evidensbaserad vård. Sjuksköterskorna trivdes med sitt arbete och kände att deras kunskaper värderades högt i vårdteamet. Resultatet visade dock att det inte fanns tillräckligt stöd från ledningen för att utveckla vården. De rapporterade att de nästan inte alls fick återkoppling i vårdarbetet. Det saknades stödfunktioner och strategier för att implementering av forskningsresultat skulle vara möjligt att implementera i vårdarbetet. Majoriteten av sjuksköterskorna såg positivt på forskningsanvändning.

Translating and testing the Alberta Context Tool for use among nurses in Swedish elder care

Background. There is emerging evidence that context is important for successful transfer of research knowledge into health care practice. The Alberta Context Tool (ACT) is a Canadian developed research-based instrument that assesses 10 modifiable concepts of organizational context considered important for health care professionals’ use of evidence. Swedish and Canadian health care have similarities in terms of organisational and professional aspects, suggesting that the ACT could be used for measuring context in Sweden. This paper reports on the translation of the ACT to Swedish and a testing of preliminary aspects of its validity, acceptability and reliability in Swedish elder care. Methods. The ACT was translated into Swedish and back-translated into English before being pilot tested in ten elder care facilities for response processes validity, acceptability and reliability (Cronbach’s alpha). Subsequently, further modification was performed. Results. In the pilot test, the nurses found the questions easy to respond to (52%) and relevant (65%), yet the questions’ clarity were mainly considered ‘neither clear nor unclear’ (52%). Missing data varied between 0 (0%) and 19 (12%) per item, the most common being 1 missing case per item (15 items). Internal consistency (Cronbach’s Alpha > .70) was reached for 5 out of 8 contextual concepts. Translation and back translation identified 21 linguistic- and semantic related issues and 3 context related deviations, resolved by developers and translators. Conclusion. Modifying an instrument is a detailed process, requiring time and consideration of the linguistic and semantic aspects of the instrument, and understanding of the context where the instrument was developed and where it is to be applied. A team, including the instrument’s developers, translators, and researchers is necessary to ensure a valid translation. This study suggests preliminary validity, reliability and acceptability evidence for the ACT when used with nurses in Swedish elder care.