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.

Inlärning och öppet-fält aktivitet hos förskolebarn

The purpose of this study was to analyze the impact of learning on open-field activity among pre-school children varying from 3 to 5 years old. Altogether 25 children, 13 girls and 12 boys, entered the test from three different preschools in Dalarna. Six of these children represented the control group. The children were asked to learn 2 tasks, 1 visual memory task and 1 spatial constructing-kit task. Before, between and after the tasks, the children were allowed to move freely in the open field. The control group did not solve any learning tasks and only entered the open field, which was divided into 18 equally large squares, where the children’s activities were observed. The children’s learning times as well as their spontaneous open-field activity and wall-seeking behaviour were registered. The result showed as a general rule that the learning time was reduced between each session. However, the visual memory task increased the children’s spontaneous open-field behaviour more and decreased their wall seeking to a greater extent than the spatial-construction learning task.

Arbetsorganisation i träbränsleeldande fjärrvärmeverk

The objective of this study has been to describe and analyse existing forms of organisation in heating plants using wood fuels, regarding work tasks, organisational structure, skill demands, crew recruitment, working hours and wage conditions. Sixteen plants ranging from 10 to 120 MW have been studied by means of interviews, work place observations and written material. The job of the operator of heating plants is fairly qualified, independent and varied. The most negative factor is shift work. Some of the bigger plants (enterprises) have a relatively hierarchic, segmented and perhaps also an oversized organisation. However, modern concepts of organisation, such as customer orientation, ”flat organisation”, integration of production and maintenance etc, are gaining ground. Blue collar and white collar tasks are increasingly being integrated. Some of the medium sized enterprises have reached very far and may serve as models for bigger enterprises.

Assessing the physical environment of older people’s residential care facilities: development of the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM)

Background There is emerging evidence that the physical environment is important for health, quality of life and care, but there is a lack of valid instruments to assess health care environments. The Sheffield Care Environment Assessment Matrix (SCEAM), developed in the United Kingdom, provides a comprehensive assessment of the physical environment of residential care facilities for older people. This paper reports on the translation and adaptation of SCEAM for use in Swedish residential care facilities for older people, including information on its validity and reliability. Methods SCEAM was translated into Swedish and back-translated into English, and assessed for its relevance by experts using content validity index (CVI) together with qualitative data. After modification, the validity assessments were repeated and followed by test-retest and inter-rater reliability tests in six units within a Swedish residential care facility that varied in terms of their environmental characteristics. Results Translation and back translation identified linguistic and semantic related issues. The results of the first content validity analysis showed that more than one third of the items had item-CVI (I-CVI) values less than the critical value of 0.78.  After modifying the instrument, the second content validation analysis resulted in I-CVI scores above 0.78, the suggested criteria for excellent content validity. Test-retest reliability showed high stability (96% and 95% for two independent raters respectively), and inter-rater reliability demonstrated high levels of agreement (95% and 94% on two separate rating occasions). Kappa values were very good for test-retest (κ= 0.903 and 0.869) and inter-rater reliability (κ= 0.851 and 0.832). Conclusions Adapting an instrument to a domestic context is a complex and time-consuming process, requiring an understanding of the culture where the instrument was developed and where it is to be used. A team, including the instrument’s developers, translators, and researchers is necessary to ensure a valid translation and adaption. This study showed preliminary validity and reliability evidence for the Swedish version (S-SCEAM) when used in a Swedish context. Further, we believe that the S-SCEAM has improved compared to the original instrument and suggest that it can be used as a foundation for future developments of the SCEAM model.