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.

Fakalakalaka : The impact of a Tongan notion of development in a contemporary transnational world

This paper aims to explore a Tongan notion of development –'fakalakalaka' – in light of Western notions of development. Two case studies of international development aid schemes illustrate the impact of Tongan development ideas in practice. Drawing on a number of ethnographers' work on Tonga, 'fakalakalaka' appears broader than the Western notion of development. The latter is characterised by influential ideals of controllability and industrialisation. The notion of development among Tongans, on the other hand, tends to be directed by an underlying persistence that, for instance, reflects Tongan core values regarding social organisation. The production of textile 'koloa', controlled by women, emerges as central to the accomplishment of this three-dimensional development notion of intertwined physical, mental and spiritual aspects. The importance attributed to this specific kind of textile has increased in recent years and found two additional roles, or development strategies, in Tongans' contemporary transnational world.

Development of an instrument measuring the quality of residential care facilities for older people

Aims. To validate the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM). The instrument’s items measure environmental elements important for supporting the needs of older people, and conceptualized within eight domains. Methods. Item relevance was assessed by a group of experts and measured using content validity index (CVI). Test-retest and inter-rater reliability tests were performed.  The domain structure was assessed by the inter-rater agreement of a second group of experts, and measured using Fleiss kappa. Results. All items attained a CVI 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). Domain structure was good,  Fleiss’ kappa was 0.63 (range 0.45 to 0.75).    Conclusion. The S-SCEAM of 210 items and eight domains showed good content validity and construct validity. The instrument is suggested for use in measuring of the quality of the physical environment in residential care facilities for older persons.

The physical classroom environment : roles, conceptions, and preferences

The problem addressed in this thesis is that a considerable proportion of students around the world attend school in inadequate facilities, which is detrimental for the students’ learning outcome. The overall objective in this thesis is to develop a methodology, with a novel approach to involve teachers, to generate a valuable basis for decisions regarding design and improvement of physical school environment, based on the expressed needs for a specific school, municipality, or district as well as evidence from existing research. Three studies have been conducted to fulfil the objective: (1) a systematic literature review and development of a theoretical model for analysing the role of the physical environment in schools; (2) semi structured interviews with teachers to get their conceptions of the physical school environment; (3) a stated preference study with experimental design as an online survey. Wordings from the transcripts from the interview study were used when designing the survey form. The aim of the stated preference study was to examine the usability of the method when applied in this new context of physical school environment. The result is the methodology with a mixed method chain where the first step involves a broad investigation of the specific circumstances and conceptions for the specific school, municipality, or district. The second step is to use the developed theoretical model and results from the literature study to analyse the results from the first step and transform them in to a format that fits the design of a stated preference study. The final step is a refined version of the procedure of the performed stated preference study.