Factor Structure, Reliability and Measurement Invariance of the Alberta Context Tool and the Conceptual Research Utilization Scale, for German Residential Long Term Care.

Matthias Hoben,Janet E Squires,Carole A Estabrooks,Johann Behrens

doi:10.3389/fpsyg.2016.01339

Abstract

We translated the Canadian residential long term care versions of the Alberta Context Tool (ACT) and the Conceptual Research Utilization (CRU) Scale into German, to study the association between organizational context factors and research utilization in German nursing homes. The rigorous translation process was based on best practice guidelines for tool translation, and we previously published methods and results of this process in two papers. Both instruments are self-report questionnaires used with care providers working in nursing homes. The aim of this study was to assess the factor structure, reliability, and measurement invariance (MI) between care provider groups responding to these instruments. In a stratified random sample of 38 nursing homes in one German region (Metropolregion Rhein-Neckar), we collected questionnaires from 273 care aides, 196 regulated nurses, 152 allied health providers, 6 quality improvement specialists, 129 clinical leaders, and 65 nursing students. The factor structure was assessed using confirmatory factor models. The first model included all 10 ACT concepts. We also decided a priori to run two separate models for the scale-based and the count-based ACT concepts as suggested by the instrument developers. The fourth model included the five CRU Scale items. Reliability scores were calculated based on the parameters of the best-fitting factor models. Multiple-group confirmatory factor models were used to assess MI between provider groups. Rather than the hypothesized ten-factor structure of the ACT, confirmatory factor models suggested 13 factors. The one-factor solution of the CRU Scale was confirmed. The reliability was acceptable (>0.7 in the entire sample and in all provider groups) for 10 of 13 ACT concepts, and high (0.90–0.96) for the CRU Scale. We could demonstrate partial strong MI for both ACT models and partial strict MI for the CRU Scale. Our results suggest that the scores of the German ACT and the CRU Scale for nursing homes are acceptably reliable and valid. However, as the ACT lacked strict MI, observed variables (or scale scores based on them) cannot be compared between provider groups. Rather, group comparisons should be based on latent variable models, which consider the different residual variances of each group.

Highlights

Use of best practices based on research is less than optimal in German residential long term care (LTC) settings (Kuske et al, 2009; Meyer et al, 2009; Majic et al, 2010; Treusch et al, 2010; Wilborn and Dassen, 2010; Reuther et al, 2013) with far-reaching consequences for the highly vulnerable residents in LTC
We expected the residual variances to differ substantially between provider groups. These results indicate that comparisons between the provider groups should not be based on the observed items or item scores, but rather on models accounting for the different residual variances
Building on two previous publications providing validity evidence based on instrument contents and response processes, this study provides validity evidence based on the internal structure of the tools

Summary

Introduction

Use of best practices based on research (research utilization) is less than optimal in German residential long term care (LTC) settings (Kuske et al, 2009; Meyer et al, 2009; Majic et al, 2010; Treusch et al, 2010; Wilborn and Dassen, 2010; Reuther et al, 2013) with far-reaching consequences for the highly vulnerable residents in LTC. Many are functionally impaired (e.g., hearing problems, visual limitations, decreased communication abilities, reduced mobility) and are highly vulnerable to infections, falls and fractures, malnutrition, pressure ulcers, and many other risks (Lahmann et al, 2010; Volkert et al, 2011; Balzer et al, 2013) Due to these complex care needs LTC residents are vulnerable to problems in quality of care, and it is important that caregivers are providing care in line with research based best practices. In LTC settings, contextual factors are not well understood and their measurement has rarely been addressed (Estabrooks et al, 2009a; Masso and McCarthy, 2009; Boström et al, 2012; Rahman et al, 2012) This is true for German LTC where dissemination and implementation research has played a small role and few such research tools are available (Hoben et al, 2014b). In three previous publications (Hoben et al, 2013, 2014a,b) we pointed out the lack of research tools to study the association of organizational context factors (e.g., leadership, organizational culture, feedback) with research utilization in German LTC settings

Objectives

Methods

Results

Discussion

Conclusion