Abstract
BackgroundTo study the association between organizational context and research utilization in German residential long term care (LTC), we translated three Canadian assessment instruments: the Alberta Context Tool (ACT), Estabrooks’ Kinds of Research Utilization (RU) items and the Conceptual Research Utilization Scale. Target groups for the tools were health care aides (HCAs), registered nurses (RNs), allied health professionals (AHPs), clinical specialists and care managers. Through a cognitive debriefing process, we assessed response processes validity–an initial stage of validity, necessary before more advanced validity assessment.MethodsWe included 39 participants (16 HCAs, 5 RNs, 7 AHPs, 5 specialists and 6 managers) from five residential LTC facilities. We created lists of questionnaire items containing problematic items plus items randomly selected from the pool of remaining items. After participants completed the questionnaires, we conducted individual semi-structured cognitive interviews using verbal probing. We asked participants to reflect on their answers for list items in detail. Participants’ answers were compared to concept maps defining the instrument concepts in detail. If at least two participants gave answers not matching concept map definitions, items were revised and re-tested with new target group participants.ResultsCognitive debriefings started with HCAs. Based on the first round, we modified 4 of 58 ACT items, 1 ACT item stem and all 8 items of the RU tools. All items were understood by participants after another two rounds. We included revised HCA ACT items in the questionnaires for the other provider groups. In the RU tools for the other provider groups, we used different wording than the HCA version, as was done in the original English instruments. Only one cognitive debriefing round was needed with each of the other provider groups.ConclusionCognitive debriefing is essential to detect and respond to problematic instrument items, particularly when translating instruments for heterogeneous, less well educated provider groups such as HCAs. Cognitive debriefing is an important step in research tool development and a vital component of establishing response process validity evidence. Publishing cognitive debriefing results helps researchers to determine potentially critical elements of the translated tools and assists with interpreting scores.
Highlights
To study the association between organizational context and research utilization in German residential long term care (LTC), we translated three Canadian assessment instruments: the Alberta Context Tool (ACT), Estabrooks’ Kinds of Research Utilization (RU) items and the Conceptual Research Utilization Scale
Substantial evidence suggests that residential long term care (LTC) providers’ use of best practices is sub-optimal in Germany [1,2,3,4,5,6,7]
Translation guidelines state that cognitive debriefing is an important step in instrument translation, but guidelines differ in the suggested methods and the level of detail of the instructions [38,44]
Summary
To study the association between organizational context and research utilization in German residential long term care (LTC), we translated three Canadian assessment instruments: the Alberta Context Tool (ACT), Estabrooks’ Kinds of Research Utilization (RU) items and the Conceptual Research Utilization Scale. We translated three Canadian tools into German (see [27] for details): the Alberta Context Tool (ACT) [28,29,30], the Estabrooks’ Kinds of Research Utilization (RU) items [31,32] (residential LTC version [18]) and the Conceptual Research Utilization (CRU) Scale [33] These tools have been widely used to investigate health care providers’ utilization of research in their daily work and its association with organizational context [18,33,34,35]. See [36] for the ACT pediatric acute care version, based on RN responses; [20] for the ACT residential LTC version, based on health care aide (HCA) responses; [35] for an overview of studies assessing the psychometric properties of the Estabrooks’ Kinds of RU items; and [33] for the CRU Scale, based on HCA responses
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