Abstract
The Adult Social Care Outcomes Toolkit four response-level interview schedule (ASCOT INT4) for service users was translated into Finnish. The aim of this paper was to investigate the construct validity and structural characteristics of the Finnish ASCOT. We used data from a face-to-face interview survey of older people receiving publicly funded home care services, which was conducted in 2016-2017 (n=493), excluding missing values and proxy respondents (n=334). Chi-square tests, adjusted residuals and analyses of variance were used to examine hypothesised associations between each attribute and a number of relevant variables regarding health and well-being, disabilities, living arrangements, social contact and support, experience of service use, and the nature of the locality and environment. Structural characteristics were explored using exploratory factor analysis and Cronbach's alpha test. The EQ-5D-3L and ASCOT were moderately correlated (r=0.429; p<0.001). The ASCOT attributes were statistically positively related to the overall quality of life. For other tested variables, we found a high number of significant associations with the control over daily life, occupation, social participation, and personal cleanliness attributes, but fewer significant associations with the other attributes. Cronbach's alpha was 0.697 and a single factor was extracted. This assessment provides evidence to support the construct validity of the Finnish ASCOT. The results support the introduction of the Finnish ASCOT into Finland for use in practical applications. Future research on its reliability would be useful.
Highlights
There is a need for criteria which can provide information to help decision-makers allocate limited resources effectively to and within the health and aged care sector (Bergmark et al, 2000; Bowling &Dieppe, 2005; OECD, 2017) and to identify effective services for successful ageing (Clough et al, 2007; Lipszyc et al, 2012; Milne et al, 2014)
Reflecting the social care concern with quality of life (QoL) rather than health, to facilitate decision-making about the relative cost- effectiveness of social care interventions the National Institute for Health and Care Excellence (NICE) suggests using a ‘social care quality-adjusted life year’ (NICE, 2014), as described by the Adult Social Care Outcome Toolkit (ASCOT). This decision is informed by the evidence demonstrating that the ASCOT measure is more responsive to the effects of social care interventions (Forder & Caiels, 2011; Malley et al, 2012) than the 5-dimensional EuroQol instrument (EQ-5D) (EuroQol Group, 1990)—the measure traditionally suggested by NICE (2014) for economic evaluation of health technologies
We studied whether the Finnish ASCOT attributes described expected associations with the chosen variables
Summary
There is a need for criteria which can provide information to help decision-makers allocate limited resources effectively to and within the health and aged care sector (Bergmark et al, 2000; Bowling &Dieppe, 2005; OECD, 2017) and to identify effective services for successful ageing (Clough et al, 2007; Lipszyc et al, 2012; Milne et al, 2014). Reflecting the social care concern with QoL rather than health, to facilitate decision-making about the relative cost- effectiveness of social care interventions the National Institute for Health and Care Excellence (NICE) suggests using a ‘social care quality-adjusted life year’ (NICE, 2014), as described by the Adult Social Care Outcome Toolkit (ASCOT). This decision is informed by the evidence demonstrating that the ASCOT measure is more responsive to the effects of social care interventions (Forder & Caiels, 2011; Malley et al, 2012) than the 5-dimensional EuroQol instrument (EQ-5D) (EuroQol Group, 1990)—the measure traditionally suggested by NICE (2014) for economic evaluation of health technologies. Evidence for the construct validity of the ASCOT has been found in assessments performed in England (Malley et al, 2012; Rand, 2017), the Netherlands regarding the Dutch-translated ASCOT (van Leeuwen et al, 2015) and Austria regarding the German ASCOT (Trukeschitz, Litschauer, et al, 2020)
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