Development and assessment of the Alberta Context Tool

Abstract

BackgroundThe context of healthcare organizations such as hospitals is increasingly accepted as having the potential to influence the use of new knowledge. However, the mechanisms by which the organizational context influences evidence-based practices are not well understood. Current measures of organizational context lack a theory-informed approach, lack construct clarity and generally have modest psychometric properties. This paper presents the development and initial psychometric validation of the Alberta Context Tool (ACT), an eight dimension measure of organizational context for healthcare settings.MethodsThree principles guided the development of the ACT: substantive theory, brevity, and modifiability. The Promoting Action on Research Implementation in Health Services (PARiHS) framework and related literature were used to guide selection of items in the ACT. The ACT was required to be brief enough to be tolerated in busy and resource stretched work settings and to assess concepts of organizational context that were potentially modifiable. The English version of the ACT was completed by 764 nurses (752 valid responses) working in seven Canadian pediatric care hospitals as part of its initial validation. Cronbach's alpha, exploratory factor analysis, analysis of variance, and tests of association were used to assess instrument reliability and validity.ResultsFactor analysis indicated a 13-factor solution (accounting for 59.26% of the variance in 'organizational context'). The composition of the factors was similar to those originally conceptualized. Cronbach's alpha for the 13 factors ranged from .54 to .91 with 4 factors performing below the commonly accepted alpha cut off of .70. Bivariate associations between instrumental research utilization levels (which the ACT was developed to predict) and the ACT's 13 factors were statistically significant at the 5% level for 12 of the 13 factors. Each factor also showed a trend of increasing mean score ranging from the lowest level to the highest level of instrumental research use, indicating construct validity.ConclusionsTo date, no completely satisfactory measures of organizational context are available for use in healthcare. The ACT assesses several core domains to provide a comprehensive account of organizational context in healthcare settings. The tool's strengths are its brevity (allowing it to be completed in busy healthcare settings) and its focus on dimensions of organizational context that are modifiable. Refinements of the instrument for acute, long term care, and home care settings are ongoing.

Advancing the argument for validity of the Alberta Context Tool with healthcare aides in residential long-term care

“…In this study, we offer internal structure validity evidence and relations to other variables validity evidence, adding to the existing validity evidence from content (the extent to which items represent the content domain) and response processes (how respondents interpret, process, and elaborate on item content and whether this is in accordance with the construct) reported previously [10]. Follow-up studies are in progress in which we are assessing the ACT with a wide array of healthcare workers-nurses, allied healthcare providers and professionals, physicians, and specialists (e.g., educators), and care managers in long-term care (nursing home) settings.…”

Exploring knowledge exchange: A useful framework for practice and policy

“…Taylor et al 2011). These efforts have also tended to focus on knowledge translation as an implementation problem and, as Estabrooks et al point out, are therefore limited in their ability to speak to the complex and disparate circumstances which surround the knowledge exchange process (Estabrooks et al 2009). An alternative understanding of context is that defined by the Japanese concept of "ba" (Ray & Little 2001).…”

Investigating the Utilization of Research Evidence in the 4-H Youth Development Program

“…Critics (e.g. ; Estabrooks, Squires, Cummings, Birdsell, & Norton, 2009) consider this to be a weakness and have called for studies that include additional variables such as organization and context (Davies & Nutley, 2008;Estabrooks et al, 2008).…”