German translation of the Alberta context tool and two measures of research use: methods, challenges and lessons learned

BMC Health Services Research, Nov 2013

Background Understanding the relationship between organizational context and research utilization is key to reducing the research-practice gap in health care. This is particularly true in the residential long term care (LTC) setting where relatively little work has examined the influence of context on research implementation. Reliable, valid measures and tools are a prerequisite for studying organizational context and research utilization. Few such tools exist in German. We thus translated three such tools (the Alberta Context Tool and two measures of research use) into German for use in German residential LTC. We point out challenges and strategies for their solution unique to German residential LTC, and demonstrate how resolving specific challenges in the translation of the health care aide instrument version streamlined the translation process of versions for registered nurses, allied health providers, practice specialists, and managers. Methods Our translation methods were based on best practices and included two independent forward translations, reconciliation of the forward translations, expert panel discussions, two independent back translations, reconciliation of the back translations, back translation review, and cognitive debriefing. Results We categorized the challenges in this translation process into seven categories: (1) differing professional education of Canadian and German care providers, (2) risk that German translations would become grammatically complex, (3) wordings at risk of being misunderstood, (4) phrases/idioms non-existent in German, (5) lack of corresponding German words, (6) limited comprehensibility of corresponding German words, and (7) target persons’ unfamiliarity with activities detailed in survey items. Examples of each challenge are described with strategies that we used to manage the challenge. Conclusion Translating an existing instrument is complex and time-consuming, but a rigorous approach is necessary to obtain instrument equivalence. Essential components were (1) involvement of and co-operation with the instrument developers and (2) expert panel discussions, including both target group and content experts. Equivalent translated instruments help researchers from different cultures to find a common language and undertake comparative research. As acceptable psychometric properties are a prerequisite for that, we are currently carrying out a study with that focus.

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German translation of the Alberta context tool and two measures of research use: methods, challenges and lessons learned

BMC Health Services Research German translation of the Alberta context tool and two measures of research use: methods, challenges and lessons learned Matthias Hoben 0 1 Cornelia Mahler Marion Br Sarah Berger Janet E Squires Carole A Estabrooks Johann Behrens 0 0 Institute of Health and Nursing Sciences, Medical Faculty, Martin-Luther-University Halle-Wittenberg , Halle-Wittenberg , Germany 1 Network Aging Research (NAR), Ruprecht-Karls-University Heidelberg , Bergheimer Str. 20, Heidelberg 69115 , Germany Background: Understanding the relationship between organizational context and research utilization is key to reducing the research-practice gap in health care. This is particularly true in the residential long term care (LTC) setting where relatively little work has examined the influence of context on research implementation. Reliable, valid measures and tools are a prerequisite for studying organizational context and research utilization. Few such tools exist in German. We thus translated three such tools (the Alberta Context Tool and two measures of research use) into German for use in German residential LTC. We point out challenges and strategies for their solution unique to German residential LTC, and demonstrate how resolving specific challenges in the translation of the health care aide instrument version streamlined the translation process of versions for registered nurses, allied health providers, practice specialists, and managers. Methods: Our translation methods were based on best practices and included two independent forward translations, reconciliation of the forward translations, expert panel discussions, two independent back translations, reconciliation of the back translations, back translation review, and cognitive debriefing. Results: We categorized the challenges in this translation process into seven categories: (1) differing professional education of Canadian and German care providers, (2) risk that German translations would become grammatically complex, (3) wordings at risk of being misunderstood, (4) phrases/idioms non-existent in German, (5) lack of corresponding German words, (6) limited comprehensibility of corresponding German words, and (7) target persons' unfamiliarity with activities detailed in survey items. Examples of each challenge are described with strategies that we used to manage the challenge. Conclusion: Translating an existing instrument is complex and time-consuming, but a rigorous approach is necessary to obtain instrument equivalence. Essential components were (1) involvement of and co-operation with the instrument developers and (2) expert panel discussions, including both target group and content experts. Equivalent translated instruments help researchers from different cultures to find a common language and undertake comparative research. As acceptable psychometric properties are a prerequisite for that, we are currently carrying out a study with that focus. Translation; Cultural adaptation; Alberta Context Tool; Estabrooks' Kind of Research Utilization; Conceptual Research Use scale; Organizational context; Research utilization; Residential long term care - Background Gaps between research-informed best practice and actual health care practice exist across countries, health care disciplines, and settings [1-5]. Many people thus receive care that is less effective, ineffective or potentially harmful [5]. Closing the research-practice gap is complex and challenging [6-15]. Myriad influencing factors at interacting levels (e.g., structural, organizational, innovation, health care provider, care recipient characteristics) contribute to this complexity [16]. Characteristics of the organizational context are believed to be particularly important for research implementation [12,15-18]. Contextual factors such as feedback mechanisms, available information resources, etc. are potentially modifiable. They influence research utilization by individuals and teams and can be used effectively to improve research implementation [19-25]. Research implementation is under-investigated in the residential long term care (LTC) setting [26-29]. LTC is a complex care environment for highly vulnerable residents with cognitive and physical impairments; residents are threatened if health care staff provide less than best practices [30-32]. Current international research programs e.g., [28,33-35] propose to increase our understanding of organizational context in LTC, how it relates to research implementation and care quality, and how both can be improved. German LTC settings show substantial evidence of suboptimal use of best practices and resulting poor quality e.g. [32,36-41]. We thus intended to study the influence of organizational context on research implementation in German residential LTC. Reliable and valid assessment instruments are essential for such a study [16,42]. We sought a tool that (1) was constructed on a sound theory and evidence base, (2) assessed potentia (...truncated)


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Matthias Hoben, Cornelia Mahler, Marion Bär, Sarah Berger, Janet E Squires, Carole A Estabrooks, Johann Behrens. German translation of the Alberta context tool and two measures of research use: methods, challenges and lessons learned, BMC Health Services Research, 2013, pp. 478, 13, DOI: 10.1186/1472-6963-13-478