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Rehab Measures: Alberta Context Tool

Link to instrument

Link to Instrument 

Title of Assessment

Alberta Context Tool 

Acronym

ACT

Instrument Reviewer(s)

Anisha Ajgaonkar

Summary Date

4/2/2016 

Purpose

  • The ACT assesses the individual healthcare providers’ perception of context by encompassing eight dimensions of organizational context.
  • It is used to help researchers identify the elements of context, namely, leadership (6 items), culture (6 items), evaluation (6 items), social capital (6 items), informal interactions (7-10 items), formal interactions (4 items), structural/electronic sources (11 items), and organizational slack that includes 3 concepts as follows: staff (2-3 items), space (3 items), and time (4 items).
  • These concepts can facilitate or restrict the application of evidence in practice and can influence patient outcomes. It thereby predicts research utilization or knowledge translation.

Description

  • There are three versions of the ACT, acute care, residential long term care, and community/home care. Each version has forms for the following provider groups: health care aides, nurses, physicians, allied health providers, practice specialists, and care managers.
  • Items are scored using the 5 point Likert-type Scale, ranging from strongly disagree to strongly agree, and never to almost always for some questions. 

The final score is calculated using one of two methods:

  • Mean score method where the mean value of the scores for the items within a concept is calculated.
  • Count method where the scores are coded and counted to obtain a final score.

Administration instructions can be found in ACT manual at:

 

http://www.kusp.ualberta.ca/en/ACT/~/media/Knowledge%20Utilization%20Studies%20Program/Documents/ACT/ACTManual2014.pdf

Area of Assessment

Patient Satisfaction 

Body Part

Not Applicable 

ICF Domain

 

Domain

 

Assessment Type

Patient Reported Outcomes 

Length of Test

06 to 30 Minutes 

Time to Administer

Approximately 10-15 Minutes

Number of Items

56-58; depending on form used 

Equipment Required

  • Pen (written format)
  • Paper (written format)
  • Computer (online format)

Training Required

No Training Required

Type of training required

No Training 

Cost

Free 

Actual Cost

Instrument access is free if request approved by test developers.

Age Range

Adult: 18-64 years; Elderly adult: 65+ 

Administration Mode

Paper/Pencil 

Diagnosis

 

Populations Tested

  • Nurse
  • Health care aide
  • Allied health care professions

3 different versions for the following settings:

  • Acute care (adult and pediatric hospitals)
  • Residential long term care (nursing homes)
  • Community/ home care

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Not Established

Normative Data

Not Established

Test-retest Reliability

Not Established

Interrater/Intrarater Reliability

Not Established

Internal Consistency

Nurses: (Squires et al, 2015; n=2361; mean age=45 years; professional nurses from long-term care, acute pediatric hospitals, acute adult hospitals, and community/home care; ACT nurse version containing 56-59 items depending on setting)

 

Cranach alpha values for the dimensions of the ACT nurse version
 

Dimension

Cronbach’s Alpha

Leadership

Excellent= 0.91

Culture

Excellent= 0.80

Evaluation

Excellent= 0.92

Social Capital

Excellent= 0.80

Formal interactions

Poor= 0.59

Informal interactions

Excellent= 0.80

Structural and electronic sources

Excellent= 0.80

Organizational slack

 

Time

Excellent= 0.80

Space

Excellent= 0.80

Staff

Excellent= 0.86

 

(Eldh et al, 2013; n= 288; registered/licensed practical nurses, long term care nurse version; 59 items and 10 contextual concepts; Swedish translation of ACT)

  • Adequate internal consistency for five concepts (Cronbach’s alpha>0.70)
  • Poor internal consistency for informal interactions, culture, and social capital (Cronbach’s alpha= 0.56, 0.63, 0.68 respectively)

Cronbach's alpha values for the dimensions of the ACT nurse version

 

Dimension

Cronbach’s Alpha

Leadership

Excellent= 0.87

Culture

Poor= 0.63

Evaluation

Excellent= 0.87

Social Capital

Poor= 0.68

Formal interactions

Adequate= 0.73

Informal interactions

Poor= 0.56

Structural and electronic sources

Adequate= 0.77

Organizational slack

Excellent= 0.87

 

(Estabrooks et al, 2009; n=764 professional nurses; pediatric care hospitals; long term care nurse version; refined ACT; 56 items and eight contextual dimensions)

  • Excellent internal consistency for leadership, evaluation, and organizational slack-human resources (Cronbach’s alpha= 0.91, 0.91, 0.83).
  • Adequate internal consistency for culture, social capital, informal interactions-non direct care and direct care, structural and electronic sources- formal, and organizational slack-time.  (Cronbach’s alpha= 0.72, 0.77, 0.75, 0.70, 0.71, 0.74).
  • Poor internal consistency for formal interactions, structural and electronic sources- traditional and electronic, and organizational slack- space (Cronbach’s alpha= 0.60, 0.60, 0.54, 0.63).

Cronbach's alpha values for the dimensions of the ACT nurse version

 

Dimension

Cronbach’s Alpha

Leadership

Excellent= 0.91

Culture

Adequate= 0.72

Evaluation

Excellent= 0.91

Social Capital

Adequate= 0.77

Formal interactions

Poor= 0.60

Informal interactions

 

Non-direct care

Adequate= 0.75

Direct care

Adequate= 0.70

Structural and electronic sources

 

Formal

Adequate= 0.71

Traditional

Poor= 0.60

Electronic

Poor= 0.54

Organizational slack

 

Time

Adequate= 0.74

Space

Poor= 0.63

Human Resources

Poor= 0.83

(Mallidou et al, 2011; n=752 nurses; pediatric hospital setting; acute care version; nurses and allied health care forms)

  • Excellent internal consistency reliability for staff (Cronbach’s alpha= 0.83)
  • Poor to Adequate internal consistency reliability for space and time (Cronbach’s alpha= 0.63, 0.74)

Health care aides: (Estrabrooks et al, 2011; 859 professional nurses; pediatric hospital setting; pediatric nurse version; 56 items and eight contextual dimensions)

  • Excellent internal consistency for three concepts (Cronbach’s alpha>0.80)
  • Adequate internal consistency for five concepts (Cronbach’s alpha >0.70)
  • Poor internal consistency for formal interactions (Cronbach’s alpha= 0.37)
  • Poor internal consistency for space (Cronbach’s alpha= 0.64)

Allied health care professions: (Mallidou et al, 2011; n= 197 allied health care professionals; pediatric hospital setting; acute care version; allied health providers form)

  • Excellent internal consistency reliability for staff, space, and time (Cronbach’s alpha= 0.81)

Criterion Validity (Predictive/Concurrent)

Not Established

Construct Validity (Convergent/Discriminant)

Nurses: (Estrabrooks et al, 2009; n=764 professional nurses; pediatric care hospitals; long term care nurse version; refined ACT; 56 items and eight contextual dimensions)

  • Significant bivariate correlation between instrumental research utilization levels and 12 of 13 factors of the ACT were statistically significant at the 5% level.
  • With the exception of staff and instrumental research use, the bivariate relationships between slack subscales and instrumental and conceptual research use were statistically significant.

Content Validity

Not Established

Face Validity

Not Established

Floor/Ceiling Effects

Not Established

Responsiveness

Not Established

Professional Association Recommendations

None

Considerations

  • As per the manual, the survey should be completed in an uninterrupted environment with no pauses.
  • To date no satisfactory measures of organizational context have been constructed. The ACT is comprehensive and concise, and is a suitable tool for clinical use.

Bibliography

Squires, J. E., Hayduk, L., Hutchinson, A. M., Mallick, R., Norton, P. G., Cummings, G. G., & Estabrooks, C. A. (2015). “Reliability and Validity of the Alberta Context Tool (ACT) with Professional Nurses: Findings from a Multi-Study Analysis.” Plos ONE, 10(6), 1-17. doi:10.1371/journal.pone.0127405

 

Eldh, A. C., Ehrenberg, A., Squires, J. E., Estabrooks, C. A., & Wallin, L. (2013). “Translating and testing the Alberta context tool for use among nurses in Swedish elder care.” BMC Health Services Research, 13(1), 1-10. doi:10.1186/1472-6963-13-68

 

Estabrooks, C. A., Squires, J. E., Hayduk, L. A., Cummings, G. G., & Norton, P. G. (2011). “Advancing the argument for validity of the Alberta Context Tool with healthcare aides in residential long-term care.” BMC Medical Research Methodology, 11, 107. doi:10.1186/1471-2288-11-107

 

Estabrooks, C. A., Squires, J. E., Cummings, G. G., Birdsell, J. M., & Norton, P. G. (2009). “Development and assessment of the Alberta Context Tool.” BMC Health Services Research, 9234. doi:10.1186/1472-6963-9-234

 

Mallidou, A. A., Cummings, G. G., Ginsburg, L. R., Chuang, Y., Kang, S., Norton, P. G., & Estabrooks, C. A. (2011). “Staff, space, and time as dimensions of organizational slack: a psychometric assessment.” Health Care Management Review, 36(3), 252-264. doi:10.1097/HMR.0b013e318208ccf8

Year published

2009 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 8/11/2016 3:34 PM  by Jason Raad 
Last modified at 8/11/2016 3:35 PM  by Jason Raad