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

<p>Abstract</p> <p>Background</p> <p>Organizational context has the potential to influence the use of new knowledge. However, despite advances in understanding the theoretical base of organizational context, its measurement has not been adequately addressed, limiting our ability to quantify and assess context in healthcare settings and thus, advance development of contextual interventions to improve patient care. We developed the Alberta Context Tool (the ACT) to address this concern. It consists of 58 items representing 10 modifiable contextual concepts. We reported the initial validation of the ACT in 2009. This paper presents the second stage of the psychometric validation of the ACT.</p> <p>Methods</p> <p>We used the <it>Standards for Educational and Psychological Testing </it>to frame our validity assessment. Data from 645 English speaking healthcare aides from 25 urban residential long-term care facilities (nursing homes) in the three Canadian Prairie Provinces were used for this stage of validation. In this stage we focused on: (1) advanced aspects of internal structure (e.g., confirmatory factor analysis) and (2) relations with other variables validity evidence. To assess reliability and validity of scores obtained using the ACT we conducted: Cronbach's alpha, confirmatory factor analysis, analysis of variance, and tests of association. We also assessed the performance of the ACT when individual responses were aggregated to the care unit level, because the instrument was developed to obtain unit-level scores of context.</p> <p>Results</p> <p>Item-total correlations exceeded acceptable standards (> 0.3) for the majority of items (51 of 58). We ran three confirmatory factor models. Model 1 (all ACT items) displayed unacceptable fit overall and for five specific items (1 item on <it>adequate space for resident care </it>in the Organizational Slack-Space ACT concept and 4 items on use of electronic resources in the Structural and Electronic Resources ACT concept). This prompted specification of two additional models. Model 2 used the 7 scaled ACT concepts while Model 3 used the 3 count-based ACT concepts. Both models displayed substantially improved fit in comparison to Model 1. Cronbach's alpha for the 10 ACT concepts ranged from 0.37 to 0.92 with 2 concepts performing below the commonly accepted standard of 0.70. Bivariate associations between the ACT concepts and instrumental research utilization levels (which the ACT should predict) were statistically significant at the 5% level for 8 of the 10 ACT concepts. The majority (8/10) of the ACT concepts also showed a statistically significant trend of increasing mean scores when arrayed across the lowest to the highest levels of instrumental research use.</p> <p>Conclusions</p> <p>The validation process in this study demonstrated additional empirical support for construct validity of the ACT, when completed by healthcare aides in nursing homes. The overall pattern of the data was consistent with the structure hypothesized in the development of the ACT and supports the ACT as an appropriate measure for assessing organizational context in nursing homes. Caution should be applied in using the one space and four electronic resource items that displayed misfit in this study with healthcare aides until further assessments are made.</p

A systematic review of the psychometric properties of self-report research utilization measures used in healthcare

<p>Abstract</p> <p>Background</p> <p>In healthcare, a gap exists between what is known from research and what is practiced. Understanding this gap depends upon our ability to robustly measure research utilization.</p> <p>Objectives</p> <p>The objectives of this systematic review were: to identify self-report measures of research utilization used in healthcare, and to assess the psychometric properties (acceptability, reliability, and validity) of these measures.</p> <p>Methods</p> <p>We conducted a systematic review of literature reporting use or development of self-report research utilization measures. Our search included: multiple databases, ancestry searches, and a hand search. Acceptability was assessed by examining time to complete the measure and missing data rates. Our approach to reliability and validity assessment followed that outlined in the <it>Standards for Educational and Psychological Testing</it>.</p> <p>Results</p> <p>Of 42,770 titles screened, 97 original studies (108 articles) were included in this review. The 97 studies reported on the use or development of 60 unique self-report research utilization measures. Seven of the measures were assessed in more than one study. Study samples consisted of healthcare providers (92 studies) and healthcare decision makers (5 studies). No studies reported data on acceptability of the measures. Reliability was reported in 32 (33%) of the studies, representing 13 of the 60 measures. Internal consistency (Cronbach's Alpha) reliability was reported in 31 studies; values exceeded 0.70 in 29 studies. Test-retest reliability was reported in 3 studies with Pearson's <it>r </it>coefficients > 0.80. No validity information was reported for 12 of the 60 measures. The remaining 48 measures were classified into a three-level validity hierarchy according to the number of validity sources reported in 50% or more of the studies using the measure. Level one measures (n = 6) reported evidence from any three (out of four possible) <it>Standards </it>validity sources (which, in the case of single item measures, was all applicable validity sources). Level two measures (n = 16) had evidence from any two validity sources, and level three measures (n = 26) from only one validity source.</p> <p>Conclusions</p> <p>This review reveals significant underdevelopment in the measurement of research utilization. Substantial methodological advances with respect to construct clarity, use of research utilization and related theory, use of measurement theory, and psychometric assessment are required. Also needed are improved reporting practices and the adoption of a more contemporary view of validity (<it>i.e.</it>, the <it>Standards</it>) in future research utilization measurement studies.</p

Mature Modifications and Sexual Dimorphism

Allometric growth between different parts of the shell often hampers the identification of mollusk shells, particularly in such cases where preadult shell growth varies strongly. Especially in gastropods, the terminal aperture is often less variable and yields morphological information essential for species determination (e.g. Vermeij 1993; Urdy et al. 2010a, b). In fossil mollusk shells, the adult aperture (peristome)is often missing, partially due to an early death, and partially due to destructive processes, which occurred post mortem (taphonomy). Therefore, the entire shell ontogeny is known only from a small fraction of all ammonoid taxa (e.g., Landman et al. 2012). Nevertheless, knowledge of the adult shell of ammonoids is very important since it can yield morphological information essential for systematics and for the reconstruction of various aspects of their paleobiology

Obstacles to the implementation of evidence-based physiotherapy in practice: A focus group-based study in Belgium (Flanders)

Over the past few years concerns have been rising about the use of Evidence-Based Practice (EBP). We explored obstacles among Belgian physiotherapists to the implementation of EBP in clinical work. We used a qualitative research strategy based on five focus groups, organised between October 2004 and May 2005. Purposeful sampling was used to recruit 43 participants from diverse geographical regions in Flanders, working in different settings and with a variety of interest and expertise in EBP. Data collection and analysis were concurrent and guided by “grounded theory approach.” A problem tree was developed. Important obstacles to the implementation of EBP include physiotherapists’ lack of autonomy and authority to decide on patients’ treatments or to negotiate with government. In addition, the lack of evidence, inaccessibility and inapplicability of scientific evidence, the economic parameters influencing government and physicians, the expectations from patients and a lack of motivation hamper the implementation of EBP. The problem tree developed reveals direct links between the lack of autonomy from physiotherapists and the dominant position from physicians in the Belgian health care system, which further impacts the boundaries between both professions and the weight of physiotherapists in governmental advisory boards. Direct access to physiotherapy has not yet been considered in Belgium. However, it could have major advantages for physiotherapists who are in favour of a more autonomous, professional status.Karin Hannes, Filip Staes, Jo Goedhuys and Bert Aertgeertshttp://informahealthcare.com/doi/abs/10.3109/0959398080266194