In recent decades, understanding of what influences implementation of evidence based knowledge in health care has increased. Among other influences, contextual factors are important . Organizational context includes both observable aspects, such as the physical environment and availability of information resources, and underlying aspects, such as social interactions and management . To better understand what hinders and facilitates knowledge transfer, context needs to be assessed . Apart from more generic instruments on employees’ experience of work context (such as; Situational Outlook Questionnaire (SOQ) , Quality-Work-Competence (QWC) , and The revised Nursing Work Index (NWI) ) there are few instruments available particularly for measuring context in relation to knowledge transfer in health care settings. When this study was initiated we recognised three instruments designated for this specific purpose: the Context Assessment Index (CAI) , the Organizational readiness to Change Assessment (ORCA) , and the Alberta Context Tool (ACT) . At that time point, CAI was being tested in Sweden, resulting in a proposed need for further refinement , while ORCA and ACT had not previously been tested in Sweden. The ACT appeared to have promising properties for use in Swedish health care settings, considering similarities in health care organisation and professional practice in Canada and Sweden. Further, the ACT was being considered for a international study on implementation of evidence in elder care, involving both Sweden and Canada .
The Alberta Context Tool was designed to measure modifiable aspects of organizational context in health care settings. It is administered to individuals (i.e., health care staff) to elicit their perceptions of context at the care unit and/or facility level, depending on the context of care delivery. For nurses, this level is frequently the patient or resident care unit. The ACT was developed by Estabrooks and colleagues in Canada and consists of a series of items representing 10 modifiable contextual concepts: (1) leadership, (2) culture, (3) evaluation, (4) social capital, (5) structural and electronic resources, (6) formal interactions, (7) informal interactions, (8) organizational slack – staffing, (9) organizational slack – space, and (10) organizational slack – time .
The theoretical framing for the ACT was the Promoting Action on Research Implementation in Health Services (PARIHS) framework , and related literature in the fields of organizational science, research implementation, and knowledge translation [11–13]. The ACT exists in 3 versions (acute care, long-term care and home care), each with multiple forms for different target groups (health care assistants/aides (HCA); nurses, i.e., licensed practical nurses (LPN) and registered nurses (RN); allied health professionals; physicians; practice specialists (e.g. educators), and care managers). Further, the ACT is accompanied by a set of demographic questions regarding sex, age, education, professional experience and working hours. Scores obtained using the ACT with nurses and HCA’s in paediatric care and residential long-term care facilities respectively, have demonstrated acceptability, reliability, and construct validity [14, 15]. Further, the ACT has been applied in studies on knowledge transfer in health care in Canada and Australia [16–19].
Swedish and Canadian health care have similarities with regards to a variety of aspects, such as political governance and health care financing , health care policies and legislation, and health care professionals’ education and staff perceptions, e.g., with regards to the concept of research utilization among nurses . As a result, the need for an instrument to measure organizational context in knowledge transfer research in Sweden prompted a decision to translate ACT to Swedish, rather than constructing a new instrument. Also, with the similarities between the countries, the possibility for cross-country comparisons was of interest.
Translation of an instrument should consider linguistic, semantic and contextual aspects, aiming to create a valid instrument for the new setting . These aspects refer to a) words and grammar (linguistics), b) concepts (semantics), and c) the context where the instrument was developed and shall be applied, respectively. The linguistic and semantic aspects require consideration of language; For example, according to Ogden and Richard’s  theory on language meaning, there is an indirect relation between a term and a phenomenon by the use of a thought or idea, presented as a concept. When sharing words, as in speaking, listening or reading, the reference to the phenomenon needs to be common for the utterer and the receiver, provided by the shared idea (the concept) linking the word to the phenomenon. Thus, when translating words, we need to make sure not only that we use equal terms but also that we have a common idea of the phenomenon, manifested by the concept. In order for a valid process and outcome, back translation and inclusion of experts and the original instrument developers in the process are important , to manage potential semantic and contextual issues. Since all three aspects need to be considered, i.e. linguistic, semantic and contextual, translation of an instrument signifies a complex and demanding undertaking . This paper reports on the translation of the ACT to Swedish, including linguistic, semantic and contextual aspects, and a testing of preliminary aspects of its validity as well as acceptability and reliability in elder care.