Organizational context for evidence-based practices: The Alberta Context Tool (ACT)

Description

Organizational context has a significant impact on successful implementation of evidence-based practices. The Alberta Context Tool (ACT) was developed to be brief and practical, so it can be used in busy health care settings.This tool is a 56-item survey that measures organizational context to implement evidence in the following domains:

• Leadership
• Culture
• Evaluation
• Social Capital
• Informal Interactions
• Formal Interactions
• Structural/Electronic Resources
• Organizational Slack

The development of ACT is informed by the the PARiHS framework (Promoting Action on Research Implementation in Health Services). The PARiHS framework guides the successful implementation of research evidence results from three elements:

• Evidence — The nature and strength of the evidence
• Facilitation — Types of support needed to help people change their attitudes, behaviours, skills
• Context — Organizational context in which the proposed change will be implemented, including culture, leadership and evaluation

ACT measures the context domain of the PARiHS framework.

Three different versions of the ACT target different clinical settings: adult care, pediatric care and long-term care.

Other related resources are:

• Organizational Readiness to Change Assessment (ORCA) Tool, which is also developed from the PARiHS framework. The ORCA tool assesses all three domains of the PARiHS framework (evidence, facilitation and context) and is a longer instrument (77 items).
• Prevention Program Assessment tool is designed to assess organizational readiness to implement evidence-based programs in chronic disease.

Steps for Using Method/Tool

To use the ACT:

1. Make a decision about the level of analysis (the whole organization or a team within an organization) the tool intends to capture.
2. Decide if everyone in the organization/team will be asked to complete the tool, or if a representative or random sample can be achieved.
3. Administer the tool.
4. Analyze the results and report to decision-makers.

Evaluation

Psychometric properties (validity and reliability) of the Alberta Context Tool have been tested several times in different health care settings, with different health care professionals. Individuals' responses to the tool have been aggregated to provide team or unit scores of organizational context (Estabrooks et al., 2009; Cummings et al., 2010; Estabrooks et al., 2011a; Estabrooks et al., 2011b). In general, more positive organizational contexts are associated with higher reports of research use in practice (Cummings et al., 2010).

Validity

Validity was tested with 764 pediatric nurses (Estabrooks et al., 2009) using factor analysis and principal component analysis (PCA). PCA indicated a 13-factor solution accounting for 59.26% of the variance in organizational context. In another study (Estabrooks et al., 2011a), the Standards for Educational and Psychological Testing was used to frame validity assessment of ACT with 645 health care aides. This study provided additional support for construct validity of ACT. In another study (Estabrooks et al., 2011b), ACT was tested with 859 pediatric nurses using hierarchical linear modelling to determine the extent to which ACT is able to discriminate between patient care units. This study supports the use of ACT to discriminate between patient care units by all contextual domains.

Reliability

ACT demonstrated adequate reliability with Cronbach's alpha coefficients raning from 0.54 to 0.91 for the 13 factors (Estabrooks et al., 2009); 0.37 to 0.92 for 10 ACT concepts (Estabrooks et al., 2011a). In assessing the reliability of aggregating data to the patient care unit level, interclass correlation (1) values ranged from 0.0918 to 0.2968, indicating perceptual agreement among nurses (i.e., nurses' perceptions about their own unit were similar).