1. Context Assessment Index Translation, adaptation to Swedish Health care and test of psychometric properties in a Swedish group of RNs Kerstin Nilsson Kajermo

2. 2 CAI 37 items Representing 3 context elements (PARIHS framework) culture, leadership, evaluation 5 factors identified (Collaborative practice, Evidence-informed practice, Respect for person, Practice boundaries, Evaluation) (McCormack et al 2009)

3. 3 Translation and adaptation Two persons familiar with Swedish Health Care and with good knowledge in English independently translated CAI to Swedish The translations were discussed by an expert group until consensus was reached Back translation to English by a professional translator with English as mother tongue The back translated version was checked by Brendan McCormack

4. 4 Cognitive evaluation ”Think aloud” interviews with 6 RNs and 1 LPN The respondents answered the questionnaire while thinking aloud about the items and the response alternatives The interviews were analysed using a method described by Conrad & Blair (1996) 21 items were adjusted Contact with Brendan McCormack for verification of the final version

5. 5 Testing on a large sample Sample 372 (77.5%) RNs from 17 units (university hospital, home care, geriatric care, psychiatric care) of these 11 units are involved in an intervention project regarding the management of peripheral venous catheters (PVC).

6. 6 CAI 37 items response process Missing data: 2 (0.5%) - 10 (2.7%) per item No ceiling or floor effect Open-ended question for comments about CAI: 32 comments

7. 7 Item analysis Item correlations with the 5 factors identified in the Irish study (Collaborative practice, Evidence-informed practice, Respect for person, Practice boundaries, Evaluation) Some items had higher correlations with other factors than the factor it belonged to Cronbach’s alpha for the five factors.57 -.82

8. 8 Exploratory Factor Analyses Principal Component Analyses with orthogonal rotation and Principal Axis Analyses with orthogonal and oblique rotation number of factors set at 5 gave other factor models than the Irish study, but possible to name, explaining 47 – 39 % of the variance 1 item (item no 24) did not load on any factor independent on type of analysis

9. 9 Five factor model - Swedish data 1.Development and supportive leadership (9-10 items) 2.Professional practice (9-10 items) 3.Patient’s and significant other’s participation (6 items) 4.Collaboration (6 items) 5.Availability of evidence (3 items) 2 items (24, 35) did not load distinctly on any factor

10. 10 Exploratory Factor Analyses cont. Factor extraction based on Eigen values > 1 gave 8 factors explaining 57 – 45 % of the variance

11. 11 Exploratory factor analyses cont. number of factors set at 3 gave also factors possible to name explaining 40 – 35 % of the variance. Not identical with the 3 elements of Context as described in the CAI guide

12. 12 Test-retest Sample 23 RNs Percentage agreement 29 – 81 6 items < 50 percentage agreement

13. Future plans Confirmatory factor analyses Feedback of results to participating units – how to present the findings in a meaningful way? 13

14. Reflections What constitutes context and how do we operationalize these concepts? What is culture? 14