Alberta Context Tool

Last Updated

April 02, 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.

Link to Instrument

Instrument Details

Acronym ACT

Area of Assessment

Patient Satisfaction

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Allied Health Care Professions

Nurses

There are three versions of the ACT:
1) Acute care
2) Residential long term care
3) Community/home care
Each version has forms for the following provider groups:
1) Health care aides
2) Nurses
3) Physicians
4) Allied health providers
5) Practice specialists
6) 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:
1) Mean score method where the mean value of the scores for the items within a concept is calculated.
2) 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

Number of Items

56-58

Depending on form

Pen
Paper
Computer (online format)

10-15 minutes

Required Training

No Training

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Anisha Ajgaonkar

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.

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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)

Construct Validity

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.

Internal Consistency

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)

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

Last Updated

Purpose

Link to Instrument

Area of Assessment

Assessment Type

Administration Mode

Cost

Number of Items

Required Training

Instrument Reviewers

Considerations

Internal Consistency

Construct Validity

Internal Consistency

Bibliography

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