I recently returned from Knowledge Utilization 2010 (KU10), in Halifax, Nova Scotia, Canada. This international gathering of primarily nurses has been meeting annually for a decade to address the many challenges we face in working toward evidence-informed decision making (EIDM) in health care.

Maureen Dobbins

Among the most challenging topics discussed at KU10 were appropriate research designs; identification of appropriate outcomes associated with knowledge translation; and reliable, valid measurement of those outcomes. As the group begins its second decade of deliberations, we still have much work to do in developing evidence-informed knowledge translation strategies, evaluating the impact of these strategies on nursing practice and, more importantly, assessing their effect on health outcomes for patients, communities and health systems.

Key factors emerging from KU10, specifically, and the knowledge translation (KT) field, generally, are the importance of culture and context in EIDM. Culture is defined as “the set of shared attitudes, values, goals and practices that characterize an institution, organization or group." Context, on the other hand, is defined as “the surroundings, circumstances, environment, background or settings that determine, specify or clarify the meaning of an event." While both of these factors—culture and context—have received much EIDM-related attention in recent years, the KT field has struggled to develop tools to measure these constructs in a reliable and valid way.

Furthermore, from an evaluation perspective, it is unclear if these factors are best utilized to understand if, how and why a KT strategy is effective in changing practice and health outcomes (independent variable), or if they are outcomes themselves—meaning effective KT strategies will result in culture and context that are conducive to EIDM (dependent variable). A third option is that culture and context both explain the outcome and are the outcome, depending on what one is attempting to achieve.

While a significant challenge has been lack of reliable and valid tools to measure these constructs, a number of tools are now available, some that still require additional evaluation (psychometric testing) to determine if they are culture- and context-relevant and appropriate for nurses and the organizations in which they work.

Have questions you want Maureen Dobbins to answer in her column or topics you’d like her to address? Send questions and suggested topics to dobbinsm@mcmaster.ca. The Context Assessment Index (CAI) is a 37-item tool that explores the concepts of culture, leadership and evaluation using five-point Likert scales. Although individuals complete the survey independently, scores are tallied across an organization to derive an overall context score, ranging from weak (not receptive to change) to strong (receptive to change). The tool has been tested extensively in Ireland and the United Kingdom for reliability, validity and usability. Use of the tool is optimized when a facilitator assists nurses in completing it, understanding the score and making practice changes based on the results.

The Alberta Context Tool assesses organizational context in complex health care settings such as acute care, long-term care and home care. Completed by nurses and managers, this tool determines individual perceptions of the context of a patient care unit or organization. It assesses 10 modifiable concepts, such as leadership, culture, evaluation, social capital, formal and informal interactions, structural and electronic resources, and organizational staffing, space and time. The tool has been validated among samples of Canadian and Swedish pediatric nurses and is currently being tested among health care aides in long-term care facilities. Learn more about this tool.

The Absorptive and Receptive Capacity Scale (ARCS) is a 14-item tool that assesses the degree to which factors associated with positive organizational context for implementation are evident in an organization. It assesses four components: knowledge need, acquiring new knowledge, knowledge sharing and knowledge use. Two additional items assess leadership and learning culture. While the tool was developed and tested among allied health professionals in the United Kingdom, efforts are ongoing to evaluate the tool among other health professionals, including nurses. The tool can be used to establish benchmarks to identify where organizations are with respect to research use, as well as identifying and sharing good organizational practices. Although the tool has been shown to have good internal reliability, additional validity testing is required. Learn more about this tool.

These are examples of tools available from three organizations. There are many others, worldwide, including the “Is Research Working for You?” self-assessment tool from the Canadian Health Services Research Foundation. While the tools can be used to measure change in an organization’s EIDM behavior over time, they also provide an excellent way to assess where an organization currently is, with respect to EIDM, and develop strategies to address identified limitations.

Since these tools vary in their approach, the key is to explore each and choose the one most relevant and appropriate for your specific organizational context. Finally, given that many of the available tools require further psychometric testing, I encourage you to contact the developers to explore how you can contribute data from your organization toward that end. I welcome your feedback on these tools and others.  RNL

Maureen Dobbins, RN, PhD, is an associate professor at McMaster University School of Nursing in Hamilton, Ontario, Canada, and a founder and primary investigator for www.health-evidence.ca, a free, searchable online registry of public health review evidence that saves researchers time and effort in locating, screening and assessing the quality of evidence for improved decision making. Dobbins is a member of the International Advisory Board of Reflections on Nursing Leadership and also serves on the editorial board of Worldviews on Evidence-Based Nursing, published by Wiley-Blackwell and the Honor Society of Nursing, Sigma Theta Tau International.