Swe-IPAT: Assessing Implementation in Swedish Elderly Care

This research article, titled “The Implementation Process Assessment Tool: translation, contextualization, and psychometric evaluation of a Swedish version in a municipal elderly care context,” addresses the pressing challenge of a growing number of older adults with complex healthcare needs coupled with limited resources in health services. To effectively meet this challenge, it is crucial for healthcare staff to be motivated and capable of continuously translating new knowledge and working methods into their daily practice.

The authors highlight that while the efficient implementation of evidence-based practices, smart home devices, and coordinated care interventions is vital for ensuring high-quality future care, the process of implementing innovations and new practices often takes too long, and sustaining improvements remains difficult. The study emphasizes the importance of measuring the implementation process and system factors that influence it, such as contextual, cultural, and economic aspects. It notes that many existing instruments for quantifying these factors have limitations, including unknown psychometric properties, focusing only on the pre-implementation phase, being specific to one setting, or not adequately capturing the staff perspective.

Against this backdrop, the study’s primary aim was to translate, contextualize, and test a Swedish version of the Implementation Process Assessment Tool (IPAT), specifically for measuring the facilitation needs among staff implementing new working processes in municipal elderly care. The original IPAT is a 27-item questionnaire developed in a specialized mental healthcare context in Norway, grounded in the Consolidated Framework for Implementation Research (CFIR) and the stages of change theory.

The research employed a mixed-method design involving three key steps:

• Translation: The original Norwegian IPAT was translated into Swedish, followed by a review by a professional translator and back-translation into Norwegian to ensure accuracy and consistency.
• Contextualization and Face Validity Testing: Twelve staff members from diverse healthcare professions participated in Think-aloud interviews to contextualize the translated instrument and assess its face validity. The instrument, subsequently named Swe-IPAT, was adjusted after each of four rounds of these interviews based on participant feedback to ensure clarity and relevance, particularly for staff in municipal elderly care. Comprehension was the most common area of feedback, with participants suggesting simpler words.
• Psychometric Evaluation: The adjusted Swe-IPAT underwent psychometric evaluation through a cross-sectional survey administered to 305 staff members in municipal elderly care (nursing homes and home help services) in southern Sweden. An exploratory factor analysis (EFA) was conducted to investigate underlying constructs and assess the instrument’s validity and reliability.

The psychometric evaluation of the Swe-IPAT revealed satisfying properties. The EFA suggested three distinct factors, largely consistent with the four factors of the original IPAT, which collectively explained 64.1% of the variance in the data. These factors are:

• Individual phases for behavioral change and perception of the intervention. This factor showed a high internal consistency with a Cronbach’s alpha of 0.93.
• Individual activities. This factor demonstrated good internal consistency with a Cronbach’s alpha of 0.84.
• Collective readiness and support. This factor also exhibited strong internal consistency with a Cronbach’s alpha of 0.95. The overall internal consistency for the total Swe-IPAT instrument was very high, with a Cronbach’s alpha of 0.96.

In conclusion, the study found that the 27-item Swe-IPAT, after translation and contextualization, demonstrates satisfactory psychometric properties when tested in an elderly care context. The authors propose that this instrument can be highly useful in providing feedback to managers for tailoring support and assessing implementation efforts among healthcare staff in elderly care. It has the potential to deliver constructive feedback to managers and implementation teams, helping to foster staff engagement early in the process and identify challenging areas, thereby allowing for tailored implementation support based on specific needs. However, further research is recommended to evaluate its properties throughout the entire implementation process and to test its usability in other healthcare settings.

Reference: Kaltenbrunner, M., Hagerman, H., Fagerström, C., Hartveit, M., Nordheim, E., & Ekstedt, M. (2024). The Implementation Process Assessment Tool: translation, contextualization, and psychometric evaluation of a Swedish version in a municipal elderly care context. BMC Health Services Research, 24(1), 1391. https://doi.org/10.1186/s12913-024-11889-x