Abstract

Objectives: ASCOT, a measure of service-users’ and carers’ quality of life, has been noted by researchers, policy makers and practitioners in many countries as a measure with the potential to appropriately capture the outcomes of long-term care and other services for older people. Adapting such instruments for use in other countries requires adequate cross-cultural translation and validation.

This paper aims to provide an overview of the translation of the ASCOT instrument for service users (ASCOT-S) and carers (ASCOT-C) into German and the cross-cultural validation.

Methods: The ASCOT-SCT4 instruments were translated from English into German by a translation company. Back-forward translations, independent proofreading, consultations of the ASCOT-team and pilot testing reviews aimed to assure a high quality translation.

For evaluating cross-cultural validity, we applied two methodological approaches. First, we conducted cognitive interviews with service users, carers, professional care workers to test for the understanding of the main concepts. Second, quantitative methods were used: a factor analysis (confirmative factor analysis, using a maximum likelihood estimate) was employed to identify whether one single factor underlies the ASCOT items. We used hypothesis testing to assess the relationship between the domains of the ASCOT measure and related constructs. These associations had been established in previous English studies and were tested using Chi-squared tests and one-way analysis of variance.

Results: Qualitative methods supported cross-cultural validity of the German ASCOT-instruments. A Cronbach’s alpha of 0.7 (ASCOT-S) and 0.8 (ASCOT-C) and a confirmatory factor analysis provided further support that the domains of the 4-level ASCOT instrument measure a single underlying construct, namely social care related quality of life. Hypothesis testing showed that the ASCOT items are statistically significantly associated with related constructs.

Discussion: Our research gives insight into the manifold steps taken to generate a valid instrument for assessing social-care related quality-of-life of German speaking homecare service users and their carers. In addition, the instrument may help care organisations and policy makers to learn more about service users’ living situation. Future research should explore the potential of the Austrian ASCOT instruments to inform economic, or other, evaluations of long-term care and other services for older people.