Abstract

Objectives: Policymakers need to focus on delivering social care services that make the greatest difference to people’s lives in order to deliver them effectively and efficiently. There has been a call for developing appropriate self-reported outcome measures to support such a goal. The Adult Social Care Outcomes Toolkit (ASCOT) was developed in England to measure self-reported outcomes of users of long-term social care services. The aim of this paper is to provide an overview of findings from the process of adapting the English ASCOT for service users involving translating the instrument into Finnish and assessing the construct validity of the Finnish-translated ASCOT.

Methods: The ASCOT-SCT4 instrument was translated from English into Finnish in summer and early autumn 2015 by a translation agency, using forward and back translation methods. To test cross-cultural validity of the translated instrument, cognitive interviews on five service users were conducted in January–February 2016. For assessing the construct validity of the translated ASCOT-INT4 measure, we used data from face-to-face structured interviews of people aged 55 or older receiving publicly-funded home care services. The interviews were conducted in 12 Finnish regions in 2016–2017 (n=493). The analysis data excluded proxy respondents and those with missing values on the analysis variables (n=334). To test the construct validity of each ASCOT attribute, associations between a large number of categorical variables and the attributes were analysed using chi-square tests and relationships between the EQ5D (EuroQol five-dimension scale) score and the attributes were tested using analyses of variance.

Results: Findings from cognitive interviews generally supported cross-cultural validity of the translated instrument. In construct validation, the EQ5D was found to be positively related to the ASCOT attributes, and overall QoL (quality of life) positively related to the attributes other than the dignity attribute. For other characteristics, significant associations with the control over daily life, occupation, social participation and involvement, and personal cleanliness and comfort attributes were found, while fewer significant associations with the food and drink, accommodation cleanliness and comfort, personal safety, and dignity attributes were obtained.

Conclusions: Our findings support the possibility of adapting the ASCOT instrument to countries with different languages and cultures. To ensure comparability of the instruments, translation should be carried out following official guidelines. The results also suggest evidence for the construct validity of the ASCOT attributes and support the use of the Finnish-translated ASCOT version in economic evaluations as well as indicate the viability of its use among older people receiving home care services in Finland.