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Open Access Research article

German translation of the Alberta context tool and two measures of research use: methods, challenges and lessons learned

Matthias Hoben12*, Cornelia Mahler3, Marion Bär4, Sarah Berger3, Janet E Squires56, Carole A Estabrooks7 and Johann Behrens2

Author Affiliations

1 Network Aging Research (NAR), Ruprecht-Karls-University Heidelberg, Bergheimer Str. 20, Heidelberg 69115, Germany

2 Institute of Health and Nursing Sciences, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle-Wittenberg, Germany

3 Department of General Practice and Health Services Research, University Hospital, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany

4 Institute of Gerontology (IfG), Ruprecht-Karls-University Heidelberg, Heidelberg, Germany

5 School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada

6 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada

7 Faculty of Nursing, University of Alberta, Edmonton, Canada

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BMC Health Services Research 2013, 13:478  doi:10.1186/1472-6963-13-478

Published: 16 November 2013



Understanding the relationship between organizational context and research utilization is key to reducing the research-practice gap in health care. This is particularly true in the residential long term care (LTC) setting where relatively little work has examined the influence of context on research implementation. Reliable, valid measures and tools are a prerequisite for studying organizational context and research utilization. Few such tools exist in German. We thus translated three such tools (the Alberta Context Tool and two measures of research use) into German for use in German residential LTC. We point out challenges and strategies for their solution unique to German residential LTC, and demonstrate how resolving specific challenges in the translation of the health care aide instrument version streamlined the translation process of versions for registered nurses, allied health providers, practice specialists, and managers.


Our translation methods were based on best practices and included two independent forward translations, reconciliation of the forward translations, expert panel discussions, two independent back translations, reconciliation of the back translations, back translation review, and cognitive debriefing.


We categorized the challenges in this translation process into seven categories: (1) differing professional education of Canadian and German care providers, (2) risk that German translations would become grammatically complex, (3) wordings at risk of being misunderstood, (4) phrases/idioms non-existent in German, (5) lack of corresponding German words, (6) limited comprehensibility of corresponding German words, and (7) target persons’ unfamiliarity with activities detailed in survey items. Examples of each challenge are described with strategies that we used to manage the challenge.


Translating an existing instrument is complex and time-consuming, but a rigorous approach is necessary to obtain instrument equivalence. Essential components were (1) involvement of and co-operation with the instrument developers and (2) expert panel discussions, including both target group and content experts. Equivalent translated instruments help researchers from different cultures to find a common language and undertake comparative research. As acceptable psychometric properties are a prerequisite for that, we are currently carrying out a study with that focus.

Translation; Cultural adaptation; Alberta Context Tool; Estabrooks’ Kind of Research Utilization; Conceptual Research Use scale; Organizational context; Research utilization; Residential long term care