gms | German Medical Science

Background: In dementia care, the design of the environment is regarded as an essential element of the care concept of a nursing home. To date, there is no valid instrument in the German-speaking countries that systematically assesses the quality of the physical environment in nursing homes.

Aim: Therefore, the Australian "EAT-HC" developed by Fleming and Bennett (2015) was translated into German, linguistically validated and culturally adapted. The process took place in close collaboration with the Australian instrument developers. The aim was to generate a valid instrument that could be internationally compared with the origin version and further translations of the EAT-HC.

Methods: The procedure was carried out following an adapted multi-step process of the World Health Organization (1998) by involving scientific and practical experts from Germany as well as the developers of the instrument. After the forward translation, linguistic validation and cultural adaption was performed by consulting a bilingual panel, conducting five focus groups interviews with practitioners and scientific experts in the field and a content validity indexing (according to Lynn, 1984) with scientific experts. In the focus groups, participants were asked about the meaningfulness of the individual items and the need for adaptation. The quantitative survey focused on the experts´ assessment of the relevance and understanding of the individual items. To complete the process, the German version of the EAT-HC (GEAT) was back-translated and reviewed by the instrument developers.

Results: The comprehensive translation and adaptation process made it possible to generate a first version of the german EAT-HC (GEAT). The instrument contains 77 questions that can be categorized into 10 dimensions. By involving various experts in the adaptation process, it was possible to identify several cultural differences between the country of origin and the country of destination, which must be included in the German version of the instrument. Fire safety regulations and the implementation of the Housing and Participation Act should be emphasized.

Discussion: The GEAT adaptation process made it possible to clarify the complexity of the quantified assessment of the physical environment. The psychometric properties of the instrument now has to show whether the operationalisation of the GEAT construction can include all structural factors of the long-term care setting in Germany. It must also be tested to what extent highlighted cultural differences between Australia and Germany lead to the redundancy of specific items or make the extension of the instrument necessary.

Practical implications: By adapting the GEAT, an attempt was made to be able to quantify the dementia-friendliness of the environment in long-term care facilities. The mapping of the factor of the physical environment could also help in future to differentiate the influence of this more clearly from that of the social environment (staff, family, and other residents).