Adapting the Individualised Care Scale for cross-cultural comparison: an international study

Riitta Suhonen, Agneta Berg, Ewa Idvall, Maria Kalafati, Jouko Katajisto, Lucy Land, Chryssoula Lemonidou, Lee A. Schmidt, Maritta Välimäki, Helena Leino-Kilpi

Research output: Contribution to journalArticlepeer-review

28 Citations (Scopus)


Rationale:  Cross-cultural comparative studies using reliable and valid instruments can increase awareness of the differences and similarities between health worker’s ability to respond to patients’ individual needs within different health systems. This will enable a better understanding of cultural perspectives in individualized nursing care.

Aim:  To describe the translation and adaptation process of the Individualized Care Scale (ICS) and examine its reliability and validity in a cross-cultural study.

Design:  A cross-sectional comparative study.

Settings:  Twenty-seven orthopaedic and trauma in-patient units at 14 hospitals in 5 countries.

Participants:  A total of 1126 patients were included in the study: Finland (n = 425), Greece (n = 315), Sweden (n = 218), UK (n = 135) and USA (n = 33).

Methods:  A systematic forward- and back-translation procedure using bilingual techniques, a committee approach, pretest techniques and pilot testing were used with a convenience sample to produce a valid ICS for each participating group. Psychometric evaluation of the adapted ICS was based on means, SD, missing data analysis, Cronbach’s alpha coefficients and average inter-item correlations. Construct validity was examined using sub-scale correlations to total scales and principal components analysis.

Results:  The use of the range of options and the sub-scale mean scores ranging from 2.72 to 4.30 demonstrated the sensitivity of the scale. Cronbach’s alpha coefficients (0.77–0.97) and average inter-item correlations (0.37–0.77) were acceptable. The sub-scale correlations to total scales were high (0.83–0.97). The underlying theoretical construct of the ICS was demonstrated by the explained variances ranging from 58% to 79%.

Conclusions:  The ICS shows promise as a tool for evaluating individualized care in European cultures. The international expansion of an existing instrument developed for one country facilitates comparative studies across countries. There is a need to further test the construct validity and appropriateness of the ICS in different settings in European and nonwestern cultures.

Original languageEnglish
Pages (from-to)392-403
Number of pages11
JournalScandinavian Journal of Caring Sciences
Issue number2
Publication statusPublished - 2010

Swedish Standard Keywords

  • Nursing (30305)


  • cross-cultural comparison
  • individualized nursing care
  • inpatients
  • instrument adaptation


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