title: The German version of the Assessment of Chronic Illness Care: instrument translation and cultural adaptation.
abstract: BACKGROUND
  In Switzerland, there is a dearth of information on the extent to which patients with chronic illnesses receive care congruent with the Chronic Care Model (CCM). To drive quality improvement programmes, it is necessary to have practical assessment tools in the country's own language to evaluate the delivery of CCM activities.
  
  
  METHODS
  German translation and adaptation of the original Assessment of Chronic Illness Care (ACIC). We followed a sequential forward and backward translation approach. In a multidisciplinary committee review the original English version and the translations were compared, instructions and formats modified and cross-cultural equivalences verified. The second version was pre-tested and multidisciplinary group discussion led to the final version which aimed to create a comprehensive culturally adapted translation capturing the original idea of the items rather than a direct one to one translation.
  
  
  RESULTS
  Difficulties encountered during the translation process consisted in the difference of health care settings and health care organization in Switzerland and USA.The adapted German version was delivered to a managed care organization in the city of Zurich to test the initial use for diabetes care. The average ACIC subscale scores were: organization of the health care delivery system: mean (m) = 7.31 (SD = 0.79), community linkages: m = 3.78 (SD = 1.09), self-management support: m = 4.88 (SD = 1.21), decision support: m = 4.79 (SD = 1.16), delivery system design: m = 5.56 (SD = 1.28) and clinical information systems: m = 4.50 (SD = 2.69). Overall, the ACIC subscale scores were comparable with the scores of the original testing.
  
  
  CONCLUSIONS
  After cultural adaptations the German version of the ACIC is applicable as a tool to guide quality improvement in chronic illness care in German speaking countries in Europe.
authors.affiliation: Department of General Practice and Health Services Research, University of Zurich, University Hospital of Zurich, Switzerland. claudia.stey@usz.ch
authors.forename: Claudia
authors.initials: C
authors.lastname: Steurer-Stey
authors.forename: Anja
authors.initials: A
authors.lastname: Frei
authors.forename: Gabriela
authors.initials: G
authors.lastname: Schmid-Mohler
authors.forename: Sibylle
authors.initials: S
authors.lastname: Malcolm-Kohler
authors.forename: Marco
authors.initials: M
authors.lastname: Zoller
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D054521:Cultural Competency; D003920:Diabetes Mellitus / Q000628:therapy; D006801:Humans; D008962:Models, Theoretical; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires / Q000592:standards*; D013557:Switzerland; D014175:Translating