title: Assessing the physical environment of older people's residential care facilities: development of the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM).
abstract: BACKGROUND
  There is emerging evidence that the physical environment is important for health, quality of life and care, but there is a lack of valid instruments to assess health care environments. The Sheffield Care Environment Assessment Matrix (SCEAM), developed in the United Kingdom, provides a comprehensive assessment of the physical environment of residential care facilities for older people. This paper reports on the translation and adaptation of SCEAM for use in Swedish residential care facilities for older people, including information on its validity and reliability.
  
  
  METHODS
  SCEAM was translated into Swedish and back-translated into English, and assessed for its relevance by experts using content validity index (CVI) together with qualitative data. After modification, the validity assessments were repeated and followed by test-retest and inter-rater reliability tests in six units within a Swedish residential care facility that varied in terms of their environmental characteristics.
  
  
  RESULTS
  Translation and back translation identified linguistic and semantic related issues. The results of the first content validity analysis showed that more than one third of the items had item-CVI (I-CVI) values less than the critical value of 0.78. After modifying the instrument, the second content validation analysis resulted in I-CVI scores above 0.78, the suggested criteria for excellent content validity. Test-retest reliability showed high stability (96% and 95% for two independent raters respectively), and inter-rater reliability demonstrated high levels of agreement (95% and 94% on two separate rating occasions). Kappa values were very good for test-retest (κ = 0.903 and 0.869) and inter-rater reliability (κ = 0.851 and 0.832).
  
  
  CONCLUSIONS
  Adapting an instrument to a domestic context is a complex and time-consuming process, requiring an understanding of the culture where the instrument was developed and where it is to be used. A team, including the instrument's developers, translators, and researchers is necessary to ensure a valid translation and adaption. This study showed preliminary validity and reliability evidence for the Swedish version (S-SCEAM) when used in a Swedish context. Further, we believe that the S-SCEAM has improved compared to the original instrument and suggest that it can be used as a foundation for future developments of the SCEAM model.
authors.affiliation: Dalarna University, School of Education, Health and Social Studies, Falun, Sweden. snr@du.se.
authors.forename: Susanna
authors.initials: S
authors.lastname: Nordin
authors.forename: Marie
authors.initials: M
authors.lastname: Elf
authors.forename: Kevin
authors.initials: K
authors.lastname: McKee
authors.forename: Helle
authors.initials: H
authors.lastname: Wijk
mesh_terms: D000368:Aged; D004779:Environment Design; D005260:Female; D006272:Health Facility Environment; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D015588:Observer Variation; D011788:Quality of Life; D015203:Reproducibility of Results; D013548:Sweden; D014177:Translations