The Swedish Version of the Barrier and Facilitator Assessment Instrument: Translation, Adaptation, and Initial Psychometric Testing in a Large and Nationwide Sample

Abstract Background Few scales designed to assess factors that facilitate and/or impede the uptake of guidelines in routine care are valid, reliable, and cover multiple domains. The Barriers and Facilitators Assessment Instrument (BFAI) measures barriers on four scales: Innovation, Provider, Patient, and Context and is one of few evaluated for psychometric properties, primarily in the context of adult health care. This study aimed to contribute to the development and cross-validation of the BFAI by examining a Swedish version as part of a larger depression guideline implementation across child and adolescent mental health services (CAMHS). The study also explored the relationship between attitudes toward evidence-based practice, as measured by the Evidence-Based Practice Attitude Scale (EBPAS), and perceived barriers to guideline implementation. Methods The BFAI was translated, adapted, and completed by 440 CAMHS clinicians (52% response rate) across Sweden. Items were tested and scales’ internal consistency and dimensionality were examined using Cronbach alpha and exploratory factor analyses. Results Items satisfied criteria set by developers. The internal consistency and dimensionality of the four scales were supported. The Patient and Innovation scales had the best psychometric properties, while the Context scale had some issues due to the intra- and interdomain correlations. Correlations between BFAI and EBPAS scales were in the expected direction (negative) but weak. Conclusion The Swedish version of the BFAI exhibited acceptable psychometric properties; single items can be used for tailoring local strategies in implementation programs. The BFAI scales might also be suitable for research by providing more specific information about guideline implementation challenges than the EBPAS.