ArticleJMIR formative research2026
Unified Theory of Acceptance and Use of Technology Questionnaire in Swedish Prehospital Care: Translation, Cross-Cultural Adaptation, and Pilot Psychometric Study.
Article in JMIR formative research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Digital technologies in emergency medical services (EMS) have become crucial for patient outcomes and survival, and the integration of novel technologies drives rapid transformation within EMS. Understanding the acceptance and use of digital technology among EMS health care providers is paramount for implementation and effective use of novel digital tools. Currently, instruments assessing acceptance of technology are lacking within the Swedish EMS context. Objective: The aim of this study was to translate and culturally adapt the unified theory of acceptance and use of technology (UTAUT) questionnaire into Swedish for use in prehospital health care and to evaluate its psychometric properties. Methods: A methodological study was conducted using sequential qualitative and quantitative components, following the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines for translation and cultural adaptation, and the Rasch Reporting Guideline for Rehabilitation Research (RULER) framework to guide the reporting of Rasch analysis. The translation process included forward and backward translation and harmonization, followed by a first round of cognitive interviews with ambulance nurses (n=6). A revised version was tested in the second round with the same participants. The adapted questionnaire was pilot tested among EMS personnel (n=91). Psychometric properties, including unidimensionality, response category functioning, targeting, reliability, and differential item functioning (DIF), were evaluated using Rasch analysis. Results: The cognitive interviews identified linguistic and contextual ambiguities requiring item revisions for several UTAUT constructs related to performance expectancy, social influence, and behavioral intention (BI). Rasch analysis revealed disordered response categories for several items, requiring collapsing of categories before analysis. After adjustment, overall item fit was acceptable, with minor misfit in a small number of items (facilitating conditions 1 infit mean square fit statistics [MSQ]=0.68; BI2 infit MSQ=0.57). Unidimensionality was supported for each UTAUT construct (Eigenvalues 1.59-1.80), although reliability (person separation index range 0.55-0.75) and targeting (person mean location 0.29-0.74 logits) differed, with limited item coverage and measurement precision for the construct BI (1.24 logits). No substantial DIF for sex was identified. Conclusions: The translated and adapted Swedish UTAUT questionnaire achieved linguistic and contextual relevance among Swedish EMS personnel, although acceptable psychometric properties were not observed across all constructs, particularly the construct of BI. This indicates that translation and adaptation alone are not sufficient, and further refinement of the questionnaire with larger samples is warranted before routine and broader application can be recommended in Swedish prehospital care.
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