Occupational Therapy In Health Care
ISSN: 0738-0577 (Print) 1541-3098 (Online) Journal homepage: http://www.tandfonline.com/loi/iohc20
Factor Structure and Construct Validity of Children Participation Assessment Scale in Activities Outside of School–Parent Version (CPAS-P) Malek Amini, Afsoon Hassani Mehraban, Hamid Haghani, Emad Mollazade & Masoome Zaree To cite this article: Malek Amini, Afsoon Hassani Mehraban, Hamid Haghani, Emad Mollazade & Masoome Zaree (2017) Factor Structure and Construct Validity of Children Participation Assessment Scale in Activities Outside of School–Parent Version (CPAS-P), Occupational Therapy In Health Care, 31:1, 44-60, DOI: 10.1080/07380577.2016.1272733 To link to this article: http://dx.doi.org/10.1080/07380577.2016.1272733
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Date: 03 February 2017, At: 12:08
OCCUPATIONAL THERAPY IN HEALTH CARE , VOL. , NO. , – http://dx.doi.org/./..
Factor Structure and Construct Validity of Children Participation Assessment Scale in Activities Outside of School–Parent Version (CPAS-P) Malek Aminia , Afsoon Hassani Mehrabanb , Hamid Haghanic , Emad Mollazaded , and Masoome Zareed a
Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran; b Department of Occupational Therapy and Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran; c Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran; d School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
ABSTRACT
ARTICLE HISTORY
The aim of this study was assess the factor structure, reliability and construct validity of the Children Participation Assessment Scale in Activities Outside of School–Parent Version (CPAS-P). The participants of this study were 700 parents of children aged 6– 12 years. For data analysis, the confirmatory factor analysis, internal consistency, and test–retest reliability were conducted. Convergent validity was calculated by correlation with the Vineland Adaptive Behaviour Scale. The results indicated the CPAS-P has good internal reliability. Overall, Cronbach’s alpha for the participation measures ranged between 0.87 and 0.91, indicating good homogeneity, and Spearman correlations for convergent validity was acceptable. The temporal stability of the CPAS-P was supported with Intra-Class Correlations ranging from 0.79 to 0.94. Therefore, the CPAS-P, which evaluates all eight areas of occupation (i.e., activities of daily living, instrumental activities of daily living, play, leisure, social participation, education, work, and sleep/rest) has demonstrated good psychometric properties; and can be used as a reliable and valid measure to assess children’s participation at the age of 6–12 years.
Received May Accepted December KEYWORDS
Child participation; occupation; parent’s questionnaire; out-of-school activities
Participation is defined by International Classification of Functioning, Disability and Health (ICF) as involvement in life Situations (WHO 2001). Participation is a multidimensional construct affected by many factors (e.g., gender, age, and performance skills) as well as environmental factors (e.g., accessibility, social, and economic status) (Chen & Cohn, 2003). Considering the ICF’s definition of participation and the fact that participation is deemed as the ultimate product of rehabilitation for people with disabilities (Adair et al., 2015, Rosenberg et al., 2010), it is essential to thoroughly and properly evaluate participation in different CONTACT Afsoon Hassani Mehraban, PhD
[email protected] Associate Professor, Department of Occupational Therapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran Alley, Shahnazari Str., Madar Sq., Mirdamad Blv, Tehran, Iran. Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/iohc. © Taylor & Francis Group, LLC
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aspects of life using inclusive and comprehensive tools with the aim of setting goals, implementing treatment programs, and estimating the efficiency of interventions (Forsyth & Jarvis, 2002, Simeonsson & Lollar, 2005). Participation measurement should assess children engagement in all areas of occupation at home, at school and in society (Simeonsson & Lollar, McConachie et al., 2006, Coster & AlunkalKhetani, 2008). One of the drawbacks of the current tools, such as Children Assessment of Participation and Enjoyment (CAPE) (King et al., 2004), Pediatric Activity Card Sort (PACS) ( Mandich et al.), and Life-Habit (Life-H) ( Morris et al., 2005), is that despite the fact that they have been developed by occupational therapists, they do not measure all areas of occupation. The frequently used CAPE includes the occupations of activities of daily living (ADL), education, work, and sleep/rest, but does not measures play, social participation, and leisure (Heah et al., 2007, Amirian et al., 2015). The PACS has been developed for children aged 5 to 14 years, and includes ADL, instrumental activities of daily living (IADL), play, leisure, social participation, and education, but does not address work and sleep/rest (Chien et al., 2013). In a similar vein, Life-H does measure ADL, IADL, leisure, and social participation, but does not measure education, work, and sleep/rest (Morris et al., 2005). In addition to the requirement of including all areas of occupation in assessment tools, for each activity there should be some objective dimensions for responses in order to be able to measure complex and multidimensional participation more accurately and obtain more comprehensive information on children’s participation. These objective dimensions are as include: diversity (the activity is performed or not), frequency (the frequency of participation), with whom (the activity is performed alone or with others), the children’s level of enjoyment and parent satisfaction. Table 1 illustrates each tools, the age group, and other characteristics of some existed instruments. Participation and environment are multidimensional constructs that have been challenging to measure (Coster et al., 2012). In regard to lack of some important aspects of current participation assessment tools, this study conducted to evaluate factor structure, construct validity, and test–retest reliability of CPAS-P. Method Participants
The sample of this study consisted of parents of typically developing students in grades one to six (aged 6–12 years old) in Tehran. The sampling type used in this study was multistage. In stage 1, different parts of Tehran were classified as the North, South, East, and West areas. Then, as stage 2, one district was randomly selected from each of these areas by General Center of Education, and was introduced to the researcher. Afterwards, General Center of Education sent a letter of introduction to these districts. At stage 3, one region was randomly selected from each of these districts by Department of Education of the corresponding district and then finally, in stage 4, a one boy’s school and one girl’s school were randomly chosen from these regions, and then the process of sampling commenced.
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Table . Feature of participation scales. Assessment
Age Range (years)
Format of administration
Assessment areas (according to OTPF)
Objective dimension for responses diversity, intensity, with whom, where, enjoyment, preference Diversity, Intensity, Independence, Child enjoyment, Parent satisfaction Diversity, Frequency, Like or enjoyement
CAPE (Heah et al., )
–
Self or interviewer Individual/group
Leisure, Social participation, Play
CPQ (Rosenberg et al., )
–
Parent-Report
PACS (Chien et al., )
–
interview-based self-report
Life-H (Morris et al., )
–
Self/parent report
ADL, IADL, Play, Leisure, Social participation, Education ADL Play, Leisure, Social participation, Education ADL, IADL, Leisure, Social participation
CLASS (Telford et al., )
–
Self report
Leisure
PEM-CY (Coster et al., )
–
Parent report
Education, ADL, IADL
Interview
Can be used for all areas ADL, IADL, Play, Leisure, Social participation, Education, Work, Sleep/Rest
GAS (Kiresuk et al., ) CPAS_P (Amini et al., )
All ages –
Parent-report
Assisstance, Satisfaction, Difficalty Variety, Frequency, Sociability, Preference frequency, extent of involvement, and desire for change — Diversity, Frequency, with Whom, Enjoyement, Parent Satisfaction
The sample size for factor analysis must be three to ten times the number of items in the questionnaire under study (Guadagnoli & Velicer, 1988, Knapp & Brown, 1995). Since in this study, the number of items in the questionnaire was 71, 700 parents were asked to complete the subjects. A sample of 31 parents was used for estimating the test–retest reliability and a sample of 700 parents for assessing the internal consistency. And a sample of 122 parents were asked for convergent validity.
Instruments The children participation assessment scale in activities outside of school The CPAS-P was developed for children aged 6 to 12 years in two versions (a child version and parent version) and evaluate children’s activities outside of school and across two major settings (home and community) (Aminiet al., 2016). Both versions are in English. In this study, the parent version (CPAS-P) was selected to be studied. A pilot study on the procedure of developing the CPAS_ P showed that selecting the age of 6–12 is appropriate for instrument (Amini et al., 2016). The construction and design of this instrument and its framework are based on Occupational Therapy Practice Framework: Domain and Process, 3th edition (OTPF-3) (American Association of Occupational Therapy 2014). The instrument was designed to be used as a descriptive and evaluative questionnaire with healthy children and children with disabilities. The process of developing this the CPAS-P was based on the OTPF, expert reviews, experts panels, pilot study with children’s and parents’ views,
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and included the verification of face and content validities (Amini et al., 2016). The 71 items in this questionnaire cover eight areas of occupation: ADL (such as taking a shower), IADL (such as cleaning their room), play (computer games), leisure (watching TV), social participation (partaking in a friend’s birthday party), education (participating in sports classes), work (doing paid work), and sleep/rest (reading before bed). For all activities, the diversity, frequency of children’s participation, with whom they performed the activity, the level of their pleasure and enjoyment, and parent satisfaction must be reported. Therefore, the CPAS-P includes five scales: (1) diversity of performing the activity (taking the value of 1) or not performing it (taking the value of 0), (2) the frequency of participation with scores ranging from 1 (done once in 4 months) to 6 (carried out every day), (3) with whom the activity is done with scores ranging from 1 (done alone) to 5 (done with others), (4) the level of enjoyment with scores ranging from 1 (not at all) to 5 (a lot), and (5) parent satisfaction from 1(not at all satisfied) to 4 (very satisfied) (Amini et al., 2106). Vineland Adaptive Behavior Scale. The Vineland Adaptive Behaviour Scale (VABS) (Sparrow et al., 1984) is a semistructured interview addressed to parents or caregivers to assess children’s adaptive behavior from birth to 18 years of age. The VABS was chosen to establish criterion validity of the CPAS-P as it is the only instrument that assesses similar constructs to those of the CPAS-P, and is commonly used in validity studies of developing new tools (Ognowski et al., 2004, Saigal et al., 2005). The VABS has sound psychometric properties (Balboni et al., 2001). CPAS-P developed for children aged 6–12 years, and evaluate children’s activities outside of school. The responses to the items in this tool were obtained via self-reports. The time required for the completion of the questionnaire was 30–45 minutes (Amini et al., 2016).
Procedure
This project was approved by the Ethics Committee of Iran University of Medical Sciences. The study was undertaken on parents of children via self-reports. The questionnaires (demographic, CPAS_P, and VABS) and consent form were put together in packages for the children to take home. A comprehensive explanation of how to complete the questionnaire was provided as well as the informed consent form. The parents were asked to sign their informed consent within 2 weeks if they agree on participation in this research, and send them to school via their child. Packages containing the questionnaires were sent to 1200 families (300 families in each area), and 720 families gave their consent to this research, and the rest were excluded, as this is a right for all potential participant. Twenty questionnaires were excluded because of incomplete information. The final sample size was 700. In order to determine the test-retest reliability, the package containing the questionnaire, the necessary explanation of the research purposes and how to answer the items of the questionnaire, were sent to the children’s families from final sample who
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were asked to declare their consent if they agree. Then, in order to retest of questionnaire, parents completed it with the interval of two weeks again. In order to check the test–retest reliability of the questionnaire, it was sent to 50 families, and just 31 of them completed the questionnaire, and the rest were excluded. Also, VABS was sent to 150 of that parents from final sample size for convergent validity, and 122 of them completed the questionnaires. Data analysis
Factor analysis was run via LISREL software 8.80, and GFI (Goodness of fit index), AGFI (Adjusted Goodness of Fit Index), NFI (Normal Fix Index), CFI (Comparax2 tive Fit Index), IFI (Incremental Fit Index), df index, and Root Mean Square Error of Approximation (RMSEA) were estimated for frequency scores. GFI, AGFI, NFI, CFI, and IFI Indices are between 0 and 1, and the closer they are to 1, the greater the goodness of fit model will be for the observed data (Baumgartner & Hombur, 1996, Hu & Bentler, 1998, Sharma et al., 2005, Hooper et al., 2008, Yusoff 2011). If the RMSEA value is less than 0.08, the fitness model meets the acceptable level, and x2 if it is greater than this value, the model is designed poorly. If the df index is less than 3, the goodness of fit will better (Hu & Bentler, 1998, Hooper et al., 2008). SPSS software and Cronbach’s alpha were used to determine the internal consistency. In order to analyze the test-retest reliability, SPSS software and Intraclass Correlation Coefficient (ICC) were used. The Spearman correlation test was used for convergent validity. Results The mean age of the children participating in this study was 9.45 years (SD = 1.76 years) and the means age of parents was 41.47 years for fathers and 36.53 years for mothers (Table 2). Confirmatory factor analysis
For the confirmatory factor analysis, LISREL software 8.80 was used. In the fitness test, in the confirmatory and path analysis, if the value of RMSEA index, or the Root x2 Mean Square of error variance, is approximately less than 0.08, the df index is less than 3, and GFI, CFI, IFI, NNFI is greater than 0.90, and if the significant coefficients (T-Value) of each variable is larger than 1.96 and less than −1.96, the model is a good fit. The confirmatory factor analysis was conducted in two stages. Initially, the confirmatory analysis was run for each factor separately, and those items with low correlations were identified, and in the second stage, confirmatory factor analysis was run for all items (Somers et al., 2003). We used the Diagonally Weighted Least Squares (DWLS) estimator in first and second step. All steps of procedure with results as summarized in Figure 1.
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Table . The results of demographic properties. Variables Chilren’s Age
Gender Residence Types Ownership Living area
N
Years
Percentage Frequency
years old years old years old years old years old years old years old Girls Boys
. . . . . . . . .
Apartment House messuage Owner Tenant
. . . .
East West North South
. . . .
First step
The confirmatory factor analysis was run for each of the eight areas in the questionnaire separately. Each of the areas (11 item ADL, 10 item IDAL, 13 item play, 16 item leisure, 12 item social participation, 4 item education, 2 item work, and
Figure . The measurement of the overall model in standard state.
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3 item sleep/rest) and the individual items were inserted in the model as latent variables and as observed variables, respectively. Considering the significant values of factor loading (which must be higher than 1.96 or less than −1.96), Item 10 (putting on and taking off clothes, and maintaining Aid supplies with a significant value of −0.08), Item 38 (watching TV or CDs with a significant value of 1.49), and Item 67 (doing paid work with a significant value of 1.94) were excluded from the questionnaire. Therefore, the number of items in the questionnaire was 68 for the subsequent analyses (see Appendix). At the first stage of factor analyzing of separated factors, three items excluded and all of the factors reached good fit Indexes and the models of each structures was confirmed (RMSEA> 0.08, and GFI, CFI, IFI, NNFI > 0.9) ( see Table 3). Second step in the confirmatory factor analysis of CPAS-P
Three items (10, 38, and 67) were excluded in the first stage. At the second stage, 68 items as observed and 8 factors as latent variable were inserted in LISREL as the input and were analyzed via LISREL software 8.80 (see Figure 1). Based on Table 3, which presents the model fit indices, the values for all fit indices were proved to be at an acceptable and good fit of the model and data, and reached satisfactory levels of model fitting. Internal consistency of CPAS-P
In order to calculate the internal consistency of the data, Cronbach’s alpha was used. The guide for Alpha coefficient values are above 0.9 (high), between 0.7 and 0.9 (good), between 0.6 and 0.7 (acceptable), between 0.5 and 0.6 (weak), and less than 0.5 (unacceptable) (Cortina 1993, Coster et al., 2011, Kielhofner 2006). The Cronbach’s alpha coefficients for participation dimensions (frequency, with whom, levels of enjoyment and parent satisfaction) of each of the areas of occupation as well as the overall Cronbach’s alpha coefficient were estimated. The results of these data analyses are reported in Table 4. In order to determine test-retest reliability, the ICC was used. In ICC, the value above 0.75 indicates an excellent reliability; the reliability value above 0.70 is acceptable. If it is between 0.60 and 0.75, it is deemed to have a good level of reliability, and a value between 0.40 and 0.59 shows weak reliability (Portney & Watkins 2009, Naghdi et al., 2015). Convergent validity of CPAS-P
Convergent validity was computed using Spearman correlations between the CPAS-P total measures (diversity, frequency, with whom, enjoyment, and parent satisfaction) and the VABS subscales (ADL, Communication, Socialization, and Motor skills; see Table 5). Convergent validity was partially supported by the significant, low to moderate correlations between the objective CPAS-P total participation
χ /df GFI (Goodness of Fit Index) AGFI (Adjusted Goodness of Fit Index) RMR (Root Mean square Residual) NFI (Normed Fit Index) NNFI (Non-Normed Fit Index) IFI (Incremental Fit Index) CFI (Comparative Fit Index) RMSEA (Root Mean Square Error of Approximation)
Fit indices . >. . >. >. >.
