Young Children's Participation and Environment Measure: Swedish Cultural Adaptation

Child and adolescent participation measurement tools and their translations: A systematic review

BACKGROUND

Numerous participation measurement tools targeting children and youth have been developed. Despite the translation of these tools into specific languages and cultures, the reliability and validity of the translated versions remain uncertain. To address this gap in knowledge, this study aims to identify tools for assessing the participation of children aged 5-18 years and to appraise the psychometric properties of their translated versions.

METHODS

Four electronic databases were searched for peer-reviewed studies published in English. Preferred Reporting Items for Systematic Reviews guidelines was followed. Study titles and abstracts were screened by four independent reviewers. Data were extracted for both original and translated versions of eligible tools. Instrument quality assessments were performed using the Outcome Measures Rating Form Guidelines. Any discrepancies were resolved by consensus.

RESULTS

Out of the 31 measurement tools examined, 18 tools had at least one translated version available, and among those original measurement tools, a total of 58 translated versions were identified. The most widely translated tool was the Physical Activity Questionnaire for Children (12 languages), and the most frequently translated language was Chinese (7 tools). Most translated versions verified internal consistency and content validity. Only three translated versions were verified inter-rater reliability, and seven translated versions were tested criterion validity with the gold standard tools assessing participation of children (e.g., accelerometer, Pediatric Evaluation of Disability Inventory and four 24-h recalls). None of the translated versions were tested for intra-rater reliability and responsiveness.

CONCLUSIONS

These findings can support the selection of psychometrically sound tools for children with disabilities, given their culture and language, and tool quality.

Translation and cross-cultural adaptation of the young children participation and environment measure for its use in Austria, Germany, and Switzerland

Background

Concepts such as participation and environment may differ across cultures. Consequently, cultural equivalence must be assured when using a measure like the Young Children Participation and Environment Measure (YC-PEM) in other settings than the original English-speaking contexts. This study aimed to cross-culturally translate and adapt the YC-PEM into German as it is used in Germany, Austria, and Switzerland.

Methods

Following international guidelines, two translations were compared, and the research and expert team made the first adaptations. Twelve caregivers of children with and without disabilities from three German-speaking countries participated in two rounds of think-aloud interviews. Data were analyzed by content analysis to look for item, semantic, operational, conceptual, and measurement equivalence to reach a cultural equivalence version in German.

Results

Adaptations were needed in all fields but prominently in item, operational, and conceptual equivalence. Operational equivalence resulted in graphical adaptations in the instructions and questions to make the German version of YC-PEM, YC-PEM (G), more user-friendly.

Conclusion

This study presents a cross-cultural translation and adaptation process to develop a German version of the YC-PEM suitable for Germany, Austria, and Switzerland. A culturally adapted YC-PEM (G) is now available for research, practice, and further validation.

Environment Mediates the Relationship Between Preschoolers Functioning and Involvement in Out-of-School Activities

This study aims to understand the associations between child functioning and environmental barriers and the involvement of preschool children, with and without disabilities, in out-of-school activities, namely, home and community activities. Particularly, we aimed to investigate if environmental barriers mediate the relationship between child functioning and their involvement in these activities. Parents of 116 preschool-aged children (42 children with disabilities) reported on children's involvement and environmental factors at home and in the community. Preschool teachers assessed child functioning. Multiple linear regressions and mediation analysis were performed. Results indicated significant associations between child functioning, perceived environmental barriers, and involvement at home and in the community. A significant indirect association of child functioning on involvement through the perception of environmental barriers was found in both contexts. Findings support the biopsychosocial model of participation and a focus on environmental features by practitioners designing and implementing intervention strategies.

The Structured Preschool Participation Observation (SPO) for Children with ASD: Adaptation, Initial Psychometric Properties, and Children's Participation

Aims: Due to the lack of tools evaluating participation of children with ASD in the educational setting, this study aimed to adapt the Structured Preschool Participation Observation (SPO), which assess the participation of preschool children attending mainstream-educational settings to children with ASD attending non-inclusive special education (content validity), to measure its initial psychometric properties (internal reliability, inter-rater reliability), and to describe children's participation characteristics, creating an effective tool to fill this gap.Methods: Content validity was evaluated by 21 experts using questionnaires. Thirty-five children with ASD were observed in their educational setting using the adapted tool (SPO-ASD).Results: Content validity was satisfactory regarding the items and their classification into occupational areas. Moderate to excellent internal consistency (α = .73-.92) and inter-rater reliability (ICC = .61-.95, p<.05) were found for all scales and most areas. Children's participation frequency was high in learning and activities of daily living (ADL), low in play and social participation. Performance level was low in social participation. Enjoyment level was low, and needed assistance in ADL was high.Conclusions: Based on our initial evaluation, the SPO-ASD may be suitable for assessing participation of children with ASD attending special education preschools. Additional studies are needed to more securely establish its psychometric properties.

A guiding process to culturally adapt assessments for participation-focused pediatric practice: the case of the Participation and Environment Measures (PEM)

PURPOSE

There is unprecedented opportunity to evaluate children's participation in diverse cultural contexts, to enhance cross-cultural research, advance the delivery of culturally responsive pediatric rehabilitation, and translate new knowledge on a global scale. The participation concept is complex and heavily influenced by a child's context. Therefore, effectively capturing the participation concept requires valid, reliable, and culturally sensitive participation-focused measures. This perspective paper proposes a structured process for culturally adapting measures of participation for children and youth with disabilities.

METHODS

Elements of the Applied Cultural Equivalence Framework and Beaton and colleagues' six-step process were used to create a guiding process for culturally adapting a Participation and Environment Measure (PEM) while drawing on two distinct cultural contexts. This process included forward and back language translations, and semi-structured cognitive interviews, to develop adapted versions of the PEM that are ready for psychometric validation.

RESULTS

Common challenges to culturally adapting PEM content and administration are identified and methodological strategies to mitigate these challenges are proposed.

CONCLUSIONS

The proposed process can guide rehabilitation specialists and researchers in adapting participation measures that are suitable for their culture. Such a process can facilitate scalable implementation of evidence-based tools to support participation-based practice in the rehabilitation field.Implications for RehabilitationThe use of a systematic process can harmonize efforts by rehabilitation researchers and service providers to effectively culturally adapt pediatric participation measures to optimize its impact for culturally sensitive research and practice targeting participation.Two distinct, yet complementary, illustrative exemplars showcase the range of considerations and strategies, such as by conducting consecutive rounds of cognitive interviews, when teams use this systematic process to cultural adapt a pediatric participation measure.The systematic process outlined in this paper promotes rigor in achieving all elements of cultural equivalency, when feasible, to best ensure that the participation measure is suitable for use in the target cultural context.

Voices of children with intellectual disabilities on participation in daily activities

Background

Participation in daily activities is expressed as a human right. Full participation of children with disabilities in daily activities creates optimal opportunities for learning and development. Previous studies have focused primarily on proxy ratings of participation of children with intellectual disabilities in daily activities. However, little is known about how the children rate barriers and facilitators to their participation in everyday activities.

Objectives

To identify barriers to and facilitators for everyday activities as experienced by children with intellectual disabilities from low- and middle-income countries and high-income countries. The research questions were as follows: 'what barriers to participation do children with disabilities experience in everyday activities?' and 'what facilitators to participation do children with disabilities experience in everyday activities?'

Method

A qualitative content analyses was used in this study, and individual interviews were conducted with 49 children with intellectual disabilities. The interviews were performed using pictures. The children also selected the most important activities and described in their own words the facilitators and barriers relevant to being able to perform the activities.

Results

The most important activities were organised leisure activities, formal learning at school, taking care of other family members and family mealtimes. Self-reported barriers identified were personal functioning, social exclusion and lack of resources. The identified facilitators included satisfaction, personal capability, being included and having access to resources.

Conclusion

These findings provide important knowledge about the factors to consider in the development of interventions, aimed at improving the participation of children with intellectual disabilities.

Occupational Performance Coaching With Parents to Promote Community Participation of Young Children With Developmental Disabilities: Protocol for a Feasibility and Pilot Randomized Control Trial

Background: High rates of restricted community participation have been reported in young children with developmental disabilities. Occupational performance coaching (OPC), grounded in self-determination theory, aims to facilitate children's participation in life situations through coaching parents. However, there have been limited randomized controlled trials demonstrating the efficacy of OPC, especially with a specific focus on children's community participation. The proposed study is the first step in evaluating the feasibility and acceptability of conducting a pilot randomized controlled trial of OPC in Hong Kong and testing its initial efficacy (in comparison to parent consultation) in promoting children's community participation. Method/Design: A feasibility and pilot double-blind randomized controlled trial will be undertaken. Fifty children aged 6 years or below with developmental disabilities and their parents will be recruited from early intervention centers and/or through social media in Hong Kong. Parents will be randomly assigned to receive OPC or consultation, and will be blinded to group allocation. Outcomes will be assessed by blinded assessors at baseline, pre-intervention, post-intervention, and follow-up. Predetermined success criteria will be used to assess the feasibility of the trial. Qualitative interviews will be conducted with parents to explore the acceptability and perceived impact of OPC. Discussion: This trial will test whether the study protocol and OPC are feasible and acceptable, as well as assess the initial efficacy of OPC to obtain effect size estimates. The results of the trial will inform future preparations for conducting a full-scale efficacy trial of OPC. Trial Registration: ClinicalTrials.gov, U.S. National Library of Medicine, National Institutes of Health (#NCT04796909), Registered on 15th March 2021.

Participation Measures for Infants and Toddlers Aged Birth to 23 Months: A Systematic Review

AIMS

Participation is a key health outcome; however little is known specifically about how to measure participation of infants and toddlers. The aim of this review was to identify and examine the psychometric properties of participation measures for infants and toddlers aged birth to 23 months according to family of Participation-Related Constructs (fPRC).

METHODS

Four electronic databases were searched to identify (i) measures available in English, (ii) that quantify at least one participation concept of 'attendance' and/or 'involvement' according to the fPRC, (iii) with psychometric data for infants or toddlers aged from birth to 23 months published in a full text, peer reviewed journal. Psychometric quality was examined using the COSMIN checklist.

RESULTS

Four measures met the inclusion criteria: Child Engagement in Daily Life (CEDL) measure, Daily Activities of Infants Scale (DAIS), Test of Playfulness (ToP), and Young Children's Participation and Environment Measure (YC-PEM). All measured 'attendance' and three also measured 'involvement'. Measures showed unknown to moderate validity and unknown to moderate reliability, with the CEDL reporting the strongest psychometric properties.

CONCLUSION

There are few measures that evaluate infant and toddler participation. Further research is needed to develop psychometrically sound participation measures that evaluate 'attendance' and 'involvement' for this population.

Pilot implementation of an electronic patient-reported outcome measure for planning and monitoring participation-focused care in early intervention

BACKGROUND

Family-centered care is a valued approach to improving child and family outcomes in early intervention (EI), yet there is need to implement interventions that support information exchange for shared decision-making when planning and monitoring EI care. This study aims at estimating the feasibility, acceptability, and value of implementing the Young Children's Participation and Environment Measure (YC-PEM), a valid electronic patient-reported outcome (e-PRO) that is designed to support family engagement when planning care and monitoring outcomes of care.

METHODS

Data were gathered from caregivers (N = 139) that were enrolled in a Phase 1 trial of the YC-PEM e-PRO as implemented within 1 month of their child's next EI evaluation of progress. YC-PEM e-PRO feasibility was estimated according to enrollment and completion rates, and mean completion time. Chi-square tests were used to examine parent perceptions of YC-PEM e-PRO acceptability by caregiver education and family income. Caregiver feedback via open-ended responses were content coded to inform intervention and protocol optimizations. YC-PEM e-PRO value was estimated via composite and item-level scores to capture the extent of participation difficulty in home and community activities, and common areas of need regarding caregivers desired change in their child's participation.

RESULTS

Feasibility of implementing the YC-PEM e-PRO in routine EI care was mixed, as evidenced by low enrollment rates (21.0-29.2%), a high completion rate (85.3%), and limited missing data (80.6% of completed cases contained no missing data). More than half of the participants reported that the completion of the YC-PEM e-PRO was at least somewhat helpful, regardless of family income or caregiver education, providing support for its acceptability. As for its value, the YC-PEM e-PRO results were viewed by 64% of caregivers, whose desire for change most often pertained to the child's participation in non-discretionary activities at home and structured activities in the community.

CONCLUSIONS

Results may support the implementation of YC-PEM e-PRO as a feasible, acceptable, and valued option for engaging families in planning the child's EI care. Results also inform select intervention and protocol optimizations prior to undertaking a multi-site pragmatic trial of its effectiveness on family engagement and shared decision-making within an EI clinical workflow.

TRIAL REGISTRATION

Trial number: NCT03904797 . Trial registered at Clinicaltrials.gov . Registered 22 March 2019. Retrospectively registered.

A Systematic Review on Clinimetric Properties of Play Instruments for Occupational Therapy Practice

Play is considered the main occupation for children. Pediatric occupational therapists utilize play either for evaluation or intervention purpose. However, play is not properly measured by occupational therapists, and the use of play instrument is limited. This systematic review was aimed at identifying play instruments relevant to occupational therapy practice and its clinimetric properties. A systematic search was conducted on six databases (Academic Search Complete, CINAHL, MEDLINE, Psychology and Behavioral Science Collection, Scopus, and ASEAN Citation Index) in January 2020. The quality of the included studies was evaluated using Law and MacDermid's Appraisal for Clinical Measurement Research Reports, and psychometric properties of play instruments were evaluated using Terwee's checklist while the clinical utility is extracted from each instrument. Initial search identifies 1,098 articles, and only 30 articles were included in the final analysis, extracting 8 play instruments. These instruments were predominantly practiced in the Western culture, which consists of several psychometric evidences. The Revised Knox Preschool Play Scale is considered the most extensive and comprehensive play instrument for extrinsic aspect, whereas the Test of Playfulness + Test of Environmental Supportiveness Unifying Measure is a promising play instrument for intrinsic aspect on play, where both instruments utilize observation. My Child's Play is a potential questionnaire-based play instrument. However, the current development of play instruments in the occupational therapy field is immature and constantly evolving, and occupational therapists should exercise good clinical reasoning when selecting a play instrument to use in practice.

A Chinese version of the young children's participation and environment measure: psychometric evaluation in a Hong Kong sample

PURPOSE

To investigate the psychometric properties of a Chinese-translated version of the Young Children's Participation and Environment Measure.

MATERIALS AND METHODS

The Young Children's Participation and Environment Measure was translated into Chinese using cultural adaptation by adding/replacing with activities relevant to Chinese culture. Parents of 53 children aged 2-5 years with developmental disabilities and of 50 typical developing children completed the questionnaires. Internal consistency, test-retest reliability, known-group validity, and discriminant validity were examined using Cronbach's alpha, intraclass correlation coefficient, Mann-Whitney U tests, and Spearman's rank correlation coefficients respectively.

RESULTS

Internal consistency was acceptable for most scales (α = 0.42-0.89). Test-retest reliability of the summary scores was moderate to high for all scales (intraclass correlation coefficient = 0.65-0.90). Known-group validity was supported by demonstrating significant differences by disability status in all community participation scales, two daycare/preschool participation scales, and one home participation scale. Low or negative correlations between the scores of some scales and children's cognition (ρ = 0.27-0.32; -0.36-to-0.35) and parental stress (ρ = -0.42-to-0.31) supported discriminant validity.

CONCLUSION

This study provided psychometric evidence supporting the use of the Young Children's Participation and Environment Measure to assess Chinese children's participation and environmental support.IMPLICATIONS FOR REHABILITATIONThe Young Children's Participation and Environment Measure is translated into Chinese using a cultural adaptation process.The Chinese version of the Young Children's Participation and Environment Measure demonstrates evidence for internal consistency, test-retest reliability (including the minimal detectable change).The Chinese version of the Young Children's Participation and Environment Measure demonstrates evidence for known-group validity and discriminant validity.The Chinese version of the Young Children's Participation and Environment Measure holds promise for use in children aged 2-5 years to assess their participation and identify environmental barriers warranting intervention.

The role of environment in explaining frequency of participation of pre-school children in home and community activities

Objectives: The main goal of the present study was to promote an understanding of the role of environment in explaining frequency of participation of pre-school children in home and community activities. Method: Parents of 116 children from completed an adapted version of the Young Children's Participation and Environment Measure (YC-PEM). Pre-school teachers assessed child functioning. Results: Maternal education was significantly related to the child's frequency of participation in home and community activities. Child functioning had an indirect effect on frequency of participation in home activities through perceived environmental barriers by parents. In the community setting, child functioning was a predictor of the parents' perception of environmental barriers and there was no evidence of a mediating effect of perceived environmental barriers. Conclusion: These findings highlight the importance of modifying specific environmental factors to promote child participation and functioning.