Participation is defined as “
The Preschool Activity Card Sort (PACS) is a semistructured tool to measure participation in preschool children 3–6 years of age [
The original as well as Spanish versions of the PACS were found to be valid and reliable in several studies using different groups of children. For example, the original PACS was found to be valid and reliable in terms of content and construct validity [
The psychometric properties of the Arabic version of the PACS are not yet studied. Therefore, the purpose of the present study is to examine the psychometric properties of the A-PACS for children aged 3 to 6 years old. Construct and concurrent validity and internal consistency and test-retest reliability were tested.
A total of one hundred fifty-one parents were recruited randomly responding to an advertisement placed in public areas like shopping malls, universities, community, and child care centers and in neighborhoods. Caregivers were recruited proportionally from different geographical areas of Jordan to reflect demographics obtained from the Jordanian Department of Statistics. Parents were recruited to complete the A-PACS if they had at least one child with normal development between the ages of 3 to 6 years. Moreover, parents had to speak Arabic as their native language to be included in the study. Parents were excluded if their preschool child had any physical or mental problems or had been enrolled in first grade or if Arabic was not their native language. Children were divided into three age groups; group 1 included children who are three years old up to 3 years and 11 months old, group 2 included children who are 4 years to 4 years and 11 months old, and group 3 had children who are 5 to 6 years old. Most of the participants interviewed were mothers (70.2%) with a mean age of 32.8 years. Children were almost equally distributed between males and females (52.3% males). Demographic characteristics of the participants are delineated in Table
Demographic characteristics of the sample.
Total |
Age groups | |||
---|---|---|---|---|
Group 1 (3-3, 11) |
Group 2 (4-4, 11) |
Group 3 (5-6) |
||
Parent | ||||
Mother | 106 (70.2) | 41 (38.7) | 28 (26.4) | 37 (34.9) |
Father | 45 (52.3) | 16 (35.6) | 14 (31.3) | 15 (33.3) |
Gender of child | ||||
Male | 79 (52.3) | 30 (52.6) | 19 (45.2) | 30 (57.7) |
Female | 72 (47.7) | 27 (47.4) | 23 (54.8) | 22 (42.3) |
Socioeconomic status | ||||
1 | 52 (35.4) | 20 (36.4) | 15 (37.5) | 17 (32.7) |
2 | 65 (44.2) | 20 (36.4) | 20 (50.0) | 25 (48.1) |
3 | 20 (13.6) | 11 (20.0) | 5 (12.5) | 4 (7.7) |
4 | 7 (4.8) | 3 (5.5) | 0 (0.0) | 4 (7.7) |
5 | 3 (2.0) | 1 (1.8) | 0 (0.0) | 2 (3.8) |
Living area | ||||
City | 107 (72.3) | 39 (68.4) | 30 (76.9) | 38 (73.1) |
Village | 41 (27.7) | 18 (31.6) | 9 (23.1) | 14 (26.9) |
Mother’s age (years), M (SD) | 32.8 (5.7) | 32.2 (5.7) | 31.8 (4.9) | 34.1 (6.1) |
Father’s age (years), M (SD) | 37.9 (5.8) | 37.5 (5.8) | 37.1 (4.8) | 39.0 (6.3) |
In addition to the A-PACS, parents completed the Arabic version of the Vineland Adaptive Behavior Scale (VABS) [
Ethical Approval was obtained from the School of Rehabilitation Sciences research committee and the Deanship of Academic Research at the University of Jordan. All participants signed an informed consent after receiving detailed information about the study. Participants were informed that they had the right to withdraw from the study at any time.
A total of 151 parents participated in this study. Parents completed the A-PACS and the VABS as 1 : 1 interviews. Two trained occupational therapy researchers conducted interviews. The time to complete the two measures varied from 40 to 60 minutes. To assess test-retest reliability, a randomly selected subsample of 30 parents, 10 from each age group (3-3; 11, 4-4; 11, 5-6 years), completed the A-PACS twice in a 2-week interval.
Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) for windows version 20.0. To establish the construct validity, a Kruskal-Wallis one-way analysis of variance by ranks was used to compare the mean subscale scores for each of the seven domains of the A-PACS in order to identify group differences. Concurrent validity was evaluated using the Pearson correlations coefficient between the A-PACS and the VABS domains and subdomains (with correlations <0.25 = little or no relationship; 0.25–0.50 = fair; 0.51–0.75 = good; >0.75 = excellent; [
For establishing the A-PACS homogeneity (internal consistency), Cronbach’s alpha was used with the criteria
The mean number of activities in which children participated in each of the A-PACS domains is reported in Table
Mean number of A-PACS activities reported by total sample and age group.
A-PACS | Total sample | Group 1 |
Group 2 |
Group 3 |
---|---|---|---|---|
Self-care | 15.35 |
|
|
|
Community mobility | 13.08 |
|
|
|
HD leisure | 8.19 |
|
|
|
LD leisure | 15.20 |
|
|
|
Social interaction | 13.36 |
|
|
|
Domestic | 5.11 |
|
|
|
Education | 9.09 |
|
|
|
Note: a, b, and c = if letters are the same, there are no significant differences between groups.
A-PACS = Arabic Preschool Activity Card Sort; HD = high demand; LD = low demand.
Table
Relationships among A-PACS and Vineland domains and subdomains for total sample.
Vineland | A-PACS | ||||||
---|---|---|---|---|---|---|---|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
.155 |
.153 |
.002 |
.169 |
.229 |
.096 |
|
Receptive | .070 |
.221 |
.211 |
|
|
.055 |
|
Expressive | .109 |
.196 |
.097 |
.211 |
.250 |
.081 |
|
Written | .194 |
.193 |
.051 |
.201 |
.148 |
−.095 |
|
|
|||||||
|
.101 |
|
.086 |
|
.209 |
.152 |
|
Personal | .176 |
|
.201 |
|
|
.255 |
|
Domestic | .138 |
|
.110 |
|
.167 |
.171 |
|
Community | .194 |
|
.041 |
|
.226 |
.105 |
|
|
|||||||
|
.095- |
|
.087 |
|
.237 |
.165 |
|
Interpersonal relations | .006 |
.167 |
.137 |
|
|
.128 |
|
Play and leisure | −.044 |
|
.152 |
|
.218 |
.109 |
|
Coping | −.086 |
|
.063 |
|
.210 |
.100 |
|
|
|||||||
|
.191 |
.146 |
.294 |
|
|
|
|
Gross | −.035 |
.098 |
.314 |
.281 |
|
.220 |
|
Fine | .069 |
.298 |
.276 |
.338 |
|
.339 |
|
Note:
A-PACS = Arabic Preschool Activity Card Sort; CM = community mobility; HD = high demand; LD = low demand.
Among the domestic and social domains of the A-PACS and the VABS motor domain, fair correlations were observed (
As for the low demand leisure domain of the A-PACS, it was significantly and fairly correlated with the VABS ADL (
The community mobility domain of the A-PACS was significantly and fairly correlated with the ADL domain of the VABS (
Interestingly, the high demand leisure and self-care domains of the A-PACS were not significantly correlated with any of the VABS domains.
The overall internal consistency for all the 98 items of the A-PACS was excellent (
The ICC (3,195) = .976 for the test-retest reliability showed good stability for the A-PACS (
The purpose of the current study was to establish the psychometric properties of the A-PACS that was recently translated into Arabic and cross-culturally adapted on a Jordanian population of parents of children with typical development.
In congruence with developmental theory [
Significant differences between children aged 3-4 years and children aged 5-6 years were found in community mobility and low demand leisure domains with higher participation for older children. However, there were no significant differences between children aged 3-4 years and 4-5 years. This can be explained by the nature of the items in the domains of community mobility and low demand leisure which most require exposure to new skills and experiences. For example, most of the items in the community mobility domain are taught when the children join education settings. Examples include crossing the street, taking the bus, going to a supermarket, learning money management, climbing the stairs, using a public bathroom, and going on field trips. The domain of low demand leisure includes items that require skill acquisition and tools, such as doing puzzles, using scissors, and playing with playdough. Therefore, children aged 4-5 years have just begun to learn these skills. They are emerging; the skills are not yet well established and not yet evident to parents. However, when children enter their second level of kindergarten after they have had an entire of exposure to these experiences, parents are able to see the difference and report it.
When comparing the 3 age groups, the overall pattern of participation appeared similar in the domains of self-care, high demand leisure, social interaction, and domestic activities. This result can be attributed to the nature of the items in aforementioned domains as these activities mostly do not require specific tools or skills such as jumping and running. Moreover, for the domestic domain, it is noteworthy to notice that Jordanian children reported low participation level at all age groups as noted in Table
The Arabic version of the VABS was used in this study to explore the concurrent validity of the A-PACS. Results of this study suggest that some domains of the A-PACS correlated with others in the VABS. However, most of these correlations were fair.
Only the education domain of the A-PACS correlated with all of the VABS domains and subdomains. An important observation is that, with the exposure of children to educational experiences in kindergarten, children are getting training in all of the other domains like communication, ADL, social, and motor skills. A lot of preschoolers form new repertoire of social interaction and communication, they learn social behaviors and morals, and they get to go on field trips to parks and play areas which will increase their motor skills. They get exposed to academics and use pencils and utensils and they are encouraged to do self-care activities like brushing their teeth. Consequently, as participation in the number of educational activities as measured by the A-PACS increased, an increase in participation level in all domains and subdomains of the VABS was noted.
The number of significant correlations between the A-PACS and the VABS differed depending on the domain; education domain of the A-PACS had the highest and strongest correlations (15 correlations) which indicates that education might have a positive impact on child’s skills. Based on the number of correlations, the low demand leisure domain ranked second (11 correlations), followed by the community mobility and social domain (6 correlations each) and the domestic domain (2 correlations).
An interesting finding was that the A-PACS low demand leisure was fairly and significantly correlated with the play and leisure subdomain (social-VABS) and the A-PACS social domain was significantly and fairly correlated with the interpersonal relations (social-VABS) which indicates that the two tests are examining different activities of the same domain suggesting that both tests complement each other.
The finding that no correlation existed between the self-care and high demand leisure domains of the A-PACS and any of the domains or subdomains of the VABS might be explained by the way items are distributed into domains in each of the A-PACS and the VABS. We found that items in the A-PACS were sporadically distributed in different domains of the VABS which made it increasingly difficult to make obvious correlations between one domain and the other. For example, the self-care items of the A-PACS are similar to items on the VABS that are found across domains and not specifically situated in the personal living skills section alone. In other words, the self-care and high demand leisure domains of the A-PACS bring added evaluative value and information than using the VABS clinically.
The excellent internal consistency for all the 98 items of the A-PACS reflects the appropriateness of the new items added to the original tool in measuring participation levels. However, the relatively lower value of Cronbach’s alpha for the high demand leisure (0.559) may reflect variability in frequency of participation across children in the study sample.
The ICC coefficients between the first and second A-PACS scores varied from .96 to .98 supporting test-retest reliability. This finding indicates that when change is not expected scores are sufficiently stable to support using the A-PACS to measure change over time.
Small sample size in this study limits the generalizability of the results; therefore, results should be interpreted with caution. Further studies should be completed with larger sample sizes. The validity of the A-PACS for use with children with disabilities should also be explored. Finally, further studies are needed to test whether the A-PACS is sensitive to change in children. In conclusion, the A-PACS have demonstrated acceptable psychometric properties. Therefore, the A-PACS can be used as a reliable and valid measure to assess children’s participation at the age of 3–6 years who speaks the Arabic language.
The authors declare that they have no conflicts of interest.
This investigation was funded by the Deanship for Academic Research at the University of Jordan (Grant no. 2427).