The Activity Card Sort (ACS) measures the level of participation, as perceived by each person which, unlike other scales, makes it both personal and significant. However, there is a limitation to applying the ACS to Spanish older adults as it is restricted to culturally relevant activities solely in the United States. Therefore, the aim of this study was to select activity items that reflected Spanish older adults’ lifestyles in order to develop the Activity Card Sort-Spain Version (ACS-SP). Frequently, activities performed in Spain (
Participation entails a connection between the person, their specific context, and the tasks performed. Thus, participation occurs when a person performs, or wishes to perform, an activity, has the opportunity to undertake the same, and has overcome any challenges that might limit their engagement in the activity at the preferred location [
The importance of community participation is highlighted as being a key as an indication that the rehabilitation process has been a success [
At present, despite the importance of participation, problems with the definition continue to exist and are often confused with related concepts, such as the health-related quality of life or community integration [
The Activity Card Sort (ACS) is a tool that was developed by occupational therapists in the United States [
Although originally configured as a scale for people with Alzheimer’s disease, this scale has been used among other populations, such as on individuals with Parkinson’s disease [
There are few scales validated for Spanish speakers that enable the assessment of participation. Some examples of available scales are the Community and Socio-Political Participation Scale (SCAP) [
The aim of this study was to select activity items reflecting Spanish older adults’ lifestyles and develop a Spanish version of the ACS scale (ACS-SP).
The study participants came from different regions in Spain and were well known by the researchers’ families and/or work circle. The participants who responded to the questionnaire, regarding the frequency of their performance of daily living activities in Spain, were recruited according to the following inclusion criteria: people living in the community and who were able to comprehend and communicate in Spanish, people who had retired from their full-time jobs or were homemakers from the outset, and those aged 60 years or older. Figure
Adaptation process of the ACS scale to the Spanish population.
In order to develop the Spanish adaptation of the ACS scale, we first analyzed the second edition of the ACS [
Thereafter, the different adaptations of the scale performed in other countries were reviewed for the purpose of selecting activities considered common in Spain. With this aim, the following ACS versions were consulted: the ACS-Israeli version [
After this initial analysis, a group of occupational therapists (
After gathering this information, the research team established an initial list of items. This list was administered as a questionnaire to people aged 60 years and older, without health problems, and from various regions in Spanish. Following the examples of the ACS-Aus, ACS-UK, and the A-ACS [
The research group decided that the final version should only include those activities that presented scores equal to or greater than two, as is done in the ACS-UK version [
Permission was first obtained from the authors of the test for the translation and validation of the same among the Spanish population. We then obtained authorization from the Rey Juan Carlos University Ethics Committee.
The calculation of the mean scores was performed using the IBM SPSS Statistics 22.0 for Windows (IBM Corporation, Armonk, NY, USA) statistical program.
Based on the analysis of the different versions of the ACS scale, the first draft produced a list of activities (
These participants came from different regions in Spain: Madrid, Castilla-La Mancha, Castilla y León, Extremadura, Canarias, Cataluña, and Aragón (
Characteristics of the study participants (
Variable | Madrid ( |
Other regions ( |
Total ( | |
---|---|---|---|---|
Sex | Female, |
37 (67.3) | 29 (67.4) | 66 (66.7) |
Male, |
18 (32.7) | 14 (32.6) | 32 (32.3) | |
Age, |
||||
Education | Basic, |
12 (21.8) | 10 (23.3) | 22 (22.2) |
Secondary, |
23 (41.8) | 12 (27.9) | 35 (35.4) | |
University, |
20 (36.4) | 21 (48.8) | 41 (41.4) | |
Marital status | Single, |
3 (5.5) | 2 (4.7) | 5 (5.1) |
Widow/er, |
13 (2.3) | 3 (7) | 16 (16.2) | |
Married, |
37 (67.3) | 36 (83.7) | 73 (73.7) | |
Divorced, |
2 (3.6) | 2 (4.7) | 4 (4) |
Once the questionnaires had been administered to the participants, the final version of the ACS-SP was drafted by including all items with scores equal to or greater than two (
Activities included and excluded in the final version of the ACS-SP ordered according to the frequency estimated by participants (
Activities by ranking number | Mean (SD) |
---|---|
(1) Watching television | 3.77 (0.54) |
(2) Shopping (supermarket, shop) | 3.73 (0.44) |
(3) Talking on the phone | 3.62 (0.73) |
(4) Going to shopping centers | 3.40 (0.84) |
(5) Going to a doctor’s appointments | 3.32 (0.70) |
(6) Taking out the rubbish | 3.31 (0.92) |
(7) Paying bills | 3.24 (0.85) |
(8) Family events | 3.21 (0.83) |
(9) Voting | 3.14 (0.66) |
(10) Surfing on the internet | 3.13 (0.82) |
(11) Listening to music | 3.12 (0.70) |
(12) Driving | 3.09 (0.75) |
(13) Filling up on petrol | 3.09 (0.76) |
(14) Working | 3.08 (0.79) |
(15) Cooking | 3.05 (0.68) |
(16) Having a coffee | 3.04 (0.73) |
(17) Visiting family/friends (ill) | 3.04 (0.74) |
(18) Listening to the radio | 3.04 (0.91) |
(19) Visiting friends | 3.03 (0.81) |
(20) Going out for a drink | 3.03 (0.84) |
(21) Going to the beach | 3.01 (0.72) |
(22) Using the computer | 3.00 (0.73) |
(23) Using social media | 3.00 (0.84) |
(24) Spending time with friends | 2.99 (0.89) |
(25) Washing dishes | 2.96 (0.80) |
(26) Using public transport | 2.95 (0.66) |
(27) Housekeeping (ironing, cleaning, making beds) | 2.86 (0.79) |
(28) Going shopping (leisure) | 2.85 (0.84) |
(29) Walking | 2.83 (0.77) |
(30) Taking a nap | 2.83 (0.81) |
(31) Going to the hairdresser | 2.81 (0.88) |
(32) Washing clothes | 2.81 (1.10) |
(33) Travelling | 2.80 (0.69) |
(34) Going to funerals | 2.78 (0.90) |
(35) Betting, gambling | 2.78 (0.91) |
(36) Taking care of young children | 2.76 (0.70) |
(37) Going to the cinema | 2.76 (0.78) |
(38) Taking the car to the mechanic | 2.75 (0.85) |
(39) Reading | 2.70 (0.73) |
(40) Taking care of pets | 2.67 (0.81) |
(41) Going to parties | 2.66 (0.74) |
(42) Packing bags | 2.65 (0.76) |
(43) Going to restaurants | 2.65 (0.84) |
(44) Taking children to extracurricular activities | 2.62 (0.85) |
(45) Going to the park | 2.57 (0.82) |
(46) Playing videogames | 2.56 (0.87) |
(47) Exercising | 2.53 (0.66) |
(48) Taking photos | 2.51 (0.82) |
(49) Studying | 2.49 (0.79) |
(50) Reading newspapers | 2.49 (0.85) |
(51) Going to see sports games (sports stadiums) | 2.48 (0.92) |
(52) Handling finances (investments, going to the bank) | 2.42 (0.91) |
(53) Sorting out cupboards, clothes | 2.41 (0.92) |
(54) Planning a trip | 2.40 (0.81) |
(55) Going to the swimming pool | 2.39 (0.83) |
(56) Going to the gym | 2.38 (0.78) |
(57) Going to the dentist | 2.37 (0.73) |
(58) Job searching | 2.37 (0.81) |
(59) Reading stories to children | 2.36 (0.82) |
(60) Taking care of ill people | 2.31 (0.83) |
(61) Doing administrative tasks | 2.30 (0.78) |
(62) Going to concerts | 2.29 (0.76) |
(63) Doing team sports | 2.21 (0.64) |
(64) Visiting exhibitions | 2.21 (0.80) |
(65) Riding a bicycle | 2.20 (0.78) |
(66) Going to the theatre | 2.18 (0.72) |
(67) Going running | 2.17 (0.64) |
(68) Going dancing | 2.16 (0.71) |
(69) Having a party at home | 2.15 (0.78) |
(70) Doing crossword puzzles, pastimes | 2.14 (0.80) |
(71) Playing card games | 2.13 (0.67) |
(72) Hiking | 2.13 (0.82) |
(73) Home decorating | 2.11 (0.76) |
(74) Visiting museums | 2.09 (0.79) |
(75) Doing yoga, Pilates, tai chi | 2.07 (0.71) |
(76) Going camping | 2.07 (0.82) |
(77) Board games | 2.06 (0.71) |
(78) Playing tennis, paddle tennis | 2.01 (0.69) |
(79) Taking care of/watering plants | 2.01 (0.72) |
Activities excluded from the final version according to the participants ( | |
(80) Collecting | 1.99 (0.81) |
(81) DIY | 1.97 (0.69) |
(82) Belonging to associations | 1.97 (0.74) |
(83) Cooking as a hobby | 1.96 (0.67) |
(84) Going to church | 1.88 (0.74) |
(85) Going to the post office | 1.88 (0.82) |
(86) Going to bull fighting events | 1.86 (0.66) |
(87) Going to bingo | 1.86 (0.84) |
(88) Painting | 1.85 (0.73) |
(89) Going to the library | 1.84 (0.76) |
(90) Changing the butane cylinder | 1.83 (0.86) |
(91) Sewing | 1.83 (0.92) |
(92) Playing a musical instrument | 1.82 (0.80) |
(93) Doing handicrafts | 1.80 (0.67) |
(94) Volunteering | 1.71 (0.80) |
(95) Doing puzzles | 1.64 (0.65) |
(96) Going to the casino | 1.55 (0.64) |
(97) Fishing | 1.55 (0.68) |
(98) Singing in a choir | 1.51 (0.68) |
(99) Carpentry activities | 1.47 (0.57) |
(100) Bowling | 1.47 (0.60) |
(101) Reading the bible | 1.47 (0.71) |
(102) Knitting/macramé | 1.45 (0.66) |
(103) Writing | 1.36 (0.53) |
The activities (
Distribution of the activities included in the final version of the ACS-SP by areas.
Instrumental ( |
Leisure ( |
Social participation ( |
Productivity and education ( |
---|---|---|---|
Going shopping |
Seeing sports in a sports stadium |
Going to the pool |
Working |
The items included in the final version of the scale primarily arose from the second edition of the ACS (
With regard to the changes made to the sample Spanish population, three new activities were included: taking a nap, going out for a drink or tapas, and searching for a job. Although the meaning of these words may appear similar to the original ACS (resting, clubbing, or entertaining), they differ due to the cultural difference, resulting in a different meaning. For example, taking a nap in Spain is not just resting; it is a short sleep period taken between productive activities, after lunch (midday).
The process of crosscultural adaptation of the ACS to the Spanish population resulted in a list of 79 activities, divided into four distinct areas: instrumental activities, leisure activities, social participation activities, and productivity and education.
The final list was developed after both reviewing the available international versions of the ACS and considering the contributions made by different occupational therapists, as well as after analyzing the responses provided by a group of people over the age of 55 regarding the frequency of the selected activities they considered being performed in Spain. This process of item generation based on population surveys was also used for the development of the ACS-Aus, ACS-UK, and A-ACS versions of the scale [
The total number of activities included in the Spanish version is similar to that in ACS-NL (
Regarding the number of items that coincide with other versions, it is worth noting that the final ACS-SP version includes 61 activities listed in the 2nd edition of the ACS. In the case of ACS-Aus, both versions include 65 similar activities while, in the case of the version for adults between 18 and 64 years, 72 activities coincide [
Compared to the second edition of the ACS, 30 activities from the former version are unlisted and 21 new activities have been included. The activities excluded from the Spanish version are performing DIY, resting, cooking as a hobby, sewing, doing handicrafts, doing macramé/petit poi embroidery, collecting, doing puzzles, playing musical instruments, reading the bible, singing in a choir, writing, writing a letter, bird watching, going to the casino, going to bingo, sitting and thinking, doing carpentry activities, going bowling, playing golf, garden games, sailing, fishing, going to church, spending time with a spouse, volunteering, going to a club, and going on a picnic. Shopping at a supermarket and buying food were combined as a “going shopping” activity. Similarly, travelling locally and travelling to other countries were combined as “travelling,” and swimming was categorized as “going to the pool.”
Twenty new activities have been included into the ACS-SP, which are not included in the second edition of the ACS American version: taking care of young children, taking care of people who are ill, using the computer, packing bags, using public transport, planning a trip, performing administrative tasks, organizing cupboards and clothes, internet surfing, job searching, betting/gambling, going to the beach, going to the gym, taking a nap, taking children to different extracurricular activities, going out for a drink, going to a funeral, going to exhibitions, and voting.
Regarding the differences between the ACS-SP and the remaining versions, this version contains three items that do not appear in the rest of the scales, namely, going out for a drink, taking a nap, and searching for a job. Going out for a drink and taking a nap are very typical activities among the Spanish population which are not necessarily performed in other countries. Taking a nap is not just resting; it is a short sleep period taken between productive activities, after lunch (midday), and sometimes can extend to the period of one hour. Spanish residents are accustomed to taking a nap, and this is considered a well-established Spanish custom.
Regarding searching for a job, the occupational therapists consulted felt that it was advisable to include as it was also commonplace in Spain; thus, it was included as being both a productive activity and an educational activity and in different sections, as the Association of American Occupational Therapy considers that this can be categorized as two different activities [
Furthermore, our version was the only one, together with the ACS-UK [
On the other hand, the final version of the scale does not include activities, such as going to a religious center or reading religious material, both of which were included in the other available versions [
Our scale was divided into four dimensions: instrumental activities, leisure activities, social participation, and productivity and education. This is a different criterion compared to other versions as we did not consider dividing leisure activities according to their physical demand; rather, the corresponding activities were classified as being “leisure” due to the inclusion of leisurely activities.
This work presents several limitations. In the first place, it would be advisable to have included younger age groups in the population sample for comparative purposes to obtain the most representative activities in a larger sample. Secondly, our study did not analyze the results considering the origin of the participants as in whether these came from urban and rural areas; therefore, it is possible that some activities may not be so representative in certain contexts.
This paper has detailed the process for adapting the ACS scale to the Spanish population by generating a new scale entitled ACS-SP. This scale may be used across a wide variety of settings and situations. The majority of the items on this scale have already been used in the different versions of the ACS that have been developed in other countries. However, after a process of analysis and a survey of a small sample of the Spanish population, the most frequent activities were included, some of which are unique when compared to other versions. The ACS-SP will serve as a descriptive tool for assessing community participation among Spanish community-dwelling adults and may be a useful outcome measure for determining the effects of rehabilitation interventions on participation and for establishing tailored occupation-focused goals.
The adaptation to ACS for the Spanish native population will make it possible to measure the level of an individual’s participation in a community, in this case with elderly people living at their place of residence, to whom a broad and comprehensive set of performance areas will be addressed.
If you need it, we could give you part of the data from the SPSS Statistics program, which is where we have all the data information.
This study was approved by the Rey Juan Carlos University Ethics Committee (internal register number 0502201802018).
The authors report no conflicts of interest concerning the research, authorship, and/or publication of this article.
The authors thank all people who participated in this study.