New Zealand Rehabilitation Association, Inc.

These authors set about developing and testing a measure of community participation for children and teenagers (aged 8-20) with disabilities.  This is an interesting endeavour: there is already considerable information about the impact of disability during childhood on levels of social participation – but can this be measured in any meaningful way?  What does ‘community participation’ mean for children anyway?

These authors designed a 19-item questionnaire – with each item consisting of a statement regarding one aspect of ‘participation’ followed by a Likert-type scale from one to six, where the child scores the degree of difficulty they have with that item on a day-to-day basis.  The authors were careful to write the questionnaire for people with a ‘second grade’ (8 and up) reading age.  Clearly however this design limited the use of the scale to children with no more than mild cognitive impairment - (indeed in this study they excluded children who had a modified Mini-Mental State Examination score below 17/25).  In other words, this measure of participation was intended from the outset to be mainly for children with physical disability.  This is not a major negative of the scale – just a consideration.  

Looking at the scale in detail however, it becomes a little more apparent that the authors have not clearly operationalised the concept of ‘participation’.  While a number of the items explicitly relate to what might be considered social participation, (e.g. ‘Be in clubs or do fun stuff after school?’, ‘Play sports or games outside?’) others are clearly activity-related (according to the International Classification of Functioning, Disability and Health definitions of ‘activity’ and ‘participation’).  For example it is a quite a stretch to consider the third item in the questionnaire (‘use of toilet’) as a component of community ‘participation’!  Likewise, other items such as whether children have any difficulty with ‘getting [their] coat on and off?’, ‘use the phone?’, and ‘[ability to] cross the street’ are measures of activity limitations rather than participation restrictions.  In fact, while the purpose of the PCPQ is stated as being to measure ‘participation’, in the body of the article the authors start referring to these additional items as ‘barriers to participation’ – which is of course a different construct to measure altogether.

The authors go about testing their new measure by using it with 105 children and teenagers with physical disabilities.  They compare scores on the PCPQ with scores on the Functional Disability Inventory (FDI), finding a statistically significant correlation between these two measures – supporting the validity of the PCPQ.  (However the authors note that this was somewhat expected because a number of the item on the PCPQ overlap with items on the FDI.)  To further support the valid of the PCPQ, Washington et al. also demonstrated that their measure was able to statically predict who from their group of children was able to walk and who was not.  (Again however, because the items in the scale included several specific questions related to community mobility, this was somewhat unsurprising.)  Finally, Washington et al. investigated the internal consistency of the measure (the degree to which scores on individual items in the questionnaire statistically correlated with each other) and found this to be excellent.

In summary then, the idea of developing a measure of social participation for children and teenagers is a good one.  This measure has some validity in terms of its correlation with other similar measures and its internal consistency, but it is questionable whether the PCPQ specifically measures the construct under investigation – participation.