presentation at the International symposium of adapted physical activity, Charlottesville 2019.

1. UEF // University of Eastern Finland
Kwok Ng, School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland;
Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
Piritta Asunta, LIKES research centre for physical activity and health, Jyväskylä, Finland
Niko Leppä, City of Jyväskylä, Jyväskylä, Finland
Pauli Rintala, University of Jyväskylä, Jyväskylä, Finland.
International Symposium of Adapted Physical Activity, 17th June 2019, Charlottesville, VA, USA.
@kwokwng | #isapa
Adapting physical activity survey
instruments for children in
special education settings

2. UEF // University of Eastern Finland
Outline
• Background to including children in surveys
• Conversion for self-report
• Organising the study in special education settings
• Intra-rater test-retest reliability
• Considerations for self-report Child Functioning Module
Kwok Ng – Testing self-report CFM
#isapa2019 | @kwokwng

3. UEF // University of Eastern Finland
Children have a voice, that should be heard
• Finland has a long history of collecting health related survey
data from children
– 1977 - NTTT (health behaviour of young Finns) – biennial
– 1983/4 – HBSC (health behaviour of school aged children) –
quadrennial; international survey, currently 49 member countries
– 1996/7 – SHP (school health promotion study) – biennial
– 2014 – F-SPA (Finnish school-aged physical activity study) –
biennial
• Until recently, children with disabilities have been excluded
from participating in such surveys
#isapa2019 | @kwokwng

4. UEF // University of Eastern Finland
• The HBSC study goals are to increase the
understanding of adolescent health and well-being by
identifying related health behaviours, life styles and
contexts and describe adolescent health behaviour
between countries. (Boyce et al, 2009)
• Issues to developing items
– A short set of questions
– Items need to remain comparable between collection years
and between countries
– It must compliment other mandatory questions
– Advantageous to be comparable with Census
questionnaires
#isapa2019 | @kwokwng

5. UEF // University of Eastern Finland
Conversion for self-report
#isapa2019 | @kwokwng

6. UEF // University of Eastern Finland
TUTKA-project Questionnaire development
L
10-13 yrs
49 Q
14-18 yrs
56 Q
Standard
language
M
10-13 yrs
36 Q
14-18 yrs
40 Q
Easy-to-
read
S
10-18 yrs
24 Q
Easy-
to- read
HBSC
92
question
s
F-SPA
31
question
s
71
Disability Surveys - #isapa2019 | @kwokwng

7. UEF // University of Eastern Finland
HBSC study in Finland
• If yes, (check box) what difficulties
– Seeing
– Hearing
– Speaking
– Moving around
– Handling objects
– Breathing
– Epileptic Seizures (Fits)
2002 2006 2010 2014 2018
Long term illnesses or Disabilities (Yes | No)
• Do you have difficulty..
• in seeing, even with glasses?
• hearing, even with a hearing aid?
• In speaking fluently?
• In moving?
• In handling objects?
• In breathing, for example, shortness of breath?
• In remembering things?
• In concentrating?
• In sitting still during lessons?
No difficulties
Difficulties do not affect functioning
Difficulties affect functioning somewhat
Difficulties affecting functioning a lot
Difficulties affect functioning very much
Self-reported CFM
2016 F-SPA
Seeing
Hearing
Speaking
Moving
Breathing
Remembering or
concentration
(Osteras et al, 2008)
#isapa2019 | @kwokwng

8. UEF // University of Eastern Finland
HBSC 2014 (left) and WG themes (right)
• seeing things
• hearing others?
• speaking to others?
• moving around?
• handling objects?
• breathing?
• Epileptic seizures (fits)?
• Remembering?
• Concentrating?
• Sitting Still?
• Vision (seeing)
• Hearing
• Walking (mobility)
• Communication
• Learning
• Playing
• Relationship
• Self-care
• Emotion
• Behaviour
• Attention
• Coping with Change
Other HBSC
Items
Kwok Ng – Testing self-report CFM
17th June 2019Disability Surveys - #isapa2019 | @kwokwng

9. UEF // University of Eastern Finland
Child Functioning Module in 2018
Do you have difficulty seeing, even if wearing your glasses or contact lenses?
Do you have difficulty hearing sounds like people’s voices, even if using a hearing aid?
Do you have difficulty walking 100 yards/meters on level ground, even if you use any
equipment or receive assistance? That would be about the length of a football field [or insert
country specific example]
Do you have difficulty with self-care such as feeding or dressing yourself?
When you speak, do you have difficulty being understood by people outside of your home?
Compared with students of the same age, do you have difficulty learning things?
Compared with students of the same age, do you have difficulty remembering things?
Do you have difficulty concentrating on an activity that you enjoy doing?
Do you have difficulty accepting changes in your routine?
Compared with students of the same age, do you have difficulty controlling your behaviour?
Do you have difficulty making friends?
https://data.unicef.org/resources/module-child-functioning-concept-note/
None Some A lot Cannot do
#isapa2019 | @kwokwng

10. UEF // University of Eastern Finland
Disability Surveys - #isapa2019 | @kwokwng
What about emotional difficulties?
Child Functioning Module
• How often does (name) seem very
anxious, nervous or worried?
– Would you say: daily, weekly, monthly, a
few times a year or never?
• How often does (name) seem very sad or
depressed?
– Would you say: daily, weekly, monthly, a
few times a year or never?
HBSC Symptoms Checklist
• In the last 6 months: how often have you
had the following....?
– Feeling low
– Irritability or bad temper
– Feeling nervous
• About every day, More than once a week,
About every week, About every month,
Rarely or never
17th June 2019
?
?
?
Kwok Ng – Testing self-report CFM

11. UEF // University of Eastern Finland
Questionnaire items were …
• aided by images
• modified to easy-to-read language
#isapa2019 | @kwokwng

12. UEF // University of Eastern Finland
A tool for teachers to choose the right version
L-version
(standard language)
M-version
(easy-to-read language)
S-version
(easy-to-read language)
 challenges in being physically
active, hearing, seeing, or
behaving
 mild challenges in attention
deficit or regulating one’s
activity
 mild challenges in
understanding and learning
 cognitive challenges
 severe challenges in attention
deficit or regulating one’s
activity
General support Intensified support Special support
The level of support is minimal The level of support is maximal
Kwok Ng – Testing self-report CFM
#isapa2019 | @kwokwng

13. UEF // University of Eastern Finland
Intra-rater Test-Retest
Reliability
#isapa2019 | @kwokwng

14. UEF // University of Eastern Finland
Study Design
• Pilot study on 6 special schools, with a target of 60
pupils in 5th – 9th grade pupils.
• Location – South of Finland
• Administration – Research led
• 2- week gap
• Versions
– L & M versions
• Incentive – sports equipment for the school
Ng et al, (submitted). Intra-rater test-retest reliability of self-reporting child functioning module. IJDDE
Kwok Ng – Testing self-report CFM
#isapa2019 | @kwokwng

15. UEF // University of Eastern Finland
Study Characteristics
Ng et al, (submitted). Intra-rater test-retest reliability of self-reporting child functioning module. IJDDE
Kwok Ng – Testing self-report CFM
#isapa2019 | @kwokwng

16. UEF // University of Eastern Finland
Kwok Ng – Testing self-report CFM
#isapa2019 | @kwokwng

17. UEF // University of Eastern Finland
Points of Discussion based on the re-test study
• Substantial agreement with vision item, but it is
perceived as complex and difficult to understand
• Poor agreement with self-care
– Examples are too varied – 1) feeding, 2) dressing oneself
– ICF (WHO, 2007), 5 codes related to ‘feeding’
• Poor agreement with attention (concentration)
– Knowing what a person enjoys may vary by time
• Poor agreement with coping with change (own routine)
– Difficulties in understanding what a routine is
#isapa2019 | @kwokwng

18. Thank you!
uef.fiul.iejyu.fifulbright.fi
#isapa2019 | @kwokwng