Further validation of the Health Promoting Activities Scale with mothers of typically developing children

Feasibility of Health Promoting Activity Coaching for Mothers of Children With Disabilities: Pilot Nonrandomized Controlled Trial

IMPORTANCE

Mothers of children with disabilities experience health disparity. Interventions targeting maternal mental health need to be developed.

OBJECTIVE

To determine the feasibility and preliminary effectiveness of the Healthy Mothers Healthy Families-Health Promoting Activities Coaching (HMHF-HPAC) intervention for mothers to improve participation in healthy activities and mental health and to evaluate outcome measures.

DESIGN

Nonrandomized controlled pilot feasibility study with one group who received HMHF-HPAC and a control group.

SETTING

Pediatric occupational therapy service; on site or telehealth.

PARTICIPANTS

Twenty-three mothers completed prequestionnaires; of those, 11 mothers participated in the intervention, and 5 did not (7 withdrew).

INTERVENTION

Eleven pediatric occupational therapists were trained to deliver six 10-min sessions of HMHF-HPAC to mothers, integrated into their child's therapy session or separately via telehealth.

OUTCOMES AND MEASURES

Mixed-design analysis of variance explored changes in scores on the Depression Anxiety Stress Scale-21 Items and the Health Promoting Activities Scale.

RESULTS

The intervention group reported, on average, significant reductions in depressive symptoms and stress symptoms and significant increases in participation in health-promoting activity. No significant main effect of time was found for these variables in the control group.

CONCLUSIONS AND RELEVANCE

The HMHF-HPAC program is a viable occupational therapy coaching intervention that can be embedded in existing services for families of children with disabilities. Future trials that evaluate the effectiveness of the HMHF-HPAC intervention for mothers of children with disabilities are warranted. What This Article Adds: This article provides support for the feasibility of appropriate and sensitive outcome measures and program content and delivery to implement the novel HMHF-HPAC intervention in further research. Mothers of children with disabilities benefited from integrated HMHF-HPAC delivered by pediatric occupational therapists within the family's existing services.

Cross-Cultural Validation of the Chinese Version of the Health Promoting Activities Scale

IMPORTANCE

The Health Promoting Activities Scale (HPAS) measures the frequency of participation in health-promoting activities of mothers of children with disabilities. Translation of the HPAS into Chinese and validation of the Chinese version will enable its use with Chinese-speaking mothers of children with disabilities.

OBJECTIVE

To translate the HPAS into Chinese and assess its construct validity in relation to measures of well-being, mental health, and activity satisfaction.

DESIGN

Cross-cultural validation.

SETTING

Community.

PARTICIPANTS

Eight bilingual Chinese speakers were involved in the translation. Ethnic Chinese mothers of children with disabilities living in Australia, Singapore, or Taiwan (N = 89) were recruited via purposive snowball sampling. Participants self-selected to complete the Chinese e-survey.

OUTCOMES AND MEASURES

Translation was guided by recommended frameworks. The Chinese versions of the Warwick-Edinburgh Mental Well-being Scale (WEMWS), Personal Well-being Index (PWI), and Kessler Psychological Distress Scale-10 (K10) were used to determine construct validity. Internal reliability was investigated.

RESULTS

The Chinese version of the HPAS correlated significantly with satisfaction ratings (r = .45, p < .001; n = 87), WEMWS Total score (r = .61, p < .001; n = 85), PWI mean score (r = .44, p < .001; n = 84), and K10 total score (r = -.33, p = .002; n = 81). Internal reliability was moderate (Cronbach's α = .74).

CONCLUSIONS AND RELEVANCE

The Chinese version of the HPAS was found to be cross-culturally equivalent to the original HPAS and psychometrically sound for use with Chinese-speaking mothers of children with disabilities. What This Article Adds: This study provides an example of the cross-cultural validation process. The Chinese version of the HPAS is psychometrically sound and could be used as an outcome measure of Chinese mothers' participation in health-promoting activities.

Cross‐cultural Adaptation, validity, and Reliability of the Turkish Version of Health Promoting Activities Scale

Purpose: The Health Promoting Activities Scale (HPAS) is a short scale designed to question activities that may be beneficial for the mental and physical health of the mother and to evaluate mothers in this sense. The aim of the study was to cross-culturally adapt the Turkish version of the Health Promoting Activities Scale (HPAS-T) and to assess its reliability and validity. Methods: Eighty mothers of disabled children who received physiotherapy in a rehabilitation center were recruited in the study. HPAS-T was administered to mothers twice, one-week apart. Internal consistency of HPAS-T was assessed with Cronbach's alpha coefficient. Additionally, test–retest reliability was analyzed using intra-class correlation coefficient. Exploratory factor analysis was conducted to evaluate the construct validity. Besides, known-group validity in terms of body mass index was conducted to reveal the discriminant capacity of the HPAS-T. Results: The mean age of the mothers and their children was 37.46.3 years and 8.14.1 years, respectively. The internal consistency and reproducibility of the HPAS-T total score was excellent (α>0.80, ICC>0.80). SEM95 and MDC95 of the HPAS-T values were 0.58 and 1.61, respectively. HPAS-T, all items were loaded into a single component (0.470-0.833). According to the results of known-group validity model, the HPAS-T score of the mothers in the group whose children's body mass index was ≥18 was significantly lower (p

Maternal and child factors associated with the health-promoting behaviours of mothers of children with a developmental disability

BACKGROUND/AIM

Mothers caring for their child or adult with a developmental disability can experience mental health disparity. Protective factors such as healthy behaviours are under-researched. This study investigated relationships between mental health, healthy behaviours, and disability factors.

METHODS

The cross-sectional online survey included: Depression Anxiety Stress Scales (DASS); Family Empowerment Scale (FES); Health Promoting Activities Scale (HPAS); and a measure of childhood quality of life (QoL).

RESULTS

All mothers were raising offspring (aged 3-36 years) with a developmental disability. Fifty-two percent of mothers (N = 81) had a mental health diagnosis. DASS scores were elevated for depression (58 %), anxiety (52 %) and stress (68 %). Mothers participated in health promoting activities infrequently and reported low satisfaction with community health-supporting facilities. Depressive symptoms, maternal empowerment and two indicators of child-related QoL explained 29.7 % of the variance in healthy behaviours. Depressive symptoms were the most important predictor of lack of health promoting behaviours.

CONCLUSIONS

Better mental health predicted more frequent participation in health promoting behaviour. Future research might explore the extent to which health promoting behaviours protect mental health. Service changes including family health focused services, and custom designed health promotion or coaching programs may improve the health behaviours of mothers with high care responsibilities.

Fathers of children with a disability: health, work, and family life issues

PURPOSE

Fathers in families raising children with disabilities are under-researched. Fathers' perspectives can be better accommodated in childhood disability services that operate on a family-centred paradigm if their perspectives are understood. This study aimed to investigate the perspectives of fathers on caring and family life, work, and health.

METHODS

A mixed-methods design with an online questionnaire included open-ended questions and three instruments: Depression Anxiety Stress Scales (DASS); Health Promoting Activities Scale (HPAS-M); Fathers of Children with Developmental Challenges (FCDC) Scale.

RESULTS

Fathers (n = 33) reported high depressive (58%), anxiety (37%), and stress symptoms (61%). Fathers reported low participation in health-promoting activity with less than weekly: planning health activities (58%); solo physical activity (26%); social activity (3%); time relaxing (16%). Sixty-four percent worked full-time, although work was reported to be challenged by family responsibilities. Fathers described directly caring for their children although service interactions were low and delegated to mothers.

CONCLUSIONS

Fathers in this study reported stress, mental health issues, and low participation in healthy activity. Fathers experienced challenges related to career progression and job choices due to family responsibilities. Providing individualised and responsive support to fathers of a child with a disability would better support the family unit.IMPLICATIONS FOR REHABILITATIONFathers of children with a disability in this study experienced high mental health symptoms.Fathers were involved with their child's care at home but had low service interactions suggesting that service providers need to discover new ways to better engage fathers.Fathers experienced challenges to participation in paid work secondary to care responsibilities for their child with a disability and resulting needs of their family.Services that better support fathers are important to promote better health and wellbeing and support families.

Consumer engagement in occupational therapy health-related research: A scoping review of the Australian Occupational Therapy Journal and a call to action

INTRODUCTION

Consumer engagement in research is becoming an ethical, political, and moral imperative. The aim of this scoping review was to provide a snapshot of the current status of the emerging area of consumer engagement in occupational therapy health-related research, as published in the Australian Occupational Therapy Journal.

METHODS

A scoping review was conducted of all health-related original research published in the Australian Occupational Therapy Journal for 5½ years, plus Early View, as at June 2019. Eligible papers were examined for consumer engagement content which included any active choice or control by consumers, beyond being a research participant. A recognised six stage methodology was used with quantitative and qualitative data analysed. Two consumers collaborated in interpreting the data including finalising themes, leading theme naming, developing key discussion points, and producing recommendations.

RESULTS

Of the 123 eligible papers, 48 (39.02%) included consumer engagement. However, only two incorporated consumer engagement across all research phases-preparation, execution and translation. A total of 103 consumer engagement activities were charted and categorised across all papers. There were limited instances of consumer collaboration (14/103, 13.59%) or consumer-led research processes (15/103, 14.56%) reported. Four themes emerged: Parity in research partnerships; It's important to know the Who, What, When, How and So What of consumer involvement; Consumer engagement must be a two-way process-not a dead end street; and Meeting the challenge-being diverse and inclusive.

CONCLUSION

Comprehensive consumer-researcher partnerships may not be common-place in health-related occupational therapy research in the Australian Occupational Therapy Journal. This paper is a call to action. Occupational therapists must embrace consumer research partnerships as a demonstration of the key philosophies of enabling and empowering consumers and communities. Collaboration with two consumers in finalising data analysis, results interpretation and reporting added a diverse and valuable perspective.

Personal, environmental, and family factors of participation among young children

OBJECTIVE

The purpose of this study is to assess the influences of environment, population characteristics, and service utilization on participation frequency and involvement in the home setting among children 0 to 5 years.

METHOD

Data were collected from parents of 236 children (mean age 3 years and 5 months, SD = 1.30, girls = 152 and boys = 84) using a children's treatment centre in Ontario through an online survey. Two path models measuring home frequency and home involvement were assessed using structural equation modelling. The exogenous factors in the models included child's age, child's sex, child's complexity, number of environmental barriers, income, mother's participation, and service utilization. In addition to participation as the primary outcome, each model explored predictors of service utilization and mother's participation.

RESULTS

The involvement model (R²  = 0.46) explained more variance than the frequency model (R²  = 0.33). Age (0.35, P < 0.001) and barriers (0.07, P = 0.001) predicted participation frequency in the home, χ² (9) = 8.51, P < 0.4, root mean square error of approximation (RMSEA) = 0.00, comparative fit index (CFI) = 1.00. The home involvement model, χ² (6) = 9.79, P < 0.13, RMSEA = 0.06, CFI = 0.97, showed that increasing age (0.09, P < 0.001), lower complexity (0.13, P = 0.001), and higher mother's participation (0.057, P = 0.001) were significantly related to higher participation. An increase in child's age or complexity significantly influenced service utilization across both models. Complexity reduced mother's participation in both the frequency and involvement models.

CONCLUSIONS

This study is one of the first in Canada to examine participation of young children. The aggregation of each unit factor, particularly barriers and complexity, can accrue a large impact on the child's and mother's participation. The potential to mediate this impact by removing environmental barriers and promoting mother's participation merits further study.

Intrarater Reliability and Other Psychometrics of the Health Promoting Activities Scale (HPAS)

OBJECTIVE. The Health Promoting Activities Scale (HPAS) measures the self-rated frequency with which adults participate in activities that promote health. We evaluated the internal consistency, construct validity, and intrarater reliability of the HPAS with a cohort of mothers (N = 56) of school-age children.

METHOD. We used an online survey that included the HPAS and measures of mental and physical health. Statistical analysis included intraclass correlation coefficients (ICCs), measurement error, error range, limits of agreement, and minimum detectable change (MDC).

RESULTS. The HPAS showed good internal consistency (Cronbach’s α = .73). Construct validity was supported by a significant difference in HPAS scores among participants grouped by physical activity level; no other differences were significant. Results included a high aggregate ICC of .90 and an MDC of 5 points.

CONCLUSION. Our evaluation of the HPAS revealed good reliability and stability, suggesting suitability for ongoing evaluation as an outcome measure.