The Keele Assessment of Participation
The World Health Organization has proposed participation restriction to reflect the societal consequences of health conditions. Participation restriction can be multiply determined and represents the outcome of an individual’s ongoing interaction with their environment and with society; it emphasizes the independent causal role of environmental factors in determining functioning and refers to what is actually performed by the individual in real life situations. It is appealing concept for those interested in older populations and the impact of chronic diseases because even when health conditions and activity limitations persist, there may still be potential to maintain participation. Despite its importance, participation restriction is inconsistently represented or absent from the content of many health status instruments and has not been clearly measured in population studies.
This chapter describes the development of the Keele Assessment of Participation (KAP), a self-complete instrument designed to provide estimates of person-perceived participation restriction in population-based surveys. It specifies a conceptual model of participation restriction (based on the individual’s perception of performance of tasks), outlines how the instrument was developed (with the aim of being short and simple for application in epidemiological studies) and how its scale scores were decided (to allow differentiation between large groups in the population). It also describes, and reports the results of the pre-pilot studies and pilot studies designed to investigate its measurement properties. The KAP performed adequately in validity and reliability tests and can be considered as an instrument that is likely to detect and provide sensible estimates of participation restriction in postal surveys.
KeywordsDiscriminant Validity Activity Limitation Cognitive Interview Participation Restriction Item Discrimination
List of Abbreviations:
- 95% CI
95% confidence intervals
international classification of functioning, disability and health
impact on participation and autonomy
keele assessment of participation
North Staffordshire osteoarthritis project
reintegration to normal living
World Health Organization
The study in which this work was undertaken was supported financially by a Program Grant awarded by the Medical Research Council, UK (grant code: G9900220) and by funding secured from the North Staffordshire Primary Care R&D Consortium for NHS service support costs. The author would like to thank Dr George Peat, Dr Elaine Thomas, Dr Helen Hooper and Professor Peter Croft for their input in developing the KAP. Also the administrative and health informatics staff at Keele University’s Primary Care Sciences Research Centre and the doctors, staff and patients of the participating general practice and the rheumatology wards of the Haywood Hospital, North Staffordshire.
- Abramson ZH, Abramson JH. (1999). Survey Methods in Community Medicine: Epidemiological Research, Programme Evaluation, Clinical Trials. Churchill Livingstone, Edinburgh.Google Scholar
- McColl E, Jacoby A, Thomas L, Soutter J, Banford C, Steen N, Thomas R, Harvey E, Garratt A, Bond J. (2001). Health Technol Assess. 5(31): 43–101.Google Scholar
- McDowell I, Newell C. (1996). Measuring Health. A Guide to Rating Scales and Questionnaires, 2nd ed. Oxford University Press, Oxford.Google Scholar
- Moser CA, Kalton G. (1971). Survey Methods in Social Investigation, 2nd ed. Dartmouth Publishing, Aldershot.Google Scholar
- Streiner DL, Norman GR. (2003). Health Measurement Scales: A Practical Guide to Their Development and Use, 3rd ed. Oxford University Press, Oxford.Google Scholar
- Sudman S, Bradburn N. (1974). Response Effects in Surveys: A Review and Synthesis. Aldine, Chicago.Google Scholar
- World Health Organization. (2001). International Classification of Functioning, Disability and Health. World Health Organization, Geneva.Google Scholar