Development, Cross-Cultural Adaptation, and Psychometric Testing of the Child and Adolescent Activity Card Sort (CA-ACS)-Arabic version of the Adolescent and Young Adult-ACS (AYA-ACS)

Abstract

Occupational therapy (OT) takes a client-centered approach in which OT practitioners work with clients to create and meet goals; this is a valued approach in the United States (U.S.) However, In Saudi Arabia, children with NDDs are rarely asked to select their therapy goals, likely due to a lack of instruments that support the child's participation in the process. In the U.S., activity card sorts are increasingly being used in pediatrics to include children in goal setting. This dissertation presents three studies focused on developing and validating a school-aged Activity Card Sort (ACS) for Saudi children and adolescents. Study 1 aimed to develop a comprehensive occupation-based, culturally tailored tool adapted from the U.S.-developed Adolescent and Young Adult-Activity Card Sort (AYA-ACS) (Berg et al., 2015). Following Beaton and colleagues’ cultural tailoring and translation process, forty-six percent were retained or modified from the AYA-ACS, and 54% were unique to the Saudi culture. This resulted in an 83-activity card sort, Child Adolescent-Activity Card Sort-Arabic version (CA-ACS). The activity cards were sorted into nine domains, including ADLs, obligatory chores, leisure, social, health and wellness, education and learning, caring for other children, religion, and sports. Study 2 aimed to pilot-test the newly developed CA-ACS-Arabic version and establish its face and content validity. The results showed that parents and children rated the activities of the CA-ACS-Arabic version as frequently culturally appropriate activities. There was good face validity as parents rated the activity cards as clearly demonstrating the captioned activity. Study 3 examined the psychometric testing of the CA-ACS-Arabic version, which showed excellent reliability (Cronbach’s alpha = 0.893). Two analyses were conducted to assess convergent and discriminate validity to establish construct validity. There was a significant positive relationship between the CA-ACS-Arabic version and the Arabic CAPE (r = 0.72, P <0.001), demonstrating good convergent validity. Lastly, there was a significant difference between the NT and NDD groups’ scores on the CA-ACS-Arabic version (P=<0.05), suggesting good discriminative validity. Future research is needed to examine the usefulness of the CA-ACS-Arabic version for NDD populations in developing occupational profiles and identifying goals in Saudi Arabia.