Psychometric Study of Chinese Version of the Volitional Questionnaire for Clients with Depressive Disorders in Taiwan

Abstract

Introduction：Occupational therapy seeks to facilitate the clients’ functional performance through motivated, meaningful participation in life occupations. Clients with depressive disorder commonly experience reduction in motivation and energy. Poor motivation can be an impediment to their adaptive functioning. Hence, Data collected on a person’s motivation enables the therapists to identify motivational barriers to functioning and to plan appropriate intervention. Volition refers to the motivation for occupation.

The Volitional Questionnaire can provide individualized and concrete information about the person’s specific motivational characteristics (e.g., personal causation, values, and interests), and identify environmental factors that support or hinder the person’s volition. The purpose of this thesis is to validate the psychometric properties of the Chinese version of the Volitional Questionnaire for clients with depressive disorders in Taiwan.

Methods：The Volitional Questionnaire was translated into Mandarin via 2 stage methodology and tested on 97 clients who were diagnosed with depressive disorders and were recruited from one university-affiliated hospital and two psychiatry rehabilitation hospitals in northern Taiwan. The clients were consisted of twenty-three males and seventy-four females. The average age of the clients was 47.14 years old. (SD=14.12). All subjects participated in purposeful activities that were arranged by the researcher or choose by self, then, the volitional status of the clients was assessed by the researcher. Furthermore, the clients had to finish 5 assessments tools in order to examine the psychometric properties of the Chinese version of the Volitional Questionnaire. The data was analyzed by using Rasch measurement model and traditional test theory.

Results：Rasch analysis indicated that the Volitional Questionnaire-Chinese version encompasses a unidimensional construct. The results of the study showed that test-retest reliability of the Volitional Questionnaire-Chinese version, ICC= .82. Kappa value of individual item of the Volitional Questionnaire-Chinese version was between .449 and .876. The item separation coefficient is 1.00 showed that the Volitional Questionnaire-Chinese version had ideal internal consistency reliability. Lower correlations between the VQ-C and the criterion-related assessment tools revealed that the concurrent validity of the VQ-C was within acceptable level. Furthermore, The 49 clients took part in two different activities with different occupational forms of environment that indicated significant difference in volitional performance (t = 8.670 ，p =.000). This result did meet the theory of the「Model of Human Occupation」. That is, the volitional function of the clients could be influenced by environmental features.

Conclusions：This study confirmed that the VQ-C is a reliable and effective assessment tools, which can provide useful information to therapists about the client’s volitional performance as references in clinical evaluation, intervention program, progression of treatment, or academic research.

Refrences:
Yang, M. S. (2007). Psychometric Study of Chinese Version of the Volitional Questionnaire for Clients with Depressive Disorders in Taiwan. Unpublished master’s thesis, National Taiwan University, Taipei.

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Psychometric Study of Occupational Self Assessment – Chinese version for patients with schizophrenia in Taiwan

Abstract

Objective:

Functional performances were emphasized on the occupational therapy in mental health. However, lacking of standardized evaluation tools was noticed.The Occupational Self Assessment (OSA) was developed based on the model of human occupation and client- center intervention. The purpose of this study was to examine the psychometric properities of Chinese version of OSA.

OSA was translated into Mandarin by research members before testing. 93 patients diagnosed as schizophrenia were recruited from 2 community hospitals (either from day care program or outpatient department) in northern Taiwan. 51 of the subjects were accepted the retest of OSA within 2 weeks.

Method:
Rasch measurement model was selected to examine the construct validity. Items matching percentage of COPM and OSA and Spearman’s correlation between subjects Rasch score as well as COPM performance score and satisfaction score were used to examine the concurrent validity. Weighted Kappa was used to examine test- retest reliability.

Result:
The results of Rasch model measurement revealed that OSA had good construct validity. There were 73% items matched between OSA and COPM. Besides, moderate correlation was noted between Rasch score as well as COPM performance mean score and satisfaction mean score, which was suggested that OSA had moderate concurrent validity. Weighted kappa in 75% to 100% items of four subscales was up to 0.4, which was suggested that OSA had moderate test-retest reliability.

Discussion:
The research findings suggested that OSA had good psychometric properties, and can be applied in clinic to be a valid and reliable assessment tool.

Reference:
Wang, S. M. (2004). Psychometric Study of Occupational Self Assessment – Chinese version for patients with schizophrenia in Taiwan. Unpublished master’s thesis, National Taiwan University, Taipei.

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Psychometric study of the Assessment of Communication and Interaction Skills---Chinese version (ACIS-C)

Abstract

Background：There is a lack of standardized social skill assessments which are developed based on occupational therapy theories with good psychometric properties in Taiwan. The Assessment of Communication and Interaction Skills (ACIS) is an observational rating scale with acceptable construct validity, discriminative validity and reliability. However, the psychometric properties of the Chinese version are unclear.

Objective：The purpose of this study is to examine the reliability and validity of the Assessment Communication and Interaction Skills---Chinese version (ACIS-C) with psychiatric patients in Taiwan. Methods：The subjects were recruited from 3 day care wards in northern and eastern Taiwan. The minimal educational level is elementary school. Exclusion criteria for the subjects included diagnoses of organic brain injury and substance abuse. We recruited 101 patients. After explaining the process and purpose of the study to patients and obtaining their informed consent, each subject was tested on the Mini-Mental State Examination (MMSE). Only patients whose scores on MMSE were equal or larger than 24 were recruited. After securing the permission of the patient and ward staff, the researcher observed subjects’ performance during group session and a simulated social situation. The ACIS-C was used to assess the communication and interaction skills of the patients. Construct and discriminative validity as well as test-retest reliability were examined through Rasch measurement model and related inferential statistics.

Results: The mean age of the subjects are 38.6 years (SD=11.5years). 55.4% are female and 44.6% are male. The majority of the subjects are diagnosed as schizophrenia (77.2%). 70.3% of the patients were unmarried. Most of the educational level is at college or above. 97% of the subjects were unemployed. The results of the Rasch analysis showed that the items of the ACIS-C form a unidimensional construct except for one item (item 7). The test retest reliability is good (ICC=.93). The internal consistency of the scale is .96. The ACIS-C is a sensitive scale which could be used to differentiate social skills among psychiatric patients. The easiest item is ”ask” and the hardest item is”relate”.

Discussion：The ACIS was translated into Chinese through careful two stage translation process. The ACIS-C has acceptable construct validity, discriminative validity and test-retest reliability. The reason for misfit item could be attributed to side effect of psychotropic medications. Therapists can utilize the level of difficulties of ACIS-C items from the study to design matching training programs. For example, a therapist could start the training focus from easier item such as body movement, then progress to harder items such as relates and respects. The results of the study also showed that the severity of symptoms did not influence the patients’ social skills. Future study needs to emphasize inter-rater and intra-rater reliability of the ACIS-C as well as ACIS-C’s validity in different context.

References:

Hsu, W. L. (2007). Psychometric study of the Assessment of Communication and Interaction Skills---Chinese version (ACIS-C). Unpublished master’s thesis, National Taiwan University, Taipei.

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The Study of Psychometric Properties of the Model of Human Occupation Screening Tool (MOHOST)

Abstract

Background: Increasing numbers of people around the world are developing mental illness. Of the people comprising this large group, approximately half are adults, who should be producers or workers in their current life stages. A major consequence of psychiatric symptoms and functional degeneration in clients with psychiatric disorders is unemployment.

A multidimensional assessment could be used to evaluate the holistic work participation of clients with psychiatric disorders and then to help determine their work potential and limitations. In this study, we chose the MOHOST as the assessment tool. We translated it into Chinese and then examined if the MOHOST-Chinese version (MOHOST-C) was an appropriate tool for evaluating the work participation of clients with psychiatric disorders in work or task-oriented situations. In addition, we examined the psychometric properties of the MOHOST-C.

Methods: The MOHOST-C was developed through translation of the MOHOST. It was back-translated twice and checked by a committee of experts to ensure that the meaning of the original was maintained. The translated version was applied to 101 clients with psychiatric disorders aged between 18 to 65 years old. Clients were from 4 different groups: 28 from task-oriented occupational therapy groups, 41 from vocational training programs, 20 from sheltered employment, and 12 from supported employment. Researcher used the MMSE to screen the primary cognitive abilities of clients, and those with MMSE scores above 24 were included. Four occupational therapists were involved in this study. The forty clients included were rated by at least two raters simultaneously.
Clients were observed for 20-30 minutes when participating in work or a task-oriented group and interviewed according to the MOHOST-C interview guidelines. In addition to the interview, the clients were administered related questionnaires, including the National Taiwan University Hospital Symptom Checklist (NTUHSC) and the Chinese version of the Occupational Self Assessment (OSA-C). The researcher combined the results of observations and filled out the MOHOST-C, the Chinese version of the Volitional Questionnaire (VQ-C), and the Chinese version of the Assessment of Communication and Interaction (ACIS-C).

Data analysis: We used the SPSS (version 11.5) and Facets (version 3.62.0) to do data analysis.Scores on the MOHOST-C were transformed to interval data by Rasch measurement model. Item separation reliability was used to examine internal consistency; Rasch analysis was used to examine inter-rater reliability, construct validity and differential item function (DIF) on gender. Additionally, Pearson’s correlation coefficient was used to examine the concurrent validity between the VQ-C, ACIS-C, OSA-C, and the MOHOST-C. Spearman’s correlation coefficient was used to examine the concurrent validity between the NTUHSC and the MOHOST-C. In addition, one-way ANOVA was used to examine the score differences for the four work types.

Results: The MOHOST-C was found to have excellent internal consistency. The items on the MOHOST-C could be separated into the Self aspect and the Environment aspect, and both aspects represented unidimensionality. The MOHOST-C and the VQ-C showed positive correlation (r=0.568, p<0.000), r="0.767," r="0.169," p="0.091" r="0.116," p="0.249" r="0.010," p="0.922)">

Reference:
Fan, C. W. (2008). The Study of Psychometric Properties of the Model of Human Occupation Screening Tool (MOHOST). Unpublished master’s thesis, National Taiwan University, Taipei.

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Role Checklist: The Reliability and Validity Study for Taiwanese Psychiatric Patients

Abstract

We play many roles in our lives. Our spaces and times are arranged and occupational behaviors are organized according to these role. Researchers proposed that cognitive, emotional impairments and restricted learning experience might limit people to practice various roles. Thus, it is necessary to understand client's roles in relation to his or her context for occupational therapists. Occupational therapists found that the test results provide practical information to facilitate clients' motivation in participating the treatment program and their self-awareness.

The purpose of the study is to examine the reliability and construct validity of the Role Checklist for Taiwanese clients. Twenty-nine clients were recruited for reliability study from a psychosomatic unit of a university-affiliated hospital in Taiwan. The diagnoses include mood disorders (55.2%), neurotic, stress-related and somatoform disorders (34.4%), and others (10.3%). All clients were tested and retested during one-week interval. Kappa statistics from SAS computer program were used for analyses. The validity study included 229 clients from the same unit as above. The diagnoses include mood disorders (62.9%); neurotic, stress-related and somatoform disorders (7.0%); Schizophrenia (2.6%), and others (21.4%). Rasch measurement model was used to analyze construct validity through BIOSTEPS computer program.

Kappa values varied from 0.30 to 0.52 for test-retest reliability study. Eighty percents of these values were at the acceptable level. Rasch analysis indicated that the Role Checklist encompasses a uni-dimensional construct. The three most valued roles were ‘value of being a family member', 'value of being a friend', and 'value of being a caregiver'. Value of organization member role was the least valued role among these subjects. The internal consistency is high as demonstrated by high item separation reliability index. The role checklist was supported of its test-retest reliability as well as construct validity of the value items.

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References:
Liu, L. T., Chen, T. J., Chung, L. I. & Pan, A. W. (2004). Role Checklist: The Reliability and Validity Study for Taiwanese Psychiatric Patients. Formosan Journal of Medicine, 8 (5), 630-638.

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Model of Human Occupation in Occupational Therapy

Hello,

We have set up a MOHO center in Taiwan in Feb of 2006.

Here is the first website of the center.

Hope you find it useful.

MOHO proposes that human being is composed of three systems and interact with sourrounding environment to generate occupational behavior. The three system within a person including personal causation which influences how you choose, how you interprete the experience and how you view your own effectiveness.The second system refers to habit of daily life which concerns habits and roles. To put it in simple way, it means that a person functions better if he or she remains a habitual way of life.The third system is about performance which mainly concerns about skills.The environment aspect is related to how resources or limitations of the environment will enable or constrain performance.The MOHO is useful in various areas of clinical practice in Occupational Therapy throughout the world


Ay-Woan Pan, Ph.D
School of OT, NTU
Taiwan

The application of MOHO in the treatment of a patient with depression in Taiwan: A case study

Yun-Ling Chen, Ay-Woan Pan, Tsyr-Jang Chen
Department of Occupational Therapy, National Taiwan University

Background:
Although the current treatment of depression centers on anti-depressant medication use and specific psychotherapy techniques, such as cognitive-behavioral therapy, there are still needs to employ different psychosocial approach to assist the patients with depression to live independently and happily. The purpose of the case study is to illustrate the application of the Model of Human Occupation (MOHO) in the assessment and treatment of a patient with recurrent depression.

Methods:
The patient was recruited from a psychiatric inpatient unit in a medical center in northern Taiwan. She was diagnosed as recurrent depressive disorder with previous history of anorexia nervosa, conversion disorder and obsessive-compulsive disorder. Multiple Chinese version MOHO assessments were applied to her at initial stage. The therapeutic relationship with the patient was developed through the discussion of the results of the assessment and treatment planning.The process focused on facilitating patient’s change and the most frequent therapeutic strategies used in the treatment included identifying, negotiating, advising, structuring and feedback.

Results:
The patient obtained high scores on all symptom checklists and lower satisfaction of her lifestyle and performance initially. A set of meaningful occupations were constructed with her and the steps to apply to her life were negotiated. Before her discharge in a month, her daily living function, role performance, occupational identification and competence improved from previous state. The most important point is the mobilization of her to initiate subtle change.

Conclusion:
The MOHO is a useful theoretical base in the clinical assessment and treatment of patients with minor mental disorder. The emphases of enhancing client’s motivation to engage in occupation and the employment of the therapeutic strategies to support client’s change are essential components of effective intervention.

MOHO center in Taiwan

We move our website to the new address!