http://myjms.mohe.gov.my/index.php/bsk
Copyright © 2022 Faculty of Health Science UKM. All right reserved Artikel Asli/Original Article
The Development, Validation and Reliability of Recreational Activity Assessment Tool for Children Aged 6 to 12 Years Old in Malaysia
Pembangunan, Kesahan dan Kebolehpercayaan Alat Penilaian Aktiviti Rekreasi untuk Kanak- kanak Berusia 6 hingga 12 Tahun di Malaysia
NOR AFIFI RAZAOB, MASNE KADAR & HASSANATU IMRAAH HASSAN
ABSTRACT
Participation in recreational activities is a vital part of children’s development, as it is related to their quality of life.
It is an essential process of education experience for them. Therefore, this study aims to develop, validate and determine the reliability of the assessment on the preference of children participation in recreational activities among children aged six to 12 years old in Malaysia. This study involved three phases. Phase one was the development of recreational activities assessment based on previous literature review and standardised assessments. Phase two consisted of i) content validation process through focus group discussion (FGD) among ten experts consist of occupational therapists, a clinical psychologist, parents and a teacher and ii) face validity process among five children. A total of 95 respondent was participated in phase three for reliability study of the assessment which it was assessed by using intra class correlation (ICC) and standard error of measurement (SEM) in phase three. The finding showed that the CVI value was reported at 1.0 for both I-CVI and S-CVI. The ICC value was 0.85 and the SEM value was recorded as 0.08. Results shows that this newly developed assessment tool has highly validity and reliable to be used in assessing the preference of participation in recreational activities among children aged six to 12 years old in Malaysia.
Keywords: Preferences, participation, assessment tools, children, recreational activities
ABSTRAK
Penglibatan dalam aktiviti rekreasi adalah aspek penting dalam perkembangan kanak-kanak, kerana ia berkait dengan kualiti hidup mereka. Ia adalah bahagian yang penting dalam proses pengalaman pendidikan bagi mereka Oleh itu, tujuan kajian ini dijalankan untuk membangun, mengesah dan menentukan kebolehpercayaan alat penilaian mengenai kecenderungan penglibatan kanak-kanak dalam aktiviti rekreasi bagi kanak-kanak usia enam hingga 12 tahun di Malaysia. Kajian ini melibatkan tiga fasa. Fasa pertama adalah pembangunan penilaian aktiviti rekreasi berdasarkan kajian kepustakaan terdahulu dan berdasarkan penilaian piawai. Fasa dua terdiri daripada i) proses pengesahan kandungan melalui perbincangan kumpulan fokus (FGD) dalam kalangan sepuluh pakar terdiri daripada ahli terapi pekerjaan, ahli psikologi klinikal, ibu bapa dan seorang guru dan ii) proses kesahihan muka dalam kalangan lima kanak-kanak. Seramai 95 responden telah mengambil bahagian dalam fasa tiga untuk kajian kebolehpercayaan penilaian yang dinilai dengan menggunakan korelasi intra kelas (ICC) dan ralat pengukuran piawai (SEM) dalam fasa tiga. Hasil penemuan menunjukkan bahawa nilai CVI dilaporkan pada 1.0 untuk kedua- dua I-CVI dan S-CVI. Nilai ICC adalah 0.85 dan nilai SEM direkodkan sebagai 0.08. Hasil menunjukkan alat penilaian yang baru dibangunkan ini mempunyai kesahihan yang tinggi dan boleh dipercayai untuk digunakan dalam menilai keutamaan penyertaan dalam aktiviti rekreasi di kalangan kanak-kanak berumur enam hingga 12 tahun di Malaysia.
Kata kunci: Pecenderungan, penglibatan, alat penilaian, kanak-kanak, aktiviti rekreasi
INTRODUCTION
Participation is important for all individuals, especially for children. Participation in everyday activities is considered to be a vital part of children's
development, which is related to their quality of life and future life outcomes (King et al. 2003, Laverdure
& Beisbier 2021, Majnemer 2011). The International Classification of Functioning, Disability and Health (ICF) defines participation as an individual's involvement in a life situation or condition.
Elsewhere, the definition of participation includes the concept of involvement, which may further be defined as taking part, being included or joining in an area of life, being accepted or having access to needed resources (Coster & Khetani 2008).
Active participation helps children to develop skills and competencies, form friendships and relationships, achieve mental, physical and emotional well-being. It also helps them to develop their personality and acquire a sense of meaning and purpose in life (King et al. 2006; Larson & Verma 1999; Laverdure & Beisbier 2021, Sandler et al.
2004). According to a survey conducted in Canada on 23,000 randomly selected children and youth aged 4 to 15 years old indicated that youth who had participated in organized activities but stopped are three times more likely to have lower self-esteem, have difficulty making friends, increase the prevalence of smoking cigarettes, and perform poorly in reading and math (Law 2002).
Recreational activity is defined as involvement in activities such as playing games, relaxation, going to theatres, doing crafts, playing music and tourism.
Formal recreational activities include organized sports, other skill-based activities, and involvement in activities organized by clubs, groups, and/or organizations. While informal recreational activities include hobbies in crafts works and games, social activities, quiet recreation such as reading, active physical activities and entertainment (King et al.
2009). Formal and informal recreational activities are thought to have different effects on youth’s physical, social, emotional, and civic development (Beauvais 2001). Participation in recreational activities is associated with increased quality of life and life satisfaction that is essential to our lives (Potvin, Prelock & Snider 2008). The benefits of recreational participation are universal for all children including those with disabilities. The participation of children with disabilities in recreational activities able to minimizes deconditioning, optimizes physical functioning, and enhances overall well-being (Murphy, Carbone & Council on Children with Disabilities 2008).
It can reduce behavioral and emotional disorders, help develop social relationships and friendship, improve physical and mental health, and help children develop their interests (King et al. 2003;
Mactavish & Schleien 2004) . Recreational participation is also associated with improvements in family relationships and family life satisfaction (Mactavish & Schleien 2004). Moreover, participation in recreational activities is related to an increased quality of life and life satisfaction, both
determinants of health and well-being (Law et al.
2004). As a lot of benefits can be gained through participation in recreational activities especially for children, therefore, it is important for us to enhance the participation of children in their daily routine.
Based on previous reviews, one of the main barriers for children to participate in activities is environmental factors such as lack of equipment, limited access to facilities, cultural and geographic location, as well as parents’ involvement (Shikako- Thomast et al. 2008; Yu et al. 2022). For participation to be meaningful, there must be a feeling of choice or control over the activity, a supportive environment to facilitate easy attention to the activity, a focus on the task and not on the long- term consequences, a sense of challenge from the activity, and a sense of mastery (Law 2002).
Family's style, preferences, and demands, as well as environmental or community-based limitations in restricting a given child's ability to participate in an array of recreational activities (Potvin et al. 2008). A person's preference for participation significantly affects the choice and actual participation and enjoyment (Kimiecik et al. 1996; Lovell et al. 1996, King et al. 2008). This factor refers to the child's affinity for specific types of formal and informal activities (Shikako-Thomas et al. 2008). The model indicates that stronger preferences to take part in specific activities will be related to greater child participation (King et al, 2008).
Potvin et al. (2013) reported that children feel greater enjoyment for activities for which they reported greater preference. Through the literature, it can be seen that participation in activities is highly related to one's interests or preferences. Therefore, in order to understand children's participation, it's important to understand their preferences in activities.
A few standardised assessments was developed in identifying children’s’ participation in daily activities such as Preferences for Activities of Children (PAC)(King et al. 2007) and Children’s Leisure Assessment Scale (CLASS) (Rosenblum et al. 2010). It is important to gather information on the children’s preferences activities (King et al. 2006).
However, PAC and CLASS were developed based on overseas culture and environment (Rosenblum et al.
2010). The different geographical location leads the selection of activities become not suitable for Malaysian weather, environment and culture. In addition, it was written in English version. These factors are the limitation of the current assessments.
As children's participation in recreational activities plays a big role in children's development,
these activities must be evaluated to enhance its benefits. This study aims to develop, validate and perform reliability testing on an assessment of preferences in recreational activities among children aged six to 12 years old in Malaysia. Developing the assessment on the preference of children participation in recreational activities may serve as a good indicator to know their development in social, emotional and physical health. It is also a good indicator to know their level of ability and interest in recreational activities as well as their preferences towards such activities.
MATERIALS AND METHODS
ETHICS APPROVAL
Ethics approval was granted by the Research Ethics Committee, Universiti Kebangsaan Malaysia (UKM) with reference number UKM.FSK.800-2/27/9(NN- 2020-005). Consent form was obtained prior to the study.
RESEARCH DESIGN AND SAMPLE SIZE This was a cross-sectional and involved three phases of the study. Phase one was the development of the assessment by using previous study and current standardised assessment PAC and CLASS. Phase two involved validation of the assessment process with the panel experts in focus group discussion (FGD) and face validity by using cognitive interviewing Phase three was a reliability study.
Phase one began with identifying suitable recreational activities for children in Malaysia by reviewing published peer-reviewed articles. Database searches were performed to obtain relevant articles.
Current assessments PAC and CLASS was used to identify the gap due to cultural, environment and geographical limitation. The newly developed self- administered assessment was further discussed in phase two with the experts' panel in a focus group discussion (FGD) session to get their comments on the newly developed assessment. This FGD involved ten participants with inclusion criteria for the expert panels were: i) healthcare professionals with at least one year working experience with children, ii) parents with children aged six to 12 years old and iii) teachers with at least three years of experience in teaching children aged six to 12 years old. The exclusion criteria were: i) healthcare professionals, parents and teachers who do not understand Malay language and ii) foreigners. (Wong 2008) and
Content Validation Index form was given to all experts after amendment was done. This FGD lasting for two hours, at Skill Rooms Occupational Therapy Clinic. All responses were noted and recorded.
In phase three of the study, face validity was performed to test their understanding of the instructions, images and activity description of the newly developed assessment. Verbal probing technique was used in cognitive interviews as specific information were obtain through asking questions. Children aged six to 12 years old were included and those who do not understand Malay language, foreigner and children with disabilities were excluded from the cognitive interview. A total of 15 children were recruited in the cognitive interviewing process (Beatty & Willis 2007; Willis 2004).
Phase 4 involved the test-retest reliability of the assessment involving children aged six to 12 years old in the community. Participants were asked to complete the assessment twice within a 10-15 days interval. The sample size calculation was based on Bujang and Baharum (2017). The total sample size needed for this study was 95 children.
STATISTICAL ANALYSIS
Content validation index (CVI) can be determined using the viewpoint of the panel of experts. It can be calculated both for item level (I-CVIs) and the scale- level (S-CVI). In item level, I-CVI is computed as the number of experts giving a rating 3 or 4 of each item was divided by the total number of experts while S- CVI was the proportion of items on an instrument that achieved a rating of 3 or 4 by the content experts.
According to Sirajudeen et al. (2012), the degree of the agreement can be considered to be excellent agreement, high agreement and moderate agreement at the value of 0.90 until 1.00, 0.80 until 0.89 and 0.70 until 0.79 respectively.
IBM Statistical Package for the Social Sciences (SPSS) was used to determine the internal consistency, test-retest reliability by using Cohen Kappa and Intraclass correlation coefficient (ICC), the limit of agreement (LOA) and standard error of measurement (SEM). Cronbach’s alpha was used to measure the internal consistency of a test or scale where it was expressed as a number between zero and one (Tavakol & Dennick 2011). Internal consistency was determined before a test can be employed for research or examination purposes to ensure reliability. The acceptable values of cronbach’s alpha were ranging from 0.70 to 0.95 and the value of alpha
was increased if the items in a test are correlated to each other (Tavakol & Dennick 2011).
Agreement between items in recreational activities (inter-rater agreement) was measured by using Cohen’s kappa coefficient (k). The interpretation of Cohen’s k-coefficient was theoretically 1.0 for perfect agreement (Jakobsson et al. 2005). Values are interpreted as below 0.20 regarded as poor, 0.21–0.40 as fair, 0.41–0.60 as moderate, 0.61–0.80 as good and >0.80 as a very good agreement (Altman 1991). Based on Fleiss and Cohen (1973), cohen’s kappa scaled vary from negative one to positive one, so that a negative value indicates poorer than chance agreement, zero indicates exactly chance agreement, and a positive value indicates better than chance agreement.
The ICC was calculated using variance estimates obtained through the partitioning of total variance into between and within-subject variance (known as analysis of variance or ANOVA) (Bruton, Conway &
Holgate 2000). ICC is a value between zero to one. A value below 0.5 indicates poor reliability, between 0.5 and 0.75 is moderate reliability, 0.75 and 0.9 indicate good reliability and any value more than 0.9 is excellent reliability (Koo & Li 2016).
The LOA technique has become a standard and valuable measurement for reliability because it quantifies the differences between two subject means with repeated observation. This difference between two measurements indicates the bias. This design involves a calculation of two most important values – paired differences and mean scores of paired data.
The graph was plotted with plus/minus 2SD.
According to Bland and Altman (1986), the difference score must fall within this 2SD (expectation 95% CI). This 95% of LOA was calculated by multiplying the SD of differences by 1.96. The interpretation of LOA involves four criteria; i) the bias or outliers can be seen clearly, ii) the association of the closeness of means to the mean differences, iii) the closeness of the mean differences to zero and iv) the spread of score for paired means.
The last method in reliability was measuring the degree of measurement error within a specific measurement variable. Measurement error can be estimated based on an equation or formula but SEM analysis and it is commonly presented as a percentage of 95% confidence. SEM measures the tendency of variability of error between two measurements and overcomes the difficulties of determining changes in error (Lexell & Downham 2005). The formula for SEM as SEM = SD √1-r with SD = Standard deviation of mean difference and r = Intraclass Correlation Coefficient value.
The combination of the three tests described above was used in this study to rate the final determination of reliability by using a rating scale on which positive (+) indicates that the measurement is strongly reliable and negative (-) represents that low reliability if found between the measurements. The icon (±) indicates inconclusive which means that the method has identified that some elements of the measurement are reliable but that there are some points which are still insufficient to meet the criteria of reliability.
RESULTS
According to the literature review on previous research study such as the assessment CAPE/PAC and CLASS, a total of 10 recreational activities was identified as suitable for children in Malaysia. Each of these activities was described accordingly in phrases and images to enhance understanding. A 3- point Likert scale was included in each item to be rated by the child. The 3-point Likert scale was presented as the image of a thumb up (I would really like to do), okay (I would sort of like to do) and thumb down (I would not like to do it at all) in order to provide a better understanding for children. The scoring was decided to put 1 = I would not like to do it at all, 2 = I would sort of like to do and 3 = I would really like to do.
Table 1 present the demographic of the expert panels. During FGD process with 10 expert panels, 10-items/activities was agreed to be included in the recreational activities. The item included in the assessment was doing jigsaw puzzle, play board game, doing craft, play computer game, play with pet, role play, play with toys, going for walk, play at playground and watch television.
CVI evaluation based on four items (relevance, clarity, simplicity and ambiguity) has a high face and content validity. Both the I-CVIs and S-CVI scores were 1.00. Hence, it shows that the recreational activities assessment has an excellent validation.
The finding of face validity showed that all children were able to understand the instructions, images and activities descriptions in the assessment, and that the assessment was easy to rate.
A total of 95 children aged from six to 12 years old with mean 9.82 years old (1.72 SD) were recruited as subjects with their parent’s consent.
There were 51 male (53.7%) and 44 females (46.3%).
The majority of the children involved in this study are Malay which is 59 children (62.1%), followed by Chinese with 36 children (37.9%). The internal
consistency was established. The cronbach's alpha coefficient for the pooled 10 items in both test and retest was alpha=0.483 and alpha=0.491 respectively.
From the result, it is considered the recreational items
in the test were moderately correlated to each other because the value of alpha was increased if the items in a test are correlated to each other.
TABLE 1 Sociodemographic of expert panel
n Percent
Gender
Male 2 20
Female 8 80
Race
Malay 10 100
Education Level
Diploma 1 10
Degree 6 60
Master 3 30
Occupation
Parents 2 20
Occupational Therapist 6 60 Clinical Psychologist 1 10
Teacher 1 10
Experiences with Childrem
1 – 10 years 6 60
11 – 20 years 4 40
The test -retest reliability of the recreational activities was established by testing cohen's kappa coefficient (k), intraclass correlation coefficient (ICC), the limit of agreement (LOA) and standard error of measurement (SEM). Agreement between items was measured by using cohen's kappa coefficient (k). The cohen's kappa coefficients in the recreational items scale ranged from 0.290-0.627,
indicated as fair to good agreement of items between test and retest.
The ICC coefficients of the recreational activities calculated and shown in Table 2. It was found the ICC values were 0.848 with a 95% confidence interval from 0.772 to 0.899 which indicated good test-retest reliability for the recreation activities.
TABLE 2 Intraclass Correlation Coefficient (ICC)
Instrument F value P Single ICC Average ICC
Recreation Activities 6.576 <0.05 0.736 0.848
According to the Bland and Altman plot (Fig. 1), the graph plot illustrates the LOA. From the graph, it shows some outliers can be seen clearly.
Furthermore, the mean of differences for the recreation activities is -0.0069, which indicates the closeness of the variance to the mean difference.
According to one of the criteria of LOA stated in the
method, the mean differences of the data were close to zero in this graph. The result also shows that the data was spread evenly which the larger spread reflects large discrepancies of the differences of variance. The detailed results of the interpretation of LOA are shown in Table 3.
FIGURE 1 LOA for the assessment
TABLE 3 Interpretation of LOA according to 4 criteria
Criteria Recreation activities
Outliers that can be seen clearly ±
Closeness of means to the mean differences + Closeness of the mean differences to zero + The spread of score for paired means +
(+) = strongly reliable (±) = moderate reliable or inconclusive (-) = low reliable
TABLE 4 Interpretation of the test-retest reliability Statistical Analysis Recreation activities
ICC +
LOA +
SEM +
ICC=intraclass correlation coefficient, OA=limit of agreement, SEM=standard error of measurement, (+) = reliable (±) = moderate or inconclusive (-) = not reliable
SEM was calculated in which the value of SEM was 0.08. The value of SEM 1SD and SEM 2SD
were 0.11 and 0.23 respectively. The combination of the three tests described above was summarized in
Table 4. The final determination of reliability was analyzed by using a rating scale on which positive (+) indicates that the measurement was strongly reliable, negative (-) represents low reliability and the icon (±) indicates inconclusive or moderate reliable as shown in Table 3. Based on the result, all the test-retest reliability shows that the recreational activities in the assessment is strongly reliable. In conclusion, the newly developed recreational activities in the assessment have high validity and reliability.
DISCUSSION
The development of an assessment of recreational activities in this study can be considered as valid for use with children in Malaysia. The newly developed assessment reported an excellent result for I-CVIs and S-CVI. Input from experts in the fields can be considered beneficial in improving the assessment.
The important process of cognitive interviewing involving children aged six to 12 years old emerged as one of the essential methods for identifying and correcting problems with survey questions (Beatty &
Willis 2007). A cognitive interviewing is used to help determine whether the question is generating the information intended and to evaluate the quality of the response. This study shows that the children's population gave their feedback during cognitive interviews which all of them understood the meaning of instructions, images and activities of the newly developed assessment.
The value of alpha was an important concept in the evaluation of the newly developed assessments. It is mandatory that researchers add validity and accuracy to the interpretation of the data. Based on Tavakol and Dennick (2011), the value of cronbach's alpha was affected by the number of test items, item inter-relatedness and dimensionality. A low value of alpha could be due to poor inter-relatedness between items, a low number of questions, or heterogeneous constructs (Tavakol & Dennick 2011). Hence, the value of alpha for 10 items in this current study was considered moderately correlated to each other items.
A newly developed assessment is good if it has high reliability on it. High reliability implies great tracking of changes in measurements and better precision of single measurements in research or practical settings (Hopkins 2000). Test-retest reliability concerns the reproducibility of the observed value when the measurement is repeated which retest correlation is difficult to interpret, mainly because its value is sensitive to the heterogeneity of the sample of participants. A wider
understanding of reliability and adoption of the typical error of reliability would improve the assessment of tests. Based on the result of the cohen kappa coefficient, ICC, LOA and SEM for test-retest reliability in this study, the results show that the newly developed assessment of recreational activities is strongly reliable.
Furthermore, the validity and reliability findings of the current study indicate that the measures of preferences of recreational activities can be used to describe typically developing children’s participation patterns in their leisure time. The development of the new assessment needed a valid and reliable tool for the evaluation of children's preferences toward recreational activities. The detailed process of items identification, the involvement of experts in the fields, cognitive interviewing and test-retest reliability testing manages to produce an accurate assessment of recreational activities. This current study would be helpful in the future study in order to assess children aged six to 12 years old on their preferences in recreational activities in Malaysia.
CONCLUSION
Participation in recreational activities is associated with increased quality of life and life satisfaction.
There is a need for psychometrically sound measures of children’s participation in recreation activities, for both clinical and research purposes. Although, there are relatively few measures that assess the preference of children's participation, all the assessment was developed based on western culture. Hence, developing the new assessment on the preference of children participation in recreational activities may serve as a good indicator to understand their development in social, emotional, interest and physical health. The newly developed assessments involved the process of focus group discussion and CVI to make sure this assessment has good validity.
Determination of reliability is complex and requires the use of various statistical analysis methodologies to assess reliability levels. In this study, a few statistical tests were used to identify the level of reliability. The combination test of internal consistency, cohen's kappa coefficient, ICC, LOA and SEM shows the comprehensive result in this study.
Hence, the overall result showed that the assessment was highly valid and reliable. In conclusion, this newly developed assessment has a good psychometric which can be used as one of the
assessments to assess the preference of children participation towards recreational activities in Malaysia. This study also can help with other psychometric studies that are related to this assessment. Lastly, this study also has positive implications for health-care professionals especially occupational therapists and teachers in the implementation of intervention towards children.
ACKNOWLEDGMENT
The author(s) would like to give some appreciation to the education authorities, occupational therapies, teachers, parents and children for their support and involvement in this study.
REFERENCES
Altman, D. G. 1991. Practical Statistics for Medical Research. New York: Chapman and Hall/CRC.
Beatty, P. C. & Willis, G. B. 2007. Research synthesis: The practice of cognitive interviewing.
Public Opin. Q. 71(2): 287–311.
Beauvais, C. 2001. Literature review on learning through recreation. CPRN Discussion Paper.
Available at
http://www.eric.ed.gov/ERICWebPortal/contentd elivery/servlet/ERICServlet?accno=ED475445 Bland, J. M. & Altman, D. 1986. Statistical methods
for assessing agreement between two methods of clinical measurement. Lancet 327(8476): 307–
310.
Bruton, A., Conway, J. H. & Holgate, S. T. 2000.
Reliability: What is it, and how is it measured?
Physiotherapy 86(2): 94–99.
Bujang, M. A. & Baharum, N. 2017. A simplified guide to determination of sample size requirements for estimating the value of intraclass correlation coefficient: a review. Arch.
Orofac. Sci. 12(1): 1-11
Burtner, P. A., McMain, M. P. & Crowe, T. K. 2002.
Survey of occupational therapy practitioners in Southwestern schools. Phys. Occup. Ther.
Pediatr. 22(1): 25–39.
Coster, W. & Khetani, M. A. 2008. Measuring participation of children with disabilities: Issues and challenges. Disabil. Rehabil. 30(8): 639–
648.
Fleiss, L. J. & Cohen, J. 1973. The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ.
Psychol. Meas. 33(3): 613–619.
Hopkins, W. G. 2000. Measures of reliability in sports medicine and science. Sports Med. 30(3):
1-15.
Jakobsson, Ulf & Westergren, A. 2005. Statistical methods for assessing agreement for ordinal data. Scand. J. Caring Sci. 19(4): 427–431.
Kimiecik, J. C., Horn, T. S. & Shurin, C. S. 1996.
Relationships among children’s beliefs, perceptions of their parents’ beliefs, and their moderate-to-vigorous physical activity. Res. Q Exerc. Sport. 67(3): 324–336.
King, G., Law, M., King, S., Hurley, P., Hanna, S., Kertoy, M. & Rosenbaum, P. 2007. Measuring children’s participation in recreation and leisure activities: Construct validation of the CAPE and PAC. Child: Care Health Dev. 33(1): 28–39.
King, G., Law, M., Hanna, S., Hurley, P., Rosenbaum, P., Marilyn, K. & Petrenchik, T.
2006. Predictors of the leisure and recreation participation of children with physical disabilities: A structural equation modeling analysis. Child Health Care 35: 37–41.
King, G., Law, M., King, S., Rosenbaum, P., Kertoy, M. K. & Young, N. L. 2003. A conceptual model of the factors affecting the recreation and leisure participation of children with disabilities. Phys.
Occup. Ther. Pediatr. 23(1): 63–90.
King, G., Petrenchik, T., Law, M. & Hurley, P. 2009.
The enjoyment of formal and informal recreation and leisure activities: A comparison of school- aged children with and without physical disabilities. Int. J. Disabil. Dev. Ed. 56(2): 109–
130.
Koo, T. K. & Li, M. Y. 2016. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J. Chiropr.
Med. 15(2): 155–163.
Larson, R. W. & Verma, S. 1999. How children and adolescents spend time across the world: Work, play, and developmental opportunities. Psychol.
Bull. 125(6): 701–736.
Laverdure, P., & Beisbier, S. (2021). Occupation-and activity-based interventions to improve performance of activities of daily living, play, and leisure for children and youth ages 5 to 21: a systematic review. Am. J. Occup. Ther. 75(1): 1- 24.
Law, M. 2002. Participation in the occupations of everyday life. Am. J. Occup. Ther. 56(6): 640–
649.
Law, M., Finkelman, S., Hurley, P., Rosenbaum, P., King, S., King, G. & Hanna, S. 2004.
Participation of children with physical disabilities: Relationship with diagnosis, physical
function, and demographic variables. Scand. J.
Occup. Ther. 11(4): 156–162.
Lexell, J. E. & Downham, D. Y. 2005. How to assess the reliability of measurements in rehabilitation.
Am. J. Phys. Med. Rehabil. 84(9): 719.
Lovell, T. A., Dattilo, J. & Jekubovich, N. J. 1996.
Effects of leisure education on women aging with disabilities. Act. Adapt. Aging. 21(2): 37–
58.
Mactavish, J. B. & Schleien, S. J. 2004. Re-injecting spontaneity and alance in family life: Parents’
perspectives on recreation in families that include children with developmental disability. J.
Intellect. Disabil. Res. 48(2): 123–141.
Majnemer, A. 2011. Importance of Motivation to Children's Participation: A Motivation to Change.
Phys. Occup. Ther. Pediatr. 31(1): 1-3.
Murphy, N. A., Carbone, P. S. & American Academy of Pediatrics Council on Children With Disabilities. 2008. Promoting the participation of children with disabilities in sports, recreation, and physical activities. Pediatrics 121(5): 1057–
1061.
Potvin, M. C., Prelock, P. A. & Snider, L. 2008.
Collaborating to support meaningful participation in recreational activities of children with autism spectrum disorder. Top. Lang.
Disord. 28(4): 365–374.
Potvin, M. C., Snider, L., Prelock, P., Kehayia, E. &
Wood-Dauphinee, S. 2013. Recreational participation of children with High Functioning Autism. J. Autism Dev. Disord. 43(2): 445–457.
Rosenblum, S., Sachs, D. & Schreuer, N. 2010.
Reliability and validity of the children’s leisure assessment scale. Am. J. Occup. Ther. 4(4): 633–
641.
Sandler, I. N., Ayers, T. S., Suter, J. C., Schultz, A. &
Twohey-Jacobs, J. 2004. Adversities, strengths, and public policy. In: K. I. Maton, C. J.
Schellenbach, B. J. Leadbeater & A. L. Solarz (Eds.), Investing in children, youth, families, and communities: Strengths-based research and policy, USA: American Psychological Association.
Shikako-Thomas, K., Majnemer, A., Law, M. &
Lach, L. 2008. Determinants of participation in leisure activities in children and youth with cerebral palsy: systematic review. Phys. Occup.
Ther. Pediatr. 28(2): 155-169.
Sirajudeen, M., Pillai, P., Shah, U. & Mohan, N.
2012. Content validity and inter-rater reliability of a checklist to assess the ergonomic practice of computer professionals. Int. J. Ther. Rehabil.
1(2): 11 – 18.
Tavakol, M. & Dennick, R. 2011. Making sense of cronbach’s alpha. Int. J. Med. Educ. 2: 53 – 55.
Willis, G. B. 2004. Cognitive Interviewing: A Tool for Improving Questionnaire Design. National Cancer Institute: Sage Publishing.
Wong, L. P. 2008. Focus group discussion: a tool for health and medical research. Singap. Med. 49(3):
256-260.
World Health Organization. 2008. International classification of functioning, disability and health of World Health Organization (ICF). Geneva:
World Health Organization.
Yu, S., Wang, T., Zhong, T., Qian, Y. & Qi, J. 2022.
Barriers and facilitators of physical activity participation among children and adolescents with intellectual disabilities: A scoping review.
Healthcare 10(2): 233.
Nor Afifi Razaob Masne Kadar
Centre for Rehabilitation and Special Needs Faculty of Health Science
Universiti Kebangsaan Malaysia Jalan Raja Muda Abdul Aziz
50300 Wilayah Persekutuan Kuala Lumpur Hassanatu Imraah Hassan
Nourani Therapy Centre,No 10, Jalan 15/5 L, Garden Homes, Seksyen 15, 43650 Bandar Baru Bangi, Selangor
Corresponding Author: Nor Afifi Razaob E-mail: [email protected] Tel: 603-92897350
Fax: 603-2691 4304 Received: 31 May 2022 Revised: 23 August 2022
Accepted for publication: 6 October 2022
