Development and Validation of the Community Participation Activation Scale

Much effort has been made to clarify the definition of participation and identify how to best measure the construct since the International Classification of Functioning, Disability and Health (ICF) model included participation as a major component. A growing body of literature supports that participation requires continuous management of individual and social needs and values. Enabling and activating people with stroke to be ready to participate in the community is a desired outcome of stroke rehabilitation; yet, no measures are available to assess how ready or activated a person is for community participation that can then inform participation-focused interventions tailored to the person’s level of activation. Therefore, the aim of the study was to develop and validate a new measure called “Community Participation Activation Scale (CPAS)” that examines how activated a person is by assessing attitudes and actions facilitating community participation. An exploratory mixed method design was used, in which the qualitative study (phase 1 and 2) complemented the quantitative study (phase 3). In phase 1, a conceptual model explaining factors activating participation was developed based on findings from focus groups, in-depth interviews, and literature review. The conceptual model showed that there is a dynamic interaction between attitudes and actions which activates and enables community participation post stroke. In phase 2, the CPAS items were developed based on the conceptual model, then refined using expert reviews and cognitive testing. A pool of 41 items was examined by eight experts. The overall scale level content validity index was 0.90 after deleting five items based on ratings and comments from the experts. Then, 37 items were tested and revised based on findings from cognitive testing with five individuals with stroke. Revision included combining items, deleting irrelevant items, clarifying the meaning of ambiguous items, simplifying wording, and lowering the reading level. In phase 3, a pool of 27 items were field-tested with 93 individuals with stroke living in the community. Rasch modeling and classic test theory were used to examine the psychometric property of the CPAS. After deleting a misfitting person and items, Rasch analysis supported the unidimensionality and monotonicity of 15 action items and 10 attitude items. Person separation reliabilities of the Action and Attitude domains were 0.75 and 0.72 respectively, and internal consistency reliabilities were 0.82 and 0.84 respectively. The CPAS showed low to moderate correlation with community integration and enfranchisement constructs (r=0.39-0.55). The CPAS represents an important contribution to the literature for increasing our understanding of activation in the context of community participation. Although the assessment needs further development to improve precision, the initial findings demonstrated that CPAS can be explained by two distinct domains: Action and Attitude domains. The study provides preliminary findings supporting that CPAS can be used as an assessment to examine community participation activation in people with stroke and may help inform individually designed, participation-focused interventions.