Cross-Cultural Adaptation and Evaluation of the Participation and Environment Measure for Children and Youth to the Indian Context—A Mixed-Methods Study

• Main Authors: Roopa Srinivasan, Vrushali Kulkarni, Sana Smriti, Rachel Teplicky, Dana Anaby
• Format: Article
• Language: English
• Published: MDPI AG 2021-02-01
• Series: International Journal of Environmental Research and Public Health
• Subjects: rehabilitation; PEM-CY; participation; cultural adaptation; India
• Online Access: https://www.mdpi.com/1660-4601/18/4/1514
• ISSN: 1661-7827; 1660-4601

Culturally appropriate measures enable knowledge transfer and quality improvement of rehabilitation services in diverse contexts. The Applied Cultural Equivalence Framework (ACEF) was used in a two-phased mixed methods study to adapt and evaluate the Participation and Environment Measure-Children and Youth (PEM-CY) in India. Cognitive interviews with caregivers of children with disabilities (<i>n</i> = 15) aged 5–17 years established conceptual, item, semantic, and operational equivalence of the Indian PEM-CY. Construct validity was assessed by comparing PEM-CY scores of children with and without disabilities (<i>n</i> = 130) using a case-control design. Cognitive interviews resulted in operational (60.3%), semantic (26.4%), and item-level (13.2%) modifications in the PEM-CY with no changes at the conceptual level. Internal consistency (<i>n</i> = 130) was acceptable to excellent (0.61–0.87) on most scales. Test–retest reliability (<i>n</i> = 30) was good to excellent (ICC ≥ 0.75, Kappa 0.6–1.0) for most scales. Significant differences in all PEM-CY summary scores were found between children with and without disabilities, except for environmental supports. Children with disabilities had lower scores on frequency and involvement in activities across all settings; their caregivers desired greater change in participation and reported experiencing more environmental barriers across settings. Findings suggest the adapted PEM-CY is a valid and reliable measure for assessing the participation of Indian children.