The content and face validity for the Test of Perceived Motor Competence for children with visual impairments: A Delphi investigation

Abstract

The Perceived Physical Competence subscale of the Pictorial Scale of Perceived Competence and Social Acceptance (PSPCSA) is a valid, reliable, and widely used assessment of perceived motor competence (PMC) for young children. Recently, Brian, Haegele, and Bostick modified the PSPCSA to create the Test of Perceived Motor Competence (TPMC) for children with visual impairments (VI). However, they determined that content and face validity of the TPMC-VI was necessary. Therefore, the purpose of this study was to explore the content and face validity of the TPMC-VI for use in children with VI. This study features the Delphi technique with a panel of experts as well as participant interviews with one child and her teacher. Findings demonstrated that the TPMC-VI shows preliminary content and face validity for assessing PMC of children with VI. The TPMC-VI allows researchers and practitioners to accurately estimate the PMC of students with VI.

Keywords

Blindness disability motor skills physical activity physical education

Children with visual impairments (VI), that is, those who are blind or have low vision, tend to be less physically active and more susceptible to health-related issues associated with sedentary lifestyles (e.g. obesity, cardiovascular disease) than peers without VI of a similar age (Augestad & Jiang, 2015; Haegele & Porretta, 2015). Although a number of factors that limit physical activity for those with VI have been identified, the current literature has not focused on the role fundamental motor skill competence plays in supporting physical activity behaviors (Stodden et al., 2008). Children with VI tend to acquire motor skills later in life and have deficiencies in object control and locomotor skills in comparison to sighted, age-corroborated peers (Haegele, Brian, & Goodway, 2015). These delays coincide with low physical activity levels, which support a potential association with physical activity.

Along with fundamental motor skill competence, an additional mechanism that can drive physical activity behavior for children is perceived motor competence (PMC). PMC has been defined as an individual’s personal perception of his or her physical strength, movement capability, capacity for sport, and fitness level (Fox & Corbin, 1989). Harter (1978) suggests that PMC may be a stronger predictor of children’s decisions to participate in physical activity than levels of motor competence (Harter, 1978). In addition, PMC tends to mediate the relationship between motor competence and physical activity for children without VI (Barnett, Morgan, van Beurden, Morgan, & Beard, 2008). Specifically, young children tend to overestimate their PMC in comparison to their actual fundamental motor skill competence (Goodway & Rudisill, 1997). An inflated PMC allows children to be persistent and engage in motor skill activities, even when they have limited actual competence, because they believe they will be successful. Conversely, when children have low PMC, they may believe they are not as advanced as peers and find physical activity less enjoyable. This could lead children toward selecting more sedentary activities for leisure.

Given that PMC can influence a child’s decision to participate in physical activity (Stodden et al., 2008), it is an important mechanism that warrants exploration for children with VI. However, little research has been conducted in this area. While attention has been given to the importance of PMC for children (e.g. Barnett et al., 2008), just one recent preliminary study (Brian, Haegele, & Bostick, 2016) has explored this variable for children with VI. The results demonstrated that PMC has a positive, non-significant correlation with levels of visual acuity (r = .278; p = .437) and that levels of PMC (M = 2.27; standard deviation [SD] = .81) were similar to that of sighted peers from disadvantaged settings (Robinson, Rudisill, & Goodway, 2009). One limitation of this recent study was that the instrument utilized to collect data had not been validated for children with VI. Because of this, data may not accurately portray the PMC of the children in the study. PMC instruments are typically largely visual (pictorial), so validation is critical when considering use in children with VI.

Because children with VI tend to participate in low physical activity levels, they also trend with higher rates of poor health-related fitness and can be at high risk of developing mental health conditions (Brunes, Flanders, & Augestad, 2015; Lieberman, Byrne, Mattern, Watt, & Fernandez-Vivo, 2010). PMC has been identified as a contributing variable to children’s physical activity and health-related fitness (Stodden et al., 2008); however, little research has been done which explores this variable for children with VI (Brian et al., 2016). Since children with VI tend to demonstrate low physical activity and health-related fitness levels (Haegele & Porretta, 2015; Lieberman et al., 2010), it is essential to understand any variables that may influence participation. Prior to doing so, it is important to develop a validated instrument to assess levels of PMC accurately for young children with VI. Therefore, the purpose of this study was to explore the content and face validity of a modified version of the Pictorial Scale of Perceived Competence and Social Acceptance (PSPCSA) instrument for utilization in children with VI. Content validity refers to elements within a measurement procedure representing the construct for which it is intended to measure (Lomax & Hahs-Vaughn, 2012). Face validity, in contrast, is not what the instrument actually measures but what it appears to measure (Lomax & Hahs-Vaughn, 2012).

Methods

Prior to the start of this study, an institutional review board at a university in the United States provided written approval. All adult participants consented to participate while children assented to participate along with their parents providing consent. This study occurred across four phases (Figure 1). The purpose of Phase 1 was to establish a preliminary understanding of PMC for children with VI. In addition, Phase 1 established a rationale to modify the PSPCSA for use in children with VI (see Brian et al., 2016). The PSPCSA was chosen because it is widely used and considered valid and reliable to examine PMC for young children (Harter & Pike, 1984). Moreover, the format of the PSPCSA yields scores that are easy to translate for both research and practice (e.g. 1 = poor and 4 = high). For an in-depth description of the PSPCSA and Phase 1 of this study, refer to Brian and colleagues (2016).

Figure 1.

Sequence of events to content and face validate the new instrument.

This study begins with Phase 2. During Phase 2, eight experts (seven females and one male) were contacted to determine interest in participating in a Delphi consultation. A Delphi consultation is an iterative process aimed at seeking consensus from a panel of experts on a topic (Hsu & Sandford, 2007). Delphi consultation with experts can be used to develop content validity of an instrument (Barnett, Hardy, Brian, & Robertson, 2015). Experts comprised three categories: (a) researchers who actively publish studies focusing on physical education, motor development, or education for individuals with VI (n = 4); (b) teachers actively providing direct services for children with VI in schools (teachers of students with visual impairments [TVI], orientation and mobility instructors, adapted physical education teachers at schools for the blind; n = 3); and (c) one TVI who has experience conducting research pertaining to individuals with VI (Figure 2). In order to be considered an expert and qualify for this study, one must have indicated extensive training or coursework in VI and motor development or be a current professor of motor development, adapted physical education, or a related field (Figure 2). All respondents who met the inclusion criteria were included in this study (Figure 2).

Figure 2.

Visual impairment experience profile of experts.

Experts were contacted via email and were provided with the purpose of the study, instructions to complete the inquiry, the original PSPCSA, the modified instrument (Figure 3), and were asked to complete the expert qualification table. The original PSPCSA was distributed for comparison purposes and qualified experts were asked to provide feedback on the modified instrument as they saw fit. Qualified experts (N = 8) responded to inquiries via email (Figure 4).

Figure 3.

Initial sample item distributed to panel of experts during Phase 2.

Figure 4.

Summary of changes recommended by experts after Phase 2.

After receiving feedback from the experts, Phase 2 was complete. Subsequently, several changes were made to the original modification of the PSPCSA based on the recommendations of the experts (Figure 4) and the updated version was renamed the Test of Perceived Motor Competence for children with VI (TPMC-VI). After completing the suggested changes and developing the TPMC-VI, Phase 3 began, which included follow-up communication with the experts for the second round of the Delphi inquiry. Phase 3 sought to solicit comments on the TPMC-VI. Upon receiving feedback, all necessary changes were made (Figure 4) and the study proceeded to Phase 4.

During Phase 4, a child with a VI (age 5 years, female, African-American, English speaking, visual acuity of 20/1000) completed the TPMC-VI (Figure 5). Concurrently, we conducted an additional inquiry with the child and her teacher while she completed the TPMC-VI. The purpose of the child completing the TPMC-VI along with the additional inquiry to both the child and her teacher was to establish face validity of the TPMC-VI and pilot test its feasibility. Face validity was determined by corroborating the child’s responses to the TPMC-VI with her knowledge of each item substantiated by her teacher.

Figure 5.

Final version of instrument after Phase 4.

Findings

After Phase 2, the expert panel recommended several changes (Figure 4). The changes ranged from clarifying respondent understanding, increasing breadth and depth of descriptions of the pictures, and clarifying the instrument protocol (Figure 4). The main changes suggested by the expert panel were to include language to help describe the orientation of the respondent in three-dimensional space and increase the specificity of the story within the vignette (Figure 4). After the second Delphi inquiry, all experts were satisfied with the TPMC-VI and did not provide additional changes (Figure 4). As such, the content validity of the instrument was found to be acceptable by the experts after the second Delphi round.

The findings from Phase 4 included the results of the TPMC-VI corroborated with additional questions to the participant and her teacher. The child’s results of the TPMC-VI were a 15 out of 24 (M = 2.50), indicating a below average PMC (Harter & Pike, 1984). While completing the TPMC-VI, the child was asked about her level of knowledge regarding each of the skills with additional questions. In regard to her familiarity with skipping, she responded with the following, “I know what skipping is (child begins singing), Lou, Lou, skip to my Lou, Lou, Lou, skip to my Lou.” A follow-up question was then asked regarding whether the child had ever skipped before and she responded with “no.” The teacher indicated that the child had indeed never skipped before, but it was a skill that they were going to work on together. Interestingly, she answered the question about skipping with a “4” indicating that she believes she is very good at skipping. The participant was then asked if she would like to try to skip and she emphatically said “yes.”

Climbing elicited similar responses to skipping. The participant was asked if she knew what it meant to climb high on the monkey bar, which started the following conversation:

Yes, I call for help (participant). You call for help? Why (data collector)? Because I can get really high, it’s fun, I want to go high (participant). What does high mean for you (data collector)? It means that my feet are off the ground. I can go three times before I call for help (participant). Do you like to climb (data collector)? Yes, I love to climb (participant).

The participant scored a “4” for climbing.

For the swinging assessment, we asked if the participant was aware of swinging and if she ever attempted to swing by herself. The participant was asked, “Do you know what it means to swing on a swingset all by yourself?” She said, “Yeah, kinda. I swing at [my school].” She was then asked whether she typically swings on her own, where she responded: “No, someone pushes me. I hold onto the chains, someone helps, I just hold on.” She then responded “no” when asked if she would think she would be good at swinging by herself, and whether she would want to attempt to swing on her own. She scored a “1” on the swinging assessment.

For running, we asked if she ever ran in a racing game, where the participant responded “no.” However, when asked if she was fast, she said “very fast” and indicated that she would like to run in a racing game. She scored a “3” on the running assessment. In direct contrast, when prompted about hopping, she indicated that she did not know what hopping was, never tried hopping, and did not want to do so. When prompted to share further, she could not communicate an understanding of hopping. The data collector provided more description to elicit further understanding:

when you hop you put one leg up in the air, like this (the teacher physically guided the child’s leg into the hopping position) and then you move your body forward with your other leg like this (the researcher and the teacher held the child’s hands and propelled her forward). Do you think you would want to try this?

The child said, “no way, that’s scary. Why would you want to do that?” She scored a “1” on the hopping assessment.

The participant’s teacher was in the room during her assessments and corroborated all of her accounts. She said,

I am the one who helps her when she climbs on the bars. If I let her, she would go all the way up top. We have never tried skipping or hopping but perhaps we should, I never thought of it. I think it would be good for her coordination skills if we did. Also, she walks well with her cane but I am not sure if she is a fast runner. I think we should try to find out. Some of the kids in the [local city’s] cane club do run in the local 5k race with helpers. I think we should work on her running if it is something she has confidence in. It seems that your assessment is pretty accurate with what [she] thinks of herself. I like it but I think you should add some questions that are more in line with what kids would actually do.

Overall, the child’s answers were positively related with her desire to subsequently participate in the skill. Moreover, the child appeared to understand all skills except hopping and scores were parallel with cognition of the skill. The participant’s teacher corroborated all responses, indicating agreement with the child and providing a basis for face validity.

Discussion

The purpose of this study was to explore the content and face validity of a modified version of the PSPCSA instrument for utilization in children with VI. There are several strengths inherent within this study. First, this process began with a valid and reliable assessment. The PSPCSA is readily used and widely accepted as a valid and reliable assessment of PMC of children ages 3–7 years. The PSPCSA is a pictorial assessment and thus needed modifications for children with VI. We needed to ensure that the modifications accurately represented the original intention of the PSPCSA (content validity) and that the questions asked sought answers to what it was intended to ascertain (face validity). The experts felt it important to situate the skills in three-dimensional space. A child with a VI may not understand physical positioning in space (i.e. climbing high) as “good” or even what that may feel like. Therefore, it was important to develop a script that delivered a clear concept of what the questions asked and that the respondent understood what was intended. The preliminary findings indicate that the young child who completed the TPMC-VI did understand the questions and also understood what was meant by “good” and “not good.” Her responses also corresponded with her willingness to subsequently participate in the task, which directly aligns with the motor development literature (e.g. Barnett et al., 2008; Stodden et al., 2008).

Although this study possesses several strengths (i.e. Delphi investigation, corroboration, in-depth participant interview and testing), there are a number of limitations within this study. First, we recognize that not all the experts responded on the second Delphi inquiry. Next, as this study is a pilot feasibility trial we tested the TPMC-VI and corroborated preliminary findings with one child and her TVI. Future research should expand and include more expert response during the second inquiry. Unfortunately, this is a limitation beyond the control of the researchers. Finally, although we began to establish validity of the modified assessment, reliability is still in question. Future research should establish test–retest reliability along in order to enhance the integrity of the assessment. Furthermore, future research should obtain a large sample with enough power to further enhance reliability measures.

In summary, children with VI tend to be less physically activity and possess lower motor competence than sighted peers (Augestad & Jiang, 2015; Haegele & Porretta, 2015; Haibach, Wagner, & Lieberman, 2014). Currently, little evidence exists exploring the PMC of children with VI, which may be attributed to a lack of valid assessments of PMC for children with VI (Brian et al., 2016). With a valid PMC assessment, teachers can plan/evaluate programming geared toward improving/maintaining high levels of PMC. Moreover, researchers can evaluate PMC along with motor competence in order to better understand the underlying mechanisms driving physical activity decisions for children with VI. Physical activity will help children combat childhood obesity and other health-related diseases, retain high levels of PMC, and provide children the tools necessary to remain physically active throughout their life span.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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