Peer-Reviewed Journal Articles

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Assessing therapeutic communication during rehabilitation: The Clinical Assessment of Modes
(2016) Fan, Chia-Wei; Taylor, Renee R.
OBJECTIVE. This study applied Rasch analysis to test four versions of the Clinical Assessment of Modes (CAM), an assessment based on Taylor’s Intentional Relationship Model: CAM–P, which assesses clients’ pretreatment preferences; CAM–E, clients’ treatment experience; CAM–T, therapists’ self-reported perspective; and CAM–O, an observer rating scale. METHOD. The CAM–P was administered to 63 inpatients. The CAM–E was administered to 110 inpatients and outpatients. Trained raters rated therapists’ modes with 59 inpatients and outpatients on the CAM–O. The CAM–T was administered to 38 therapists. Analyses of reliability and validity were conducted. RESULTS. The CAM demonstrated adequate construct validity. All versions showed acceptable internal consistency and unidimensionality within each of the subscales. Disorder between the 5 points on the ordinal rating scale was found for the client measures (CAM–P, CAM–E) and was resolved by modifying the ratings to encompass a 4-point scale. CONCLUSION. The four CAM versions are reliable and valid measures of therapeutic communication in rehabilitation.
Evaluating the Psychometric Properties of a Clinical Vocational Rehabilitation Outcome Measurement: The Assessment of Work Performance
(2013) Fan, Chia-Wei; Taylor, Renée R.; Ekbladh, Elin; Hemmingsson, Helena; Sandqvist, Jan
This study examined the validity and reliability of the Assessment of Work Performance (AWP) using Rasch analysis. The AWP was administered to 365 clients with a variety of work-related problems. Rasch analysis and principal component analysis were used to examine the appropriateness of the rating scales and unidimensionality of AWP items. The person-response validity, internal consistency, targeting appropriateness, and differential item function were also analyzed. The Rasch analysis confirmed the 4-point rating scale, and the item set met the criteria of unidimensionality. The AWP exhibited satisfactory person-response validity and internal consistency. Among the three subdomains, the targeting of item-difficulty was sufficient in the motor skills and process skills subdomains. Differential item functioning was found across gender and diagnoses. This study presented evidence to support that the AWP functioned as a reliable and valid assessment in assessing work performance.
Examining changes in occupational participation in forensic patients using the Model of Human Occupation Screening Tool
(2016) Fan, Chia-Wei; Morley, Mary; Garnham, Mike; Heasman, David; Taylor, Renee
Introduction: In occupational therapy, there has been an increased interest in patients’ occupational participation within forensic settings. This retrospective study involved a longitudinal analysis of occupational participation within six forensic hospitals in England. The aim was to contribute to the understanding of forensic patients’ occupational participation over a two-year period. Methods: The Model of Human Occupation Screening Tool (MOHOST) was rated by 78 occupational therapists on 489 patients in low and medium secure units who were receiving occupational therapy over two years. The many-faceted Rasch Model was used to convert their MOHOST scores at each time point into interval scales. Regression analysis was used to examine changes in occupational participation over time. Results: Patients’ overall occupational participation improved over time. Specifically, participation improved in five of the six MOHOST subdomains, which included their motivation for occupation, pattern of occupation, communication/interaction skills, process skills, and environment. Patients did not demonstrate significant change in their motor skills, which varied as expected. In addition, patients in low secure units had better occupational participation than those in medium secure settings. Conclusion: Our findings indicated improvements in the patients’ occupational participation over the 2-year period. Further investigations are needed to understand factors contributing to change.
Examining the Validity of the Model of Human Occupation Screening Tool: Using Classical Test Theory and Item Response Theory
(2011) Pan, Ay-Woan; Fan, Chia-Wei; Chung, LyInn; Chen, Tsyr-Jang; Kielhofner, Gary; Wu, Ming-Yi; Chen, Yun-Ling
Introduction: This study examined the psychometric properties of the Model of Human Occupation Screening Tool, using both item response theory and classical test theory. Method: One hundred and one people with mental health problems, aged 18–65 years, were recruited. The Chinese version of the Model of Human Occupation Screening Tool, the National Taiwan University Hospital Symptom Checklist, the Volitional Questionnaire, the Assessment of Communication and Interaction Skills, and the Mini Mental State Examination were administered. Rasch analysis and correlational analysis were used to examine the construct, convergent, divergent validity and known group validity. Results: Rasch analysis confirmed that there were six subscales within the Chinese version of Model of Human Occupation Screening Tool. The Volitional Questionnaire strongly correlated with the volition subscale (r = 0.583). The Assessment of Communication and Interaction Skills strongly correlated with the communication and interaction subscale (r = 0.815). The Mini Mental State Examination was moderately correlated with the process subscale (ρ = 0.334) and the symptomatology was not associated with any of the subscales as expected. There were significant differences on selected subscale scores across four known groups of participants. Conclusion: The Chinese version of the Model of Human Occupation Screening Tool was valid when applied to people with mental health problems.
Exploring culture and therapeutic communication: Therapeutic mode use by occupational therapists in the United States and Singapore
(2020) Wong, Su Ren; Fan, Chia-Wei; Polatajko, Helene
Importance: According to the Intentional Relationship Model, six therapeutic modes characterize client–therapist interactions in occupational therapy: advocating, collaborating, empathizing, encouraging, instructing, and problem solving. However, whether these modes hold across cultural contexts is not clear. Objective: To compare therapeutic mode use in occupational therapy interactions in the United States and Singapore. Design: Cross-sectional observational study; questionnaires were collected and compared from two convenience samples of occupational therapists from the United States and Singapore, and results were analyzed using t tests and general linear modeling. Setting: Large tertiary hospitals. Participants: Occupational therapists were recruited if they had at least 6 mo experience in their clinical specialty. Adult client participants were recruited if they had or planned to have at least three occupational therapy sessions. Outcomes and Measures: The therapist version of the Clinical Assessment of Modes (CAM–T) was used to assess occupational therapists’ therapeutic mode use in interactions with specific clients. Results: A total of 74 U.S. and 39 Singaporean client–therapist interactions were assessed. U.S. therapists were more likely to use the upper end of the response scale; after we corrected for this, the pattern of mode use was similar in both cultural contexts, with instructing mode used the most. In absolute terms, U.S. therapists used the instructing mode more frequently than Singaporean therapists. Conclusion and Relevance: Further research should be done to examine the sociocultural factors that affect responses on the CAM–T and mode use. What This Article Adds: This study is the first to compare therapeutic mode use in different cultural settings. With the globalization of occupational therapy practice, it is important to consider the generalizability of occupational therapy concepts across cultures.
Occupational therapy students’ self-efficacy for therapeutic use of self: Development and associated factors
(2020) Fan, Chia-Wei; Carstensen, Tove; Småstuen, Milada C.; Yazdani, Farzaneh; Ellingham, Brian; Bonsaksen, Tore
Occupational therapy students need to develop self-efficacy for therapeutic use of self in practice. This longitudinal study examined Norwegian occupational therapy students’ self-efficacy for therapeutic use of self over a 16-month period and investigated predictors of their end-point self-efficacy. One hundred and eleven students from two universities completed a self-efficacy questionnaire related to the use of self after a workshop, and at 3-month, 10-month, and 16-month follow-up. The students’ self-efficacy development was analyzed with linear mixed effect models, while factors associated with self-efficacy were investigated with linear regressions. The students from both universities showed a linear increase in self-efficacy for therapeutic mode use (p < 0.001), recognizing clients’ interpersonal characteristics (p < 0.001), and managing interpersonal events (p < 0.001). However, for the students from University 1 the largest increase occurred in an early phase, whereas for the students from University 2 the largest increase occurred in a late phase. Only baseline scores were associated with the end-point measure at 16-month follow-up. The study indicates that students’ self-efficacy for therapeutic use of self increased during the follow-up period and adds to the knowledge about occupational therapy students’ self-efficacy development related to understanding and managing client-therapist interactions.
Predictors of Employment for Patients with Psychiatric Disorders—A Literature Review
(2007) Fan, Chia-Wei; Pan, Ay-Woan; Chang, Y
Psychometric evaluation of the Finnish translation of the assessment of communication and interaction skills (ACIS-FI)
(2020) Fan, Chia-Wei
Background: The Model of Human Occupation (MOHO) is a widely used conceptual practice model in Finland. Therefore, Finnish translations of valid and reliable MOHO assessments are needed. Objective: The primary objective of this study was to examine the psychometric properties of the Finnish translation of the Assessment of Communication and Interaction Skills (ACIS-FI) using the many-facet Rasch model approach. Methods and Materials: Twenty-eight occupational therapists completed an in-person training workshop on the ACIS-FI and participated as raters in this study. One hundred and forty-eight clients were rated using the ACIS-FI. Rating scale functioning, unidimensionality, person validity and rater severity, item targeting, and item and person separation statistics were examined. Results: The rating scales demonstrated adequate functioning; the rating category ‘deficit’ was infrequently adopted by the raters. The ACIS-FI had satisfactory construct validity, as confirmed by all items exhibiting unidimensionality within a single construct (i.e. communication and interaction skills), and appropriate item fit. Validity was further confirmed through low person misfit (6%) and low rater misfit (3.6%). No ceiling or floor effects were found. The ACIS-FI was able to separate clients into four levels of communication and interaction skills. Conclusions: This study offers evidence for the validity of the ACIS-FI as a measure of communication and interaction skills in occupational therapy. Significance: The ACIS-FI offers Finnish practitioners and researchers a valid tool to measure communication and interactions skills that is theoretically grounded in the MOHO.
Psychosocial variables related to weight-related self-stigma in physical activity among young adults across weight status
(2020) Fung, Xavier C. C.; Pakpour, Amir H.; Wu, Ya-Ke; Fan, Chia-Wei; Lin, Chung-Ying; Tsang, Hector W. H.
A healthy lifestyle with sufficient physical activity (PA) can contribute to weight management. Yet, many people do not maintain a healthy lifestyle. To explain PA, we propose a model that incorporates the Theory of Planned Behavior (TPB) with weight-related self-stigma. We recruited 325 young adults to complete questionnaires regarding their physical activities, weight-related self-stigma, and TPB factors. We used structural equation modeling to examine the model fit and the path invariance across weight groups. The model showed excellent model fit, but path invariance was not supported. Weight-related self-stigma significantly explained the perceived behavioral control, behavioral intention, and engagement of PA. People without overweight and people with overweight have different considerations for PA. Weight-related self-stigma is important for PA as well. To promote a healthy lifestyle, healthcare providers should provide different suggestions or interventions that suit their patients’ weight-related concerns.
Rasch analysis of the Self-Efficacy for Therapeutic Use of Self questionnaire in Norwegian occupational therapy students
(2021) Fan, Chia-Wei; Yazdani, Farzaneh; Carstensen, Tove; Bonsaksen, Tore
Background: Research suggested combining modern test theory with classical test theory to achieve comprehensive evaluation of an assessment tool. However, the Norwegian Self-Efficacy for Therapeutic Use of Self questionnaire has not yet been examined by the modern test theory. Aims/objective: This study aims to examine psychometric properties of the Norwegian SelfEfficacy for Therapeutic Use of Self questionnaire by using Rasch analysis. Material and methods: One hundred and eleven occupational therapy students from two universities in Norway completed the questionnaire across four time points. Rasch analysis was used to examine the appropriateness of the rating scales, unidimensionality, person response validity, item/person separation, and the Wright map. Results: The ten-point rating scale did not fully maximise the measurement potentials. Unidimensionality was confirmed except for two items. Person response validity needs further investigation. Excellent person/item separation and Wright map were found. Conclusion: This study supports the psychometric properties of the Norwegian Self-Efficacy for Therapeutic Use of Self questionnaire in assessing self-efficacy in therapeutic encounters. Further research is needed to address the misfit items and the rating scale issue. Significance: Rasch analysis showed that the Norwegian Self-Efficacy for Therapeutic Use of Self questionnaire is promising to be used as a reliable and valid tool.
The Test–Retest Reliability and the Minimal Detectable Change of the Purdue Pegboard Test in Schizophrenia
(2013) Lee, Posen; Liu, Chin-Hsuan; Fan, Chia-Wei; Lu, Chi-Pang; Lu, Wen-Shian; Hsieh, Ching-Lin
Background/Purpose: The Purdue pegboard test is widely used in measuring the hand dexterity of patients with schizophrenia. In patients with schizophrenia, the test–retest reliability and minimal detectable change (MDC) of this test remain largely unknown, limiting the interpretability of this popular measure. The purpose of this study was to estimate the test–retest reliability and the MDC of the Purdue pegboard test for patients with schizophrenia. Methods: A total of 147 patients with schizophrenia participated in this study. The participants were administrated the five subtests of the Purdue pegboard test, three trials in a row at both of the two sessions 1 week apart. The intraclass correlation coefficient (ICC) was used to examine the test–retest reliability and the MDC was calculated on the basis of standard error of measurement. Results: The test–retest reliabilities of the five subtests were moderate to good (ICC = 0.73–0.88). The MDC (MDC%) was 3.0 (22.9%) for the dominant hand subtest, 3.1 (26.1%) for the nondominant hand subtest, 3.0 (31.7%) for the both hands subtest, 6.1 (17.7%) for the dominant + nondominant + both hands subtest, and 8.5 (35.3%) for the assembly subtest. Conclusion: Our results reveal that the Purdue pegboard test has moderate-to-good test–retest reliability but substantial random measurement error. These findings should enable clinicians and researchers to monitor and interpret the changes in the hand dexterity of patients with schizophrenia more accurately and confidently.
The Use of the Model of Human Occupation to Classify Domains of Vocational Assessments for Individuals with Mental Illness: A Literature Review
(2009) Fan, Chia-Wei; Pan, Ay-Woan
Validating the Persian Intuitive Eating Scale-2 among breast cancer survivors who are overweight/obese
(2020) Nejati, Babak; Fan, Chia-Wei; Boone, William J.; Griffiths, Mark D.; Lin, Chung-Ying; Pakpour, Amir H.
Women with breast cancer are at risk of being overweight/obese which may consequently increase mortality. Intuitive eating is an adaptive eating behavior which might be beneficial for weight outcomes. The present study validated the Persian Intuitive Eating Scale-2 (IES-2) among overweight/obese Iranian females with breast cancer. Women who were overweight/obese with breast cancer (n = 762; mean ± SD age = 55.1 ± 5.7 years) completed the following questionnaires: IES-2, General Self-Efficacy Scale (GSE-6), Hospital Anxiety and Depression Scale (HADS), Short Form-12 (SF-12), Weight Bias Internalization Scale (WBIS), Body Appreciation Scale-2 (BAS-2), and Eating Attitudes Test (EAT-26). Confirmatory factor analysis (CFA) and Rasch analysis were applied to examine the psychometric properties of the IES-2. Associations between IES-2 score and other scale scores were assessed. CFA and Rasch analysis suggested that the Persian IES-2 had robust psychometric properties and all IES-2 items were meaningful in their embedded domains. The four-factor structure of the Persian IES-2 was confirmed. Concurrent validity was supported by the positive correlations between the IES-2 score and scores on the GSE-6, SF-12 mental component, and BAS-2. Negative correlations were found between the IES-2 score and the HADS (anxiety and depression subscales), WBIS, and EAT-26. The present study demonstrated that the Persian IES-2 is a well-designed instrument and is applicable for women who are overweight/obese with breast cancer.
Volitional questionnaire: Psychometric evaluation of the Finnish translation
(2020) Fan, Chia-Wei
Background: Supporting clients’ motivation to engage in occupations is essential to occupational therapy practice. The Volitional Questionnaire Finnish version (VQ-FI) can be used to evaluate volitional behaviors of clients with limited ability to communicate. Objective: The many-facet Rasch model was used to evaluate the reliability and validity of the VQ-FI using the FACETS and WINSTEPS software. Methods and materials: Forty-two therapists received an in-person training on the VQ-FI and completed 226 independent ratings of clients. The VQ-FI was evaluated in its rating scale functioning, unidimensionality, person validity, rater severity, item targeting, and item/person separation. Results: The four-point rating scale demonstrated adequate functioning; the ‘passive’ rating category was rarely adopted. The VQ-FI showed unidimensionality, with all 14 items fitting the Rasch model. No evidence for ceiling or floor effects, and the assessment demonstrated appropriate item and person separation. The VQ-FI reliably separated participants to three levels of ability. Conclusions: The study provides preliminary evidence for the reliability and validity of the VQ-FI. Significance: The VQ-FI is an observational measure that can be used to evaluate clients’ volitional behaviors. The VQ-FI offers practitioners and researchers a valid approach to evaluate volition that is theoretically grounded in the Model of Human Occupation.
Weight stigma model on quality of life among children in Hong Kong: A cross-sectional modeling study
(2021) Fan, Chia-Wei; Liu, Chieh-hsiu; Huang, Hsin-Hsiung; Lin, Chung-Ying; Pakpour, Amir H.
We proposed a model to examine the relationship among different types of weight-related stigmas and their relationship to quality of life (QoL). We recruited 430 dyads of elementary school children [mean age = 10.07 years; n-boy = 241 (56.0%); n-overweight = 138 (32.1%)] and their parents. Parents completed QoL instruments about their children assessing generic QoL and weight-related QoL. Children completed QoL instruments assessing generic QoL and weight-related QoL and stigma scales assessing experienced weight stigma, weight-related self-stigma, and perceived weight stigma. Experienced weight stigma was significantly associated with perceived weight stigma, and in turn, perceived weight stigma was significantly associated with weight-related self-stigma. However, experienced weight stigma was not directly associated with weight-related self-stigma. In addition, experienced stigma was negatively associated with both child-rated and parent-rated QoL. Perceived weight stigma was associated only with parent-rated weight-related QoL but not child-rated QoL. Self-stigma was associated with child-rated QoL but not parent-rated QoL. Moreover, perceived weight stigma and weight-related self-stigma were significant mediators in the association between body weight and children's QoL; experienced weight stigma was not a significant mediator. The study findings can be used to inform healthcare providers about the relationship among different types of stigmas and their influence on child-rated and parent-rated QoL and help them develop interventions to address the global trend of overweight/obesity in youth and pediatric populations.
Work Environment Impact Scale: Testing the Psychometric Properties of the Swedish Version
(2014) Ekbladh, Elin; Fan, Chia-Wei; Sandqvist, Jan; Hemmingsson, Helena; Taylor, Renée
BACKGROUND: The Work Environment Impact Scale (WEIS) is an assessment that focuses on the fit between a person and his or her work environment. It is based on Kielhofner's Model of Human Occupation and designed to gather information on how clients experience their work environment. OBJECTIVE: The aim of this study was to examine the psychometric properties of the Swedish version of the WEIS assessment instrument. METHOD: In total, 95 ratings on the 17-item WEIS were obtained from a sample of clients with experience of sick leave due to different medical conditions. Rasch analysis was used to analyze the data. RESULTS: Overall, the WEIS items together cohered to form a single construct of increasingly challenging work environmental factors. The hierarchical ordering of the items along the continuum followed a logical and expected pattern, and the participants were validly measured by the scale. The three occupational therapists serving as raters validly used the scale, but demonstrated a relatively high rater separation index, indicating differences in rater severity. CONCLUSION: The findings provide evidence that the Swedish version of the WEIS is a psychometrically sound assessment across diagnoses and occupations, which can provide valuable information about experiences of work environment challenges.

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