Transcultural adaptation and psychometric properties of the Spanish version of Participation and Environment Measurement - Children and Youth (PEM-CY)

Transcultural adaptation and psychometric properties of the Spanish version of Participation and Environment Measurement - Children and Youth (PEM-CY) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Transcultural adaptation and psychometric properties of the Spanish version of Participation and Environment Measurement - Children and Youth (PEM-CY) María Gómez-Vela, Mª Begoña Orgaz Baz, Isabel Vicario-Molina, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5998160/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The Participation and Environment Measure for Children and Youth (PEM-CY) captures a child’s participation across home, school, and community-based activities as well as environmental factors perceived as supporting/hindering this participation. This tool has been translated into Spanish for use in the United States and Colombia but there are linguistic and sociocultural differences between these countries and Spain. Therefore, it is necessary to develop a country-specific measure to promote environment-based interventions for Spanish children with disabilities. This study aims to adapt the PEM-CY for use with children and youth in Spain, and to investigate its psychometric properties. Methods 713 parents of children with ( n = 233) and without ( n = 480) disabilities, aged 5 to 17, completed the Spanish version of PEM-CY. For the test–retest reliability study, 30 of these parents completed the instrument twice. Results Internal consistency (0.58–0.97) and test–retest reliability (0.31–0.92) ranged from moderate to very satisfactory, according to Cronbach’s alpha and intraclass correlation coefficients. Discriminant validity, assessed through two-way ANOVA, was supported by significant differences between children with and without disabilities on participation and environment scales ( p < .05). Some significant age differences were identified for participation at home and school. Validity was supported by a significant negative Pearson’s correlation (-0.32 to -0.41, p < .05) between desire for change and overall environmental supports. Conclusions The Spanish version of the PEM-CY is a valid and reliable tool to determine the participation and associated environmental factors in Spanish children and youth, with and without disabilities. It provides useful information for designing environment-based interventions to promote their participation. participation environment disability children youth PEM-CY Spain Figures Figure 1 Background Participation is conceptualized by the International Classification of Functioning, Disability and Health (ICF) [ 1 ] as “an individual’s involvement in life situations” affected by both personal and environmental factors. Among children with disabilities, successful participation in everyday situations is a sign of health and an essential rehabilitation goal [ 2 , 3 , 4 ] because it provides many opportunities to enhance abilities, social relationships, and overall quality of life [ 5 , 6 ]. Therefore, an important aim for families and health and education professionals is to identify and improve the participation profiles of children with disabilities [ 2 , 3 , 7 , 8 ]. Most rehabilitation interventions proposed in the last decade have focused on modifying environmental conditions [ 7 , 9 , 10 ], but prior to attempting environment-based interventions, it is critical to analyze these children’s participation, as well as environmental supports and barriers, using valid and reliable measures [ 11 ]. The Participation and Environment Measure for Children and Youth (PEM-CY) by Coster et al. [ 12 , 13 ] captures a child’s participation across a broad range of home, school, and community-based activities [ 14 ] while examining a variety of environmental factors (e.g., physical layout, social or cognitive demands of activities) that parents perceive as supporting/hindering their child’s participation [ 11 ]. The PEM-CY is a reliable, valid measure for children and youths (5–17 years), with or without disabilities [ 12 , 13 , 14 , 15 ], and it is suitable for minors with all disability types [ 8 , 14 ]. It has been applied in many countries [ 11 , 16 , 17 ] and translated into 22 languages [ 18 ]. The two Spanish versions of the PEM-CY were translated for use in the United States and Colombia [ 18 ]. Because there are major linguistic, social, and cultural differences between these countries and Spain, it is necessary to develop another country-specific measure that properly assesses children’s participation and environmental factors in order to promote environment-based interventions for Spanish children with disabilities. This is one of the guidelines established by the United Nations Convention on the Rights of Persons with Disabilities [ 19 ], as well as by Spanish rehabilitation, educational, and social legislation [ 20 , 21 ]. Methods This study aimed to develop the Spanish version of the PEM-CY to be applied to Spanish children and youth aged 5 to 17 and to establish its psychometric properties, including its reliability (internal consistency and test–retest reliability) as well as its discriminant validity. Instrument The PEM-CY is a parent-report questionnaire of 25 items that assesses children’s participation in broad types of activities at home (10 items), school (5), and community (10) settings considering three dimensions: frequency, involvement, and desire for change [22]. The PEM-CY also has 45 items about the environmental impact on home, school, and community participation [12,13]. For each setting, parents are asked to report whether certain factors support/hinder their child’s participation and whether supportive resources are perceived to be available. The original PEM-CY can be completed in either paper- or web-based format. For all sections, the internal consistency of the PEM-CY has shown to be moderate to very good (Cronbach's α = 0.59–0.91) and the test–retest reliability is found to be moderate to good when assessed within a 4-week period after the completion of the first round (ICC 0.58–0.95) [12]. The validity of the PEM-CY is established because this measure identified a significant impact of disability on children’s participation across all variables and settings. Also, age group was found to have a significant effect in children (with and without disabilities) for participation involvement at home and school, but not in the community [12]. Translation and adaptation procedure In order to achieve the maximum level of conceptual, item, semantic, operational, and measurement equivalence, the Spanish version of the PEM-CY was developed considering the International Test Commission Guidelines for test translation and adaptation [23,24] as well as recommendations for cross-cultural adaptations of participation measures, including those provided by Stevelink and van Brakel [25] and Tomas et al. [8]. The adaptation process consisted of five phases, depicted in Figure 1: (1) forward translation, (2) consensual synthesis, (3) cognitive interviews, (4) back translation, and (5) pilot study. [Insert Figure 1: Questionnaire adaptation procedure] After obtaining the authors' permission to begin adaptation, two independent translations were carried out by two bilingual translators with PhDs in psychology. For each item, the translators were asked to indicate both the level of equivalence of the translated version and the difficulty of the translation according to a scale from 1 ( not at all ) to 10 ( completely ). Subsequently, a committee of experts from the research team reviewed the independent translations and generated a consensual version adapted to the Spanish context. Next, 10 parents of children with disabilities between 5 and 17 years were invited to participate in two rounds of cognitive interviews. They were asked about the degree of clarity, adequacy, and cultural acceptability of the instructions, items, and response options. The parents’ suggestions were analyzed by the research team to introduce modifications and improvements into the pre-final version of the PEM-CY. Next, a back translation was developed by a bilingual translator with a PhD in psychology. This step aimed to ensure that there were no problems of cultural accuracy and conceptual equivalence despite the modifications introduced during the process. A small pilot study was then conducted with a sample of 6 parents of children aged 5 to 17 years, both with and without diagnosis/disability. Participants were asked to read the instrument and assess (a) the format, (b) possibly misleading wording, (c) the level of comprehension of the instructions and items, (d) possible difficulties in answering the instrument, and (e) the time to complete it. Finally, the research team conducted a last review of the instrument before submitting it to the PEM-CY team for approval. Sampling and data collection procedure Ethics approval for the study was obtained from the Research Ethics Committee of University of Salamanca (Ref. 0000407). Participants were recruited via convenience sampling from schools in all geographical regions of Spain between September 2020 and September 2022, and therefore during a period of social restrictions in response to the COVID-19 pandemic. School principals and associations of families of children with disabilities were provided with detailed information on the study. Potential participants were asked to sign the informed consent form and voluntarily complete the Spanish version of the PEM-CY on an online platform if they met the following inclusion criteria: (a) they were parents or legal guardians of children and youths with or without diagnoses (e.g., chronic health problems such as asthma)/disabilities (e.g., intellectual disability, cerebral palsy, ASD), (b) they were able to read Spanish, and (c) their child was 5 to 17 years old during the study. The Spanish version of the PEM-CY was administered to a sample of 713 parents of children with ( n = 233) and without ( n = 480) diagnosis/disability. Moreover, a subsample of 30 parents was self-selected to complete the instrument twice within an interval of 6 to 8 weeks of the first completion for test–retest reliability study. This time frame was greater than in prior similar studies because of circumstances that hindered participants’ commitment to the study (i.e., the summer season). For the present study, a sociodemographic questionnaire was designed to obtain information about child and family characteristics—specifically, on children’s gender, age, and diagnoses/disabilities, as well as on respondents’ relationship with the children, educational level, and employment status (Table 1). Data analysis A total of 713 parents of children and youth with and without disabilities (Table 1) were used to determine the reliability and validity of the Spanish version of PEM-CY, after meeting the following criteria for inclusion in analysis: (1) providing responses to the “child age” and “disability” questions and (2) answering at least two questions of the “participation at home” section—the same criteria used by the authors of the original scale [12]. It should be noted that the survey was not fully completed by all participants; consequently, the number considered in each analysis differed. Descriptive statistics were used, on the one hand, to summarize participants’ characteristics, and on the other, to summarize participants’ perceptions on participation (frequency, involvement, and desire for change) and environment (environmental supports, barriers, helpfulness and resources and overall environmental supports): specifically, mean and standard deviation for continuous variables, and percentage for categorical variables. The reliability of the Spanish version of PEM-CY was assessed in terms of internal consistency and test–retest reliability. Cronbach’s alpha coefficient was used to examine the internal consistency of both participation and environment scales. Values ranging from 0.70 to 0.95 were considered satisfactory [26]. Test–retest reliability was assessed in a subsample (n = 30) similar in size to that used by the authors of the original scale [12], through intraclass correlation coefficient (ICC) with a two-way mixed effects model for absolute agreement. An ICC agreement ≥ 0.70 indicated sufficient test–retest reliability, > 0.75 excellent, 0.40 to 0.75 fair/good, and < .40 poor [27]. The validity of the Spanish PEM-CY was examined in terms of discriminant validity by assessing the extent to which scores were consistent with our hypotheses about the existence of significant differences in parents’ perceptions of their children's participation and influencing environmental factors as a function of the child having or not a disability, but not of the age group. Two-way analysis of variance (ANOVA) was used followed by post hoc tests and effect-size calculation, also including the variable age group (5–11 and 12–17 years) and disability (yes/no). Finally, consistent with the analysis used for the validation of the original scale, Pearson’s correlation coefficients were calculated between desire for change and overall environmental supports. A value of p < .05 was considered the cut-off for statistical significance. The Statistical Package for the Social Sciences (SPSS) v.26 was used for all analyses. Results Participants The Spanish version of the PEM-CY was administered to a sample of 713 parents of children with ( n = 233) and without ( n = 480) diagnosis/disability. Moreover, 30 of these parents completed the instrument twice for test–retest reliability study (Table 1). Table 1. Sociodemographic characteristics of the participating parents and their children Sociodemographic characteristics Total sample ( n = 713) Retest sample ( n = 30) n (%) n (%) Respondent Mother 637 (89.3) 24 (85.7) Father 68 (9.5) 4 (14.3) Other (grandparent, uncle/aunt, sibling) 8 (1.1) 0 (0) Father’s educational level No school certificate 9 (1.5) 1 (4.3) Primary school 151 (24.9) 2 (8.7) Secondary school or secondary vocational education 158 (26.1) 9 (39.1) Higher vocational education 77 (12.7) 1 (4.3) University 211 (34.8) 10 (43.5) Mother’s educational level No school certificate 1 (2.0) 0 (0.0) Primary school 56 (8.8) 1 (3.6) Secondary school or secondary vocational education 139 (22.0) 5 (17.9) Higher vocational education 100 (15.8) 4 (14.3) University 337 (53.2) 18 (64.3) Father’s employment status Employed 558 (92.1) 20 (90.9) Unemployed/retired 48 (7.9) 2 (9.1) Mother’s employment status Employed 477 (77.1) 24 (85.7) Unemployed/retired 142 (22.9) 4 (14.3) Family type Lone parent 54 (8.5) 7 (25.0) Nuclear 527 (83.1) 19 (67.9) Stepfamily 29 (4.6) 1 (3.6) Other (e.g., grandparents, shared custody) 24 (3.8) 1 (3.6) Child gender Female 317 (44.5) 12 (42.9) Male 396 (55.5) 16 (57.1) Child age 5–11 years 437 (61.3) 18 (62.1) 12–17 years 276 (38.7) 11 (37.9) Child with disability/diagnoses No 480 (67.3) 8 (36.4) Yes 233 (32.7) 14 (63.6) Child’s sibling s No 187 (26.2) 10 (35.7) Yes 526 (73.8) 18 (64.3) [Insert Table 1] In both samples (total and retest), most respondents were mothers in a nuclear family and had several children. A significant percentage of fathers and mothers had a high educational level (higher vocational education or university), and both fathers and mothers were employed (Table 2). The total and retest samples were similar in all sociodemographic characteristics except for the proportion of children with disability: 32.7% and 63.6%, respectively. The children’s diagnoses/disability reported most frequently by the participants were health conditions like asthma and other chronic diseases (22.3%), intellectual disability (15.5%), delayed educational system incorporation or low school performance (13.3%), and learning disabilities (12.0%) (Table 2). Table 2. Diagnosis/disability of children reported by the parents Diagnosis/disability Total sample ( n = 233) n (%) Health conditions (e.g., chronic health problems, frequent hospitalization) Intellectual disability Delayed educational system incorporation or low school performance Learning disabilities Autism spectrum disorder Physical disability Attention deficit hyperactivity disorder Developmental delay Giftedness Emotional impairment Vision impairment Hearing impairment 52 (22.3) 36 (15.5) 31 (13.3) 28 (12.0) 19 (8.2) 16 (6.7) 15 (6.4) 9 (3.9) 5 (2.2) 4 (1.7) 3 (1.3) 2 (0.8) Internal consistency: Cronbach’s alpha coefficients Cronbach’s alpha coefficients for participation and environment scales at home, school and community settings, were satisfactory (≥ .74), with the exception of frequency of participation at home and school. The best values were obtained for the community setting. Test–retest reliability: Intraclass correlation coefficients The sample sizes of these analyses were small for participation scales ( n = 30–25) and for environment scales ( n = 30–22). As for participation scales, the ICCs of frequency were fair/good for school and excellent for home and community. These coefficients were also excellent for involvement across the three settings. For environment scales, ICCs of overall environmental supports were good for school and community, but poor for home (Table 3). Table 3. Cronbach’s alpha and intraclass correlation coefficients Reliability Home School Community Cronbach’s alpha coefficients Participation scales Frequency 0.58 0.60 0.76 Involvement 0.74 0.79 0.97 Environment scales Overall environmental supports 0.87 0.89 0.94 Intraclass correlation coefficients (ICCs) Participation scales Frequency 0.87 0.49 0.77 Involvement 0.92 0.79 0.78 Environment scales Overall environmental supports 0.31 0.79 0.92 Validity: Hypothesis testing Results of two-way ANOVA to examine the effects of child’s diagnosis/disability and age group are presented separately in Tables 4 and 5, respectively, because there were no significant interaction effects between these two variables for the participation scales (frequency [F(1,470) = 1.73, p = .19], involvement [F(1,470) = 0.08, p = .78], or desire for change [F(1,470) = 0.08, p = .78]), nor for the environmental scales (supports [F(1,470) = 0.05, p = .83] and barriers [F(1,470) = 0.05, p = .83]). There was a significant effect of child’s diagnoses across all settings and all variables, except for environmental resources at home (Table 4). According to parents’ scores, children with disabilities participated in a lower percentage of activities, their frequency of participation and involvement was lower, and parents’ desire for change was higher, regardless of age group. In relation to the environment, parents of children with disabilities reported lower scores for environmental supports (except at home), helpfulness, resources, and overall environmental supports, and showed higher scores for environmental barriers, regardless of the child’s age group. The highest effect sizes were obtained for environmental barriers (eta 2 = .201), resources (eta 2 = .318), and overall environmental supports (eta 2 = .219). Table 4. Comparison of Participation and Environment scores across settings by child’s disability Home (Number of activities = 10) With disability ( n = 187) Without disability ( n = 526) F-value p-value Effect size Participation M (SD) M (SD) Percentage of activities 89.41 (14.90) 94.39 (7.27) F (1,470) = 25.93 < .001 .052 Frequency 5.67 (0.87) 6.14 (0.52) F (1,470) = 54.89 < .001 .105 Involvement 3.54 (0.79) 3.98 (0.49) F (1,470) = 49.59 < .001 .095 Desire for change 62.53 (25.65) 45.26 (25.97) F (1,470) = 41.44 < .001 .081 Environment Environmental supports 34.50 (29.08) 40.08 (37.60) F (1,666) = 2.89 .09 .004 Environmental barriers 19.73 (17.91) 5.61 (9.91) F (1,442) = 111.24 < .001 .201 Environmental helpfulness 73.29 (16.63) 82.61 (14.26) F (1,442) = 38.25 < .001 .080 Environmental resources 78.91 (16.71) 96.76 (8.82) F (1,408) = 189.81 < .001 .318 Overall environmental supports 74.72 (12.94) 87.27 (9.94) F (1,408) = 114.44 < .001 .219 School (Number of activities = 5) With disability ( n = 187) Without disability ( n = 526) Participation M (SD) M (SD) F-value p-value Effect size Percentage of activities 70.70 (25.73) 77.36 (21.67) F (1,378) = 7.21 .008 .019 Frequency 3.55 (1.62) 3.96 (1.22) F (1,378) = 7.96 .005 .021 Involvement 3.20 (1.07) 3.91 (0.86) F (1,378) = 47.86 < .001 .112 Desire for change 62.68 (38.43) 33.77 (36.35) F (1,378) = 54.23 < .001 .125 Environment Environmental supports 53.75 (24.68) 68.02(20.56) F (1,351) = 25.72 < .001 .068 Environmental barriers 20.76 (18.39) 6.99 (11.23) F (1,357) = 65.36 < .001 .155 Environmental helpfulness 72.02 (16.77) 78.97(14.61) F (1,367) = 11.61 .001 .031 Environmental resources 83.94 (15.53) 97.16 (8.64) F (1,357) = 91.19 < .001 .203 Overall environmental supports 77.06 (13.52) 86.96 (9.33) F (1,357) = 54.13 < .001 .132 Community (Number of activities = 10) With disability ( n = 187) Without disability ( n = 526) Participation M (SD) M (SD) F-value p-value Effect size Percentage of activities 62.06 (22.74) 72.70 (17.29) F (1,333) = 27.02 < .001 .075 Frequency 2.66 (1.36) 3.24 (1.07) F (1,333) = 18.90 < .001 .054 Involvement 2.04 (0.90) 2.28 (0.79) F (1,327) = 6.45 .012 .019 Desire for change 56.02 (32.94) 27.07 (29.22) F (1,333) = 66.72 < .001 .167 Environment Environmental supports 38.59 (28.37) 60.84 (24.89) F (1,328) = 51.64 < .001 .136 Environmental barriers 27.31 (24.86) 7.31 (11.62) F (1,328) = 90.41 < .001 .216 Environmental helpfulness 68.65 (19.93) 77.97 (14.75) F (1,328) = 22.35 < .001 .064 Environmental resources 74.20 (21.00) 94.78 (13.41) F (1,318) = 109.40 < .001 .256 Overall environmental supports 70.51 (15.94) 84.89 (10.52) F (1,328) = 89.09 < .001 .214 [Insert Table 4] There was a significant effect of the child’s age group for participation variables at home (except for involvement) and school, but not in the community setting (except for frequency and desire for change) or for environment variables (Table 5). In the case of home activities, parents reported that youths (12–17 years) participated in a higher percentage of activities, but with lower frequency, and parents’ desire for change was higher. In the case of school activities, significant effects were found on all variables: youths participated in a lower percentage of activities, with lower frequency and involvement, and parents’ desire for change was higher. As for community activities, youths participated with lower frequency and their parents’ desire for change was higher. This pattern of results was similar for participants with and without diagnosis/disability, as the interaction was not significant. Table 5. Comparison of Participation and Environment scores across settings by child’s age group Home (Number of activities = 10) Children 5–11 years ( n = 437) Youths 12–17 years ( n = 276) Participation M (SD) M (SD) F-value p-value Effect size Percentage of activities 91.48(10.28) 94.37 (11.27) F (1,470) = 5.95 .015 .012 Frequency 6.08 (0.66) 5.86 (0.65) F (1,470) = 9.87 .002 .021 Involvement 3.82 (0.63) 3.86 (0.67) F (1,470) = 0.53 .466 .001 Desire for change 47.80 (27.27) 57.49(25.75) F (1,470) = 11.13 .001 .023 Environment Environmental supports 39.22 (35.27) 37.55 (35.28) F (1,666) = 0.24 .628 .000 Environmental barriers 11.02 (14.90) 9.99 (15.06) F (1,442) = 0.41 .525 .001 Environmental helpfulness 74.02 (16.54) 72.01 (16.27) F (1, 442) = 0.22 .641 .000 Environmental resources 76.91 (16.89) 80.72 (16.62) F (1,408) = 1.15 .284 .003 Overall environmental supports 74.52 (12.21) 74.54 (13.73) F (1, 408) = 0.00 .985 .000 School (Number of activities = 5) 5–11 years ( n = 437) 12–17 years ( n = 276) Participation M (SD) M (SD) F-value p-value Effect size Percentage of activities 78.24 (21.72) 68.61 (24.66) F (1,378) = 17.13 < .001 .043 Frequency 4.03 (1.36) 3.46 (1.38) F (1,378) = 15.25 < .001 .039 Involvement 3.80 (0.97) 3.43 (0.99) F (1,378) = 12.39 < .001 .032 Desire for change 40.59 (39.85) 50.83 (37.91) F (1,378) = 6.58 .011 .017 Environment Environmental supports 63.79 (22.68) 61.69 (22.49) F (1,351) = 0.23 .633 .001 Environmental barriers 12.03 (15.49) 11.27 (15.49) F (1,357) = 0.08 .777 .000 Environmental helpfulness 71.82 (15.95) 73.07 (17.87) F (1,367) = 0.63 .429 .002 Environmental resources 84.28 (14.29) 84.35 (17.04) F (1,357) = 0.14 .713 .000 Overall environmental supports 76.99 (12.36) 77.97 (14.90) F (1,357) = 0.06 .808 .000 Community (Number of activities = 10) 5–11 years ( n = 437) 12–17 years ( n = 276) Participation M (DT) M (DT) F-value p-value Effect size Percentage of activities 69.91 (18.21) 67.78 (22.12) F (1,333) = 2.07 .152 .006 Frequency 3.15 (1.14) 2.90 (1.31) F (1,333) = 3.94 .048 .012 Involvement 2.34 (0.53) 2.22 (0.57) F (1,327) = 1.78 .183 .005 Desire for change 33.35 (32.24) 44.73 (33.46) F (1,333) = 11.10 .001 .032 Environment Environmental supports 52.49 (27.34) 54.38 (29.08) F (1,328) = 0.23 .635 .001 Environmental barriers 15.09 (20.50) 13.30 (19.24) F (1,328) = 0.33 .568 .001 Environmental helpfulness 68.78 (19.90) 68.57 (19.44) F (1,328) = 0.01 .948 .000 Environmental resources 72.26 (20.79) 75.26 (21.19) F (1,318) = 0.96 .328 .003 Overall environmental supports 69.77 (15.79) 71.08 (16.26) F (1,328) = 0.49 .485 .001 [Insert Table 5] Validity: Correlation coefficient For the whole sample, there was a significant negative medium correlation ( p < .001) between desire for change and overall environmental supports for each setting: home ( r = -.32), school ( r = -.41), and community ( r = -.40). The same pattern of relations was found in both groups: disability (home, r = -.24, p = .003; school, r = -.39, p < .001; community, r = -.44, p < .001) and without disability (home, r = -.18, p = .002; school, r = -.26 p < .001; community, r = -.09, p = .156). These correlations were higher for children with a diagnosis/disability. Discussion The Spanish version of the PEM-CY is a valid and reliable instrument to assess the participation of Spanish children and youths (with and without disabilities) at home, school, and community settings, as well as the environmental factors that support or hinder this participation. Reliability assessed with internal consistency was satisfactory to excellent for all scales except frequency of participation at home and school. These results are similar to those of the original [ 12 ] and other versions [ 11 , 16 , 28 ]. Additionally, the test–retest reliability of the Spanish version of PEM-CY was excellent for participation involvement across the three settings, and for participation frequency at home and in the community, but not at school. Between the two applications of the PEM-CY, there were continuous modifications of the measures implemented in the schools to adapt to the changing situation of the COVID-19 pandemic; this directly influenced the stability of the measure of participation in the school. The ICC scores for environment scales were good for school and community, but poor for home; the small size of the sample may explain this last result. Also, because the retest was applied during summer holidays, participants’ homes and their supports/barriers may have varied, as well as their personal involvement in providing support to their children. In relation to discriminant validity, and similarly to the original [ 12 ] and other versions of the PEM-CY [ 11 , 16 , 22 , 28 ], the Spanish version can differentiate between children with and without disabilities. Children with disabilities participated in fewer activities across all settings, their frequency of participation and involvement were lower, and their parents’ desire for change was higher, regardless of age group. Additionally, these parents reported fewer environmental supports and more barriers to the participation of their children, again independently of age group. Similarly to Kaya Kara et al. [ 16 ] and Jeong et al. [ 28 ], no significant differences were found in environmental supports at home. This result may indicate that families provide supports at home regardless of the diagnoses/disability of their children, even in exceptional circumstances such as COVID-19 lockdowns, which made some environmental factors favorable in the home settings. In any case, these results highlight the need for environment-based interventions to enhance the participation of children with disabilities. With regard to age, we found significant differences for participation at home and school. Youths participated in a higher percentage of activities at home, perhaps due to their increased autonomy, albeit with lower frequency. Further implications may be derived from the data related to the school setting. Youths participated in a lower percentage of school activities, with a lower frequency and involvement, and their parents’ desire for change was higher. This result differs slightly from that obtained in other studies where activity participation has been found to increase as children without disabilities grow older, and decrease for those with disabilities [ 16 , 29 ]. In our case, participation was lower in both groups of youths (i.e., with and without disabilities) compared to the sample of children. Again, this may be partly explained by the fact that the study was developed during COVID-19 pandemic. It is possible that, as social restrictions loosened, youths prioritized community activities to counteract the isolation suffered in the previous months. Parents’ desire for change may have resulted from fear of their children becoming infected if they increased their social contacts in non-formal settings. Finally, the significant negative correlation between desire for change and environmental supports in all settings corroborates the validity of the measure. Study limitations The present study has some limitations. First, the instrument was applied only in an online, self-administered format because of the COVID-19 socio-health situation. Thus, on the one hand, the anonymity of the web-based procedure may have led participants to provide less thoughtful responses, especially in the retest phase. On the other hand, participation was one of the dimensions most affected by the pandemic, which prevents the generalization of results to less extraordinary situations. Second, the educational level of participants is high and may not be representative of the general population. Moreover, because two-parent Spanish families with high educational levels are more likely to enjoy higher incomes, they are in a better position to offer support to their children with disabilities, and their responses may not be applicable to families with lower educational and economic levels. Therefore, future studies should ensure representation of families with different educational levels and incomes, and should also compare the differences in participation and environmental support/barriers according to other relevant child or family variables (e.g., severity of the disability). Finally, the PEM-CY is a parent-reported questionnaire and, as such, parents’ perceptions of their children’s participation may differ from their children’s self-perceptions [ 30 ]. Therefore, there is a need to develop child-reported participation measures. Currently, we have the Spanish Children’s Assessment of Participation and Enjoyment (CAPE) to assess children’s participation in leisure activities [ 31 ], and we are developing the School Participation Questionnaire to assess the school participation of students with and without disabilities from the student’s own perspective. Conclusions The Spanish version of the PEM-CY is a valid and reliable instrument to assess the participation of Spanish children and youths (with and without disabilities) at home, school, and community settings, as well as the environmental factors that support or hinder this participation. It provides useful information for designing environment-based interventions aimed at minimizing the effect of the barriers that limit this participation. Abbreviations ICF: International Classification of Functioning, Disability and Health PEM-CY: Participation and Environment Measure for Children and Youth ICC: Intraclass correlation coefficient ASD: Autism spectrum disorder ANOVA: Analysis of variance CAPE: Children’s Assessment of Participation and Enjoyment Declarations Ethics approval and consent to participate Ethics approval for the study was obtained from the Research Ethics Committee of University of Salamanca (Ref. 0000407). Informed consent was obtained from all participants. Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study was funded by Ministerio de Ciencia, Innovación y Universidades of Spain (REF. RTI2018-096539-B-I00). Authors' contributions M.G-V. has made substantial contributions to the conception and design of the work, the acquisition, analysis, and interpretation of data, has drafted the work, and substantively revised it. MB.OB. has made substantial contributions to the design of the work, the acquisition, analysis, and interpretation of data, and has substantively revised the work. I.V-M. has made substantial contributions to the acquisition, and interpretation of data, has drafted the work, and substantively revised it. E.GO. has made substantial contributions to the acquisition, and interpretation of data, has drafted the work, and substantively revised it. M.BC. has made substantial contributions to the conception and design of the work, and has substantively revised it. All authors have approved the submitted version and have agreed both to be personally accountable for their own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which they were not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. Acknowledgements Authors thank the schools and families participating in this study. We are also thankful to Rachel Teplicky for her assistance. References World Health Organization. International Classification of functioning, disability, and health. WHO. 2001. [Internet] [cited 2024 Apr 1] Available from: https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health Coster W, Khetani MA. Measuring participation of children with disabilities: issues and challenges. Disabil Rehabil. 2008; 30(8):639–48. http://dx.doi.org/10.1080/09638280701400375 Law M. Participation in the occupations of everyday life. Am J Occup Ther. 2002; 56(6):640–9. http://dx.doi.org/10.5014/ajot.56.6.640 Rosenfeld L. Participation of children with disabilities across the life course: using socio-ecological perspectives to guide research and practice. Dev Med Child Neurol. 2020; 62(4):406. http://dx.doi.org/10.1111/dmcn.14442 Anaby D, Avery L, Gorter JW, et al. Improving body functions through participation in community activities among young people with physical disabilities. Dev Med Child Neurol. 2020; 62(5):640-646. http://dx.doi.org/10.1111/dmcn.14382 Arakelyan S, Maciver D, Rush R, et al. Family factors associated with participation of children with disabilities: a systematic review. Dev Med Child Neurol. 2019; 61(5):514–22. http://dx.doi.org/10.1111/dmcn.14133 Palisano RJ, Chiarello LA, King GA, et al. Participation-based therapy for children with physical disabilities. Disabil Rehabil. 2012; 34(12):1041–52. http://dx.doi.org/10.3109/09638288.2011.628740 Tomas V, Srinivasan R, Kulkarni V, et al. A guiding process to culturally adapt assessments for participation-focused pediatric practice: the case of the Participation and Environment Measures (PEM). Disabil Rehabil. 2022; 44(21):6497–509. http://dx.doi.org/10.1080/09638288.2021.1960645 Anaby DR, Law MC, Majnemer A, et al. Opening doors to participation of youth with physical disabilities: An intervention study: Favoriser la participation des adolescents ayant des handicaps physiques: Étude d’intervention. Can J Occup Ther. 2016; 83(2):83–90. http://dx.doi.org/10.1177/0008417415608653 Imms C, Mathews S, Richmond KN, et al. Optimising leisure participation: a pilot intervention study for adolescents with physical impairments. Disabil Rehabil. 2016; 38(10):963–71. http://dx.doi.org/10.3109/09638288.2015.1068876 Chien C-W, Li-Tsang CWP, Cheung PPP, et al. Development and psychometric evaluation of the Chinese version of the Participation and Environment Measure for Children and Youth. Disabil Rehabil. 2020; 42(15):2204–14. http://dx.doi.org/10.1080/09638288.2018.1553210 Coster W, Bedell G, Law M, et al. Psychometric evaluation of the participation and environment measure for children and youth: Participation and environment measure. Dev Med Child Neurol. 2011; 53(11):1030–7. http://dx.doi.org/10.1111/j.1469-8749.2011.04094.x Coster W, Law M, Bedell G, et al. Development of the participation and environment measure for children and youth: conceptual basis. Disabil Rehabil. 2012; 34(3):238–46. http://dx.doi.org/10.3109/09638288.2011.603017 Khetani M, Marley J, Baker M, et al. Validity of the Participation and Environment Measure for Children and Youth (PEM-CY) for Health Impact Assessment (HIA) in sustainable development projects. Disabil Health J. 2014; 7(2):226–35. http://dx.doi.org/10.1016/j.dhjo.2013.11.003 Khetani MA, Cliff AB, Schelly C, et al. Decisional support algorithm for collaborative care planning using the participation and environment measure for children and youth (PEM-CY): A mixed methods study. Phys Occup Ther Pediatr. 2015; 35(3):231–52. http://dx.doi.org/10.3109/01942638.2014.899288 Kaya Kara O, Turker D, Kara K, et al. Psychometric properties of the Turkish version of Participation and Environment Measure for Children and Youth. Child Care Health Dev. 2020; 46(6): 711–22. http://dx.doi.org/10.1111/cch.12801 Krieger B, Schulze C, Boyd J, et al. Cross-cultural adaptation of the Participation and Environment Measure for Children and Youth (PEM-CY) into German: a qualitative study in three countries. BMC Pediatr. 2020; 20(1):492. http://dx.doi.org/10.1186/s12887-020-02343-y CanChild. PEM-CY – Participation and Environment Measure – Children and Youth. [Internet] [cited 2024 Apr 1]. Available from: https://canchild.ca/en/shop/2-pem-cy-participation-and-environment-measure-children-and-youth UN General Assembly. Convention on the rights of persons with disabilities: resolution/adopted by the General Assembly. 2007 [Internet] [cited 2024 Apr 1]. Available from: http://www.refworld.org/docid/45f973632 Real Decreto Legislativo 1/2013, de 29 de noviembre, por el que se aprueba el Texto Refundido de la Ley General de derechos de las personas con discapacidad y de su inclusión social. (Boletín Oficial del Estado, 289 , de 3 de diciembre de 2013). https://www.boe.es/eli/es/rdlg/2013/11/29/1/con Ley Orgánica 3/2020, de 29 de diciembre, por la que se modifica la Ley Orgánica 2/2006, de 3 de mayo, de Educación. (Boletín Oficial del Estado, 340 , de 30 de diciembre de 2020). https://www.boe.es/eli/es/lo/2020/12/29/3 Srinivasan R, Kulkarni V, Smriti S, et al. Cross-cultural adaptation and evaluation of the Participation and Environment Measure for Children and Youth to the Indian context-A mixed-methods study. Int J Environ Res Public Health. 2021; 18(4):1514. http://dx.doi.org/10.3390/ijerph18041514 International Test Commission. ITC Guidelines for the Large-Scale Assessment of Linguistically and Culturally Diverse Populations [Internet]; 2018 [revised 2019-2020; cited 2024 Apr 1]. Available from: www.InTestCom.org Muñiz J, Elosua P, Hambleton RK, et al. Commission Guidelines for test translation and adaptation: second edition. Psicothema. 2013; 25(2):151–7. http://dx.doi.org/10.7334/psicothema2013.24 Stevelink SAM, van Brakel WH. The cross-cultural equivalence of participation instruments: a systematic review. Disabil Rehabil. 2013;35(15):1256–68. http://dx.doi.org/10.3109/09638288.2012.731132 Tavakol M, Dennick R. Making sense of Cronbach’s alpha. Int J Med Educ. 2011; 2:53–5. http://dx.doi.org/10.5116/ijme.4dfb.8dfd Fleiss JL, Levin B, Paik MC. Statistical Methods for Rates and Proportions. 1a ed. New York, Estados Unidos de América: Wiley-Interscience; 2003. [28] Jeong Y, Law M, Stratford P, et al. Cross-cultural validation and psychometric evaluation of the Participation and Environment Measure for Children and Youth in Korea. Disabil Rehabil. 2016; 38(22):2217–28. http://dx.doi.org/10.3109/09638288.2015.1123302 Majnemer A, Shikako-Thomas K, Schmitz N, et al. Stability of leisure participation from school-age to adolescence in individuals with cerebral palsy. Res Dev Disabil. 2015; 47:73–9. http://dx.doi.org/10.1016/j.ridd.2015.08.009 Dada S, Andersson AK, May A, et al. Agreement between participation ratings of children with intellectual disabilities and their primary caregiver.Res Dev Disabil. 2020; 103715–104. https://doi.org/10.1016/j.ridd.2020.103715 Longo E, Badia M, Orgaz B, et al. Cross-cultural validation of the Children’s Assessment of Participation and Enjoyment (CAPE) in Spain. Child Care Health Dev. 2014; 40(2):231–41. http://dx.doi.org/10.1111/cch.12012 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5998160","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":414622145,"identity":"6b712c35-6c31-40b4-b9be-1d7ad69c16af","order_by":0,"name":"María Gómez-Vela","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAmklEQVRIiWNgGAWjYHACxgdAQoYkLcwGQIKHJC1sEqRp0e1fY1bN88eOh4G9/QFxWsxuvDG7zduWzMPAc8aAWC3H0m7zNjDzMEjkEOkwkJZinj/1PAzyz4l12PnmY8w8bIeBtjAQ7TDmw5Jz247zsPHkEKvl/MHGD2/+VMvxsx8n0mEMEgkQmo1I9UDAf4B4taNgFIyCUTBCAQDaISZ9TXEntAAAAABJRU5ErkJggg==","orcid":"","institution":"University of Salamanca","correspondingAuthor":true,"prefix":"","firstName":"María","middleName":"","lastName":"Gómez-Vela","suffix":""},{"id":414622149,"identity":"8a30ccd9-a3b0-4e63-96db-36f76605c355","order_by":1,"name":"Mª Begoña Orgaz Baz","email":"","orcid":"","institution":"University of Salamanca","correspondingAuthor":false,"prefix":"","firstName":"Mª","middleName":"Begoña Orgaz","lastName":"Baz","suffix":""},{"id":414622151,"identity":"56fb1225-0062-44a3-827f-d66ce91c3a17","order_by":2,"name":"Isabel Vicario-Molina","email":"","orcid":"","institution":"University of Salamanca","correspondingAuthor":false,"prefix":"","firstName":"Isabel","middleName":"","lastName":"Vicario-Molina","suffix":""},{"id":414622152,"identity":"3d6d4ca9-68c0-42ed-89b2-7c1ff803dc8a","order_by":3,"name":"Eva González Ortega","email":"","orcid":"","institution":"University of Salamanca","correspondingAuthor":false,"prefix":"","firstName":"Eva","middleName":"González","lastName":"Ortega","suffix":""},{"id":414622153,"identity":"95857e43-9535-42e0-b7ea-fe4f3fbc2351","order_by":4,"name":"Marta Badia Corbella","email":"","orcid":"","institution":"University of Salamanca","correspondingAuthor":false,"prefix":"","firstName":"Marta","middleName":"Badia","lastName":"Corbella","suffix":""}],"badges":[],"createdAt":"2025-02-10 10:23:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5998160/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5998160/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":76282095,"identity":"3eac7c12-ac03-4beb-8e1c-5d478ce1c214","added_by":"auto","created_at":"2025-02-14 10:41:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":67210,"visible":true,"origin":"","legend":"\u003cp\u003eQuestionnaire adaptation procedure.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5998160/v1/496123e34dddb740ad505a9b.png"},{"id":76568615,"identity":"e63d995a-c295-43ac-a755-651bce3859c0","added_by":"auto","created_at":"2025-02-18 13:17:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1501223,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5998160/v1/4dd5183c-1a7b-451b-8bc8-cbadb1281f2d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Transcultural adaptation and psychometric properties of the Spanish version of Participation and Environment Measurement - Children and Youth (PEM-CY)","fulltext":[{"header":"Background","content":"\u003cp\u003eParticipation is conceptualized by the International Classification of Functioning, Disability and Health (ICF) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] as \u0026ldquo;an individual\u0026rsquo;s involvement in life situations\u0026rdquo; affected by both personal and environmental factors. Among children with disabilities, successful participation in everyday situations is a sign of health and an essential rehabilitation goal [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] because it provides many opportunities to enhance abilities, social relationships, and overall quality of life [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTherefore, an important aim for families and health and education professionals is to identify and improve the participation profiles of children with disabilities [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Most rehabilitation interventions proposed in the last decade have focused on modifying environmental conditions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], but prior to attempting environment-based interventions, it is critical to analyze these children\u0026rsquo;s participation, as well as environmental supports and barriers, using valid and reliable measures [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Participation and Environment Measure for Children and Youth (PEM-CY) by Coster et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] captures a child\u0026rsquo;s participation across a broad range of home, school, and community-based activities [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] while examining a variety of environmental factors (e.g., physical layout, social or cognitive demands of activities) that parents perceive as supporting/hindering their child\u0026rsquo;s participation [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The PEM-CY is a reliable, valid measure for children and youths (5\u0026ndash;17 years), with or without disabilities [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and it is suitable for minors with all disability types [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. It has been applied in many countries [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and translated into 22 languages [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe two Spanish versions of the PEM-CY were translated for use in the United States and Colombia [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Because there are major linguistic, social, and cultural differences between these countries and Spain, it is necessary to develop another country-specific measure that properly assesses children\u0026rsquo;s participation and environmental factors in order to promote environment-based interventions for Spanish children with disabilities. This is one of the guidelines established by the United Nations Convention on the Rights of Persons with Disabilities [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], as well as by Spanish rehabilitation, educational, and social legislation [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study aimed to develop the Spanish version of the PEM-CY to be applied to Spanish children and youth aged 5 to 17 and to establish its psychometric properties, including its reliability (internal consistency and test\u0026ndash;retest reliability) as well as its discriminant validity.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eInstrument\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe PEM-CY is a parent-report questionnaire of 25 items that assesses children\u0026rsquo;s participation in broad types of activities at home (10 items), school (5), and community (10) settings considering three dimensions: frequency, involvement, and desire for change [22]. The PEM-CY also has 45 items about the environmental impact on home, school, and community participation [12,13]. For each setting, parents are asked to report whether certain factors support/hinder their child\u0026rsquo;s participation and whether supportive resources are perceived to be available. The original PEM-CY can be completed in either paper- or web-based format.\u003c/p\u003e\n\u003cp\u003eFor all sections, the internal consistency of the PEM-CY has shown to be moderate to very good (Cronbach\u0026apos;s \u0026alpha; = 0.59\u0026ndash;0.91) and the test\u0026ndash;retest reliability is found to be moderate to good when assessed within a 4-week period after the completion of the first round (ICC 0.58\u0026ndash;0.95) [12]. The validity of the PEM-CY is established because this measure identified a significant impact of disability on children\u0026rsquo;s participation across all variables and settings. Also, age group was found to have a significant effect in children (with and without disabilities) for participation involvement at home and school, but not in the community [12].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eTranslation and adaptation procedure\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn order to achieve the maximum level of conceptual, item, semantic, operational, and measurement equivalence, the Spanish version of the PEM-CY was developed considering the International Test Commission Guidelines for test translation and adaptation [23,24] as well as recommendations for cross-cultural adaptations of participation measures, including those provided by Stevelink and van Brakel [25] and Tomas et al. [8]. The adaptation process consisted of five phases, depicted in Figure 1: (1) forward translation, (2) consensual synthesis, (3) cognitive interviews, (4) back translation, and (5) pilot study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Insert Figure 1: Questionnaire adaptation procedure]\u003c/p\u003e\n\u003cp\u003eAfter obtaining the authors\u0026apos; permission to begin adaptation, two independent translations were carried out by two bilingual translators with PhDs in psychology. For each item, the translators were asked to indicate both the level of equivalence of the translated version and the difficulty of the translation according to a scale from 1 (\u003cem\u003enot at all\u003c/em\u003e) to 10 (\u003cem\u003ecompletely\u003c/em\u003e). Subsequently, a committee of experts from the research team reviewed the independent translations and generated a consensual version adapted to the Spanish context.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNext, 10 parents of children with disabilities between 5 and 17 years were invited to participate in two rounds of cognitive interviews. They were asked about the degree of clarity, adequacy, and cultural acceptability of the instructions, items, and response options. The parents\u0026rsquo; suggestions were analyzed by the research team to introduce modifications and improvements into the pre-final version of the PEM-CY.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNext, a back translation was developed by a bilingual translator with a PhD in psychology. This step aimed to ensure that there were no problems of cultural accuracy and conceptual equivalence despite the modifications introduced during the process.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA small pilot study was then conducted with a sample of 6 parents of children aged 5 to 17 years, both with and without diagnosis/disability. Participants were asked to read the instrument and assess (a) the format, (b) possibly misleading wording, (c) the level of comprehension of the instructions and items, (d) possible difficulties in answering the instrument, and (e) the time to complete it. Finally, the research team conducted a last review of the instrument before submitting it to the PEM-CY team for approval.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eSampling and data collection procedure\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval for the study was obtained from the Research Ethics Committee of University of Salamanca (Ref. 0000407). Participants were recruited via convenience sampling from schools in all geographical regions of Spain between September 2020 and September 2022, and therefore during a period of social restrictions in response to the COVID-19 pandemic. School principals and associations of families of children with disabilities\u0026nbsp;were provided with detailed information on the study. Potential participants were asked to sign the informed consent form and voluntarily complete the Spanish version of the PEM-CY on an online platform\u0026nbsp;if they met the following inclusion criteria: (a) they were parents or legal guardians of children and youths with or without diagnoses (e.g., chronic health problems such as asthma)/disabilities (e.g., intellectual disability, cerebral palsy, ASD), (b) they were able to read Spanish, and (c) their child was 5 to 17 years old during the study.\u003c/p\u003e\n\u003cp\u003eThe Spanish version of the PEM-CY was administered to a sample of 713 parents of children with (\u003cem\u003en\u003c/em\u003e = 233) and without (\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 480) diagnosis/disability. Moreover, a subsample of 30 parents was self-selected to complete the instrument twice within an interval of 6 to 8 weeks of the first completion for test\u0026ndash;retest reliability study. This time frame was greater than in prior similar studies because of circumstances that hindered participants\u0026rsquo; commitment to the study (i.e., the summer season).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor the present study, a sociodemographic questionnaire was designed to obtain information about child and family characteristics\u0026mdash;specifically, on children\u0026rsquo;s gender, age, and diagnoses/disabilities, as well as on respondents\u0026rsquo; relationship with the children, educational level, and employment status (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eData analysis \u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA total of 713 parents of children and youth with and without disabilities (Table 1) were used to determine the reliability and validity of the Spanish version of PEM-CY, after meeting the following criteria for inclusion in analysis: (1) providing responses to the \u0026ldquo;child age\u0026rdquo; and \u0026ldquo;disability\u0026rdquo; questions and (2) answering at least two questions of the \u0026ldquo;participation at home\u0026rdquo; section\u0026mdash;the same criteria used by the authors of the original scale [12]. It should be noted that the survey was not fully completed by all participants; consequently, the number considered in each analysis differed.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDescriptive statistics were used, on the one hand, to summarize participants\u0026rsquo; characteristics, and on the other, to summarize participants\u0026rsquo; perceptions on participation (frequency, involvement, and desire for change) and environment (environmental supports, barriers, helpfulness and resources and overall environmental supports): specifically, mean and standard deviation for continuous variables, and percentage for categorical variables.\u003c/p\u003e\n\u003cp\u003eThe reliability of the Spanish version of PEM-CY was assessed in terms of internal consistency and test\u0026ndash;retest reliability. Cronbach\u0026rsquo;s alpha coefficient was used to examine the internal consistency of both participation and environment scales. Values ranging from 0.70 to 0.95 were considered satisfactory [26]. Test\u0026ndash;retest reliability was assessed in a subsample (n = 30) similar in size to that used by the authors of the original scale [12], through intraclass correlation coefficient (ICC) with a two-way mixed effects model for absolute agreement. An ICC agreement \u0026ge; 0.70 indicated sufficient test\u0026ndash;retest reliability, \u0026gt; 0.75 excellent, 0.40 to 0.75 fair/good, and \u0026lt; .40 poor [27].\u003c/p\u003e\n\u003cp\u003eThe validity of the Spanish PEM-CY was examined in terms of discriminant validity by assessing the extent to which scores were consistent with our hypotheses about the existence of significant differences in parents\u0026rsquo; perceptions of their children\u0026apos;s participation and influencing environmental factors as a function of the child having or not a disability, but not of the age group. Two-way analysis of variance (ANOVA) was used followed by post hoc tests and effect-size calculation, also including the variable age group (5\u0026ndash;11 and 12\u0026ndash;17 years) and disability (yes/no).\u0026nbsp;Finally, consistent with the analysis used for the validation of the original scale, Pearson\u0026rsquo;s correlation coefficients were calculated between desire for change and overall environmental supports. A value of \u003cem\u003ep\u003c/em\u003e \u0026lt; .05 was considered the cut-off for statistical significance. The Statistical Package for the Social Sciences (SPSS) v.26 was used for all analyses.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Spanish version of the PEM-CY was administered to a sample of 713 parents of children with (\u003cem\u003en\u003c/em\u003e = 233) and without (\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 480) diagnosis/disability. Moreover, 30 of these parents completed the instrument twice for test\u0026ndash;retest reliability study (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1. Sociodemographic characteristics of the participating parents and their children\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003eSociodemographic characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003eTotal sample\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e = 713)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003eRetest sample\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e = 30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u003cem\u003eRespondent\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Mother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e637 (89.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e24 (85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Father\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e68 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e4 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Other (grandparent, uncle/aunt, sibling)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e8 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u003cem\u003eFather\u0026rsquo;s educational level\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No school certificate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e9 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Primary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e151 (24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e2 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Secondary school or secondary vocational education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e158 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e9 (39.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;Higher vocational education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e77 (12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;University\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e211 (34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e10 (43.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u003cem\u003eMother\u0026rsquo;s educational level\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No school certificate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e1 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Primary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e56 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e1 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Secondary school or secondary vocational education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e139 (22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e5 (17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;Higher vocational education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e100 (15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e4 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;University\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e337 (53.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e18 (64.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u003cem\u003eFather\u0026rsquo;s employment status\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e558 (92.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e20 (90.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Unemployed/retired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e48 (7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e2 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u003cem\u003eMother\u0026rsquo;s employment status\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e477 (77.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e24 (85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Unemployed/retired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e142 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e4 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u003cem\u003eFamily type\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Lone parent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e54 (8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e7 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003eNuclear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e527 (83.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e19 (67.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003eStepfamily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e29 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e1 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Other (e.g., grandparents, shared custody)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e24 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e1 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u003cem\u003eChild gender\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e317 (44.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e12 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e396 (55.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e16 (57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u003cem\u003eChild age\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 33.4507%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 5\u0026ndash;11 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e437 (61.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e18 (62.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 12\u0026ndash;17 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e276 (38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e11 (37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u003cem\u003eChild with disability/diagnoses\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e480 (67.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e8 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e233 (32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e14 (63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u003cem\u003eChild\u0026rsquo;s sibling\u003c/em\u003es\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e187 (26.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e10 (35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5282%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.4296%;\"\u003e\n \u003cp\u003e526 (73.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0211%;\"\u003e\n \u003cp\u003e18 (64.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e[Insert Table 1]\u003c/p\u003e\n\u003cp\u003eIn both samples (total and retest), most respondents were mothers in a nuclear family and had several children. A significant percentage of fathers and mothers had a high educational level (higher vocational education or university), and both fathers and mothers were employed (Table 2). The total and retest samples were similar in all sociodemographic characteristics except for the proportion of children with disability: 32.7% and 63.6%, respectively. The children\u0026rsquo;s diagnoses/disability reported most frequently by the participants were health conditions like asthma and other chronic diseases (22.3%), intellectual disability (15.5%), delayed educational system incorporation or low school performance (13.3%), and learning disabilities (12.0%) (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Diagnosis/disability of children reported by the parents\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76.8959%;\"\u003e\n \u003cp\u003eDiagnosis/disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.1041%;\"\u003e\n \u003cp\u003eTotal sample\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e = 233)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76.8959%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.1041%;\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76.8959%;\"\u003e\n \u003cp\u003eHealth conditions (e.g., chronic health problems, frequent hospitalization)\u003c/p\u003e\n \u003cp\u003eIntellectual disability\u003c/p\u003e\n \u003cp\u003eDelayed educational system incorporation or low school performance\u003c/p\u003e\n \u003cp\u003eLearning disabilities\u003c/p\u003e\n \u003cp\u003eAutism spectrum disorder\u003c/p\u003e\n \u003cp\u003ePhysical disability\u003c/p\u003e\n \u003cp\u003eAttention deficit hyperactivity disorder\u003c/p\u003e\n \u003cp\u003eDevelopmental delay\u003c/p\u003e\n \u003cp\u003eGiftedness\u003c/p\u003e\n \u003cp\u003eEmotional impairment\u003c/p\u003e\n \u003cp\u003eVision impairment\u003c/p\u003e\n \u003cp\u003eHearing impairment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.1041%;\"\u003e\n \u003cp\u003e52 (22.3)\u003c/p\u003e\n \u003cp\u003e36 (15.5)\u003c/p\u003e\n \u003cp\u003e31 (13.3)\u003c/p\u003e\n \u003cp\u003e28 (12.0)\u003c/p\u003e\n \u003cp\u003e19 (8.2)\u003c/p\u003e\n \u003cp\u003e16 (6.7)\u003c/p\u003e\n \u003cp\u003e15 (6.4)\u003c/p\u003e\n \u003cp\u003e9 (3.9)\u003c/p\u003e\n \u003cp\u003e5 (2.2)\u003c/p\u003e\n \u003cp\u003e4 (1.7)\u003c/p\u003e\n \u003cp\u003e3 (1.3)\u003c/p\u003e\n \u003cp\u003e2 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eInternal consistency: Cronbach\u0026rsquo;s alpha coefficients\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCronbach\u0026rsquo;s alpha coefficients for participation and environment scales at home, school and community settings, were satisfactory (\u0026ge; .74), with the exception of frequency of participation at home and school. The best values were obtained for the community setting.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eTest\u0026ndash;retest reliability: Intraclass correlation coefficients\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe sample sizes of these analyses were small for participation scales (\u003cem\u003en\u003c/em\u003e = 30\u0026ndash;25) and for environment scales (\u003cem\u003en\u003c/em\u003e = 30\u0026ndash;22). As for participation scales, the ICCs of frequency were fair/good for school and excellent for home and community. These coefficients were also excellent for involvement across the three settings. For environment scales, ICCs of overall environmental supports were good for school and community, but poor for home (Table 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3. Cronbach\u0026rsquo;s alpha and intraclass correlation coefficients\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6703%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReliability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7253%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.9451%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.6593%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommunity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6703%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCronbach\u0026rsquo;s alpha coefficients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7253%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.9451%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.6593%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6703%;\"\u003e\n \u003cp\u003e\u003cem\u003eParticipation scales\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7253%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.9451%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.6593%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6703%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Frequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7253%;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.9451%;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.6593%;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6703%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Involvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7253%;\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.9451%;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.6593%;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6703%;\"\u003e\n \u003cp\u003e\u003cem\u003eEnvironment scales\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7253%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.9451%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.6593%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6703%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Overall environmental supports\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7253%;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.9451%;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.6593%;\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6703%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntraclass correlation coefficients (ICCs)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7253%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.9451%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.6593%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6703%;\"\u003e\n \u003cp\u003e\u003cem\u003eParticipation scales\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7253%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.9451%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.6593%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6703%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Frequency\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7253%;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.9451%;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.6593%;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6703%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Involvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7253%;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.9451%;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.6593%;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6703%;\"\u003e\n \u003cp\u003e\u003cem\u003eEnvironment scales\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7253%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.9451%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.6593%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6703%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Overall environmental supports\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7253%;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.9451%;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.6593%;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eValidity: Hypothesis testing\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eResults of two-way ANOVA to examine the effects of child\u0026rsquo;s diagnosis/disability and age group are presented separately in Tables 4 and 5, respectively, because there were no significant interaction effects between these two variables for the participation scales (frequency [F(1,470) = 1.73, \u003cem\u003ep\u003c/em\u003e = .19], involvement [F(1,470) = 0.08, \u003cem\u003ep\u003c/em\u003e = .78], or desire for change [F(1,470) = 0.08, \u003cem\u003ep\u003c/em\u003e = .78]), nor for the environmental scales (supports [F(1,470) = 0.05, \u003cem\u003ep\u003c/em\u003e = .83] and barriers [F(1,470) = 0.05, \u003cem\u003ep\u003c/em\u003e = .83]).\u003c/p\u003e\n\u003cp\u003eThere was a significant effect of child\u0026rsquo;s diagnoses across all settings and all variables, except for environmental resources at home (Table 4). According to parents\u0026rsquo; scores, children with disabilities participated in a lower percentage of activities, their frequency of participation and involvement was lower, and parents\u0026rsquo; desire for change was higher, regardless of age group. In relation to the environment, parents of children with disabilities reported lower scores for environmental supports (except at home), helpfulness, resources, and overall environmental supports, and showed higher scores for environmental barriers, regardless of the child\u0026rsquo;s age group. The highest effect sizes were obtained for environmental barriers (eta\u003csup\u003e2\u003c/sup\u003e = .201), resources (eta\u003csup\u003e2\u003c/sup\u003e = .318), and overall environmental supports (eta\u003csup\u003e2\u003c/sup\u003e = .219).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4. Comparison of Participation and Environment scores across settings by child\u0026rsquo;s disability\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHome\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Number of activities = 10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWith disability\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003en\u003c/em\u003e = 187)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout disability\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003en\u003c/em\u003e = 526)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eF-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eEffect size\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eM (SD)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eM (SD)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Percentage of activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e89.41 (14.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e94.39 (7.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,470)\u0026nbsp;\u003c/sub\u003e= 25.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.052\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Frequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e5.67 (0.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e6.14 (0.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,470)\u0026nbsp;\u003c/sub\u003e= 54.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Involvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e3.54 (0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e3.98 (0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,470)\u0026nbsp;\u003c/sub\u003e= 49.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.095\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Desire for change\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e62.53 (25.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e45.26 (25.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,470)\u0026nbsp;\u003c/sub\u003e= 41.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnvironment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental supports\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e34.50 (29.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e40.08 (37.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,666)\u0026nbsp;\u003c/sub\u003e= 2.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental barriers\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e19.73 (17.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e5.61 (9.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,442)\u0026nbsp;\u003c/sub\u003e= 111.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.201\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental helpfulness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e73.29 (16.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e82.61 (14.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,442)\u0026nbsp;\u003c/sub\u003e= 38.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.080\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e78.91 (16.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e96.76 (8.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,408)\u0026nbsp;\u003c/sub\u003e= 189.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.318\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Overall environmental supports\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e74.72 (12.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e87.27 (9.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,408)\u0026nbsp;\u003c/sub\u003e= 114.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.219\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Number of activities = 5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWith disability\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003en\u003c/em\u003e = 187)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout disability\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003en\u003c/em\u003e = 526)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eM (SD)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eM (SD)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eF-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eEffect size\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Percentage of activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e70.70 (25.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e77.36 (21.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,378)\u003c/sub\u003e = 7.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; .008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Frequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e3.55 (1.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e3.96 (1.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,378)\u0026nbsp;\u003c/sub\u003e= 7.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; .005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Involvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e3.20 (1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e3.91 (0.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,378)\u003c/sub\u003e = 47.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.112\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Desire for change\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e62.68 (38.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e33.77 (36.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,378)\u003c/sub\u003e = 54.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnvironment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental supports\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e53.75 (24.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e68.02(20.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,351)\u003c/sub\u003e = 25.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.068\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental barriers\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e20.76 (18.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e6.99 (11.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,357)\u003c/sub\u003e = 65.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.155\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental helpfulness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e72.02 (16.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e78.97(14.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,367)\u003c/sub\u003e = 11.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e83.94 (15.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e97.16 (8.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,357)\u003c/sub\u003e = 91.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.203\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Overall environmental supports\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e77.06 (13.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e86.96 (9.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,357)\u003c/sub\u003e = 54.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommunity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Number of activities = 10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWith disability\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003en\u003c/em\u003e = 187)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout disability\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003en\u003c/em\u003e = 526)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eM (SD)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eM (SD)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eF-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eEffect size\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Percentage of activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e62.06 (22.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e72.70 (17.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,333)\u003c/sub\u003e = 27.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.075\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Frequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e2.66 (1.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e3.24 \u0026nbsp;(1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,333)\u0026nbsp;\u003c/sub\u003e= 18.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.054\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Involvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e2.04 (0.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e2.28 (0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,327)\u0026nbsp;\u003c/sub\u003e= 6.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Desire for change\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e56.02 (32.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e27.07 (29.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,333)\u0026nbsp;\u003c/sub\u003e= 66.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.167\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnvironment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental supports\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e38.59 (28.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e60.84 (24.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,328)\u003c/sub\u003e = 51.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.136\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental barriers\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e27.31 (24.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e7.31 (11.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,328)\u003c/sub\u003e = 90.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.216\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental helpfulness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e68.65 (19.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e77.97 (14.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,328)\u003c/sub\u003e = 22.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.064\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e74.20 (21.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e94.78 (13.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,318)\u003c/sub\u003e = 109.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.256\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3149%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Overall environmental supports\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e70.51 (15.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.436%;\"\u003e\n \u003cp\u003e84.89 (10.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.263%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,328)\u003c/sub\u003e = 89.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.86159%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4187%;\"\u003e\n \u003cp\u003e.214\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e[Insert Table 4]\u003c/p\u003e\n\u003cp\u003eThere was a significant effect of the child\u0026rsquo;s age group for participation variables at home (except for involvement) and school, but not in the community setting (except for frequency and desire for change) or for environment variables (Table 5). In the case of home activities, parents reported that youths (12\u0026ndash;17 years) participated in a higher percentage of activities, but with lower frequency, and parents\u0026rsquo; desire for change was higher. In the case of school activities, significant effects were found on all variables: youths participated in a lower percentage of activities, with lower frequency and involvement, and parents\u0026rsquo; desire for change was higher. As for community activities, youths participated with lower frequency and their parents\u0026rsquo; desire for change was higher. This pattern of results was similar for participants with and without diagnosis/disability, as the interaction was not significant.\u003c/p\u003e\n\u003cp\u003eTable 5. Comparison of Participation and Environment scores across settings by child\u0026rsquo;s age group\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHome\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Number of activities = 10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChildren\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e5\u0026ndash;11 years\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003en\u003c/em\u003e = 437)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYouths\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e12\u0026ndash;17 years\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003en\u003c/em\u003e = 276)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eM (SD)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eM (SD)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eF-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eEffect size\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Percentage of activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e91.48(10.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e94.37 (11.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,470)\u003c/sub\u003e = 5.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Frequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e6.08 (0.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e5.86 (0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,470)\u003c/sub\u003e = 9.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Involvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e3.82 (0.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e3.86 (0.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,470)\u0026nbsp;\u003c/sub\u003e= 0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Desire for change\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e47.80 (27.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e57.49(25.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,470)\u003c/sub\u003e = 11.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnvironment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental supports\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e39.22 (35.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e37.55 (35.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,666)\u0026nbsp;\u003c/sub\u003e= 0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.628\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental barriers\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e11.02 (14.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e9.99 (15.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,442)\u0026nbsp;\u003c/sub\u003e= 0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental helpfulness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e74.02 (16.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e72.01 (16.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1, 442)\u0026nbsp;\u003c/sub\u003e= 0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.641\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e76.91 (16.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e80.72 (16.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,408)\u0026nbsp;\u003c/sub\u003e= 1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Overall environmental supports\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e74.52 (12.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e74.54 (13.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1, 408)\u0026nbsp;\u003c/sub\u003e= 0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.985\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Number of activities = 5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u0026ndash;11 years\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003en\u003c/em\u003e = 437)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12\u0026ndash;17 years\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003en\u003c/em\u003e = 276)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eM (SD)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eM (SD)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eF-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eEffect size\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Percentage of activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e78.24 (21.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e68.61 (24.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,378)\u0026nbsp;\u003c/sub\u003e= 17.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.043\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Frequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e4.03 (1.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e3.46 (1.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,378)\u0026nbsp;\u003c/sub\u003e= 15.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.039\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Involvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e3.80 (0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e3.43 (0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,378)\u0026nbsp;\u003c/sub\u003e= 12.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Desire for change\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e40.59 (39.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e50.83 (37.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,378)\u0026nbsp;\u003c/sub\u003e= 6.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnvironment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental supports\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e63.79 (22.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e61.69 (22.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,351)\u003c/sub\u003e = 0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.633\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental barriers\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e12.03 (15.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e11.27 (15.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,357)\u0026nbsp;\u003c/sub\u003e= 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental helpfulness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e71.82 (15.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e73.07 (17.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,367)\u0026nbsp;\u003c/sub\u003e= 0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e84.28 (14.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e84.35 (17.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,357)\u0026nbsp;\u003c/sub\u003e= 0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.713\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Overall environmental supports\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e76.99 (12.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e77.97 (14.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,357)\u0026nbsp;\u003c/sub\u003e= 0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.808\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommunity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Number of activities = 10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u0026ndash;11 years\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003en\u003c/em\u003e = 437)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12\u0026ndash;17 years\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003en\u003c/em\u003e = 276)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003eM (DT)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003eM (DT)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eF-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eEffect size\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Percentage of activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e69.91 (18.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e67.78 (22.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,333)\u003c/sub\u003e = 2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Frequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e3.15 (1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e2.90 (1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,333)\u003c/sub\u003e = 3.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Involvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e2.34 (0.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e2.22 (0.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,327)\u003c/sub\u003e = 1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Desire for change\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e33.35 (32.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e44.73 (33.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,333)\u003c/sub\u003e = 11.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnvironment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental supports\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e52.49 (27.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e54.38 (29.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,328)\u003c/sub\u003e = 0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.635\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental barriers\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e15.09 (20.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e13.30 (19.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,328)\u003c/sub\u003e = 0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental helpfulness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e68.78 (19.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e68.57 (19.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,328)\u0026nbsp;\u003c/sub\u003e= 0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.948\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Environmental resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e72.26 (20.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e75.26 (21.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,318)\u003c/sub\u003e = 0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7818%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Overall environmental supports\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e69.77 (15.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e71.08 (16.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1,328)\u003c/sub\u003e = 0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7492%;\"\u003e\n \u003cp\u003e.485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.8436%;\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e[Insert Table 5]\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eValidity: Correlation coefficient\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFor the whole sample, there was a significant negative medium correlation (\u003cem\u003ep\u003c/em\u003e \u0026lt; .001) between desire for change and overall environmental supports for each setting: home (\u003cem\u003er\u003c/em\u003e = -.32), school (\u003cem\u003er\u003c/em\u003e = -.41), and community (\u003cem\u003er\u003c/em\u003e = -.40). The same pattern of relations was found in both groups: disability (home, \u003cem\u003er\u003c/em\u003e = -.24, \u003cem\u003ep\u003c/em\u003e = .003; school, \u003cem\u003er\u0026nbsp;\u003c/em\u003e= -.39, \u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; .001; community, \u003cem\u003er\u003c/em\u003e = -.44, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001) and without disability (home, \u003cem\u003er\u003c/em\u003e = -.18, \u003cem\u003ep\u003c/em\u003e = .002; school, \u003cem\u003er\u003c/em\u003e = -.26 \u003cem\u003ep\u003c/em\u003e \u0026lt; .001; community, \u003cem\u003er\u003c/em\u003e = -.09, \u003cem\u003ep\u003c/em\u003e = .156). These correlations were higher for children with a diagnosis/disability.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe Spanish version of the PEM-CY is a valid and reliable instrument to assess the participation of Spanish children and youths (with and without disabilities) at home, school, and community settings, as well as the environmental factors that support or hinder this participation.\u003c/p\u003e \u003cp\u003eReliability assessed with internal consistency was satisfactory to excellent for all scales except frequency of participation at home and school. These results are similar to those of the original [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and other versions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Additionally, the test\u0026ndash;retest reliability of the Spanish version of PEM-CY was excellent for participation involvement across the three settings, and for participation frequency at home and in the community, but not at school. Between the two applications of the PEM-CY, there were continuous modifications of the measures implemented in the schools to adapt to the changing situation of the COVID-19 pandemic; this directly influenced the stability of the measure of participation in the school. The ICC scores for environment scales were good for school and community, but poor for home; the small size of the sample may explain this last result. Also, because the retest was applied during summer holidays, participants\u0026rsquo; homes and their supports/barriers may have varied, as well as their personal involvement in providing support to their children.\u003c/p\u003e \u003cp\u003eIn relation to discriminant validity, and similarly to the original [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and other versions of the PEM-CY [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], the Spanish version can differentiate between children with and without disabilities. Children with disabilities participated in fewer activities across all settings, their frequency of participation and involvement were lower, and their parents\u0026rsquo; desire for change was higher, regardless of age group. Additionally, these parents reported fewer environmental supports and more barriers to the participation of their children, again independently of age group. Similarly to Kaya Kara et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and Jeong et al. [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], no significant differences were found in environmental supports at home. This result may indicate that families provide supports at home regardless of the diagnoses/disability of their children, even in exceptional circumstances such as COVID-19 lockdowns, which made some environmental factors favorable in the home settings. In any case, these results highlight the need for environment-based interventions to enhance the participation of children with disabilities.\u003c/p\u003e \u003cp\u003eWith regard to age, we found significant differences for participation at home and school. Youths participated in a higher percentage of activities at home, perhaps due to their increased autonomy, albeit with lower frequency. Further implications may be derived from the data related to the school setting. Youths participated in a lower percentage of school activities, with a lower frequency and involvement, and their parents\u0026rsquo; desire for change was higher. This result differs slightly from that obtained in other studies where activity participation has been found to increase as children without disabilities grow older, and decrease for those with disabilities [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In our case, participation was lower in both groups of youths (i.e., with and without disabilities) compared to the sample of children. Again, this may be partly explained by the fact that the study was developed during COVID-19 pandemic. It is possible that, as social restrictions loosened, youths prioritized community activities to counteract the isolation suffered in the previous months. Parents\u0026rsquo; desire for change may have resulted from fear of their children becoming infected if they increased their social contacts in non-formal settings.\u003c/p\u003e \u003cp\u003eFinally, the significant negative correlation between desire for change and environmental supports in all settings corroborates the validity of the measure.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStudy limitations\u003c/h2\u003e \u003cp\u003eThe present study has some limitations. First, the instrument was applied only in an online, self-administered format because of the COVID-19 socio-health situation. Thus, on the one hand, the anonymity of the web-based procedure may have led participants to provide less thoughtful responses, especially in the retest phase. On the other hand, participation was one of the dimensions most affected by the pandemic, which prevents the generalization of results to less extraordinary situations. Second, the educational level of participants is high and may not be representative of the general population. Moreover, because two-parent Spanish families with high educational levels are more likely to enjoy higher incomes, they are in a better position to offer support to their children with disabilities, and their responses may not be applicable to families with lower educational and economic levels. Therefore, future studies should ensure representation of families with different educational levels and incomes, and should also compare the differences in participation and environmental support/barriers according to other relevant child or family variables (e.g., severity of the disability). Finally, the PEM-CY is a parent-reported questionnaire and, as such, parents\u0026rsquo; perceptions of their children\u0026rsquo;s participation may differ from their children\u0026rsquo;s self-perceptions [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Therefore, there is a need to develop child-reported participation measures. Currently, we have the Spanish Children\u0026rsquo;s Assessment of Participation and Enjoyment (CAPE) to assess children\u0026rsquo;s participation in leisure activities [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], and we are developing the School Participation Questionnaire to assess the school participation of students with and without disabilities from the student\u0026rsquo;s own perspective.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe Spanish version of the PEM-CY is a valid and reliable instrument to assess the participation of Spanish children and youths (with and without disabilities) at home, school, and community settings, as well as the environmental factors that support or hinder this participation.\u003c/p\u003e \u003cp\u003eIt provides useful information for designing environment-based interventions aimed at minimizing the effect of the barriers that limit this participation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eICF: \u0026nbsp; International Classification of Functioning, Disability and Health\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePEM-CY: Participation and Environment Measure for Children and Youth\u003c/p\u003e\n\u003cp\u003eICC: Intraclass correlation coefficient\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eASD: Autism spectrum disorder\u003c/p\u003e\n\u003cp\u003eANOVA:\u0026nbsp;Analysis of variance\u003c/p\u003e\n\u003cp\u003eCAPE: Children\u0026rsquo;s Assessment of Participation and Enjoyment\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul\u003e\n \u003cli style=\"font-weight: bold;\"\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eEthics approval for the study was obtained from the Research Ethics Committee of University of Salamanca (Ref. 0000407).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all participants.\u003c/p\u003e\n\u003cul\u003e\n \u003cli style=\"font-weight: bold;\"\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cul\u003e\n \u003cli style=\"font-weight: bold;\"\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cul\u003e\n \u003cli style=\"font-weight: bold;\"\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cul\u003e\n \u003cli style=\"font-weight: bold;\"\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis study was funded by Ministerio de Ciencia, Innovaci\u0026oacute;n y Universidades of Spain (REF. RTI2018-096539-B-I00).\u003c/p\u003e\n\u003cul\u003e\n \u003cli style=\"font-weight: bold;\"\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eM.G-V. has made substantial contributions to the conception and design of the work, the acquisition, analysis, and interpretation of data, has drafted the work, and substantively revised it.\u003c/p\u003e\n\u003cp\u003eMB.OB. has made substantial contributions to the design of the work, the acquisition, analysis, and interpretation of data, and has substantively revised the work.\u003c/p\u003e\n\u003cp\u003eI.V-M. has made substantial contributions to the acquisition, and interpretation of data, has drafted the work, and substantively revised it.\u003c/p\u003e\n\u003cp\u003eE.GO. has made substantial contributions to the acquisition, and interpretation of data, has drafted the work, and substantively revised it.\u003c/p\u003e\n\u003cp\u003eM.BC. has made substantial contributions to the conception and design of the work, and has substantively revised it.\u003c/p\u003e\n\u003cp\u003eAll authors have approved the submitted version and have agreed both to be personally accountable for their own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which they were not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.\u003c/p\u003e\n\u003cul\u003e\n \u003cli style=\"font-weight: bold;\"\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAuthors thank the schools and families participating in this study. We are also thankful to Rachel Teplicky for her assistance.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. International Classification of functioning, disability, and health. WHO. 2001. [Internet] [cited 2024 Apr 1] Available from: https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health \u003c/li\u003e\n\u003cli\u003eCoster W, Khetani MA. Measuring participation of children with disabilities: issues and challenges. Disabil Rehabil. 2008; 30(8):639\u0026ndash;48. http://dx.doi.org/10.1080/09638280701400375 \u003c/li\u003e\n\u003cli\u003eLaw M. Participation in the occupations of everyday life. Am J Occup Ther. 2002; 56(6):640\u0026ndash;9. http://dx.doi.org/10.5014/ajot.56.6.640 \u003c/li\u003e\n\u003cli\u003eRosenfeld L. Participation of children with disabilities across the life course: using socio-ecological perspectives to guide research and practice. Dev Med Child Neurol. 2020; 62(4):406. http://dx.doi.org/10.1111/dmcn.14442\u003c/li\u003e\n\u003cli\u003e\u003cu\u003e \u003c/u\u003eAnaby D, Avery L, Gorter JW, et al. Improving body functions through participation in community activities among young people with physical disabilities. Dev Med Child Neurol. 2020; 62(5):640-646. http://dx.doi.org/10.1111/dmcn.14382 \u003c/li\u003e\n\u003cli\u003eArakelyan S, Maciver D, Rush R, et al. Family factors associated with participation of children with disabilities: a systematic review. Dev Med Child Neurol. 2019; 61(5):514\u0026ndash;22. http://dx.doi.org/10.1111/dmcn.14133 \u003c/li\u003e\n\u003cli\u003ePalisano RJ, Chiarello LA, King GA, et al. Participation-based therapy for children with physical disabilities. Disabil Rehabil. 2012; 34(12):1041\u0026ndash;52. http://dx.doi.org/10.3109/09638288.2011.628740\u003c/li\u003e\n\u003cli\u003eTomas V, Srinivasan R, Kulkarni V, et al. A guiding process to culturally adapt assessments for participation-focused pediatric practice: the case of the Participation and Environment Measures (PEM). Disabil Rehabil. 2022; 44(21):6497\u0026ndash;509. http://dx.doi.org/10.1080/09638288.2021.1960645\u003c/li\u003e\n\u003cli\u003eAnaby DR, Law MC, Majnemer A, et al. Opening doors to participation of youth with physical disabilities: An intervention study: Favoriser la participation des adolescents ayant des handicaps physiques: \u0026Eacute;tude d\u0026rsquo;intervention. Can J Occup Ther. 2016; 83(2):83\u0026ndash;90. http://dx.doi.org/10.1177/0008417415608653\u003c/li\u003e\n\u003cli\u003eImms C, Mathews S, Richmond KN, et al. Optimising leisure participation: a pilot intervention study for adolescents with physical impairments. Disabil Rehabil. 2016; 38(10):963\u0026ndash;71. http://dx.doi.org/10.3109/09638288.2015.1068876\u003c/li\u003e\n\u003cli\u003e\u003cu\u003e \u003c/u\u003eChien C-W, Li-Tsang CWP, Cheung PPP, et al. Development and psychometric evaluation of the Chinese version of the Participation and Environment Measure for Children and Youth. Disabil Rehabil. 2020; 42(15):2204\u0026ndash;14. http://dx.doi.org/10.1080/09638288.2018.1553210\u003c/li\u003e\n\u003cli\u003eCoster W, Bedell G, Law M, et al. Psychometric evaluation of the participation and environment measure for children and youth: Participation and environment measure. Dev Med Child Neurol. 2011; 53(11):1030\u0026ndash;7. http://dx.doi.org/10.1111/j.1469-8749.2011.04094.x \u003c/li\u003e\n\u003cli\u003eCoster W, Law M, Bedell G, et al. Development of the participation and environment measure for children and youth: conceptual basis. Disabil Rehabil. 2012; 34(3):238\u0026ndash;46. http://dx.doi.org/10.3109/09638288.2011.603017 \u003c/li\u003e\n\u003cli\u003eKhetani M, Marley J, Baker M, et al. Validity of the Participation and Environment Measure for Children and Youth (PEM-CY) for Health Impact Assessment (HIA) in sustainable development projects. Disabil Health J. 2014; 7(2):226\u0026ndash;35. http://dx.doi.org/10.1016/j.dhjo.2013.11.003 \u003c/li\u003e\n\u003cli\u003eKhetani MA, Cliff AB, Schelly C, et al. Decisional support algorithm for collaborative care planning using the participation and environment measure for children and youth (PEM-CY): A mixed methods study. Phys Occup Ther Pediatr. 2015; 35(3):231\u0026ndash;52. http://dx.doi.org/10.3109/01942638.2014.899288 \u003c/li\u003e\n\u003cli\u003eKaya Kara O, Turker D, Kara K, et al. Psychometric properties of the Turkish version of Participation and Environment Measure for Children and Youth. Child Care Health Dev. 2020; 46(6): 711\u0026ndash;22. http://dx.doi.org/10.1111/cch.12801\u003c/li\u003e\n\u003cli\u003eKrieger B, Schulze C, Boyd J, et al. Cross-cultural adaptation of the Participation and Environment Measure for Children and Youth (PEM-CY) into German: a qualitative study in three countries. BMC Pediatr. 2020; 20(1):492. http://dx.doi.org/10.1186/s12887-020-02343-y \u003c/li\u003e\n\u003cli\u003eCanChild. PEM-CY \u0026ndash; Participation and Environment Measure \u0026ndash; Children and Youth. [Internet] [cited 2024 Apr 1]. Available from: https://canchild.ca/en/shop/2-pem-cy-participation-and-environment-measure-children-and-youth \u003c/li\u003e\n\u003cli\u003eUN General Assembly. Convention on the rights of persons with disabilities: resolution/adopted by the General Assembly. 2007 [Internet] [cited 2024 Apr 1]. Available from: http://www.refworld.org/docid/45f973632 \u003c/li\u003e\n\u003cli\u003eReal Decreto Legislativo 1/2013, de 29 de noviembre, por el que se aprueba el Texto Refundido de la Ley General de derechos de las personas con discapacidad y de su inclusi\u0026oacute;n social. (Bolet\u0026iacute;n Oficial del Estado, 289\u003cem\u003e, \u003c/em\u003ede 3 de diciembre de 2013). https://www.boe.es/eli/es/rdlg/2013/11/29/1/con\u003c/li\u003e\n\u003cli\u003eLey Org\u0026aacute;nica 3/2020, de 29 de diciembre, por la que se modifica la Ley Org\u0026aacute;nica 2/2006, de 3 de mayo, de Educaci\u0026oacute;n. (Bolet\u0026iacute;n Oficial del Estado, 340\u003cem\u003e, \u003c/em\u003ede 30 de diciembre de 2020). https://www.boe.es/eli/es/lo/2020/12/29/3\u003c/li\u003e\n\u003cli\u003eSrinivasan R, Kulkarni V, Smriti S, et al. Cross-cultural adaptation and evaluation of the Participation and Environment Measure for Children and Youth to the Indian context-A mixed-methods study. Int J Environ Res Public Health. 2021; 18(4):1514. http://dx.doi.org/10.3390/ijerph18041514 \u003c/li\u003e\n\u003cli\u003eInternational Test Commission. ITC Guidelines for the Large-Scale Assessment of Linguistically and Culturally Diverse Populations [Internet]; 2018 [revised 2019-2020; cited 2024 Apr 1]. Available from: www.InTestCom.org \u003c/li\u003e\n\u003cli\u003eMu\u0026ntilde;iz J, Elosua P, Hambleton RK, et al. Commission Guidelines for test translation and adaptation: second edition. Psicothema. 2013; 25(2):151\u0026ndash;7. http://dx.doi.org/10.7334/psicothema2013.24\u003c/li\u003e\n\u003cli\u003eStevelink SAM, van Brakel WH. The cross-cultural equivalence of participation instruments: a systematic review. Disabil Rehabil. 2013;35(15):1256\u0026ndash;68. http://dx.doi.org/10.3109/09638288.2012.731132\u003c/li\u003e\n\u003cli\u003eTavakol M, Dennick R. Making sense of Cronbach\u0026rsquo;s alpha. Int J Med Educ. 2011; 2:53\u0026ndash;5. http://dx.doi.org/10.5116/ijme.4dfb.8dfd\u003c/li\u003e\n\u003cli\u003eFleiss JL, Levin B, Paik MC. Statistical Methods for Rates and Proportions. 1a ed. New York, Estados Unidos de Am\u0026eacute;rica: Wiley-Interscience; 2003.\u003c/li\u003e\n\u003cli\u003e[28] Jeong Y, Law M, Stratford P, et al. Cross-cultural validation and psychometric evaluation of the Participation and Environment Measure for Children and Youth in Korea. Disabil Rehabil. 2016; 38(22):2217\u0026ndash;28. http://dx.doi.org/10.3109/09638288.2015.1123302\u003c/li\u003e\n\u003cli\u003eMajnemer A, Shikako-Thomas K, Schmitz N, et al. Stability of leisure participation from school-age to adolescence in individuals with cerebral palsy. Res Dev Disabil. 2015; 47:73\u0026ndash;9. http://dx.doi.org/10.1016/j.ridd.2015.08.009 \u003c/li\u003e\n\u003cli\u003eDada S, Andersson AK, May A, et al. Agreement between participation ratings of children with intellectual disabilities and their primary caregiver.Res Dev Disabil. 2020; 103715\u0026ndash;104. https://doi.org/10.1016/j.ridd.2020.103715\u003c/li\u003e\n\u003cli\u003eLongo E, Badia M, Orgaz B, et al. Cross-cultural validation of the Children\u0026rsquo;s Assessment of Participation and Enjoyment (CAPE) in Spain. Child Care Health Dev. 2014; 40(2):231\u0026ndash;41. http://dx.doi.org/10.1111/cch.12012 \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"participation, environment, disability, children, youth, PEM-CY, Spain","lastPublishedDoi":"10.21203/rs.3.rs-5998160/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5998160/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe Participation and Environment Measure for Children and Youth (PEM-CY) captures a child\u0026rsquo;s participation across home, school, and community-based activities as well as environmental factors perceived as supporting/hindering this participation. This tool has been translated into Spanish for use in the United States and Colombia but there are linguistic and sociocultural differences between these countries and Spain. Therefore, it is necessary to develop a country-specific measure to promote environment-based interventions for Spanish children with disabilities. This study aims to adapt the PEM-CY for use with children and youth in Spain, and to investigate its psychometric properties.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e713 parents of children with (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;233) and without (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;480) disabilities, aged 5 to 17, completed the Spanish version of PEM-CY. For the test\u0026ndash;retest reliability study, 30 of these parents completed the instrument twice.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eInternal consistency (0.58\u0026ndash;0.97) and test\u0026ndash;retest reliability (0.31\u0026ndash;0.92) ranged from moderate to very satisfactory, according to Cronbach\u0026rsquo;s alpha and intraclass correlation coefficients. Discriminant validity, assessed through two-way ANOVA, was supported by significant differences between children with and without disabilities on participation and environment scales (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05). Some significant age differences were identified for participation at home and school. Validity was supported by a significant negative Pearson\u0026rsquo;s correlation (-0.32 to -0.41, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05) between desire for change and overall environmental supports.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe Spanish version of the PEM-CY is a valid and reliable tool to determine the participation and associated environmental factors in Spanish children and youth, with and without disabilities. It provides useful information for designing environment-based interventions to promote their participation.\u003c/p\u003e","manuscriptTitle":"Transcultural adaptation and psychometric properties of the Spanish version of Participation and Environment Measurement - Children and Youth (PEM-CY)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-14 10:41:07","doi":"10.21203/rs.3.rs-5998160/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2111b141-8865-44ac-befc-147339d40586","owner":[],"postedDate":"February 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-18T13:09:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-14 10:41:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5998160","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5998160","identity":"rs-5998160","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}