| 1. |
- Gabrielsson, Hanna, 1977-
(författare)
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Adults with Spina bifida : voices from everyday life and exploration of living conditions
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to generate knowledge about living with Spina bifida, by mapping the condition and together with the adults with Spina bifida explore their living conditions and experiences in everyday life. Methods Study I was a quantitative study with a cross-sectional design. In Study II, individual experiences of daily life were explored by deep interviews using a reflective lifeworld approach. Study III had a participatory approach including five members of a photovoice group who met for eight sessions. Photographs taken by the members served as a starting point for the dialogue about what was of interest in their daily life. A narrative analysis was conducted by the researchers, incorporating the analysis the group did together. Study IV focused on alignment with the methodology in which photovoice is grounded. By returning to the ideological cornerstones of photovoice, the empirical experiences from Study III and examples from the literature were elaborated through processes within photovoice. The findings show that those adults with Spina bifida who were >46 years old had less complex medical conditions and better physical and cognitive functions, and had attained a higher level of education. The main theme in Study II was presented as “The contradictory path towards wellbeing in daily life.” In Study III, the members’ experiences in everyday life showed that many solutions offered by society were “An adaptation for us, but it works for no one.” The findings are further presented under three themes: “Accessibility – a never-ending project,” “Tensions of a normative view” and “Power to influence.” By focusing on action and narrative in Study IV, it is shown that dialogue, action, and interaction are important aspects of using photovoice. In conclusion, not all adult persons receive the support they need in everyday life, something future generations of adult persons with Spina bifida may have a higher need for. The stories and experiences of adults with Spina bifida in this thesis paint a history of not being asked, concerning their own situation. This shows that there is insufficient integration of the persons’ experiences in society’s efforts to plan for, and support, these individuals. The photovoice method was feasible for this group, providing opportunity for being part of dialogue, action, and interaction.
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| 2. |
- Hsieh, Yu-Hsin, 1984-
(författare)
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Eye-gaze assistive technology for play, communication and learning : Impacts on children and youths with severe motor and communication difficulties and their partners
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Children and youths with severe motor and communication difficulties experience participation restrictions in varied everyday contexts. Adequate environmental support such as the provision of assistive technology could offer opportunities to enhance their play, learning and interactions with others. Eye-gaze assistive technology (EGAT) provides these children with opportunities to access a computer through control of eye movements, thereby to perform a range of activities for play, communication, and learning. Global research has been called for to provide more evidence on the efficacy of EGAT and to add knowledge of essential factors for implementing EGAT in everyday practices in different cultural contexts. In addition, limited evidence supports the influences of EGAT on communicative interaction between these children and their partners.The overarching aim of this thesis is to investigate the effects and feasibility of EGAT on participation in computer activities for play, communication, and learning for children and youths with severe motor and communication difficulties and their communication partners.Study I is part of an international multi-center EGAT intervention project. This study conducted a systematic video coding analysis to investigate the impacts of applying EGAT compared to the non-EGAT condition on dyadic communicative interaction. A total of 12 film clips from six dyads with children/youths aged 4-19 years were included. Studies II-IV are based on EGAT intervention research in the Taiwanese context. Studies II and III investigate the effects of a six-month intervention on participation in computer activities and technology usability. Study II applied a multiple baseline design across individuals in four young children aged three to six years with low eye-control skills. Study III is a case study for a young adult pupil with visual impairments. The intervention consisted of initial training to stakeholders, collaborative team meetings and individual support to facilitate the use of EGAT at home or in educational settings. Study IV employed mixed methods to examine the feasibility of the EGAT intervention with 16 key stakeholders (parents, teachers, and therapists) who supported the children/youths using EGAT in Studies II and III.The results from Study I demonstrated that the children/youths took more initiative and tended to provide more information when using EGAT to communicate with communication partners. In addition, the partners showed decreased dominance in communication and made fewer requests to direct children’s responding behaviors in the EGAT condition, compared to the non-EGAT condition. Study II showed that four young children increased the diversity of computer activities and the frequency of computer use from baseline to the intervention phase. There was a moderate effect on the increased duration of computer use. Six of eight predefined goals in play, communication and learning were achieved. Their parents’/teachers’ ratings on children’s performance in computer activities supplemented the findings, showing a clinically important change. The case report in Study III showed that the six-month EGAT intervention enhanced the pupil’s participation in leisure, communication, and interactions with peers and led to a positive psychosocial impact. In Study IV, the stakeholders described the EGAT intervention as suitable to increase children’s autonomy and initiations and enhance their understanding of the children’s communication messages, facilitating dyadic interactions. However, they also perceived helping the children to use EGAT as demanding; hence regular team support and ease of adjustment of eye-gaze systems were essential. The needs for more flexible team collaboration, in-service education for professionals, and a loaning program in assistive technology services were identified.Overall, this thesis indicates that using EGAT could enhance participation in play, communication, and learning for children/youths with severe motor and communication difficulties and low eye control skills. Moreover, it adds knowledge about positive impacts on dyadic communicative interactions, which indicate a transactional process in the intervention. In addition, the advantages and challenges of implementing EGAT based on the Taiwanese context are reported, which provides a crucial reference for future research and practice.
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| 3. |
- Lillvist, Anne, 1978-
(författare)
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The applicability of a functional approach to social competence in preschool children in need of special support
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the thesis, with four empirical studies, was to test the applicability of a functional approach in investigating social competence of children in need of special support within the preschool context. The main theoretical framework was systems theory. Study I and II investigated preschool teachers’ definitions of children in need of special support and social competence respectively. Study III was a prevalence study investigating the number of children in need of special support based on traditional disability categories and functional difficulties. In study IV the social competence of children perceived to be in need of special support based on traditional categories and functional difficulties was compared using an observational method. The results in study I showed that teachers adopt either a child perspective or an organizational perspective in defining children in need of special support. The child perspective was related to a greater number of children in need of special support in the preschools, indicating that in preschools with several children in need of special support, teachers are more prone on seeing the needs of individual children, as opposed to the needs of the organisation. Study II found that teachers define social competence in young children in terms of intrapersonal skills, or as interpersonal relations. Study III found that the majority of children in need of special support are undiagnosed children with functional difficulties related to speech- and language and peer interaction. Study IV found similar profiles of social competence between diagnosed children and undiagnosed children perceived to be in need of special support. Overall, the results yielded support for adopting a functional approach in studying the social competence of children in need of special support.
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| 4. |
- Niia, Anna
(författare)
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Participation in school for children in socially challenged areas : Achieving and socializing
- 2023
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Swedish school is not only an institution for learning. It is also the most significant social context for its students. In the Swedish regulatory documents for school the importance of democracy, democratic values and becoming a citizen of a democratic society is emphasized, as is the importance of interaction. When the number of students with foreign background is increasing in Swedish classrooms, there can be cultural and linguistic challenges to this. Getting students, as well as their parents, who might be newly arrived in Sweden or have lesser linguistic skills to participate in the school context demands to overcome language as well as cultural barriers.This research emanates from the notion of positive academic outcomes due to increasing participation in school. The studies focus on the relationships between teachers’ and students’ ratings of availability of school related activities and the frequency of attending them. Students’ and teachers’ ratings are subjected to principal component analysis showing different outcomes where teachers have an academic focus and students have a social focus. Teacher ratings of frequency of attending are related to academic achievement while student ratings are not.Parental involvement in terms of communication with school is also explored showing over all coherence between parents and teachers. Teachers rate the communication and trust between school and home higher regarding students with lower grades.Students with native and non-native mother tongue rate the availability and frequency of attending in school activities differently. Student with a non-native mother tongue rate the availability lower but their frequency of attending higher. Teachers’ ratings do not differ between students with native or non-native mother tongue.This thesis assesses participation in terms of attending but not involvement. A review of studies in the Nordic countries that study participation shows that attendance is often used as a measurement of participation but often rated by an observer. This research shows that the complexity of the concept of participation creates challenges in the pursuit of capturing it in scientific studies.The results show that students experience their school context differently than teachers, there are also differences between students with native and non-native mother tongue. Teachers have an academic focus while students have more of a social focus. This is especially pronounced for students with non-native mother tongue. As the number of students with foreign background is increasing, so is the number of students with non-native mother tongue. In order to promote participation in school for all students and to provide them with the prerequisites to become citizens of a democratic society, school needs to be more receptive to students own perception of the school context.
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| 5. |
- Ritoša, Andrea
(författare)
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Measurement of child engagement in early childhood education and care
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Children's engagement is a widely studied concept in the field of education, early interventions, and disability research. High engagement among children is consistently associated with desired academic, social, and emotional outcomes. However, the engagement of young children in Early Childhood Education and Care (ECEC) settings has received less systematic attention. The aim of this thesis is to investigate the measurement of child engagement in ECEC and related conceptualizations of the construct. The thesis includes two empirical studies and two literature reviews on child engagement in ECEC.The first empirical study validates the Engagement Versus Disaffection with Learning: Teacher Report questionnaire in a Swedish preschool class. The relationship between a questionnaire of school engagement and questionnaire of child engagement was also investigated. Second study is a scoping literature review exploring how child engagement is conceptualized and operationalized in ECEC settings. For the third study, a subset of the identified studies using two or more measures of child engagement was included in an in-depth review exploring how multimethod measurement of child engagement is implemented in ECEC settings and what are the associations between different measures of child engagement. Lastly, a profile analysis of observed momentary engagement and global engagement was performed among a sample of preschool children in Sweden to investigate typical and atypical engagement profiles.Findings show that observations are the dominant method for measuring young children’s engagement in ECEC, while teacher questionnaires are mostly used for assessing academic engagement in kindergarten classes in US. Self-reports where young children can report about their own engagement are extremely rare. Child engagement can be rated as low and high in value, as a category that either is or is not present, or as a variable that can be qualitatively described and coded on mutually exclusive categories, even within a same study.Although we discovered a strong correlation between child engagement and school engagement in the Swedish preschool class, suggesting that these constructs are highly similar, literature review indicates that the conceptualization and measurement of school engagement and engagement of young children in ECEC differ in several aspects. Child engagement is dominantly associated with behaviors and seen as contextual, whereas school engagement includes internal aspects and can be seen as a stable tendency or even a trait of the child. Results from empirical studies and the in-depth literature review show that teacher questionnaires of child engagement, even if they nominally assess different aspects of engagement, tend to correlate higher than questionnaires and observations of child engagement. This indicates that questionnaires and observations of child engagement tap into qualitatively different aspects of what is considered engagement. Low global engagement in children is rare and probably more indicative of problems in functioning than low observed engagement. On the other hand, high observed engagement can indicate child’s potential for high engagement within a certain context, partly independent of child’s global engagement. Observations of child engagement are more sensitive to changes induced by interventions, whereas teacher-rated global engagement serves as a stronger predictor of future outcome.
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| 6. |
- Åström, Frida
(författare)
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Everyday life in preschool – Swedish and international approaches
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The ultimate outcome of inclusive Early Childhood Education and Care (ECEC), with the focus on everyday life in preschool in this dissertation, is child participation, i.e., being there and being engaged while being there. Little is known about the individual variation in child participation in preschool, and few studies have examined how the practices of preschool vary both in an international and national Swedish perspective, and what this variation may mean for child participation.Aim: This dissertation aims to examine variations in preschool practices and environments within an international and national Swedish perspective, and to describe how these variations relate to participation in those environments for children. The findings will be discussed in relation to preschool quality, inclusive education, and the Swedish preschool for all children.Method: Behavior count systematic observations were used to describe between- and within country variations in children’s and preschool teachers’ activities, behaviors, and environments in preschools in Sweden (n = 78 preschool units), Portugal (n = 42 classrooms), and the U.S. (n = 168 classrooms), and to provide comprehensive descriptions of activities in Swedish preschools (n = 78 preschool units). Behavior counts were also used to explore variations in observed participation patterns (based on level of engagement, associative/cooperative interactions, pretend play, and proximity to a small group including a teacher) between children in Swedish preschool free play (n = 453 children).Results: The largest variation across the countries concerned the dominant activity setting. Free play was the main activity setting for Swedish preschools, while teacher-led whole group was dominant in Portugal and the U.S. Swedish preschoolers spent much time outdoors and had a relatively high proportion of associative child-child interactions. Across the countries, children were less engaged in their dominant activity setting. Child engagement was among the highest in teacher-led small-groups, but those occurred infrequently. For several preschool practices, the within-country variance was high in all three countries.Swedish preschoolers focused on various contents, where construction, art, music, and less sophisticated play in small groups of children was most common, followed by pretend play. Teachers in the Swedish preschools displayed a large variety of teacher tasks where managing, i.e., organizing the child group, was most frequent.Two groups of children displayed low-to-very-low observed participation in Swedish preschool free play. Second language learners and children from preschool units including several second language learners tended to reveal lower levels of observed participation, but not children with special education needs. Children with the lowest observed participation levels appeared unseen by preschool teachers.Conclusions: The results reflect that cultural ideas and values are related to preschool practices on several system levels. The practices in Sweden reflect a social pedagogy tradition, whereas practices in Portugal and the U.S. reflect an early education tradition. A culture’s ideas and values also seem to be reflected in instruments measuring preschool practices and quality and demands caution when selecting measures. What children participate in, and their engagement when being there both seem influenced and defined by the activity setting. Changing activity settings more frequently may increase children’s engagement levels. In Swedish preschools, proximal processes for children’s participation may concern child-child interactions, as much as teacher-child interactions. In free play, some children do not get the support they need to participate in activities despite inclusive policies and the Swedish preschool curriculum emphasizing a “preschool for all children”.
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| 7. |
- Antonsson, Helena, 1962-
(författare)
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Interaktion i särskilt boende för personer med utvecklingsstörning och utmanande beteende
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Många personer med utvecklingsstörning har kommunikativa svårigheter och har därför behov av att utveckla olika sätt att kommunicera för att kunna förstå andra och göra sig förstådda. Svårigheter i kommunikationen påverkar interaktionen mellan personer med utvecklingsstörning och deras vårdare. Detta ställer höga krav på vårdare att kunna tolka och förstå den enskilda individens sätt att uttrycka önskningar och behov. På samma sätt riskerar vårdares budskap att missförstås. Om vårdaren misslyckas att förstå den boendes kommunikation och vice versa, kan det leda till situationer med utmanande beteende exempelvis i form av vägran, verbal eller fysisk aggressivitet.Syfte: Det övergripande syftet med avhandlingen är att studera interaktion mellan vuxna personer med utvecklingsstörning och vårdare i gruppbostäder, samt att studera effekter av en utbildningsintervention för vårdare som arbetar i gruppbostäder.Metod: Avhandlingens samtliga delstudier har genomförts i gruppbostäder för personer med utvecklingsstörning bland boende och vårdare i ett län i norra Sverige. I studie I insamlades data kring 556 personer med utvecklingsstörning. I studie II och III deltog 16 vårdare och 11 personer med utvecklingsstörning. I studie IV deltog 7 vårdare. Studie I bygger på personalens skattningar av funktionsnivåer och förekomst av begränsningsåtgärder. I Studie II och III utgörs data av videoobservationer och narrativa intervjuer. I studie IV användes flera datainsamlingsmetoder i en mixed method design med både vårdarnas skattningar, med hjälp av instrument och semi-strukturerade intervjuer. Analys av materialet i studie II, III och IV har gjorts med kvalitativ innehållsanalys och i studie I och IV har data analyserats statistiskt.Resultat: I studie I framkom att av 556 boende hade 99 (18%) varit föremål för fysiska begränsningsåtgärder under den senaste veckan. Av dessa 99 hade nästan alla varit föremål för mer än en typ av begränsningsåtgärd. Den vanligaste begränsningsåtgärden var bälte i stol (74%). Användningen av begränsningsåtgärder var relaterade både till fysiska funktionsnedsättningar och till beteende.I studie II reflekterade vårdare över videoinspelad interaktion där vårdarna medverkat, både framgångsrik och misslyckad interaktion. Exempel på framgångsrik interaktion var att förstå tecken, kunna möta behov och hantera situationer med utmanande beteenden. Vårdarna reflekterade över att framgångsrik interaktion ledde till säkerhet, trygghet och självförtroende hos de boende. Vårdarna reflekterade även över de konsekvenser misslyckad interaktion fick i form av irritation, aggression och våld från de boende.I studie III studerades videoinspelad interaktion mellan 11 personer med utvecklingsstörning och 16 av deras vårdare. Verbal och icke-verbal interaktion identifierades. Fyra inspelade situationer valdes ut för att belysa framgångsrikt samspel. Resultatet visade att framgångsrikt samspel mellan personer med utvecklingsstörning och deras vårdare bland annat bygger på möjligheten att bekräfta varandra, dela vardagshändelser, ge tid och utrymme och på att använda ett kongruent och tydligt språk.I studie IV utvärderades effekterna av en web-baserad utbildningsintervention, vars syfte var att förbättra interaktionen mellan personer med utvecklingsstörning och vårdare samt att därmed reducera förekomsten av situationer med utmanande beteende. Resultatet visade att vårdarna hade förbättrat sin förmåga att hantera situationer med utmanande beteende och att förekomsten av utmanande beteende minskat. Vårdarna beskrev att den web-baserade utbildningen upplevts givande och möjlig att ta del av parallellt med arbetet.Slutsats: Fysiska begränsningsåtgärder förekommer i gruppbostäder för personer med utvecklingsstörning. Användningen av begränsningsåtgärder kan vara relaterade både till fysiska funktionsnedsättningar och till beteenden i samspelet mellan brukare och vårdare. Vårdare upplever användningen av fysiska begränsningsåtgärder svår och tröttande. Brott i kommunikationen mellan personer med utvecklingsstörning och deras vårdare kan leda till försvårad interaktion med risk för situationer med utmanande beteenden. När vårdare är framgångsrika i interaktionen med personer med utvecklingsstörning ger det tillfredsställelse både för de boende och vårdarna. Vårdarna upplever dock ofta hjälplöshet och osäkerhet i relation till hantering av situationer med utmanande beteende och efterfrågar utbildning. Web-baserad utbildning om interaktion med personer med utvecklingsstörning och utmanande beteende har i vår studie visat sig ge lovande effekter och bör vara möjlig att utveckla för både introduktion av nyanställda vårdare och för kompetensutveckling bland mer erfaren personal.
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| 8. |
- Granlund, Anna, 1984-
(författare)
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Facilitating Automation Development in Internal Logistics Systems
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The internal logistics system includes all activities connected with managing the flow of materials within the physical limits of a facility. This system is an important part of operations in need of increased focus and continuous improvements. Automation is one possible tool with a previously confirmed great potential to improve internal logistics. Despite this great potential and a growing trend of using automation in the area, internal logistics activities are still not automated to the same extent as other parts of operations. The overall aim of this research is therefore to develop knowledge that supports the successful use of automation in internal logistics systems.The automation development process has been identified as critical for the success of the use of automation. With the overall aim of the research in mind, the objective of this thesis is to develop a framework facilitating the automation development process in internal logistics systems. To help fulfil the objective, empirical data have been collected through five case studies and a survey study. During the empirical studies, the process of improving the internal logistics system and the automation development process have been analysed and the focus has been on identifying challenges and facilitators for the successful use and development of automation in internal logistics systems.The findings indicate a poor awareness of both current and desired performance of the internal logistics system at the companies studied. In addition, automation development is often conducted in an unstructured and poorly supported manner and there is often insecurity regarding what steps and actions to take. Foremost, the findings indicate a poor base for proper evaluation and decisions during automation development in internal logistics systems. This is analysed and concluded as a cause of unclear goals and requirements and the lack of a strategic view with regard to both internal logistics operations and the use and development of automation.A framework, including proposed guidelines to overcome the observed challenges by including identified factors facilitating successful automation development in internal logistics systems has been developed. The core of the framework is a proposed process model for automation development in an internal logistics context. Due to the identified importance and the lack of a strategy linked to and supporting the automation development process, the framework also includes a proposed model for an internal logistics strategy as well as a proposed model for an automation strategy.
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| 9. |
- Norderyd, Johanna
(författare)
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A biopsychosocial approach to functioning, oral health and specialist dental health care in children with disabilities – Swedish and international perspectives
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Maintaining good oral health may be more important for children with disabilities than others, since problems with oral health may increase the impact of a disability, or the medical condition may increase the risk for poor oral health. In addition, the risk for oral health problems may be influenced by the functioning of the child. Functioning can also affect the child’s ability to cooperate in the dental setting, and how dental treatment is performed. A medical diagnosis alone does not provide enough information about a child’s functioning, nor oral health. Thus, there is a need for a holistic perspective of oral health and dental health care in children with disabilities. The International Classification of Functioning, Disability and Health - Children and Youth (ICF-CY) enables a structured assessment of the biopsychosocial consequences of a health condition.Aim: The overall aim of this thesis was to investigate how biopsychosocial factors relate to oral health and specialist dental health care in children with disabilities in a Swedish, and an international context, with special focus on the experience of dental treatment under general anaesthesia (DGA).Material and methods: The research was conducted using a quantitative, cross-sectional, comparative and descriptive design. An ICF-CY Checklist for Oral Health was completed with data from a structured interview with children 0-16 years old, referred for specialist dental health care, and their parents/carers. Additional information was retrieved from dental and medical records. Three groups were included in data analyses: one large international group of 218 children from Argentina, France, Ireland and Sweden; one large Swedish group with 99 children with complex disabilities; and one international group of children with disabilities and manifest dental caries from Argentina, France and Sweden.Results: The ICF-CY Checklist for Oral Health identified both common and varying functional, social and environmental aspects relevant for oral health and oral health care in children who had been referred to specialist dental clinics in four countries. Swedish children with caries experience had been referred to a paediatric dental specialist clinic at a significantly older age than caries-free children. The medical diagnoses were not significantly related to dental caries or child functioning in the large Swedish group with complex disabilities and low caries prevalence, nor was there a significant relationship between dental caries and child functioning. Collinearity between dental caries and problems in the functioning factor ’Interpersonal interactions andrelationships’ was observed in the international group of children with disabilities and manifest dental caries. DGA sessions with combined medical and dental treatment were common in the large Swedish study group. Children with experience of DGA had more severe problems in intellectual functions than those without experience of DGA. Problems in interpersonal interactions and relationships increased, while problems with mobility decreased, the likelihood for children having had experience of DGA. On international group level, dmft/DMFT was significantly higher in children with the experience of DGA than in those without DGA experience, but looking at Argentina, France and Sweden separately, this was not true for the Swedish children. There were significant, international differences between the prevalence of dmft/DMFT, DGA and environmental barriers.Conclusion: The biopsychosocial perspective, operationalised by the ICF-CY, contributes a holistic view on oral health and specialist dental health care in children with disabilities. In addition to certain differences, children with different health status from different countries share many functional and environmental aspects, important for oral health and dental health care. Early referral to a paediatric specialist dental clinic seemed favourable for oral health. The medical diagnosis was not related to child functioning or dental caries. Child functioning had a significant impact on DGA, and in children with disabilities and manifest dental caries, child functioning also had a correlation with caries. The dental caries burden was a stronger factor than functioning for the experience of DGA, however, dental health organisation and country context seemed to matter the most. Combining dental and medical procedures during the same GA session is good use of resources for both the individual and the society. To ensure children with complex disabilities to have the possibility of achieving equivalent good oral health as other children, DGA is one important factor.
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| 10. |
- Shi, Linjun
(författare)
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Participation in everyday activities among children with intellectual disabilities in mainland China : The development, verification, and application of the Picture My Participation instrument
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Participation in everyday activities is seen as a main outcome of rehabilitation for children. ‘Picture My Participation’ (PMP) is a validated questionnaire for assessing participation in everyday activities by children with disabilities in low- and middle-income countries, but it is not yet available in simplified Chinese.Aims: The overall aims of this thesis were to validate a simplified Chinese version of Picture My Participation as a participation assessment tool, the PMP-C (simplified), and also to describe the attendance and involvement in everyday activities of children with IDs and their TD peers in rural and urban areas of mainland China as well as barriers and facilitators of participation from the perspectives of children and their primary caregivers.Methods: This thesis reports four studies conducted to carry out these aims. Studies I and II used a quantitative method with a cross-sectional instrument validation design to cross-culturally adapt the PMP-C (simplified) and explored its validity and reliability. Based on this, Study III used a cross-sectional design to compare the frequency and involvement of children with IDs and TD in everyday activities in rural and urban areas of mainland China. Meanwhile, Study IV used a descriptive and explorative design with an inductive qualitative content analysis approach to describe primary caregivers’ perceptions of barriers and facilitators related to participation in everyday activities among children with IDs in mainland China.Results: All items in the PMP-C (simplified) had excellent content and face validity. The internal consistency, reliability coefficient, and test-retest reliability of the subscale scores were excellent (Study I). The construct validity of the subscale scores extracted five subcomponents: organised activities, social activities, taking care of others, family life activities, and personal care and development activities (Study II). Children with IDs reported lower participation than children with TD in terms of their total scores for attendance and involvement but reported the same levels of involvement in the subcomponents taking care of others and family life activities as children with TD in urban areas. Concerning differences between urban and rural contexts, both children with TD and IDs in rural areas reported lower total scores for attendance and for all subcomponents except social activities than their urban counterparts. There was no significant difference in the total involvement score between rural and urban contexts for children with IDs; however, children with TD in urban areas reported higher involvement than their rural counterparts (Study III). Four categories of barriers to participation in everyday activities for children with IDs were identified: insufficient knowledge, attitudes, and skills in primary caregivers; ID-related characteristics of children; stigma and Chinese culture; and lack of societal support. Four categories describing facilitators were identified: the optimistic attitude of the primary caregiver, adequate family support; active school and policy environments, and enjoyable characteristics of children with IDs (Study IV).Conclusion: This thesis provides psychometric evidence that the PMP-C (simplified) is a valid and reliable measure of participation in mainland China and enable children with ID to have “a voice” and to report their own perspectives. The findings regarding ID–TD and urban–rural disparities in participation and the barriers and facilitators of participation among children with IDs offer important insights concerning environmental aspects when planning future intervention studies focused on promoting participation in mainland China.
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