Background: This thesis is was designed to evaluate aspects of reliability and validity of the School Version of the Assessment of Motor and Process Skills (School AMPS) (Fisher, Bryze, Hume, & Griswold, 2007), an observation-based evaluation of quality of occupational performance when children perform schoolwork tasks in school settings. The long term goal was to contribute to knowledge about children at risk or with mild disabilities who experience difficulties with occupational performance in school settings, and describe how the School AMPS can be used when a true top−down process of planning and implementing school-based occupational therapy services is implemented in a Swedish context. Methods: In Study I, two different split-half methods and were used to estimate reliability of the School AMPS measures. These were cross-validated using Rasch equivalent of Cronbach’s alpha. The standard error of measurement (m) was also calculated. In Studies II and III, many-facet Rasch analyses and/or relevant inferential statistics (e.g., ANOVA, tests) were used to examine for evidence of validity based on (1) internal structure related to differential item functioning (DIF), (2) relations to other variables (sensitivity) in terms of comparing groups (typically-developing children vs. children with mild disabilities), and (3) consequences of testing (benefits of testing) in terms of test fairness. In Study IV, ANOVA and tests were used to examine relations to other variables in terms of sensitivity of the School AMPS measures for detecting change based on repeated School AMPS evaluations pre- and post-interventions. Results: The three methods for estimating reliability of the School AMPS measures yielded high reliability coefficient estimates (≥0.73) and low ms. Minimal DIF was identified, and despite minimal DIF, the School AMPS measures were found to be free of differential test functioning. The School AMPS measures were sensitive enough to detect differences between groups as well as changes following consultative occupational therapy services provided in natural school settings. Conclusions: The results support the reliability and validity of the School AMPS scales and measures when used to evaluate quality of occupational performance in school settings. The results are also of clinical importance as they provide evidence that occupational therapists can have confidence in the School AMPS measures when they are used in the process of making decisions about individual students, planning interventions, and later perform follow-up evaluations to measure the outcomes. We also have objective evidence that children with mild disabilities demonstrate diminished quality of "doing" when performing schoolwork tasks. The potential long term benefits of such evidence may be to support or justify the need for children with mild disabilities to receive occupational therapy services within school settings in Sweden; and through collaboration with teachers, plan and implement better targeted and more effective interventions.

Objective The aim of this study firstly, was to translate and test the validity and reliability of two diabetes-specific self-efficacy instruments (the Diabetes Management Self-Efficacy Scale; DMSES and the Perceived Therapeutic Efficacy Scale; PTES) in a Taiwanese population. The main aim of this study was then to develop an intervention based on self-efficacy theory that was appropriate for the Taiwanese population and to examine the effects of a self-efficacy enhancing intervention program (SEEIP). Background In Taiwan, the prevalence, mortality rate and healthcare cost of diabetes has dramatically increased. People with diabetes have low participation rates in performing self-care activities, with some two-thirds of diabetic patients not controlling their disease appropriately. Moreover, few studies in Taiwan have conducted randomised controlled trials or had improvement in patient self-care or self-management as their primary goal and no instruments that measure self-efficacy related to the management of diabetes (especially for outcome expectations) have yet been found and appropriately used to measure the effectiveness of self-management. Therefore, there is a particular need for research on self-efficacy enhancing intervention programs for people with type 2 diabetes. Design A convenience sample survey (n=230) was used in order to test the validity and reliability of C-DMSES and C-PTES in a Taiwanese population. Moreover, a randomised controlled trial (RCT) (n=145; the intervention group (72); the control group (73)) design was conducted in the main study with pre (baseline) and post-testing (undertaken at 3 months and 6 months following baseline collection). Intervention Both the control group and intervention group received the standard diabetic educational program in the outpatient clinic. The intervention group participants received the standard diabetic educational program and the following additional interventions: (1) viewed a 10-minute DVD (2) received a &quotDiabetes Self-Care" booklet (3) participated in four efficacy- enhancing counselling intervention sessions, and (4) participated in telephone follow-up. The self-efficacy model was adapted from Shortridge-Baggett & van der Bijl (1996). Diabetes self-management principles were used in program development and evaluation. Main outcome measures Instruments used in data collection included 1) Self-efficacy towards management of type 2 diabetes (as measured by the Chinese version of the Diabetes Management Self-Efficacy Scale; C-DMSES and the Chinese version of the Perceived Therapeutic Efficacy Scale; C-PTES); 2) self management behavior (as measured by the Summary of Diabetes Self-Care Activities; SDSCA); 3) health-related quality of life for diabetes (as measured by the Short Form-12; SF-12); 4) psychosocial well-being (as measured by the Medical Outcomes Study (MOS), Social Support Survey (SSS) tool and the Center for Epidemiology Studies Short Depression Scale; CES-D) and 5) health care utilisation (as measured by health care utilisation self report instrument). Data analysis Data were double-entered for verification using SPSS® statistical software. Study I: Descriptive statistics, regression analysis, Pearson's correlation, Cronbach's alpha-coefficients, factor analysis and Bland-Altman plots with 95% limits of agreement (LOA) were performed to evaluate validity and reliability of C-DMSES and C-PTES. Study II: Descriptive analysis was used to examine demographic variables and outcome variables. T-tests were used to analyse differences on continuous data between mean scores for the intervention and control groups. Categorical data were analysed using Chi-square statistics to test the significance of different proportions. To assess the group differences of dependent variable changes, repeated measures ANOVA/ ANCOVA were used. Results Study I: Convergent validity showed that C-DMSES correlated well with the validated measure of the General Self-Efficacy Scale (GSE) in measuring self-efficacy. Criterion-related validity showed that the C-DMSES was a significant predictor of the Summary of Diabetes Self-Care Activities (SDSCA) scores. Factor analysis supported the C-DMSES being composed of four subscales with good internal consistency (Cronbach's alpha=.77 to .93) and stability (ICC=.82). Similarly, significant criterion-related validity was demonstrated between the C-PTES and SDSCA scores. Convergent validity was confirmed as the C-PTES converged well with the GSE Scale in measuring self-efficacy. Construct validity of the C-PTES was confirmed through factor analysis and a single subscale formed. Internal consistency with a Cronbach's alpha was .95 and the test-retest reliability (ICC) was .77 and a Bland-Altman plot showed 97% of the subjects were within 2 standard deviations of the mean. Study II: The 3- and 6-month benefits of the intervention over usual care were increases in self-efficacy, outcome expectation, self-care activities, and social support. However, the results of the health-related quality of life and depression scores indicated that the change over time was not different in the two groups. A smaller proportion of the participants significantly in the intervention group, had been hospitalised and visited the emergency room than participants who were in the control group at the 6-month period. However, health-related quality of life and depression were not significantly increased in the intervention group at the 3- and 6-month compared to the control group. Conclusion Results of Study I support the psychometric properties of C-DMSES and C-PTES in providing a measure for self-efficacy specific to persons with type 2 diabetes in Taiwan. The main study revealed that the SEEIP for type 2 diabetes based on self-efficacy theory was culturally acceptable to Taiwanese people with diabetes and that the SEEIP was effective in the self-management of people with type 2 diabetes.