| Summary: | 碩士 === 國立臺灣大學 === 職能治療研究所 === 96 === Background
Increasing numbers of people around the world are developing mental illness. Of the people comprising this large group, approximately half are adults, who should be producers or workers in their current life stages. A major consequence of psychiatric symptoms and functional degeneration in clients with psychiatric disorders is unemployment.
A multidimensional assessment could be used to evaluate the holistic work participation of clients with psychiatric disorders and then to help determine their work potential and limitations. In this study, we chose the MOHOST as the assessment tool. We translated it into Chinese and then examined if the MOHOST-Chinese version (MOHOST-C) was an appropriate tool for evaluating the work participation of clients with psychiatric disorders in work or task-oriented situations. In addition, we examined the psychometric properties of the MOHOST-C.
Methods
The MOHOST-C was developed through translation of the MOHOST. It was back-translated twice and checked by a committee of experts to ensure that the meaning of the original was maintained. The translated version was applied to 101 clients with psychiatric disorders aged between 18 to 65 years old. Clients were from 4 different groups: 28 from task-oriented occupational therapy groups, 41 from vocational training programs, 20 from sheltered employment, and 12 from supported employment. Researcher used the MMSE to screen the primary cognitive abilities of clients, and those with MMSE scores above 24 were included. Four occupational therapists were involved in this study. The forty clients included were rated by at least two raters simultaneously.
Clients were observed for 20-30 minutes when participating in work or a task-oriented group and interviewed according to the MOHOST-C interview guidelines. In addition to the interview, the clients were administered related questionnaires, including the National Taiwan University Hospital Symptom Checklist (NTUHSC) and the Chinese version of the Occupational Self Assessment (OSA-C). The researcher combined the results of observations and filled out the MOHOST-C, the Chinese version of the Volitional Questionnaire (VQ-C), and the Chinese version of the Assessment of Communication and Interaction (ACIS-C).
Data analysis
We used the SPSS (version 11.5) and Facets (version 3.62.0) to do data analysis.
Scores on the MOHOST-C were transformed to interval data by Rasch measurement model. Item separation reliability was used to examine internal consistency; Rasch analysis was used to examine inter-rater reliability, construct validity and differential item function (DIF) on gender. Additionally, Pearson’s correlation coefficient was used to examine the concurrent validity between the VQ-C, ACIS-C, OSA-C, and the MOHOST-C. Spearman’s correlation coefficient was used to examine the concurrent validity between the NTUHSC and the MOHOST-C. In addition, one-way ANOVA was used to examine the score differences for the four work types.
Results
The MOHOST-C was found to have excellent internal consistency. The items on the MOHOST-C could be separated into the Self aspect and the Environment aspect, and both aspects represented unidimensionality. The MOHOST-C and the VQ-C showed positive correlation (r=0.568, p<0.000), as well as the ACIS-C (r=0.767, p<0.000). However, the correlations of the MOHOST-C with the OSA-C (r=0.169, p=0.091 in self aspect; r=0.116, p=0.249 in environment aspect) and the NTUHSC (r=0.010, p=0.922) were not significant. Most raters fit the Rasch measurement model, and the results indicated that raters could learn the MOHOST-C by simply reading the manual. Two items (posture & mobility; strength & effort) belonging to the motor skills aspect in the MOHOST-C were detected with DIF in the Rasch measurement model. These items were easier for the males than for females. Furthermore, there were significant differences of the MOHOST-C scores between different types of work.
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