Using the BRFSS to validate a new measure of participation

Participation is a key concept in the International Classification of Function, Disability, and Health, but existing participation measures have been criticized for undesirable psychometric properties and/or failing to consider individual preferences in the areas of participation people consider important. To address these limitations, the Community Participation Index (CPI) began with 18 focus groups including 218 disability stakeholders representing people with disability, their family and caregivers, rehabilitation professionals, insurers, and policy makers who discussed their perspectives on the meaning and importance of participation and what factors support or impede full participation. The identified participation themes emerging from the qualitative analysis of focus group transcripts were used to develop value items seeking subjective responses in the CPI. More traditional approaches appearing in the literature on participation measurement were used to develop objective items assessing performance in the CPI. The pool of objective and subjective participation items was administered as a call-back survey following the Colorado 2006 BRFSS. The standard BRFSS disability questions were used to identify a target of 500 people with disabilities and 500 people without disabilities in the random-digit-dialed, general population BRFSS sample. Empirical evidence from both factor analysis and rating scale analysis supported the presence of two distinct factors (object performance items and subjective value items) and there was evidence of greater differences between people with and without disability in the performance items than the value items. The two CPI subscales validated in this BRFSS study may provide better measurement of the complex concept of participation.