title: Is assessing participation in daily activities a suitable approach for measuring the impact of disease on child development in African children?
abstract: BACKGROUND
  The Participation in Activities of Daily Living (PADL) instrument was developed out of a need for a culturally appropriate tool to measure the impact of ill health on children's well-being.
  
  
  OBJECTIVE
  We sought to devise a psychometrically sound instrument to measure well-being through participation in daily activities for rural school-age children in Kenya.
  
  
  METHODS
  The study was carried out at the Kenya Medical Research Institute/Centre for Geographic Medicine Research-Coast, in the Kilifi district of Coast Province. The process that was followed ensured an integration of community reported activity, use of a relevant vocabulary and a careful translation of concepts in the adaptation of an instrument used in other contexts. The reliability, validity and sensitivity of the PADL were evaluated in studies with clinical and community samples.
  
  
  RESULTS
  Factor analysis suggested five potential summary scores measuring levels of participation and attitude to participation (alphas 0.56-0.91). Variability in children's responses on participation was significantly associated with ill health and level of schooling.
  
  
  CONCLUSIONS
  The format and content of the questionnaire items concerning participation in activities of daily living were appropriate for use with rural children. The precise nature of the activities needs to be determined in context, taking into account both the nature of the health experience and the expected structure of a child's day.
authors: a KEMRI/Wellcome Trust Collaborative Research Programme, PO Box 230 , Kilifi , Kenya.
authors: Penny
authors: P
authors: Holding
authors: Patricia
authors: P
authors: Kitsao-Wekulo