Date Presented 4/19/2018
The study results did not support the measurement equivalence of the Chinese Flow State Scale–2 between schizophrenia and general populations. Developing a measure of flow state during activity for the schizophrenia population should be considered.
Primary Author and Speaker: Lin-Jye Huang
Additional Authors and Speakers: Fu-Chang Hu, Chinyu Wu, Yi-Hong Yang, Shu-Chun Lee, Hsu-Chang Huang, Chun-Yi Yu
PURPOSE: The aim of this study was to test the measurement equivalence of the Chinese Flow State Scale–2 (FSS–2) between schizophrenia and general populations, exploring the major characteristics of people with schizophrenia that facilitate flow experience through activity participation.
BACKGROUND: In occupational therapy practice, the just-right challenge has been encouraged to help people experience flow. According to flow theory, flow is an optimal psychological state that occurs when people perform and are involved entirely in an activity. Within the flow state, concentrating attention on participating in the activity itself becomes an intrinsic reward for doing the task, with a sense of control and the merging of action and awareness. The FSS–2 was developed to evaluate an individual’s flow state while participating in activities and contains 36 items, including four items for each of the nine dimensions of flow.
Given that the FSS–2 was developed with the general population, little is known about differences in results obtained by the schizophrenia population, who may have attention deficits and motivation problems when participating in activities. Testing measurement equivalence helps determine whether an instrument is equivalent across two independent groups, focusing on the unchanged operation of the factor loadings. In testing for the equivalence of factor loadings, the parameters for the first group are freely estimated, and then the factor loadings for the other group are constrained equal to those of the first group.
METHOD: In this cross-sectional design study, we enrolled 204 adult participants in two groups. The schizophrenia group included 100 adults diagnosed with schizophrenia or schizoaffective disorder from psychiatric outpatient clinics, day hospitals, and vocational rehabilitation programs in Taipei, Taiwan; the control group included 104 participants without severe mental illness from the same settings (e.g., staff, volunteers, interns, community residents). Participants were encouraged by the instructor with autonomy support to determine the speed of and play with an interactive ping pong ball launcher for 50 balls (right and left sides alternately with 3-s intervals). They then completed the Chinese Flow State Scale–2 and Leisure Satisfaction Scale, and participants in the schizophrenia group completed the Positive and Negative Symptom Scale.
Lisrel 9.2 (Scientific Software International, Skokie, IL) was used to analyze data. We first conducted exploratory factor analysis and confirmatory factor analysis (CFA) for each group. Then we conducted multigroup CFA with the CFA model for the control group as a standard, including factor loadings, factor correlation, and error variances invariant, and then held parameters of the schizophrenia group equal to the control group with Wald’s t test to drop an insignificant structural parameter and modification index to add an additional meaningful structural parameter. Root mean square (RMR), standardized RMR (SRMR), and goodness of fit index (GFI) were administered to assess the adequacy of fit. Then we alternatively applied the schizophrenia group as the standard to do multigroup CFA on the same procedures and criteria.
RESULTS: With the control group as the standard, the results of multigroup CFA indicated that the cross-group equivalence was poor (RMR =.234, SRMR = .224, GFI = .427); seven items for the schizophrenia group were added on this constrained model. Moreover, with the schizophrenia group as the standard, the results of multigroup CFA showed that the cross-group equivalence was better (RMR = .190, SRMR = .186, GFI = .922); 30 items for the control group were added on this constrained model.
CONCLUSION: We found that the items related to executive functions, concentration, sense of control, self-awareness, time perception, and motivation may have caused major differences between the schizophrenia and control groups in obtaining flow experience through activity participation.
IMPACT STATEMENT: This study suggests that occupational therapy practitioners should address the problems of cognitive impairments and motivational deficiencies in people with schizophrenia when encouraging them to experience flow in daily activities. The results of this study may serve as part of the evidence to establish a foundation for further inquiry regarding occupational therapy intervention outcomes and cross-cultural differences.
References
Byrne, B. M. (2008). Testing for multigroup equivalence of a measuring instrument: A walk through the process. Psicothema, 20, 872–882.
Jackson, S. A., Eklund, R. C., & Martin, A. J. (2010). The flow manual. Menlo Park, CA: Mind Garden.
Kline, R. B. (2015). Principles and practice of structural equation modeling (4th ed.). New York: Guilford Press.
Schaefer, J., Giangrande, E., Weinberger, D. R., & Dickinson, D. (2013). The global cognitive impairment in schizophrenia: Consistent over decades and around the world. Schizophrenia Research, 150, 42–50. https://doi.org/10.1016/j.schres.2013.07.009
