Abstract
The Scale of Parental Playful Attitude (PaPA) assesses parents’ self-perceptions of their playfulness when playing with their child.
Play provides time for parents to fully engage and bond with their children (Shorer et al., 2019). Parental engagement in play unfolds in everyday co-occupational play transactions between parents and children (Morozini, 2015). The benefits of engaging in this co-occupation have been noted to be essential to the parent–child relationship (Román-Oyola et al., 2022; Waldman-Levi & Weintraub, 2015). In fact, the benefits of parent–child play have been highlighted by the United Nations International Children’s Emergency Fund (Dogra, 2023) and the American Academy of Pediatrics (Yogman et al., 2018), which have touted adult playfulness as critical for both child and parent, in particular for developing a deeper connection between them. The quality of caregiver involvement during parent–child interactions is important for a child’s engagement in play activities (Kasari et al., 2010; Medina & Sobel, 2020). Optimal play transactions occur when all players are playing (i.e., acting in a playful way; Skard & Bundy, 2008). This is as true when parents and children play together as when all playmates are children or when all are adults. In the case of parent–child play, parental playfulness is important for supporting both the child’s play and the parent’s own play (Cabrera et al., 2017; Menashe-Grinberg & Atzaba-Poria, 2017).
For children, playfulness is defined as the disposition to play (Barnett, 1991) and the way that the child approaches play (Skard & Bundy, 2008). In adults, Barnett (2007) defined playfulness as the “predisposition to frame (or reframe) a situation in such a way as to provide oneself (and possibly others) with amusement, humor, and/or entertainment” (p. 955). Most available measures of adult playfulness assess it as a personality trait, focusing on areas such as fun, creativity, curiosity, and spontaneity. Examples include the Adult Playfulness Scale (Glynn & Webster, 1992); the Playfulness Scale for Adults (Schaefer & Greenberg, 1997); and the Other-directed, Lighthearted, Intellectual, and Whimsical measure (Proyer, 2017).
Available instruments that focus on adult playfulness in the context of parent–child joint play are scarce. We identified two observation-based tools: the Parental Playfulness System (PPS; Menashe-Grinberg & Atzaba-Poria, 2017) and the (2) Parent/Caregiver’s Support of Children’s Playfulness (PC-SCP; Waldman-Levi & Bundy, 2023). The PPS evaluates parents’ expressions of playful characteristics (e.g., creativity, humor) while playing with their child. The PC-SCP is based on Skard and Bundy’s (2008) Model of Playfulness. It rates the degree to which adults’ behaviors during play depict support for the child’s playfulness; it does not measure adult playfulness. For example, items assess whether the adult actively supports the child’s engagement in free play, decision-making, and interaction with objects.
Despite the relevance of adult playfulness during parent–child play, to our knowledge no tool is currently available to assess adults’ perceived playfulness relative to child playful characteristics. Addressing the importance of all players being playful goes beyond available measures that focus on adult playfulness as a personality trait and beyond observation-based assessments of adults’ support of child playfulness. Recognizing this gap in available tools, we developed the Scale of Parental Playful Attitude (PaPA [Escala AJugar]). The purpose of the PaPA is to assess a parent’s self-perception of playfulness in reference to moments of play with their child. Measuring parents’ perceived playful attitude is different from measuring parents’ actual support of their child’s playfulness, which can be done using observation-based tools (e.g., the PC-SCP). Emphasizing parents’ perception of their own playful attitude provides a potential opportunity for therapists to guide parents in reflections on aspects they might modify to maximize the benefits of play.
The PaPA examines the extent to which parents perceive their playful interactions with their children as reflecting the components of Skard and Bundy’s (2008) Model of Playfulness: intrinsic motivation (IM), internal control, freedom to suspend reality, and framing (see the “Phase 1: Initial Development of the PaPA” section for an explanation of these). Although Skard and Bundy’s model typically has been applied to children’s play, in occupational therapy its components are acknowledged as defining play more broadly (American Occupational Therapy Association, 2020). Moreover, play and playfulness are present across the life course (Barnett, 2014; Brown & Vaughan, 2009; Van Vleet & Feeney, 2015), and members of other disciplines (Rogers et al., 1998; Shen et al., 2014) also recognize the components present in Skard and Bundy’s model as definitional. Given our interest in parents’ abilities to approach play with an attitude as attuned as closely as possible to that of their child, we chose the Model of Playfulness as an adequate foundation for the PaPA.
In this article, we describe the development of the PaPA. Although our procedures aligned with the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) guidelines for content validity (Terwee et al., 2018), we chose the Standards for Educational and Psychological Testing (SEPT; American Educational Research Association [AERA] et al., 2014) as our main guide because of the construct on which we were focusing. The SEPT guidelines define validity as “the degree to which evidence and theory support the interpretations of test scores for proposed uses of tests” (p. 11). According to these guidelines, when developing a tool it is necessary to accumulate different types of evidence for validity, and test developers are responsible for furnishing such evidence. The five sources of validity evidence specified in the SEPT guidelines are based on (1) test content, (2) response process, (3) internal structure, (4) relations to other variables, and (5) consequences of testing. The first two sources, test content and response process, have particular importance during the development phase. Evidence based on test content entails an analysis of the relationship between the content of the tool and the construct it intends to measure. An analysis of the response process provides evidence of the fit between the construct and the nature of the responses provided by those being tested (AERA et al., 2014).
Guided by the SEPT standards, we established study phases aligned with the following study objectives: ▪ Phase 1: Develop items for the PaPA ▪ Phase 2: Evaluate evidence for validity based on test content ▪ Phase 3: Evaluate evidence for validity based on response process
While following a process that supports these sources of validity evidence, we sought to develop a client-centered measure that allows parents to report perceptions of their playfulness in reference to moments of play with their child.
Method
As recommended by Creswell and Plano-Clark (2018), we used a mixed-methods research design to construct the PaPA . We gathered qualitative and quantitative information at different phases of the process, addressing specific decisions at each phase before proceeding with the next. For greater clarity, we present data on the participants, process, and analysis for each phase separately. All procedures were approved by the institutional review board of the University of Puerto Rico, Medical Sciences Campus.
Phase 1: Initial Development of the PaPA
Phase 1 consisted of two steps: (1) review of the literature and (2) collection of qualitative information through focus groups and individual semistructured interviews.
Review of the Literature
Optimal parent–child play requires that both players be playing (i.e., behaving in playful ways). We view parent–child play as a co-occupation in which both actively share the physical and emotional space (Waldman-Levi & Bundy, 2016). This active exchange requires both players to be attuned to each other. Although measures of child playfulness exist, we aimed to develop a measure that focuses on parents’ reflections on their own playfulness as they play with their child. Thus, we chose Skard and Bundy’s (2008) Model of Playfulness to guide the development of the PaPA.
We reviewed the literature related to the Model of Playfulness and met on various occasions to discuss the meaning of the components of playfulness included in the model. We developed items consistent with the four components of the model: ▪ Intrinsic motivation: Reflects the player’s engagement in a play activity simply because they want to do the activity. The doing (process) has greater importance than the outcome (product; Rubin et al., 1983). ▪ Internal control: Establishes that players are responsible for their actions and, at least in part, for the activity’s outcome. Players are active decision makers; they decide who plays, what to play, when and how the play ends (Skard & Bundy, 2008). Rules must be established in a balanced way, so all players play as equals. ▪ Freedom to suspend reality: Implies that the person chooses the degree of proximity to objective reality they will assume during play. To fully engage in play, a player is free to suspend the real context of life. Pretending is acknowledged as the most obvious form of suspension of reality, but it is only one form (Bundy, 2012). ▪ Framing: Serves to demarcate play from real life. Players give cues about how they want to be treated. Reading and responding to cues allow players to sustain play. Play cues are exaggerated and thus easier to read than the subtle cues that are part of everyday life (Skard & Bundy, 2008).
Information related to the constructs of the model, along with the data collected in the next step, enabled development of the sections and items of the first draft of the PaPA.
Collection of Qualitative Information
Through focus groups and individual semistructured interviews, we explored participants’ perceptions of play and playfulness on the basis of their experiences (i.e., parents with their children and children with their parents). We recruited 24 participants through convenience sampling. We conducted three focus groups (two with parents and one with preschoolers) and six individual interviews; details on participants are provided in the sections that follow. We performed individual interviews only when we considered it necessary to enhance information gained from focus groups. In addition, we used data from 4 fathers and 4 mothers of autistic children who had participated in a previous study (Román-Oyola et al., 2018). The number of participants per information collection strategy is specified in Table 1.
Participants Per Information Collection Strategy
Note. A dash indicates not applicable.
Two of the three focus groups (the first and second) were held with parents of typically developing children. Participants in the third focus group were typically developing preschoolers.
Performed only when we considered it necessary to enhance information from focus groups. Participants in individual interviews were parents of typically developing children and typically developing preschoolers.
Participants of the previous study were parents of autistic children.
Focus groups and interviews with parents
All parents met the study inclusion criteria: an adult mother or father and having at least one child between the ages of 2.5 and 6 yr without a major diagnosed condition (e.g., cerebral palsy, autism spectrum disorder). Parents not meeting these criteria were excluded. Age range (2.5–6 yr) was decided on the basis of literature that supports the prominence of reciprocal interactions, including interactions through play between parents and children, during this period (Amodia-Bidakowska et al., 2020; Berk, 2014; Parten, 1933). Interviews from 4 fathers and 4 mothers of autistic children, obtained in a previous study (Román-Oyola et al., 2018) were also used in this study. This gave us the perspectives of parents of typically developing children (9 fathers and 4 mothers) and parents of neurodiverse children (4 fathers and 4 mothers).
Although we originally planned to conduct separate focus groups for mothers and fathers, our school contact invited both fathers and mothers to participate in the first focus group. This group was held early in the morning at the school their children attended and was moderated by Rosa Román-Oyola and two student research assistants (SRAs), who had been trained before the focus group. As part of the training, each SRA practiced the interview protocol once with two volunteer mothers. Only fathers participated in the second focus group, which was coordinated by Román-Oyola and held at the School of Health Professions of the University of Puerto Rico. This group was moderated by two male occupational therapists who had previous experience in qualitative research, to minimize the effect associated with social desirability and interviewers’ sex, which might have biased participant narratives (Broom et al., 2009 ; Pini, 2005). Before this focus group, Román-Oyola met with moderators to orient them to the study and review the interview protocol.
Focus groups and interviews with parents were guided by the same questions. For example, we asked “How do you describe the attitude of a child when playing?” “What do you consider should be the attitude of a parent when playing with his/her child?” and “What characteristics should be present in the environment to facilitate parents playing with their child?”
Focus group and interviews with children
Inclusion criteria for children were preschool age and no major diagnosed conditions (as per parent report). Children were excluded if their age was outside of the preschool range or if they had a major diagnosis (e.g., autism, cerebral palsy, attention deficit hyperactivity disorder). We recruited 11 preschoolers (ages 3–5 yr): Seven participated in a focus group, and 4 were individually interviewed. The same protocol was used for the focus group and the individual interviews. As recommended by Gibson (2012) and Prior (2016), our protocol entailed questions and activities. For example, children were asked about how they and their parents played together, they drew and talked about the most fun thing they had ever played with Mom and/or Dad, and they were shown pictures of a house to choose and talk about the part of the house where they play the most with Mom or Dad.
Analysis
All focus groups and interviews were held in Spanish because it was the participants’ native language. The audio was recorded and transcribed verbatim. An understanding of the four constructs of the Model of Playfulness, acquired from the literature review, and the strategy of template analysis (King, 2004), provided the basis for the analysis. Template analysis allows the researcher to produce a list of codes (template) a priori for the text data while also acknowledging that additional codes might emerge. We used the four constructs of the Model of Playfulness as a priori categories to analyze the interviews.
Data were initially analyzed by Román-Oyola and the SRAs. After reaching agreement about codification of participants’ narratives, Román-Oyola; the SRAs; and Anita Bundy, Shelly J. Lane, and Víctor E. Bonilla-Rodríguez met to review meaning of the components of playfulness (i.e., a priori codes) and consult their application to specific narratives. This analysis led to the development of the PaPA items. All items were developed in English and Spanish. Román-Oyola and Bonilla-Rodríguez are fluent in both languages.
Phase 2: Experts’ Review to Support Validity Based on Content
The aim of obtaining validity evidence is to ensure that the items and the response scale correspond and represent the construct under study (AERA et al., 2014). To gather evidence related to content, experts in pediatric occupational therapy, child psychology, and early education were included because of their knowledge regarding child development, the importance of the family, and the use of play. We also included experts in test development and language because of their expertise regarding the quality and clarity of developed items. Our panel included 10 experts in the areas of occupational therapy (n = 4), psychology (n = 2), test construction (n = 2), early education (n = 3), and language (n = 1). Some had expertise in more than one area. Experts were provided with a structured document to guide and collect their evaluation and recommendations on the first draft of the PaPA. Because the PaPA was developed in English and Spanish, they were asked to focus on the content that was in their primary language and provide feedback regarding (1) clarity of the instructions; (2) appropriateness of the response alternatives; (3) items’ relevance; (4) items’ wording; and (5) for those with expertise in occupational therapy, correspondence with the section in which the item was placed. Their evaluation included both quantitative (i.e., rankings assigned to each aspect evaluated) and qualitative information (i.e., recommendations for improvement).
We met on multiple occasions to review the experts’ feedback and make decisions about modifications to items to include in the PaPA. We used the content validity index (CVI; Polit & Beck, 2017) to analyze the rankings assigned by experts to each of the items. We analyzed and discussed qualitative information to determine any item modifications needed.
Phase 3: Cognitive Interviews to Support Validity Related to the Response Process
In Phase 3, we examined the cognitive process required of a participant to provide responses to the PaPA items (AERA et al., 2014). Inclusion criteria for this phase were the same as for Phase 1; however, parents of a child with a major developmental delay or diagnosed condition were included because the focus of cognitive interviews is participants’ interpretation of the questionnaire content. Four cognitive interview participants indicated that their child did not have any major developmental delays, and one mother had an autistic child. Three mothers and two fathers, recruited through convenience sampling, participated in individual cognitive interviews. This sample size (n = 5) is considered adequate for cognitive interviews, given the time and effort that they require from participants (Fowler, 2013). Cognitive interviews are used to evaluate questionnaires by studying the way in which targeted audiences understand, mentally process, and respond to the content presented. This leads to findings or insights that guide the modification of questionnaires to enhance clarity (Willis, 2015).
Cognitive interviews were performed by two members of the research team (i.e., Román-Oyola and one or two SRAs). SRAs were trained by Román-Oyola and practiced through role play before conducting cognitive interviews. Interviews were not recorded because one interviewer took detailed notes.
Román-Oyola and the SRAs who conducted the cognitive interviews complete the initial analysis of the information collected. We focused on comments in which participants’ understanding of the content of an item seemed to deviate from that item’s intention and on participants’ recommendations to enhance understanding of the items. The main modifications taken into consideration were discussed with Bundy, Lane, and Bonilla-Rodríguez. On the basis of this analysis, we determined pertinent modifications to the PaPA.
Results
We present results according to the phases described in the Method section, which are aligned with the three study objectives.
Phase 1: Initial Development of the PaPA
The first draft of the PaPA was based on literature related to the Model of Playfulness and on information collected during focus groups and individual interviews with parents and children. Data suggested that parents’ motivation to play was primarily driven by extrinsic motivators. Therefore, for the Motivation section of the scale, in addition to IM items, we included items about extrinsic motivation (EM). Examples of items developed for the first draft of the Motivation section were “I enjoy playing with my child” (IM) and “I like to play with my child because it helps him/her develop new skills” (e.g., academic skills, coordination; EM).
We used a similar process to develop initial items for other sections of the scale: Control While Playing, Suspension of Reality, and Cues During Play (Table 2). Control excerpts were identified by looking for expressions about the degree to which parents demonstrated their willingness to negotiate aspects of the play dynamics and give control to their children. Comments indicating imaginary experiences or situations that suggested some distance from reality served to inform development of items for the Suspension of Reality section. Finally, excerpts in which participants shared strategies that they used to cue their children, either to invite or prompt them during play, served to inform development of items for the Cues During Play section (which correspond to the construct of framing in the Model of Playfulness). A 5-point Likert scale reflecting levels of agreement (range = strongly agree to strongly disagree) formed the response measure.
Examples of Participants’ Excerpts And Initial Items Developed for the PaPA
Note. PaPA = Scale of Parental Playful Attitude.
Analyses also led to the identification of barriers and limitations to playing as noted by parents (e.g., tiredness and lack of time, physical agility, or imagination). Thus, an additional section, titled Barriers to play, was included with a final question about the factors that limit parents’ play with their children. We used a rank order format to score this question (i.e., “Use numbers 1 through 7 to indicate how much each of the following factors limits your play with your child.”). After multiple sessions of analysis and discussion among us, the first draft of the PaPA was completed; it included 25 Motivation items, 12 Control While Playing items, 11 Suspension of Reality items, and 11 Cues During Play items.
Phase 2: Experts Review to Support Validity Based on Content
We analyzed agreement among experts on item relevance by calculating each item’s CVI. CVI values ranged from .78 to 1.00, meaning that there was at least 78% agreement among experts on items’ relevance (for CVI per item, see Table A.1 in the Supplemental Material, available online with this article at https://research.aota.org/ajot). Changes based on expert review consisted of deleting redundant items and modifications in writing to enhance clarity or avoid negative statements, aligning with recommendations regarding language use in item development, and reducing item complexity (Abedi, 2016; DeVellis & Thorpe, 2022). The following are two examples of the changes made to the items: ▪ “Playing with my child ▪ “It is
We also added a question about the type of play parents do most with their children. This allowed previous sections to address more general experiences, without referring to a particular type of play when other items are being answered. Another modification was made to the format of the question in the final section. To minimize respondents’ mental effort, the original rank order format of the question about the factors that limit parents’ play with their children was changed to request that parents mark the three factors that they considered most relevant.
Phase 3: Cognitive Interviews to Support Validity Related to the Response Process
Various modifications were made in this phase. For example, when describing her understanding of an item of the Motivation section (“I play with my child, even though I do not have his/her same ability”), a mother of an autistic child explained that there were instances when she had greater ability than her child. This was contrary to the way that we had thought about the item because the intention was to explore whether the adult played despite having less ability (e.g., physical, imaginary) than the child. This made us aware of the potential bias associated with this item. Thus, the item was eliminated.
During cognitive interviews, participants also provided feedback about the response scale. Two suggested that the Motivation section would be clearer if the response scale referred specifically to how motivated they felt to play with their children by each of the aspects mentioned in the items. After reflection, we decided to keep the scale of level of agreement for all the sections because (1) our main intention was not to know how much motivation parents felt but to know whether the reasons mentioned in the items, in fact, led them to enjoy play, and (2) the use of a different response scale for a single section would have required a separate analysis for that section, which could limit the scope of potential future psychometric analyses.
Discussion
The purpose of this study was to describe the initial stages of development of the PaPA. Version 1 of the PaPA emerged out of Phase 1 Steps 1 and 2, which were based on the Model of Playfulness and analysis of data gathered in focus groups and individual interviews with parents and children. Phase 2 comprised experts’ revision and contributed to enhanced representation of adults’ perception of their playfulness in PaPA items. Finally, Phase 3 yielded evidence of validity derived from the response process. The use of the Model of Playfulness to guide the development of the PaPA, combined with interview data that reflected the construct of playfulness and its main elements, as well as experts’ revision, provided initial evidence of content validity.
On the basis of information collected in Phase 1, we added EM items as part of the PaPA. Although EM is not part of the components of the Model of Playfulness, its importance was strongly supported by participant narratives. In addition, findings from previous studies suggest that parents’ motivations to play tend to be outcome oriented (Román-Oyola et al., 2018). Indeed, parents tended to be so aware of how play maximizes development that they seemed to forget that the enjoyment of play is itself an important benefit to them and their children (Ginsburg, 2007; Yogman, 2018).
Inclusion of questions about barriers to play also resulted from Phase 1. During the interviews, parents spontaneously identified barriers to play, such as limited time because of multiple responsibilities. Although some researchers have advised against overloading routines at the expense of time for play and strengthening bonds between parents and children (Ginsburg, 2007; Yogman, 2018), the parents in this study identified the availability of time to play as a barrier. Similar to EM, barriers to play are not a component of the Model of Playfulness. However, we considered that inclusion of both EM and barriers to play were necessary to fully capture parents’ subjective experiences of playful interactions with their child.
We were able to establish evidence of validity based on test content and on response process for data collected with the PaPA. Content validity was supported by external experts’ review (AERA et al., 2014), validating and enhancing representation of the construct of playfulness in PaPA items. Evidence of validity derived from the response process came from parent insights regarding item comprehension; their responses resulted in important modifications to, and reflections on, PaPA content. Indeed, reflection was embedded throughout Phases 1, 2 and 3, exemplifying the iterative nature of test development characterized by repeated revisions to produce a tool that defines the intended construct (AERA et al., 2014; Egholm, 2020).
Limitations and Future Research
In accordance with the SEPT guidelines, the initial stages of PaPA development supported the validity of its intended interpretations. Although the PaPA was developed in English and Spanish, we must note that the information from the interviews and focus groups represents the experiences of the participants and should not be generalized to other contexts. This is an important limitation of this study.
Additional iterations are necessary to evaluate other sources of validity evidence. The next steps in PaPA development will focus on analysis of its internal structure to assess the degree to which relationships among test items align with the intended construct (e.g., construct validity). In addition, studies to assess evidence of validity based on relation to other variables (e.g., criterion concurrent validity) and the validity of the PaPA’s results in other countries are necessary.
Implications for Occupational Therapy Practice
The procedures and results of the initial phases of development of the PaPA have the following clinical implications for occupational therapy practice: ▪ The PaPA, which was developed in English and Spanish, provides a means to assess a parent’s self-perception of playfulness in reference to the moments of play with their child. Its grounding in the Model of Playfulness allows it to focus on parents’ ability to approach play with an attitude that is as attuned as possible to what characterizes a child’s playful attitude. ▪ Continuing collection of validity evidence will support the use of the PaPA as a helpful tool for occupational therapists and other professionals who use play when working with children and families. ▪ The PaPA provides a means for therapists to guide parents in reflection about aspects of their attitude that they might modify to maximize the benefits of play to their children and to themselves. It can become a complement to available observation-based tools (e.g., the PC-SCP) that focus on play as a co-occupation. Moreover, it can provide information about barriers to play parents face, which can be helpful in identifying alternatives to deal with those barriers (e.g., modification of routines).
Conclusion
We completed the initial development of the PaPA, a self-report questionnaire to assess parents’ self- perceptions of playfulness in reference to the moments of play with their children. The PaPA was developed in English and Spanish. The procedures and results provide evidence of validity based on test content and on the response process. Listening to the parents’ and children’s voices as part of the questionnaire development offered the client-centered emphasis we sought to portray. Additional studies are needed to assess other sources of validity.
Supplemental Material
Supplementary material for Development of the Scale of Parental Playful Attitude During the Co-Occupation of Play
Supplementary material, sj-pdf-1-aot-10.5014_ajot.2024.050569.pdf for Development of the Scale of Parental Playful Attitude During the Co-Occupation of Play by Rosa Román-Oyola, Anita Bundy, Shelly J. Lane and Víctor E. Bonilla-Rodríguez in The American Journal of Occupational Therapy
Footnotes
Acknowledgments
Special thanks to Graciela Díaz, Chastiti Vázquez, Itzamar Dasta, Coralys Yambó, and Glorian Collazo, who were master’s students at the time of the study and collaborated throughout data collection, analysis, and revisions of the initial versions of the PaPA. We also thank Jorge L. Torres and Luis D. Torres for their collaboration in moderating part of the focus groups. This project was partially supported by the Hispanic Clinical and Translational Research Education and Career Development program (R25MD007607). If interested in accessing the most current version of the PaPA, please contact Rosa Román-Oyola.
References
Supplementary Material
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