Brown, PhD, Mount Sinai School of Medicine at
Citation Brown, M. (2006). Participation
Objective, Participation Subjective. The Center for Outcome
Measurement in Brain Injury. http://www.tbims.org/
combi/pops ( accessed
OF THE POPS
The Participation Objective, Participation Subjective (POPS) is
a 26-item instrument, with two scoring systems, reflecting different
perspectives – one the disability insider’s perspective
of his/her participation in home and community activities, and the
second reflecting societal/normative (“outsider”) valuations.
The POPS emerged from a multi-focus research instrument, Living
Life After Traumatic Brain Injury (or LLATBI; Gordon, Brown,
et al, 1998). The LLATBI was developed in 1998, with most items
drawn from existing instruments (see below). It was used in several
studies implemented by the Research and Training Center on Community
Integration of Individuals with TBI at Mount Sinai School of Medicine.
In these studies, LLATBI data were gathered on 454 individuals with
TBI living in the community and on 121 individuals with no disability.
The participation items from the LLATBI were pared down to 26 to
develop a more focused instrument: the POPS. These items then were
analyzed in terms of differences between TBI subgroups, as well
as in terms of reliability and validity (Brown, Dijkers, et al,
POPS measure differs from typical community integration (CI) instruments
in several ways: (1) It focuses solely on activities, not on non-activity
indicators related to community functioning, e.g., income. (2) It
generates two measures: the PO, comprising an objective measure
of participation, and the PS, a subjective measure. (3) The PO gauges
performance in terms of level of engagement, i.e., frequency or
duration of engagement in activity in real life environments. This
differs from some CI measures in that the focus is not placed on
degree of impaired functioning. (4) Subjective assessment
(the PS measure) incorporates the preferences of the interviewee
by gauging the individual’s satisfaction with his/her level
of engagement in each activity, weighted by his/her rating of the
is true of other CI measures, the POPS can be characterized as adopting
societal assumptions with respect to the activities that are included.
That is, each of its 26 items is an activity that is part of expected
social role functioning for large segments of adults. In this respect,
the POPS honors both societal expectations, in including activities
valued by society in the PO component, as well as individual preferences,
in its incorporation of individualized weighting of activities in
the PS measure.
the POPS, participation is defined as engagement in activities that
are intrinsically social, or that are part of household
or other occupational role functioning or that are recreational
activities occurring in community settings. Each of the 26
activities listed in the POPS meets at least one of these criteria.
Thus, for example, we excluded the potential activity “engages
in exercise” because it is neither part of role functioning,
nor is it necessarily a social or an out-of-home activity. The items
in the POPS are not inclusive of all activities and roles that are
indicators of participation in life activities, but instead represent
significant and/or commonly occurring activities, organized in five
subscales: Domestic Life (e.g., cleaning the house); Major Life
Areas (e.g., working for pay); Transportation (e.g., driving or
riding in a car); Interpersonal Interactions and Relationships (e.g.,
speaking with neighbors); and Community, Recreational and Civic
Life (e.g., going to the movies). Creation of subscales was based
on conceptual considerations and conformity with the International
Classification of Functioning, Disability and Health3 (ICF) categorization
of activities/participation, rather than statistical analyses of
patterns in the data. Most of the content of the POPS was drawn
from existing questionnaires, namely, the CHART (Whiteneck, Charlifue,
et al, 1992), the CIQ (Willer, Rosenthal, et al, 1993), the Bigelow
Quality of Life Questionnaire (Bigelow, McFarland & Olson, 1991;
Bigelow, Gareau & Young, 1990), and the Community Re-entry Questionnaire
(Whiteneck, Johnston, et al, 1992) (an unpublished measure of community
involvement). Other items were developed specifically for the LLATBI/POPS,
e.g., the transportation items.
the POPS, each of the 26 activity items is addressed with two sets
of questions. (Specific wording is noted in Appendix I.) Thus, in
the Participation Objective (PO) aspect of the POPS, a stem question
is asked, which varies somewhat with the category of activity. For
the Domestic Life sub-scale activities, the stem question is couched
in terms of the proportion of the activity for which the interviewee
is responsible in a typical week. For Major Life Areas and Transportation,
the stem question is couched in terms of the number of hours in
a typical day or week the person engages in the activity. For the
two remaining sub-scales, the stem question inquires about frequency
of occurrence of the activity in a typical week or month. The interviewer,
thus, suggests a time frame (e.g., a typical week) for the person
to use in reviewing his/her activities (the appropriate time frame
is coded behind the item; D, W or M). However, if it is easier for
the person to report on “a typical day” or “a
typical month”, instead of using the suggested time frame,
he/she may do so. Frequency/duration data are recorded by the interviewer
with a clear indication of the period used (e.g., 8 hours and per
day are both recored), and are “translated” into a standard
time period later in processing the PO data.
POPS was developed using “typical week/month”
as the frame within which the interviewee is asked to respond. For
Sub-scales 2-5 (see Appendix I) the “past week/month”
may be alternatively be adopted. Problems exist with each approach.
The “typical day/week/month” framework, which
we adopted, has the advantage of asking the interviewee to “even
out” the “blips” in life activities that we all
experience and (instead) report on what is “normal”,
not on an atypical pattern that may have occurred in the past day/week/month.
In other words, the researcher relies on the interviewee to reduce
error variance relying on the insider’s knowledge of his/her
life. The disadvantage is that, for some activities, “typical”
may not occur or may be hard to define. Alternatively, using “
yesterday, or the past week/month” as the framework has the
benefit of relying upon recentness of activity to optimize the reliability
of the interviewee’s activity report. However, the past
day/week/month may have been very atypical, so that the resulting
data may “reliably” depict an aberrant activity pattern.
Our preference is the “typical” approach.
Participation Subjective (PS) portion of the POPS consists of a
second set of questions asked with respect to each activity. Simplified,
the questions are: What is the importance of this activity to your
life satisfaction? And, Would you like to change your current level
of engagement? This approach to subjective measurement was adapted
from the work of Flanagan (Flanagan, 1978; Flanagan, 1982), who
applied similar subjective stem questions in what later became the
Quality of Life Scale (attributed to him by Burckhardt and colleagues;
Burkhardt, Woods, et al, 1989).
PO AND PS SCORES
In scoring the PO, first, all hour and frequency items are converted
to a single base, which, depending on the item, is frequency or
duration per day, week or month. Standardized (“z”)
scores are then calculated by subtracting from each person’s
raw score for each activity item the mean score for the item for
the combined TBI and ND standardization samples (see Brown et al.,
2004, for a description of these samples) and dividing by the standard
deviation for the combined group. To control for outliers (due to
errors in reporting participation or errors in data entry), the
minimum and maximum z-scores are set at –3 and +3. (The percent
of scores converted to +3 or -3 was under 4%, for all items for
the standardization samples (Brown et al, 2004).) The z-score is
then weighted by a factor that is the average of the mean importance
rating of all persons in the TBI sample and the mean importance
rating of ND individuals in the standardization sample for each
item in question. This weighting ensures that all activities are
not equated in scoring. For example, the score for working “should”
be weighted more heavily than the score for going to the movies,
to the extent that the people in the standardization samples on
average view work as more important to their well-being than is
movie going. The individual’s total PO score is calculated
as the average of the weighted z-scores for the 26 individual items.
Similarly, subtotal scores are calculated as the average weighted
z-score for the items included in each subscale. (The POPS scoring
algorithm, including group means and group importance scores for
the standardization samples, is included as Appendix II.)
POPS allows individuals to select the answer “Not Applicable”
(NA) for certain items, e.g., care of children and yard work. Although
it might be argued that by not doing these activities a person is
less participatory in his/her community, and therefore a value of
zero should be recorded, we have opted to consider NA a legitimate
response. Along with “unknown” responses (participant
doesn’t know, question was not asked, etc.), NA responses
are considered missing values in the statistical analysis. All subscale
scores and the total score, on PO and PS, can be calculated when
information on a (small) number of items is missing.
of the PS is done by multiplying the individual’s importance
score by his/her satisfaction score, where a person’s wanting
less or more is scored as –1, and their being satisfied with
current level (“same”) is scored as +1 (these values
result from recoding the values recorded during the POPS interview:
see Appendix I). Thus, for each item the person’s subjective
score can range from +4, indicating a “most important”
area of life that the person is engaging in at a satisfactory level,
to –4, indicating an equally important area of life that the
person wants to do either less of or more. The individual’s
PS total score is simply a mean across the 26 activities.
work was supported in part by a grant from the National Institute
on Disability and Rehabilitation Research (NIDRR), Office of Special
Education Services, U.S. Department of Education to Mount Sinai
School of Medicine (H133B980013).
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