The main aim of the study was to verify the conceptual equivalence and validity of the Spanish version of the HPSQ in order to provide Spanish teachers and occupational therapists
with an easy, fast and reliable instrument to evaluate handwriting difficulties in primary school children. The cross-cultural adaptation was carried out following the recommendations of Beaton [12
No major discrepancy arose during the adaptation process. Some minor language discrepancies occurred during the forward and backward translations; they were discussed and easily resolved by the expert committee. No inconsistencies were found between both forward and back translations and the original items, indicating that the translated version conveys the same item content as the original version. In fact, the back translation from the English native back translator was almost perfectly equivalent to the original, suggesting that items did not require cross-cultural adaptation. Only in item 10 two participants referred an appreciation in the pilot study because they perceive this item to be difficult to quantify. Teachers referred that, in some cases, children could be satisfied with their own writing and that does not mean they have a suitable phonographic knowledge
. It is possible that children’s psychological characteristics, like self-esteem, may modulate responses to this question, and although this should be considered in a new version of the questionnaire, we decided not to modify this item to respect to the original questionnaire. Anyhow, either our work or Rosemblum´s [6
] presented no major problems about this item.
Teachers’ evaluation of the items questionnaire indicated good content validity, with values ranging from 0.7 to 1. Items’ objective congruence (IOC) values were higher than 0.5, (range 0.7-1). The highest IOC (1) was observed in 8 out of 10 items. The Spanish version of the HPSQ presented also a good internal consistency (Cronbach’s alpha= 0.78) for the 10 items, although lower than the one shown by the original version (Cronbach’s alpha= 0.9). Anyway, this indicates a high consistency between the questionnaire items. Principal-component analysis identified two factors that explained 50% of the variance. Importantly, the factorial structure of the Spanish version paralleled that of the original version identifying one factor associated to performance and well-being and another to legibility. All in all, the psychometric properties of the Spanish version of the HPSQ made it a valid tool for assessing handwriting skills. It should be commented that both the internal consistency and the proportion of the variance explained by the factorial analysis are lower than in the original questionnaire. A reason for this could rely on two factors: i) the different number of participants (165 in our study versus 230 in Rosenblum’s) and ii) in the different characteristics of the samples, whereas the age of our participants ranged between 6 and 9, it ranged between 7 and 14 in Rosenblum’s study, this makes room for more variability in their study and hence the chance to get more precise estimates.
In future, it could be useful for occupational therapy intervention to look for correlation between poor handwriting and manual dexterity in primary school children. Previous studies find a correlation between legibility and hand-writing disorders in children with different pathologies [15
]. But deep and more specific studies should be done in order to determinate this correlation in healthy primary school children.
Some limitations have been found in this study. Certain authors, as Rosales et al. [9
] and Alonso et al. [17
], recommended quantifying the conceptual equivalence and the difficulty of the translation process. The lack of inter-rater agreement in the reliability analysis can also be considered a limitation that should be taken into consideration in future investigations. In the present study other forms of validity as convergent validity have not been contemplated because of the absence of tests in Spanish to assess the quality of handwriting. In any case, due to the large parallelism between both versions, it seems reasonable to consider that the validity of the Spanish version and the original one are not very different. Finally, an avenue for future research is the exploring of the discriminant validity of the Spanish version of the questionnaire.
For occupational therapists, it is necessary to have reliable instruments to evaluate handwriting capacities as a means to determinate the severity of the handwriting problems, the goals of interventions and the progression of therapies. In spite of the fact that different evaluation scales have been developed in the last years in order to standardized handwriting quality evaluations, handwriting evaluation in occupational therapy environment are scarce. The area demands a clear evaluation instrument, concise and reliable in all languages, in order to compare studies and therapies in different countries and cultures.
This paper provides an easy and quick screening tool for handwriting proficiency that can be used for Spanish language children. HPSQ Spanish version can assist teachers, occupational therapists, doctors, physiotherapists and other professionals in identifying handwriting problems in primary school children. It also provides the preliminary basis for further studies that can be conducted in other Spanish-speaking children populations and in future studies aimed to analyse the relationships between manual dexterity, hand skills developing and writing.
Additionally, it should be considered the relevance of developing versions of the questionnaire for different school (age) levels to provide teachers an easy and fast questionnaire to quantify the quality of handwriting in children at different ages and hence, to increase our capability of detecting handwriting pathologies and their evolution with more confidence.