The Usefulness and Psychometric Study of the Kinetic-House-Tree-Person Computerized Scoring System for Persons with Mental Illness in Taiwan
Date Issued
2008
Date
2008
Author(s)
Chih-Ying Li
Abstract
Background: ccupational therapists have used creative art activities as a treatment medium in the mental health domain for a long time. According to a national survey conducted in 2000, the Kinetic-House-Tree-Person Drawing Test (KHTP) was one of the most frequently used evaluative tools in mental health occupational therapy in Taiwan. Drawing not only could help the person with mental illness to integrate the inner self, but express emotion under a safe and supportive environment. Therefore, the KHTP was especially useful for the persons with mental illness with limit of verbal expression. lthough KHTP is commonly used (77.8%), there were few studies to support the validity, reliability and usefulness of the KHTP. Therefore, the purpose of this study is to develop a KHTP Chinese computerized scoring system (KHTP-CC) and to examine its psychometric properties.ethods:Sixty-six persons with mental illness and 50 college students were recruited. Each one completed the KHTP, and the persons with mental illness also completed the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI-II), the Beck Hopelessness Scale (BHS), the Occupational Self Assessment (OSA), the mastery scale, the Inventory of Socially Supportive Behaviors (PSI) and the World Health Organization Quality of Life (WHOQOL-BREF). The Volitional Questionnaire (VQ) was assessed by the researchers. A qualitative interview was also conducted. hirty-three persons with mental illness completed the KHTP again within 2 weeks. Two raters independently scored the drawings. The KHTP-CC contains 54 items including 35 items of anxiety/depression characteristics and 28 items of psychotic characteristics (9 of them are in both subscales). These items were programmed into the computer using Visual Basic software to let the raters score with the computer.ata Analysis:PSS (11.5 version) and Winsteps (3.56 version) were used. The ICC value was used to examine the inter-rater reliability. The Kappa value was used to examine the test-retest reliability. Each drawing score was transformed into Rasch measure for subsequent analysis. The unidimensionality and item difficulty was examined by using Rasch analysis. The Spearman correlation coefficient was used to examine the concurrent validity. The t test and chi-square was used to examine if there was statistical differences of the KHTP-CC scores between the group of persons with mental illness and college studnets. Finally, the results of the qualitative interviews were analyzed. esults:he KHTP-CC showed good inter-rater reliability and acceptable test-retest reliability. It was proved to encompass unidimensional construct. The concurrent validity was poor. This could be due to different content pertaining to each measure. Persons with mental illness seldom had drawing experiences compared with the college students. People who liked to draw usually demonstrated richer contents than those who don’t. It also showed that the experiences of drawing did not relate to the KHTP-CC score.here was statistically significant difference in the KHTP-CC Rasch transformed score, age, educational level, likeness of drawing, interest about drawing, learning experience of drawing, perceived functions of drawing and time consumption between the group of persons with mental illness and college studnets. The KHTP drawn by persons with mental illness was monotonic, lack of interactions or story telling, unhappy atomosphere, poor facial expression, and the lack of connectedness of the road to the person. he KHTP could be a useful tool to accelerate self-expression and communication between the persons with mental illness and the therapists. There might be cultural differences in symbolic meanings of house between western countries and Taiwan. It was important to notice the context of the persons with mental illness when interpret their drawings. Finally, it took about 15 minutes for the persons with mental illness to complete the KHTP and for the therapist to score. Therefore, the KHTP-CC was easy to use in the clinical practice.
Subjects
occupational therapy
Kinetic House-Tree-Person Drawing Test (KHTP)
computerized scoring system
Rasch measurement
reliability
validity
SDGs
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