Development and Psychometric Evaluation of the Computer-Aided Measure of Chinese Handwriting Legibility (CAM-CHL) for School-Age Children

Wen-Feng Huang; Tien-Ni Wang; Po-Ya Chuang; Hao-Ling Chen

doi:10.5014/ajot.2023.050075

Development and Psychometric Evaluation of the Computer-Aided Measure of Chinese Handwriting Legibility (CAM-CHL) for School-Age Children

Am J Occup Ther. 2023 Jan 1;77(1):7701205170. doi: 10.5014/ajot.2023.050075.

Authors

Wen-Feng Huang¹, Tien-Ni Wang², Po-Ya Chuang³, Hao-Ling Chen⁴

Affiliations

¹ Wen-Feng Huang, BS, is PhD Candidate, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
² Tien-Ni Wang, PhD, is Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, and Senior Occupational Therapist, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
³ Po-Ya Chuang, MS, is Occupational Therapist, Tainan City Government Bureau of Education, Tainan, Taiwan.
⁴ Hao-Ling Chen, PhD, is Associate Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, and Senior Occupational Therapist, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; hlchen@ntu.edu.tw.

PMID: 36730106
DOI: 10.5014/ajot.2023.050075

Abstract

Importance: Handwriting legibility is the main criterion for determining whether a child has handwriting difficulties. A comprehensive assessment of handwriting legibility with sound psychometrics is essential to timely identification of handwriting difficulties and outcome measurement after handwriting interventions.

Objective: To evaluate the psychometrics of the Computer-Aided Measure of Chinese Handwriting Legibility (CAM-CHL) and to investigate Chinese handwriting legibility in school-age children using the CAM-CHL.

Design: Cross-sectional, repeated observation, test-retest.

Setting: Elementary schools in Taiwan.

Participants: We recruited 25 lower-grade children for the examination of test-retest reliability, 75 children from all grade levels, and 10 senior schoolteachers for the examination of the CAM-CHL's convergent validity and the investigation of handwriting legibility.

Outcomes and measures: Children were asked to copy a set of Chinese characters as legibly as possible. We used the CAM-CHL to assess handwriting legibility in four domains: Size, Orientation, Position, and Deformation. The schoolteachers were asked to subjectively assess the handwriting legibility using a 3-point Likert-type scale.

Results: The CAM-CHL demonstrated good to excellent test-retest reliability and acceptable random measurement error in all legibility domains. The CAM-CHL had fair to moderate convergent validity with schoolteachers' perceptions. Additionally, upper-grade children had better handwriting legibility in the Size and Position domains than lower-grade children.

Conclusions and relevance: The CAM-CHL, a comprehensive and objective method of assessing Chinese handwriting legibility, has sound reliability and acceptable validity, suggesting its potential as an outcome measure for school-age children. What This Article Adds: The CAM-CHL can be used in comprehensive evaluations of Chinese handwriting legibility in school-age children. The CAM-CHL has acceptable psychometrics for use as an outcome measure.

MeSH terms

Child
Computers*
Cross-Sectional Studies
Handwriting*
Humans
Psychometrics
Reproducibility of Results