The Effects of a Nurse-led Community-based Sailing Programme on Resilience of School-aged Children With Autism: An RCT

Resilience will be measured using the 14-item Resilience Scale (RS-14), which assesses personal competence, self-acceptance, and life acceptance. Each item is rated on a 7-point Likert scale (1 = "strongly disagree" to 7 = "strongly agree"), with total scores ranging from 14 to 98. Higher scores indicate greater resilience. The validated Chinese version of the RS-14, with a Cronbach's alpha of 0.86, has demonstrated good internal consistency for assessing resilience in young adolescents in Hong Kong.

Depressive symptoms will be assessed using the Chinese version of the Center for Epidemiologic Studies Depression Scale for Children (CES-DC). The scale includes 20 items across emotional, cognitive, and behavioral domains of depression. Participants rate the frequency of symptoms over the past week on a 4-point Likert scale (0 = not at all, 1 = a little, 2 = some, 3 = a lot). Total scores range from 0 to 60, with higher scores indicating more severe depressive symptoms. A score of 16 or higher suggests the presence of depressive symptoms. The Chinese version of the CES-DC, validated for use in children in Hong Kong, demonstrates strong internal consistency (Cronbach's alpha > 0.8).

Self-esteem will be measured using Rosenberg's Self-Esteem Scale (RSES), a validated tool for assessing global self-worth. The scale comprises 10 items, rated on a 4-point Likert scale (1 = strongly disagree to 4 = strongly agree). Total scores range from 10 to 40, with higher scores reflecting higher levels of self-esteem. The Chinese version of the RSES has been validated in Hong Kong, showing good internal consistency (Cronbach's alpha = 0.78).

QoL will be assessed using the Pediatric Quality-of-Life Inventory 4.0 Generic Core Scale (PedsQL™). This 23-item questionnaire evaluates physical functioning (8 items), emotional functioning (5 items), social functioning (5 items), and school functioning (5 items). Participants rate the extent of problems experienced in the past month on a 5-point Likert scale (0 = never to 4 = almost always). Scores are reverse-coded and linearly transformed to a 0-100 scale, with higher scores indicating better QoL. The Chinese version of the PedsQL™, validated in Hong Kong, demonstrates excellent internal consistency (Cronbach's alpha = 0.90).

Social functioning will be evaluated using the 2nd edition of the Social Responsiveness Scale (SRS-2), a 65-item questionnaire assessing ASD-related symptoms. Participants' parents rate each item on a 4-point Likert scale (0 = never true to 3 = almost always true). The SRS-2 includes five subscales: social awareness, social cognition, social communication, social motivation, and autistic mannerisms, as well as a total score. Higher scores indicate greater impairment in social functioning. The Chinese version of the SRS-2 has been validated in China, showing strong internal consistency (Cronbach's alpha = 0.90).