Developing an English-language ADOC-S for collaborative goal setting in schools: a Delphi study of cultural reconstruction and content validation

Purpose The purpose of this study is to verify the content validity of ADOC-S for English-speaking contexts through expert consensus, aiming to establish a foundational English-language version for collaborative goal-setting in school-based occupational therapy. Design/methodology/approach A modified two-round Web-based Delphi survey was conducted with an international panel of 14 occupational therapy experts from five countries. Participants evaluated 68 activity items and their illustrations for cultural relevance and comprehensibility. Consensus was defined as an 85% agreement rate. Qualitative feedback was systematically analysed through collaborative team review to guide iterative modifications of items and visual aids. Findings A final set of 53 items was established after two rounds. Substantial revisions included re-contextualizing culturally specific activities − such as adapting “Eating lunch” from a Japanese school lunch to a cafeteria setting − and enhancing inclusivity by adding wheelchair representations to “Moving around”. The results demonstrated that literal translation is insufficient for visually mediated tools; visual cues must be contextually authentic to minimise literal misinterpretation by children. Originality/value This study is original in its focus on “cultural reconstruction” rather than simple linguistic translation of a visually mediated goal-setting tool. It establishes the essential content validity required for the future digital implementation of the English ADOC-S. By aligning visual aids with English-speaking educational norms, this research provides a critical framework for facilitating authentic shared decision-making across diverse cultural and school-based occupational therapy contexts.