The Housing Enabler instrument, designed to measure housing accessibility, has not been used in samples with long-standing spinal cord injury. We aimed to investigate potential threats to the reliability and validity of the instrument when used among older adults with spinal cord injury.
Method
Cross-sectional data from the Swedish Aging with Spinal Cord Injury Study (N = 123, injury levels C1–L5) were utilised. The potential effect on the reliability and content validity of the House Enabler was qualitatively considered and reviewed in an iterative evaluation procedure. To analyse the potential effect on construct validity, simulations adjusting accessibility problem scores for housing adaptations and use of mobility devices were conducted.
Findings
Considerable threats to the reliability and content validity of the Housing Enabler were identified. The simulated analysis of construct validity showed a modest overall effect on the accessibility problem scores, although this was substantial in some individuals.
Conclusion
Data collection and analyses of housing accessibility with the Housing Enabler in samples characterised by high frequencies of housing adaptations and/or use of mobility devices (such as powered wheelchairs) require particular attention. Further studies are needed to propose optimisation of the instrument for use in such contexts, followed by psychometric testing to maintain reliability and validity.
ChibnallC (2011) Are home assessments beneficial in discharge planning following a stroke? A viewpoint. Australian Occupational Therapy Journal58(2): 129–131.
2.
De VetHCWTerweeCBMokkinkLBet al.(2011) Measurement in Medicine: A Practical Guide, Cambridge: Cambridge University Press.
3.
EttemaTDröesR-MDe LangeJet al.(2005) A review of quality of life instruments used in dementia. Quality of Life Research14(3): 675–686.
4.
FängeAIwarssonS (2003) Accessibility and usability in housing: Construct validity and implications for research and practice. Disability and Rehabilitation25(23): 1316–1325.
5.
GitlinLN (2003) Conducting research on home environments: Lessons learned and new directions. The Gerontologist43(5): 628–637.
6.
HelleTBrandtASlaugBet al.(2011) Lack of research-based standards for accessible housing: Problematization and exemplification of consequences. International Journal of Public Health56(6): 635–644.
7.
HelleTIwarssonSBrandtA (2014) Validation of housing standards addressing accessibility: Exploration of an activity-based approach. Journal of Applied Gerontology33(7): 848–869.
8.
HelleTNygrenCSlaugBet al.(2010) The Nordic Housing Enabler: Inter-rater reliability in cross-Nordic occupational therapy practice. Scandinavian Journal of Occupational Therapy17(4): 258–266.
Iwarsson S and Slaug B (2010) Housing Enabler – A Method for rating/screening and analysing accessibility problems in housing. Manual for the complete instrument and screening tool. Lund and Staffanstorp, Sweden, Veten and Skapen HB and Slaug Enabling Development.
11.
IwarssonSStåhlA (2003) Accessibility, usability and universal design – positioning and definition of concepts describing person-environment relationships. Disability and Rehabilitation25(2): 57–66.
12.
IwarssonSHaakMSlaugB (2012) Current developments of the housing enabler methodology. The British Journal of Occupational Therapy75(11): 517–521.
13.
IwarssonSNygrenCSlaugB (2005) Cross-national and multi-professional inter-rater reliability of the Housing Enabler. Scandinavian Journal of Occupational Therapy12(1): 29–39.
14.
IwarssonSWahlHWNygrenCet al.(2007) Importance of the home environment for healthy aging: Conceptual and methodological background of the European ENABLE-AGE Project. The Gerontologist47(1): 78–84.
15.
JörgensenSIwarssonSNorinLet al.(2016) The Swedish Aging with Spinal Cord Injury Study (SASCIS): Methodology and initial results. Physical Medicine and Rehabilitation8(7): 667–677.
16.
KirshblumSCBurnsSPBiering-SorensenFet al.(2011) International standards for neurological classification of spinal cord injury (revised 2011). Journal of Spinal Cord Medicine34(6): 535–546.
17.
KylénMEkströmHHaakMet al.(2014) Home and health in the third age – methodological background and descriptive findings. International Journal of Environmental Research and Public Health11(7): 7060–7080.
18.
LawtonMPNahemowL (1973) Ecology and the ageing process. In: EisdorferCLawtonM (eds) The Psychology of Adult Development and Ageing, Washington DC, USA: American Psychological Association, pp. 619–674.
19.
LienLLSteggellCDSlaugBet al.(2016) Assessment and analysis of housing accessibility: Adapting the environmental component of the Housing Enabler to United States applications. Journal of Housing and the Built Environment31(3): 565–580.
20.
MokkinkLBPrinsenCACBouterLMet al.(2016) The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument. Brazilian Journal of Physical Therapy20(2): 105–113.
21.
MokkinkLBTerweeCBPatrickDLet al.(2010) The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. Journal of Clinical Epidemiology63(7): 737–745.
22.
NorinLSlaugBHaakMet al.(2017) Housing accessibility and its associations with participation among older adults living with long-standing spinal cord injury. The Journal of Spinal Cord Medicine40(2): 230–240.
23.
OswaldFSchillingOWahlH-Wet al.(2006) Homeward bound: Introducing a four domain model of perceived housing in very old age. Journal of Environmental Psychology26(3): 187–201.
24.
OswaldFWahlH-WSchillingOet al.(2007) Relationships between housing and healthy aging in very old age. The Gerontologist47(1): 96–107.
25.
PetterssonCBrandtÅMånsson LexellEet al.(2015) Autonomy and housing accessibility among powered mobility device users. The American Journal of Occupational Therapy69(5): 6905290030p1–6905290030p9.
26.
StreinerDNormanGCairnyJ (2015) Health Measurement Scales, a Practical Guide to their Development and Use, Oxford: Oxford University Press.
27.
SvenssonE (2008) Bygg ikapp för ökad tillgänglighet och användbarhet för personer med funktionsnedsättning, Stockholm: Svensk Byggtjänst and the author.
WeeksALLambBAPickensND (2010) Home modification assessments: Clinical utility and treatment context. Physical and Occupational Therapy in Geriatrics28(4): 396–409.
30.
WellsGARusselASHaraouiBet al.(2011) Validity of quality of life measurement tools – from generic to disease-specific. The Journal of Rheumatology88: 2–6.
31.
WhiteneckGDijkersMP (2009) Difficult to measure constructs: Conceptual and methodological issues concerning participation and environmental factors. Archives of Physical Medicine and Rehabilitation90(11): S22–S35.
