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Abstract

Assessing living-environment accessibility is relevant for older adults and others with disabilities because they influence participation in daily activities and quality of life (QoL). The objective of this study is to test the reliability and validity of the Perceived Accessibility of Living Environment and Services questionnaire (PALES). Feedback from experts on older adults and accessibility and a sample of 495 older adults (≥60 years) with/without disabilities was used to assess validity/reliability measures. Construct validity was tested via between-group (with/without disabilities) differences and correlations between PALES responses and World Health Organization’s QoL domains, criterion validity via correlations between participant and researcher responses, and test–retest reliability. Results showed content validity, test–retest reliability (r = 0.892, p < .001), criterion validity (r = .826, p < .001), between-group differences t(493) = −6.591, p < .001, convergent validity (r = 0.41–0.31, p < .001), and discriminant validity (r = 0.16–0.14, p < .001). The PALES is suitable for assessing immediate neighborhood environment accessibility for older adults.

Plain Language Summary

Examining the Validity and Reliability of the Perceived Accessibility of Living Environment and Services Questionnaire (PALES)

Occupational therapy providers must evaluate the accessibility of buildings and services in their clients’ surroundings (i.e., living environment), particularly for older adults and people with disabilities. This is crucial because the environment affects the ability to participate in daily activities. This study tested the reliability and validity of the Perceived Accessibility of Living Environment and Services questionnaire (PALES) in conducting such evaluations. Content validity describes how well a test covers relevant parts of the topic it measures. The researcher used feedback from an expert panel to assess, adjust, and reassess the PALES’s content validity. The researcher also tested whether the PALES would return the same results each time (reliability) and other construct validity measures by using data from 495 older adults and examining its correlations with a validated instrument created by the World Health Organization, the WHOQOL-BREF. To test how accurately the PALES measures the outcomes it was designed to measure (called construct validity), the researcher examined differences between a group of older adults with disabilities and a group without disabilities. The researcher compared their answers with results from other examiners for criterion validity. Finally, the PALES’s test–retest reliability was assessed by giving the same test twice to the same 30 people and comparing their answers over time. The study’s results show that the PALES has high validity and reliability for assessing the accessibility of immediate outdoor and neighborhood environments. This short, easy-to-answer tool can pinpoint specific barriers in a person’s surroundings and could improve policy decisions. However, more studies are needed to represent a broader population and refine the test. The PALES can increase awareness of what works and what does not and help policymakers plan more inclusive neighborhoods and target adjustments and repairs to enhance accessibility.

Keywords

occupational therapy evaluation accessibility environment

Introduction

The environment can be viewed by its space and extent, classified as individual, household, neighborhood, community, or country (Law, 1991). The living environment or neighborhood environment refers mainly to the built environment outside private homes—structures such as buildings, houses, schools, playgrounds, streets, and sidewalks people design and construct (Law, 1991). The neighborhood or living environment is important to allow people to be active, contact nature, and meet friends and neighbors (Sugiyama & Thompson, 2006). This is especially true for older adults with limited capabilities, such as a sense of fatigue after walking short distances, and others with disabilities remain independent in their homes and communities (Yen & Anderson, 2012). For this study, older adults are considered 60 years of age and older.

The neighborhood provides a wide range of daily activities, from essential (e.g., residing, working, or attending school) to ordinary (e.g., grocery shopping) or discretionary (e.g., recreation; Jackson, 2018). However, it also presents barriers that could prevent older adults and people with disabilities from leaving their homes (Sugiyama & Thompson, 2006). For example, people who have difficulty seeing obstacles on unlit streets and feel unsafe may not leave their homes after dark. Another example is mobility disability, which results from interactions between individual limitations and environmental factors (Jackson, 2018), such as the combination of severe frailty and environmental barriers (Shumway-Cook et al., 2003).

The implication of the inability to navigate when the paths are not continuously accessible, such as deficient pedestrian (e.g., ramps) or public transport (e.g., accessible buses) infrastructure, can stymie social inclusion (Jackson, 2018). People who experience mobility disability report avoiding various terrain elements (e.g., stairs, stepping onto or off a curb, and uneven surfaces), heavy manual doors, crowded venues, noisy and busy places, or unfamiliar places that require attentional resources for their safety (Giroux et al., 2023). Hence, accessible environments and services can help older adults with impaired capabilities (motor, cognitive, vision) and people with functional disabilities to leave their homes and prevent further participation restrictions (World Health Organization [WHO], 2007).

The Equal Rights for Persons with Disabilities Law in Israel (Israel Ministry of Justice, 1998) seeks to promote equality for people with disabilities and refers to accessibility standards for public buildings and public services. This legislation requires reasonable accessibility to information and infrastructure, such as sidewalks and public transportation. These must be designed, built, and modified to ensure adequate accessibility, allowing people with disabilities to navigate public spaces, such as street intersections and buildings, with greater ease and independence.

Still, reasonable accessibility does not provide real access for each person’s disability (Israel Ministry of Justice, 1998). An environment’s accessibility can be shown as analogous to the zone of proximal development concept in educational psychology. This term refers to the difference between what a learner can accomplish without help and what they can achieve with the help and support of a skilled partner (Vygotsky, 1978). Similarly, accessibility is the support that helps improve community participation in daily life activities for people with various disabilities. Accordingly, a new term, the zone of proximal development of accessibility, can reflect the difference between what a person with functional difficulties can accomplish without an accessible environment and what they can achieve with such accessibility.

The ecology of the human performance framework offers a perspective within the occupational therapy profession on how environmental factors affect human functioning: “A person does not exist in a vacuum; the physical environment as well as social, cultural, and temporal factors all influence behavior” (Dunn et al., 1994, p. 595). Based on this framework, the environment (i.e., context) plays a crucial role in human performance (Dunn et al., 1994). Therefore, assessing the accessibility of the living environment should be integral to occupational therapists’ evaluations of older adults and others with functional disabilities, such as mobility disabilities.

Environmental factors are broadly defined. They include the natural environment and human-made changes, products, technology, support, relationships, attitudes, services, systems, and policies (American Occupational Therapy Association [AOTA], 2020, p. 10; WHO, 2001, p. 178). An accessible home environment crucially enables people with limited capabilities or disabilities to maintain autonomy and independence and age in place (Szanton et al., 2016). However, the living environment is the first public space they enter after exiting their private homes. Being active outside the private house is crucial to older adults and people with disabilities. It enables community participation and integration and contributes to their quality of life (QoL) and well-being (Cerin et al., 2013; Nagel et al., 2008; Rantakokko et al., 2010; Segev-Jacubovski & Shapiro, 2022). In short, an accessible built environment is key to achieving social equality because it gives citizens autonomy and means to build active social and economic lives (Kerbler, 2012).

Environmental assessments can use objective measures or self-reported, subjective measures. An example of an objective measure is the Systematic Pedestrian and Cycling Environmental Scan (SPACES) instrument, which collects road data. The SPACES measures physical environments that could influence walking and cycling in local neighborhoods (Pikora et al., 2002). Another objective method is analyzing data from the Regional Land Information System, which calculates automobile traffic on local streets, sidewalk coverage, intersection frequency, and public transportation access around residential addresses (Nagel et al., 2008). Nevertheless, objective measures have a disadvantage: They ignore the input from residents available through self-reports and subjective instruments.

Few self-reported questionnaires of living environments exist in academic literature. Notably, however, a few self-report scales on neighborhood domains, such as aesthetics, walking/exercise environment, safety from crime and violence, access to healthy foods, and social cohesion, have been found to be reliable (Echeverria et al., 2004). Examples include the self-reported Neighborhood Environment Walkability Scale for Chinese Seniors (Cerin et al., 2010), which is comprehensive but excessively long (76 items). Rantakokko et al. (2010) developed three self-report questions about the lack of resting places or long distances (distance), noisy traffic or dangerous crossroads (traffic), and hilly terrain or poor street conditions (terrain) to examine outdoor environmental barriers. Another published self-report questionnaire is the 18-item Perceptual Evaluation of Neighborhood Environment Support, which focuses on natural or green environments. This scale relates to outdoor spaces around a residence, local open spaces like parks, routes to reach such spaces, and the larger neighborhood area (Sugiyama & Thompson, 2006). The Environmental Factors Item Bank was created to assess how environmental factors influence participation. Experts and individuals with neurological injuries provided input for developing this instrument. Ultimately, 274 items were recommended. The items were categorized into six domains: access to information and technology, assistive technology, built and natural environment, systems services and policies, social environment, and economic QoL (Heinemann et al., 2015).

In addition, five-factor structures were revealed from the AARP Age-Friendly Community Survey’s 62 indicators: outdoor spaces, transportation, housing, social participation, and community and health services. People in more age-friendly communities reported better self-rated health (Kim et al., 2022). Taking a wide perspective, the recently published Age-Friendly Environment Assessment Tool examines individuals’ perspectives of their homes, local communities, and the environment’s resources and suitability to meet their daily needs (Garner & Holland, 2020).

An analysis of available living-environment measures revealed a lack of a short and comprehensive questionnaire for evaluating the physical environment from outside the private home to the neighborhood environment. Assessing the individual’s capabilities and disabilities relative to the physical environment is also missing. Thus, this study aimed to establish the reliability and validity of a new screening tool for living-environment accessibility, the Perceived Accessibility of Living Environment and Services questionnaire (PALES). The specific objectives were to examine the PALES’s (a) test–retest reliability and (b) content, construct, and criterion validity using older adult participants with and without functional disability.

Method

Perceived Accessibility of Living Environment and Services Questionnaire

Perceived accessibility in this study refers to one’s subjective perception of accessibility, which can be influenced by the objectively measurable accessibility of paths, services, and individuals’ capabilities and disabilities (Segev-Jacubovski & Shapiro, 2022). The PALES relates to the environment nearest the respondent’s home, meaning the public space between where the respondent leaves their private residence and where they arrive at a public service. It includes nine items about elevators or stairs in the private residence, driveways to the residence, sidewalks near the residence, terrain that inclines or descends, lighting, signage, service diversity, and the number of services within walking distance or a short drive. Each item is rated 0 or 1, except for the number of services within walking distance (rated 0–2). Total scores range from 0 to 10; higher scores indicate higher perceived accessibility and, therefore, higher (better) person-environment fit levels (Segev-Jacubovski & Shapiro, 2022). The PALES is detailed in the Supplemental Appendix.

Procedure

The PALES’s content validity was tested in the first step of this research. In the second step, test–retest reliability, construct validity, and criterion validity were assessed, and data were collected via an anonymous online survey. The participants completed The PALES and WHOQOL-BREF after giving informed consent. The survey was distributed during COVID-19 pandemic measures (February–May 2021) through an online survey link distributed on social media platforms, such as WhatsApp and Facebook groups, and telephone and face-to-face interviews in public places. The researcher assured data privacy by, for instance, storing it in a locked cabinet accessible only to the researcher.

The Ariel University’s Ethics Committee performed an institutional review and approved this study (AU-HEA-OSY-20201217).

Reliability

The researcher examined test–retest reliability by sending an online survey, which included the PALES, to a convenience sample of 30 colleagues and acquaintances from different parts of Israel twice (2 weeks apart) and compared their responses.

Content Validity

The PALES’s content was validated before collecting data for the construct and criterion validity and reliability analyses. First, the researcher made an extensive literature review on accessibility in living environments. The researcher also identified a panel of seven experts: five occupational therapists and two architects with knowledge and experience working with older adults and accessibility. According to Zamanzadeh et al. (2015), content evaluation panels should comprise five to 10 experts in the study domain. The researcher emailed questionnaires to the panel, and all responded with their feedback. The questionnaires asked whether the PALES items were relevant or essential for accessibility and whether the items were clearly phrased (yes/no) and covered most issues relative to accessibility in residential areas and community services (open response). In a procedure recommended by Zamanzadeh et al., (2015) the researcher revised the PALES according to the initial feedback and then emailed the revisions to the experts, asking for the same information. As indicated in the results, content validity satisfaction was reached the second time.

Construct Validity

Construct validity was examined through convergent and discriminant validity via correlations between the PALES and the WHO’s (1996) Quality of Life brief version (WHOQOL-BREF) subscales. To test construct validity, the researcher used WHOQOL-BREF data from a convenience sample of 495 Israeli participants aged 60 years and older living in their private homes or continuing care retirement communities during a previous study (Segev-Jacubovski & Shapiro, 2022). The male-to-female ratio was 36.8:62.4, 79.4% reported no functional disability, and all participants signed informed consent.

The WHOQOL-BREF is a standardized tool with high reliability and cross-cultural validation across populations and settings. It comprises 26 items in four QoL domains: social relationships and physical, psychological, and environmental health. The researcher omitted Item 21 (about sex life) due to older Israelis’ conservatism, but its removal did not affect the survey’s overall reliability (α = .87; Segev-Jacubovski & Shapiro, 2022).

The WHOQOL-BREF environmental health domain assesses broad environmental context and how these external factors subjectively affect QoL. Similarly, the PALES assesses respondents’ subjective perceptions of accessibility. Although the WHOQOL-BREF environmental health domain relates to similar theoretical content (e.g., physical living-environment conditions and accessibility of health services), it is not identical (e.g., air pollution, safety, safety, noise, and information availability) to the PALES, making it a valuable reference point for assessing convergent validity. The WHOQOL-BREF physical health domain covers aspects that assess mobility, pain, and energy levels. These are relevant for assessing convergent validity because they reflect individuals’ ability to overcome environmental barriers and can, thereby, improve their perceived environmental accessibility. Discriminant validity was evaluated through correlations between the PALES and the WHOQOL-BREF psychological health and social relationships domains, which offer different theoretical content suited for discriminant validity testing.

Another part of construct validity is known-groups validity, which differs in the variable of interest between two known groups (Streiner et al., 2015). Known-groups validity was assessed by examining the PALES’s capacity to differentiate between groups of older adults with and without disabilities.

Criterion Validity

Criterion validity was examined using correlations between the participating older adults’ answers and the researcher and research assistants’ answers. Furthermore, the researcher and research assistants familiar with each participant’s living environment completed the PALES from the participants’ perspectives to assess criterion validity. Correlations were analyzed across 45 participant–researcher/assistant pairs.

Statistical Analysis

Content validity was quantified using the content validity index (CVI) method. For each item, the item-level CVI (I-CVI) was calculated as the proportion of experts rating the item as “relevant” out of the total number of experts. The I-CVI values range from 0 to 1; each I-CVI item requires a score of at least 0.7 for inclusion. An I-CVI greater than 0.79 indicates the item is considered relevant, an I-CVI between 0.70 and 0.79 suggests the item is relevant but needs revision, and items with an I-CVI less than 0.70 are recommended for elimination (Zamanzadeh et al., 2015).

Pearson correlation coefficients were calculated using IBM SPSS (Version 25) to evaluate convergent validity, discriminant validity, criterion validity, and test–retest reliability measures. Known-groups validity was further assessed using independent t-tests. Values above 0.70 can be considered strong correlations (Akoglu, 2018; Streiner et al., 2015). Values ranging from 0.40 to 0.60 are generally considered moderate levels, and 0.10 to 0.30 values are generally considered weak (Akoglu, 2018). Anvari et al. (2024) used 0.20 as the threshold for convergent validity.

Results

Reliability

To assess test–retest reliability, we used a convenience sample of 30 adults (M = 47.41 years, SD = 10.75), 36.7% men, and 73.3% urban (this sample was separate from the 495-person sample used for construct validity). Results showed test–retest reliability, which indicates a high level of consistency between measurements over time, with a significantly strong correlation (r = .892, p < .001; 95% confidence interval (CI) = [.813, .952]) (see Table 1).

Table 1.

Perceived Accessibility of Living Environment and Services Questionnaire (PALES) Convergent, Discriminant, and Criterion Validity and Test–Retest Reliability.

PALES	Convergent validity WHOQOL-BREF		Discriminant validity WHOQOL-BREF		Criterion validity	Test–retest reliability
PALES	Environmental health	Physical health	Psychological health	Social relationships	Researcher /assistants	PALES time 2
PALES Time 1	.46**	.31**	.16**	.14*	.826**	.892**

p < .01. **p < .001.

Content Validity

The I-CVI calculations for each item’s relevancy showed two items (elevator and signage) with an I-CVI of 1.00, meaning they were relevant. Seven items were considered relevant (I-CVI = 0.714) but needed revision, and one (private vs. rented residence) was omitted because its I-CVI was 0.57. Based on the experts’ remarks about the clarity and understanding of the questions, the researcher changed the relevant items and added a question about lighting. Changes were also made to some amenity/service items: playground/sports field (less relevant for older populations) and theater (unusual in residential neighborhoods) were removed as services within walking/short driving distance, but the bus stop (necessary for public transportation) was added. However, the researcher did not add questions about the frequency of using public transportation or ways to get to friends’ houses for social needs, keeping the questionnaire short without excessive detail. The content validity on each revised item showed each item scored an I-CVI of 1.00, meaning they were relevant. Although three of the seven experts recommended adding more response options for some items, the yes/no option was retained because the PALES was designed as a screening tool.

Construct Validity

Convergent Validity

A moderately significant correlation was found between the PALES and the WHOQOL-BREF environmental (r = .46) and physical (r = .31) health domains (p < .001). Our study’s results are presented in Table 1.

Discriminant Validity

A weak (<0.2) significant correlation was found between the PALES and the WHOQOL-BREF psychological health and social relationships domains (respectively, r = .16 and r = .14, p < .01). In addition, the values of this correlation were below r = 0.2 as the threshold for convergent validity (Anvari et al., 2024), showing these domains are not associated with each other. Thus, they established a high level of discriminant validity. The results are presented in Table 1.

Known-Groups Validity

Independent t-tests showed the group of older adults with disabilities (M = 6.01; SE = 2.05) perceived their living environments as significantly less accessible, t(493) = −6.591, p < .001, than the group without disabilities (M = 7.37; SE = 1.79).

Criterion Validity

A significantly high correlation was found between the participants’ answers and the researcher/assistants’ answers (r = .826, p < .001; 95% CI [.725, .905]). The results are presented in Table 1.

Discussion

These preliminary results highlight the high validity and reliability of the PALES, a new screening questionnaire focusing on the perceived accessibility of living environments and services. The questionnaire includes nine items based on an appraisal of the accessibility literature and expert feedback on older adults, people with disabilities, and accessibility in Israel. In this study, the PALES demonstrated high test–retest reliability, reflecting measurement stability over time, as well as criterion, content, and construct validity. Occupational therapists and other accessibility advocates could use it in their practices to identify environmental barriers faced by older adults and people with disabilities.

Construct validity was found with moderate correlations between the PALES and the WHOQOL-BREF environmental health domain. As expected, only a partial correlation was found because those two questionnaires do not overlap perfectly—each covers some different environmental aspects. For example, both address physical living-environment conditions, accessibility of health services, transportation, leisure activities, and information availability. However, only the WHOQOL-BREF environmental health domain addresses safety, noise, air pollution, and economic situations (WHO, 1996).

The PALES’s discriminant validity with the WHOQOL-BREF psychological health and social relationships confirms that variables in the PALES differ from other measures. In addition, older adults with disabilities perceived their living environments as significantly less accessible. In other words, the PALES differentiated the group of older adults with disabilities from those without. Finally, criterion validity is achieved by correlations between the participants’ answers and the researcher/assistants’ answers, reinforcing that the PALES examines the same variables using two methods (participant and tester).

The PALES is heterogeneous; its intent is, to examine multiple aspects enabling accessibility. The PALES items include components that enable easy mobility and orientation in the living environment. Examples are lighting and signage for orientation, accessible paved driveways and sidewalks from the residence and around the neighborhood, and plateaus/flat terrain rather than inclines and descents for easy mobility. Having an elevator or being located on the ground floor enables people to leave their homes. Another aspect of the PALES is the diverse services near the residence, which offer opportunities to participate in nearby community activities and encourage older adults and people with disabilities to reach amenities/services by walking or driving a short distance. By intent, the questionnaire did not define “walking distance” or “short drive” but allowed each respondent to answer according to their subjective determination. Amenities and services relatively close to home attract and encourage people to go outside their residences to reach them.

Participation—the goal of the health system and particularly the occupational therapy profession—refers to involvement in a life situation (AOTA, 2020; WHO, 2001). The living or neighborhood environment must be amenable to its residents’ abilities, allowing them to participate in community, social, and civic life activities. Otherwise, it must be modified to offer access to the public streets, services, and private residences within it. Moreover, the immediate outdoor environment reflects life satisfaction and QoL for young (Khorasgani et al., 2021) and older adults (Rantakokko et al., 2010; Segev-Jacubovski & Shapiro, 2022; Tomaszewski, 2013; Vitman Schorr & Khalaila, 2018).

Segev-Jacubovski and Shapiro (2022) found that the perceived accessibility of living environments and services among healthy older adults had mainly positive effects on QoL through participation in activities in the community and some direct impact on their QoL. Similarly, Nagel et al. (2008) significantly associated the average time older adults spent walking with the number of commercial establishments and the amount of automobile traffic in their neighborhoods. This information strengthens the claim that accessible environments are relevant and beneficial even for people without disabilities. It reinforces the purpose of universal-design built environments, allowing anyone—regardless of age or disability—to move through them safely and independently (Nasarre-Aznar & Simón-Moreno, 2020).

The perceived accessibility of the living environment and services has a significant role. It reflects a better person–environment fit and can expand an individual’s social space—the rate of using shopping facilities, amenities, and social resources in the community (Lawton, 1990). The ecological theory of aging proffers that a better person–environment fit promotes psychological well-being and physical activity (Greenfield, 2012; Lawton & Nahemow, 1973).

In sum, ecology focuses on the interrelationships of organisms and their environments. The ecology of the human performance framework assumes individuals both influence and are influenced by their surroundings (Dunn et al., 1994). In this mutual relationship, environments may support or limit a person’s quality of occupational performance (AOTA, 2020), and humans can change the environment to make it age-friendly, adapting structures and services to be accessible to and inclusive of older people with varying needs and capacities (WHO, 2007). As such, health professionals and policymakers must examine environmental barriers and recommend necessary adjustments and repairs to improve accessibility. The PALES can further this purpose by helping to examine factors influencing neighborhood accessibility.

Limitations

The PALES has several limitations. First, it does not address all accessibility aspects, such as the presence or frequency of public transportation to reach amenities and services. In addition, it includes elements (e.g., plateaus/flat terrain or many stairs) that are difficult to modify. Second, the questionnaire’s response options are limited. For instance, Item 3 (walking paths) does not account for the absence of sidewalks. Third, the questionnaire answers are dichotomous (yes/no), which is less sensitive than a scale with a sequence of answers. However, dichotomous scoring provides clear information on whether an item is completely accessible. Partial accessibility may be inadequate and could prevent individuals from leaving their homes. For instance, a path with even one stair or other incline may not be accessible to someone with mobility difficulties. Fourth, this study used a convenience sampling method, and the sample included mainly people with digital literacy; hence, it limits the sample’s representativeness.

Further studies are required to strengthen the PALES’s reliability and validity by, for example, comparing PALES scores with existing self-report accessibility questionnaires and objective environmental assessments. The researcher also suggests validating the PALES representative sampling to include participants with functional disabilities and different diagnoses and digital literacy levels. Further recommendations are to create a comprehensive version of the PALES that includes public transportation and varied terrain (e.g., ramps) and uses scaled response instead of dichotomous options and to test the questionnaire’s feasibility for occupational therapy evaluation.

Implications for Occupational Therapy Practice

This study’s results have the following implications for occupational therapy practice:

The PALES expands our environmental perspective beyond home modifications, which is our expertise. It assesses the possibility of leaving the private home for a public space and can assist in finding recommended accessible living environments based on the patient’s abilities and preferences.

The PALES can help evaluate the environmental context and, hence, better match the people with their living environments, an important factor for participation in community activities and promoting aging in place.

Occupational therapists can use the PALES to recommend policymaker adjustments and repairs to improve environmental accessibility and enhance participation in community activities, especially for older adults and people with disabilities.

The PALES also has implications for fields beyond occupational therapy. It can guide urban planners and architects in planning accessible neighborhoods, identify the accessibility barriers affecting their clients’ independence to public health professionals, and help caregivers and family members make decisions about environmental changes and support needs.

Conclusion

An accessible living environment is crucial for older adults and people with disabilities. Occupational therapy aims to enhance people’s ability to function and participate in their daily activities in their environment (AOTA, 2020). The PALES reflects the interplay between individual and environmental factors influencing residents’ lives. The results of this study indicate that the PALES has high validity and reliability for evaluating the immediate outdoor or neighborhood environment. It is short and easy to answer and can pinpoint specific components in the living environment that are not accessible. It could promote health professionals’ and policymakers’ awareness and responsibility to plan accessible neighborhoods and inform them of necessary adjustments and repairs for better environmental accessibility.

Supplemental Material

sj-docx-1-otj-10.1177_15394492251322494 – Supplemental material for Perceived Accessibility of Living Environment and Services Questionnaire: Validity and Reliability

Supplemental material, sj-docx-1-otj-10.1177_15394492251322494 for Perceived Accessibility of Living Environment and Services Questionnaire: Validity and Reliability by Orit Segev-Jacubovski in OTJR: Occupational Therapy Journal of Research

Footnotes

Acknowledgements

The authors sincerely thank Dr. Ephraim Shapiro for assisting in developing the PALES. The author sincerely thanks Ariel University for the grant from the Foundation for Older Adults research (RA200000521). No funder/sponsor had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.

Ethics Approval

The study underwent an institutional review and was approved by the ethics committee of Ariel University (AU-HEA-OSY-20201217).

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was sponsored by the Foundation for Older Adult’s research at Ariel University (RA200000521).

ORCID iD

Orit Segev-Jacubovski

Supplemental Material

Supplemental material for this article is available online.

References

Akoglu

(2018). User’s guide to correlation coefficients. Turkish Journal of Emergency Medicine, 18(3), 91–93. https://doi.org/10.1016/j.tjem.2018.08.001

American Occupational Therapy Association (AOTA). (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), S1–S87. https://doi.org/10.5014/ajot.2020.74S2001

Anvari

Billinger

Analytis

P. P.

Franco

V. R.

Marchiori

(2024). Testing the convergent validity, domain generality, and temporal stability of selected measures of people’s tendency to explore. Nature Communications, 15(1), Article 7721. https://doi.org/10.1038/s41467-024-51685-z

Cerin

Sit

C. H. P.

Barnett

Cheung

Chan

(2013). Walking for recreation and perceptions of the neighborhood environment in older Chinese urban dwellers. Journal of Urban Health, 90(1), 56–66. https://doi.org/10.1007/s11524-012-9704-8

Cerin

Sit

C. H. P

Cheung

Lee

L. J.

Chan

(2010). Reliable and valid NEWS for Chinese seniors: Measuring perceived neighborhood attributes related to walking. International Journal of Behavioral Nutrition and Physical Activity, 7(1), Article 84. https://doi.org/10.1186/1479-5868-7-84

Dunn

Brown

McGuigan

(1994). The ecology of human performance: A framework for considering the effect of context. American Journal of Occupational Therapy, 48(7), 595–607. https://doi.org/10.5014/ajot.48.7.595

Echeverria

S. E.

Diez-Roux

A. V.

Link

B. G.

(2004). Reliability of self-reported neighborhood characteristics. Journal of Urban Health, 81(4), 682–701. https://doi.org/10.1093/jurban/jth151

Garner

I. W.

Holland

C. A.

(2020). Age-friendliness of living environments from the older person’s viewpoint: Development of the Age-Friendly Environment Assessment Tool. Age and Ageing, 49(2), 193–198. https://doi.org/10.1093/ageing/afz146

Giroux

Sogoloff

Bergmans

Bae

Vannostrand

Kasser

S. L.

(2023). An exploratory study of community mobility in adults with multiple sclerosis across different ambulation levels. International Journal of MS Care, 25(4), 145–151. https://doi.org/10.7224/1537-2073.2022-042

10.

Greenfield

E. A.

(2012). Using ecological frameworks to advance a field of research, practice, and policy on aging-in-place initiatives. The Gerontologist, 52(1), 1–12. https://doi.org/10.1093/geront/gnr108

11.

Heinemann

A. W.

Magasi

Hammel

Carlozzi

N. E.

Garcia

S. F.

Hahn

E. A.

Lai

J. S.

Tulsky

Gray

D. B.

Hollingsworth

Jerousek

(2015). Environmental Factors Item development for persons with stroke, traumatic brain injury, and spinal cord injury. Archives of Physical Medicine and Rehabilitation, 96(4), 589–595. https://doi.org/10.1016/j.apmr.2013.11.024

12.

Israel Ministry of Justice. (1998). Equal rights for persons with disabilities law. https://www.gov.il/en/Departments/legalInfo/equality_law

13.

Jackson

(2018). Models of disability and human rights: Informing the improvement of built environment accessibility for people with disability at neighborhood scale? Laws, 7(1), Article 10. https://doi.org/10.3390/laws7010010

14.

Kerbler

(2012). A toolkit for detecting and eliminating the barriers that people with disabilities face in the built environment: The case of Slovenia, Europe. METU Journal of the Faculty of Architecture, 29(2), Article 235.

15.

Khorasgani

A. E.

Khanghah

A. G.

Paryad

Roshan

Z. A.

Homaie Rad

(2021). The relationship between living environment and life satisfaction in residents of Rasht City, North of Iran. Journal of Holistic Nursing and Midwifery, 31, 194–202. https://doi.org/10.32598/jhnm.31.3.2083

16.

Kim

Buckley

Burnette

Kim

Cho

(2022). Measurement indicators of age-friendly communities: Findings from the AARP Age-Friendly Community Survey. The Gerontologist, 62(1), e17–e27. https://doi.org/10.1093/geront/gnab055

17.

Law

(1991). The environment: A focus for occupational therapy. Canadian Journal of Occupational Therapy, 58(4), 171–179. https://doi.org/10.1177/000841749105800404

18.

Lawton

M. P.

(1990). Residential environment and self-directedness among older people. American Psychologist, 45(5), 638–640. https://doi.org/10.1037/0003-066X.45.5.638

19.

Lawton

M. P.

Nahemow

M. L.

(1973). Ecology and the aging process. In Eisdorfer

Lawton

M. P.

(Eds.), Psychology of adult development and aging (pp. 619–674). American Psychological Association.

20.

Nagel

C. L.

Carlson

N. E.

Bosworth

Michael

Y. L.

(2008). The Relation between neighborhood built environment and walking activity among older adults. American Journal of Epidemiology, 168(4), 461–468. https://doi.org/10.1093/aje/kwn158

21.

Nasarre-Aznar

Simón-Moreno

(2020). Housing not for all: The lack of universal accessibility to housing in multi-unit buildings in Spain, Sweden and Germany. Journal of Property, Planning and Environmental Law, 12(1), 35–54. https://doi.org/10.1108/JPPEL-05-2019-0028

22.

Pikora

T. J.

Bull

F. C. L.

Jamrozik

Knuiman

Giles-Corti

Donovan

R. J.

(2002). Developing a reliable audit instrument to measure the physical environment for physical activity. American Journal of Preventive Medicine, 23(3), 187–194. https://doi.org/10.1016/S0749-3797(02)00498-1

23.

Rantakokko

Iwarsson

Kauppinen

Leinonen

Heikkinen

Rantanen

(2010). Quality of life and barriers in the urban outdoor environment in old age. Journal of the American Geriatrics Society, 58(11), 2154–2159. https://doi.org/10.1111/j.1532-5415.2010.03143.x

24.

Segev-Jacubovski

Shapiro

(2022). Role of participation in activities and perceived accessibility on quality of life among nondisabled older adults and those with disabilities in Israel during COVID-19. International Journal of Environmental Research and Public Health, 19(10), Article 5878. https://doi.org/10.3390/ijerph19105878

25.

Shumway-Cook

Patla

Stewart

Ferrucci

Ciol

Guralnik

(2003). Environmental components of mobility disability in community-living older persons. Journal of the American Geriatrics Society, 51, 393–398. https://doi.org/10.1046/j.1532-5415.2003.51114.x

26.

Streiner

D. L.

Norman

G. R.

Cairney

(2015). Health measurement scales: A practical guide to their development and use (5th ed.). Oxford University Press. https://doi.org/10.1093/med/9780199685219.001.0001

27.

Sugiyama

Thompson

C. W.

(2006). Environmental support for outdoor activities and older people’s quality of life. Journal of Housing for the Elderly, 19(3–4), 167–185. https://doi.org/10.1300/J081v19n03_09

28.

Szanton

S. L.

Leff

Wolff

J. L.

Roberts

Gitlin

L. N.

(2016). Home-based care program reduces disability and promotes aging in place. Health Affairs, 35(9), 1558–1563. https://doi.org/10.1377/hlthaff.2016.0140

29.

Tomaszewski

(2013). Living environment, social participation and wellbeing in older age: The relevance of housing and local area disadvantage. Journal of Population Ageing, 6(1–2), 119–156. https://doi.org/10.1007/s12062-012-9077-5

30.

Vitman Schorr

Khalaila

. (2018). Aging in place and quality of life among the elderly in Europe: A moderated mediation model. Archives of Gerontology and Geriatrics, 77, 196–204. https://doi.org/10.1016/j.archger.2018.04.009

31.

Vygotsky

L. S.

(1978). Mind in society: The development of higher psychological processes. Harvard University Press.

32.

World Health Organization (WHO). (1996). WHOQOL-BREF: Introduction, administration, scoring and generic version of the assessment; field trial version. http://www.who.int/mental_health/media/en/76.pdf

33.

World Health Organization (WHO). (2001). The international classification of functioning, disability and health. https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health

34.

World Health Organization (WHO). (2007). Global age-friendly cities: A guide. https://iris.who.int/handle/10665/43755

35.

Yen

I. H.

Anderson

L. A.

(2012). Built environment and mobility of older adults: Important policy and practice efforts. Journal of the American Geriatric Society, 60(5), 951–956. https://doi.org/10.1111/j.1532-5415.2012.03949.x

36.

Zamanzadeh

Ghahramanian

Rassouli

Abbaszadeh

Alavi-Majd

Nikanfar

A. R.

(2015). Design and implementation content validity study: Development of an instrument for measuring patient-centered communication. Journal of Caring Sciences, 4(2), 165–178. https://doi.org/10.15171/jcs.2015.017

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