Psychometric properties of home accessibility assessment tools: A systematic review

Abstract

Background. Although home environment assessments are commonly performed by occupational therapists working in home care, use of nonstandardized measures created in-house or lack of measure use can cast a shadow over the quality of these assessments for people with disabilities. To ensure quality of home environment assessments, occupational therapists need standardized measures with demonstrated psychometric properties. Purpose. This study provides a critical appraisal of objective accessibility measures of the home environment. Method. A systematic review was undertaken for which three databases—CINAHL, PubMed, and Embase—were searched to identify accessibility measures of the home environment and evaluate their psychometric properties. Two authors independently assessed the quality of selected studies using the critical appraisal form for psychometric articles. Findings. Ten studies discussing seven accessibility measures were identified and selected for this review. No measures showed strong evidence of both good reliability and validity. Only one study addressed the responsiveness of a measure of accessibility. Implications. As occupational therapists are specialists of the person–environment relationship, the lack of evidence of the psychometric properties of objective accessibility measures of the home environment harms evidence-based occupational therapy practice. This review identified the most promising assessment tools, but further research is needed.

Housing Assessment Tools Developed or Adapted for Use in East and Southeast Asia: A Scoping Review

“…Besides reducing fall risks, an accessible housing environment is expected to maximize the ability of older adults to stay independent in activities of daily living and to contribute to higher quality of life (Iwarsson & Isacsson, 1998b). Yet, though encouraging to find study-specific items used, in accordance with a previous systematic review (Patry et al, 2019) we did not identify any fully developed assessment tool addressing housing accessibility, even though recent research shows serious accessibility issues in Asian countries (Kobayashi et al, 2019). There is therefore an urgent need to include measures of accessibility in housing assessment tools in order to address health risk factors in this WHO prioritized area.…”

Effect of Housing Quality on the Mental Health of University Students during the COVID-19 Lockdown

“…Studies published in recent literature have started investigating, in a systematic way, the overall quality of built environment [ 29 , 30 ] and living spaces, revealing that the absence of accessible outdoor space from the house (e.g., garden, terrace) contributed to concerning levels of psychological and behavioral symptomatology [ 31 ], confirming that housing environments could be associated with the mental health and wellbeing of residents [ 32 , 33 , 34 , 35 , 36 ]. While mental illnesses can be investigated through structured and validated scales, housing quality is mainly assessed in terms of occupants’ perception, due to the complexity of surveying a high number of different apartments and the low psychometric reliability of existing tools [ 37 , 38 , 39 , 40 , 41 ].…”

Development of the Home Environmental Scale of Accessibility Instrument for Spain

“…Regarding other assessment tools developed for the evaluation of home accessibility, it should be noted that the analyses used in the HoPE [ 15 ], HACE [ 14 ], and Housing Enable Screening Tool [ 13 ] base the validity of the structure of their scales on content validation [ 59 ]. However, construct validity is considered the most acceptable system with the most evidence for the validation process [ 60 , 61 ], Regarding the number of cases used in the validation and reliability process that have been made in the aforementioned scales, these range between n = 62 of HACE [ 14 ]; HoPE with 77 [ 15 ], or n = 134 in the Housing Enabler Screening Tool [ 13 ], while in the present HESA II tool, we followed the authors who recommended 20 cases for each factor [ 62 ], and we incorporated Cronbach’s alpha and McDonald’s omega reliability indices to obtain a definitive scale that meets the most rigorous standards for the construction process.…”