Assessment and analysis of housing accessibility: adapting the environmental component of the housing enabler to United States applications

Abstract

The home environment is a primary context for daily activities, especially among older adults and persons with disabilities. Functional and age-related decline can generate problems in relation to certain environmental features, necessitating modifications or other provisions of support. The determination of appropriate home interventions is best served using a person-environment (P-E) fit approach, which considers both environmental barriers and functional limitations in measuring the magnitude of accessibility problems. In the United States (U.S.), there are few valid and reliable instruments utilizing this approach. This study aimed to adapt the environmental component of the Swedish Housing Enabler (HE) for valid use in the U.S., and furthermore investigate the inter-rater agreement of the instrument. Statistical analyses of fifty pairwise home assessments show the environmental component of the U.S. HE to be sufficiently reliable (j = 0.410, percentage of agreement = 81 %) for the region of study. A valid and reliable U.S. HE has the potential to inform appropriate housing environment interventions and therefore improve U.S. housing stock, the majority of which is currently considered inaccessible for residents with functional limitations.

Housing accessibility for senior citizens in Sweden: Estimation of the effects of targeted elimination of environmental barriers

“…The validity of the HE has been successively optimised during twenty years of research. Sufficient inter-rater reliability has been demonstrated in several studies, in Sweden and other countries [38][39][40].…”

Housing accessibility problems for people with Parkinson's disease

“…15 First introduced in 1996, the HE has subsequently been thoroughly evaluated and optimized and is extensively used in ageing research. [17][18][19] Based on the notion of P-E fit, 10 Step 1 (P component) Interview and observation of functional limitations (12 items) and dependence on mobility devices (two items), see Table 3. 16 At present, the instrument is available in Swedish, Danish, English and Finnish.…”

“…Translation procedures to other languages have included reliability studies as well as adaptation to the building regulations and standards for housing design in other countries. [17][18][19] Based on the notion of P-E fit, 10 Step 1 (P component) Interview and observation of functional limitations (12 items) and dependence on mobility devices (two items), see Table 3. All items are dichotomously assessed (Present=1/Not present=0).…”

Adaptive Strategies and Person-Environment Fit among Functionally Limited Older Adults Aging in Place: A Mixed Methods Approach

“…Demographic information for each participant was recorded, including sex, age, type of home, and years lived in present dwelling. Objective P-E fit data were gathered using a U.S. version [ 22 ] of the Housing Enabler (HE) [ 21 ]. The HE, originally developed in Sweden, provides an objective measure of P-E fit through a three-step assessment process: (1) an evaluation of a person’s functional limitations (12 items; ranging from limitations in hearing or vision to reduction or loss in upper and lower extremity function, see Table 1 ) and dependence on mobility devices (two items, present/not present; included here as both a consequence of severe limitations in function and an extension of the person which together interacts with the built environment); (2) the identification of environmental barriers in the home and exterior surroundings (161 items, present/not present); and (3) calculation of the resultant accessibility score.…”