Development and pilot testing of the Outpatient Health Care Usability Profile (OHCUP)

Background and Importance

Accessible health care facilities are a foundation for good health among people with disabilities. In fact, the Americans with Disabilities Act requires that health care facilities be accessible. While the ADA Accessibility Guidelines (ADAAG) contain over 700 specifications for accessible facilities, more concise tools can serve as a useful first step in improving accessibility. This presentation describes the development of a valid, reliable, and practical tool for assessing the "usability" of outpatient health clinics.

Methods & Results

Content Validity Ratios (CVR) were used to determine the items in the tool. Three focus groups of people with sensory, cognitive, or mobility disabilities prioritized items from the ADAAG. Items receiving a minimal CVR of .20 received further review. A panel of ADA experts reviewed each item to determine if it was essential to establish a health care facility as "useable." Items receiving a CVR of .80 were retained.

Inter-rater reliability was established with both trained and untrained raters assessing 20 clinics. Inter-rater reliability of the 158 items was strong, with an average Kappa coefficient of 0.89. Assessments revealed a number of barriers to usability, e.g., 93% of clinics had no means of weighing a wheelchair user, and 80% had no adjustable-height exam tables. Practicality was judged based on length of time required to assess a clinic (<2 hours) and training requirements.

Conclusions

The OHCUP provides reliable data on key barriers for people with disabilities attempting to use outpatient clinics, and a practical beginning point for full accessibility determinations.