Online Program

Assessment and analysis of housing accessibility: An instrument for individual or population-level housing interventions to support health

Sunday, November 1, 2015

Laura Lien, PhD, Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
Carmen Steggell, PhD, School of Design and Human Environment, College of Business, Oregon State University, Corvallis, OR
Björn Slaug, PhD, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden, Lund, Sweden
Susanne Iwarsson, PhD, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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 supports to maintain physical and psychosocial health. Determining appropriate housing interventions is best served using a person-environment fit approach, which considers both environmental barriers and functional limitations in measuring the magnitude of accessibility problems within the home. In the U.S., there are few valid and reliable instruments utilizing this approach, resulting in interventions focused on either the person or their environment, but not the holistic person-environment interaction. In response, this study aimed to adapt the Swedish Housing Enabler (HE) for valid use in the U.S. and investigate its inter-rater agreement. Statistical analyses of fifty pairwise home assessments show the environmental component of the U.S. HE to be sufficiently reliable (κ = 0.410, percentage of agreement = 81%) for the region of study. A valid and reliable U.S. HE can inform appropriate individual-level housing interventions based on a resident’s functional profile. On a population level, the instrument can strengthen national surveys measuring housing quality by including indicators of accessibility that threaten independent living. Both approaches have the potential to improve the suitability of U.S. housing stock, the majority of which is considered inaccessible for persons with functional limitations. Future studies are needed that investigate the instrument’s reliability in other regions of the country to further validate its use and strengthen its applicability in policy and practice.

Learning Areas:

Assessment of individual and community needs for health education
Other professions or practice related to public health
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Describe the adaptation and development of the U.S. HE tool and explain its application and use in individual and population-level assessments of accessibility. Discuss the impact of and need for person-environment fit assessments in informing policy and practice to support accessibility in the home environments of older adults and persons with disabilities.

Keyword(s): Accessibility, Built Environment

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal or co-principal of multiple studies focused on the accessibility and usability of the built environment among older adults with disabilities. My background in architecture and design and human behavior is pivotal and provides a unique approach to this type of research. My scientific interests include person-environment relationships and the impact of the environment on access, use, and meaning of place.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.