Carita Nygren

Cross-national and multi-professional inter-rater reliability of the Housing Enabler

In order to render reliable assessment of housing accessibility in a cross-national context possible, the objective of this study was to investigate multi-professional, cross-national inter-rater reliability of the ENABLE-AGE project-specific version of the Housing Enabler instrument. The data collection was performed with elderly persons in ordinary housing in five European countries. After participation in rater training courses, 26 raters representing different nationalities and professions performed data collection in independent pairs of raters, n=64. Inter-rater reliability was calculated by means of percentage agreement as well as Cohens kappa. The results demonstrated moderate to good overall inter-rater reliability of the project-specific version of the Housing Enabler instrument. The mean agreement for the personal component part of the instrument was 91%. For 13 of the 15 items in this part kappa values could be defined, , indicating moderate agreement. In the environmental component part the mean agreement for all 188 items was 85%, while , indicating moderate agreement. Given the complexity of the instrument and the number of different professions and countries involved, we consider the Housing Enabler as useful for cross-national research targeting housing accessibility, even if the agreement levels reached were moderate. However, the moderate agreement levels pinpoint the importance of rater training.

Assistive devices among very old people in five European countries

The aim of this study was to investigate the use and need of assistive devices (ADs) in a cross-national European sample of very old persons, focusing on national similarities and differences as well as similarities and differences according to age and level of health status. Data from the ENABLE-AGE research project were utilized involving very old persons in Sweden, Germany, Latvia, Hungary, and the United Kingdom (UK). Personal interviews with single-living old persons were conducted (n=1 918). Of the total sample 65% reported that they had and used one or more ADs, and 24% reported unfilled need. The most commonly used ADs were devices for communication, followed by devices for mobility. Participants in Hungary and Latvia used a lower total number of ADs. Comparisons among sub-groups according to age between the Western and the Eastern European national samples showed significant differences. The result can to some extent be explained by different welfare systems and presumably differences in knowledge and awareness of ADs, and further research is called for. However, the result can serve as input for future planning and development of information, services, and community-based occupational therapy, to improve healthcare and social services for older people.

Toward a Screening Tool for Housing Accessibility Problems A Reduced Version of the Housing Enabler

To present a reduced version of the Housing Enabler, useful as a screening tool in practice contexts and in research, this study identifies the core items of the environmental component of the instrument, that is, the items most important in terms of the instruments overall validity to measure accessibility problems. Utilizing cross-national data and interdisciplinary knowledge through an iterative process, a set of core items was identified. The environmental component of the reduced version comprises 61 items, compared to 188 in the original instrument. The rank correlation between the accessibility scores generated by the original and reduced versions was r ≥ .97 (p < .001). Based on comprehensive empirical research in three countries, the reduced version of the Housing Enabler is a time-efficient and valid screening instrument. It is a powerful tool for research and interventions focusing on housing accessibility problem identification.

The Nordic Housing Enabler: Inter-rater reliability in cross-Nordic occupational therapy practice

Abstract This study addresses development of a content-valid cross-Nordic version of the Housing Enabler and investigation of its inter-rater reliability when used in occupational therapy rating situations, involving occupational therapists, clients, and their home environments. The instrument was translated from the original Swedish version of the Housing Enabler, and adapted according to accessibility norms and guidelines for housing design in Sweden, Denmark, Finland, and Iceland. This iterative process involved occupational therapists, architects, building engineers, and professional translators, resulting in the Nordic Housing Enabler. For reliability testing, the sampling strategy and data collection procedures used were the same in all countries. Twenty voluntary occupational therapists, pair-wise but independently of each other, collected data from 106 cases by means of the Nordic Housing Enabler. Inter-rater reliability was calculated by means of percentage agreement and kappa statistics. Overall good percentage agreement for the personal and environmental components of the instrument was shown, indicating that the instrument was sufficiently reliable for application in practice and research in the Nordic context. The varying kappa results highlight the need for further study in order to understand the influence of prevalence more profoundly, which should be kept in mind when interpreting the results.

Very old Swedish women's experiences of mobility devices in everyday occupation: A longitudinal case study.

The use of mobility devices, such as walking sticks and rollators, increases during the ageing process. Our aim was to explore how very old single-living Swedish women experience the use of mobility devices over time, in relation to everyday occupation. A multiple case study strategy involving quantitative and qualitative data was used. The findings indicate that the use of mobility devices, rollators in particular, starts off as support for walking but over time becomes more involved in occupational performance, resulting in complex transactions between personal, environmental, and task components. Personal factors such as ability to adjust and adapt to different situations seem to be crucial for optimal mobility device use. Strategies and adaptive behavior were developed over the years while striving for maintained independence and participation. The use of mobility devices was described as something one has to accept, but also a constant reminder of your limitations, or as a possibility to remain active and to manage everyday occupation. The findings stress the need to adopt a comprehensive view when trying to facilitate everyday occupations in very old age. Physical, social, psychological aspects, combinations among assistive devices, and home modification all need to be reflected on and monitored over time.

Environmental Barriers and Housing Accessibility Problems Over a One-Year Period in Later Life in Three European Countries

Abstract The objective of this study was to describe environmental barriers and investigate the nature of accessibility problems in housing among single-living, very old people (N = 1,150) in urban regions in three European countries (Sweden, Germany, Latvia), in a one-year perspective. A specific feature of this study is the explicit conceptual differentiation between environmental barriers and accessibility problems, underlying the presentation of the following results: Environmental barriers were very common, and in all three national samples the 20 most prevalent environmental barriers were found in 77–98% of all dwellings investigated. The magnitudes of accessibility problems were similar among the three samples and did not change over one year, while differences were indicated in the types of environmental barriers generating accessibility problems.

Negotiating and effectuating relocation to sheltered housing in old age: a Swedish study over 11 years

The aim of this study was to explore how very old people consider and arrive at decisions on relocation, with specific attention to housing and health relationships during the process of ageing. The sample included 13 very old participants of an 11-year longitudinal study of relationships between housing and health. Applying a mixed-methods approach, data from qualitative interviews and quantitative survey data from three data collection waves were utilised. The quantitative data were interwoven with the qualitative findings into a coherent body of text. The core theme “Negotiating and effectuating relocation is a long process” indicates a non-linear process consisting of five phases constituting the main categories of our findings. In the first phase, some informants considered relocation while others avoided thinking about it. Next, relations between health and home changed and led to turning points triggering relocation, i.e. when dependence in everyday activities reached critical points or when sudden illness forced an involuntary move. In the third phase, once the decision to relocate was made it was set in stone by the individual, but often questioned by the authorities, leading to a situation causing much frustration. While waiting for the relocation, doubts as well as expectations about the new home were expressed. Finally, even though the actual move caused different feelings, it was most often a positive experience and resulted in subjective health improvement and increased social contacts. The results can be used for the development of positive, proactive strategies for improved housing provision along the ageing process.

The Nordic Housing Enabler: Inter-rater reliability in cross-Nordic occupational therapy practice. Previously published in Scandinavian Journal of Occupational Therapy 2010; 17: 258-266.

Abstract This study addresses development of a content-valid cross-Nordic version of the Housing Enabler and investigation of its inter-rater reliability when used in occupational therapy rating situations, involving occupational therapists, clients, and their home environments. The instrument was translated from the original Swedish version of the Housing Enabler, and adapted according to accessibility norms and guidelines for housing design in Sweden, Denmark, Finland, and Iceland. This iterative process involved occupational therapists, architects, building engineers, and professional translators, resulting in the Nordic Housing Enabler. For reliability testing, the sampling strategy and data collection procedures used were the same in all countries. Twenty voluntary occupational therapists, pair-wise but independently of each other, collected data from 106 cases by means of the Nordic Housing Enabler. Inter-rater reliability was calculated by means of percentage agreement and kappa statistics. Overall good percentage agreement for the personal and environmental components of the instrument was shown, indicating that the instrument was sufficiently reliable for application in practice and research in the Nordic context. The varying kappa results highlight the need for further study in order to understand the influence of prevalence more profoundly, which should be kept in mind when interpreting the results.