Evaluating the Impact of the Home Environment on Family Caregivers

This project is significant in that it will maximize and maintain the ability of caregivers by promoting use of evidence-based interventions to reduce strain. An estimated 48 million adults have served as a caregiver for an adult relative or friend in the United States, saving the health care system an estimated $166 billion annually. Although caregiving can be rewarding, those under strain are at risk for negative consequences to participation and health. Emerging evidence shows that home modification interventions have the potential to improve care recipient function and to reduce caregiver strain. The developed evaluation will facilitate clinicians and research to extend occupational therapy interventions to this at-risk population. The innovation of this project is the development of a person–environment fit evaluation that includes client identification of priority activities, performance-based components, and measures of physical support and self-efficacy. Currently, assessments targeting caregivers lack quantifiable, objective measures addressing levels of support provided, relying on caregiver self-report. This evaluation fills this gap, offering quantifiable, objective measures of support provided in the home that allow the evaluator to observe and rate the level of physical assistance and to identify environmental barriers. This project provides clinicians and researchers with a psychometrically sound evaluation to quantify changes in levels of support provided and the self-efficacy of caregivers before and after home modification interventions.

PURPOSE: In this study, we investigate the feasibility, validity, and interrater reliability of a new evaluation (In-Home Occupational Performance Evaluation for Providing Assistance; I–HOPE A) to guide measuring the impact of environmental barriers on caregiving.

BACKGROUND: Caregiving can be physically and emotionally taxing, placing caregivers at risk for negative health consequences. Home modifications can improve the functional abilities of people with disabilities and may reduce strain for caregivers. The impact that home modifications have on caregiving is understudied, with no assessments available to measure caregiving outcomes.

METHOD: A cross-sectional study of 31 caregivers assisting an adult family member with at least two activities of daily living (ADLs) was completed in St. Louis, Missouri. Two occupational therapists completed an in-home evaluation using the I–HOPE A. The I–HOPE A was examined for interrater reliability, internal consistency, and convergent validity. Descriptive statistics for environmental barriers were completed.

RESULTS: Subscale intraclass correlation coefficients (ICCs) ranged from .94 to 1.0, and internal consistency ranged from .82 to .90. The Self-Efficacy subscale was positively correlated with the Caregiving Inventory (r = .50, p = .01), Caregiving Mastery Scale (r = .38, p = .07), and Caregiver Competence Scale (r = .39, p = .04). The Functional Independence Measure (FIM) demonstrated negative correlations with the activity score (r = −.38, p = .03) and barrier severity score (r = −.34, p = .06), indicating that the number of caregiving activities and the severity of barriers are correlated with lower FIM scores. Common barriers include lack of hand support, type of transfer surface, and malfunctioning/lack of equipment.

CONCLUSION: Preliminary information indicates that the I–HOPE A is a psychometrically sound instrument. This study demonstrated excellent interrater reliability and good internal consistency for all subscales. The I–HOPE A has the potential to be used by researchers and clinicians for home modification interventions targeting caregivers.