Psychometrics for the Home for Life Home Assessment

PURPOSE: The purpose is to present the psychometric results of an occupational therapy home modification assessment to determine optimal recommendations for the person to live safely in the home. Home modification assessments currently available to occupational therapists (OTs) are not standardized, appear as makeshift checklists not unique to occupational therapy practice, and are underutilized due to challenging productivity standards (Leidy & Crist, 2015). Evidence points to the necessity of quality home assessments and home modification implementation to reduce falls, increase function, and reduce caregiver burden (Siebert, Smallfield, & Stark, 2014).

The Home for Life Home Assessment app is based on and incorporates the occupational therapy Person–Environment–Occupation Model. Practitioners observe occupational behaviors performed by the person, assess the environment for needed change, and select recommendations based on findings. Using a transactional approach to evaluating the person in the home, the clinician inputs data and the app calculates the accessibility of the environment and the person’s safety perception. Using the app and the clinician’s own experience, the clinician can quickly review options for recommendations and immediately show environmental recommendations or equipment to help the person understand the recommendations.

DESIGN: This is a two-part preliminary psychometric study to (1) examine interrater reliability between raters on the Home for Life Home Assessment and (2) examine construct validity between this assessment and the In-Home Occupational Performance Evaluation (I-HOPE; Stark, Somerville, & Morris, 2010). Both parts of the study have been approved by the university ethical review board.

METHOD: Ten OTs in various geographic locations who were experienced in home modification were invited to participate. A convenience sample of five OTs participated in both parts of this study and completed online trainings for both assessments. For the construct validity study, each of these OT raters will recruit five older adults in their area to allow the OT rater to evaluate the older adult’s home with both the assessments. The interrater reliability study was based on the raters’ scores for the revised online training case. Scores on the revised online training module were calculated with an intraclass correlation coefficients (ICCs), and each rater achieved an ICC >.85 (compared with the training scores). The construct validity study is in progress and will compare the five raters’ scores with a correlation coefficient for five different people (n = 25 expected) using the Home for Life Home Assessment and the I-HOPE, expecting an overall r value of >.75 and p < .05. This psychometric study will begin the evidence for practice with this unique app-based home assessment and demonstrate OTs’ essential role in home assessment practice to provide distinct, cost-effective, outcome driven, and evidence-based services.

CONCLUSION: Psychometric evidence is needed for this assessment to demonstrate that occupational therapy services cannot be replicated by other disciplines within the health care, building, or design industries. This study is directly related to the research priority of Technology and Environmental Supports in Home and Community.

References

Leidy, K., & Crist, P. (2015, March). Home modification practice: A survey of current topics and trends. Home and Community Health Special Interest Section Quarterly, 22(1), 1–3.

Siebert, C., Smallfield, S., & Stark, S. (2014). Occupational therapy practice guidelines for home modifications. Bethesda, MD: AOTA Press.

Stark, S. L., Somerville, E. K., & Morris, J. C. (2010). In-Home Occupational Performance Evaluation (I-HOPE). American Journal of Occupational Therapy, 64, 580–589. https://doi.org/10.5014/ajot.2010.08065