Validity of the Home Environmental Assessment Protocol–Revised

PURPOSE AND BACKGROUND: This study examined the validity of the Home Environmental Assessment Protocol–Revised (HEAP–R). The HEAP–R is a revision of the Home Environmental Assessment Protocol (HEAP), which was designed as a walk-through home assessment with the caregiver. The HEAP–R was designed to include both the person with dementia and the caregiver and to have clinical utility for use in home health. Domains in both tools are hazards, adaptations, visual cues, clutter, and comfort. The authors of the HEAP–R considered an occupational adaptation theory approach and added sections for collaboration to identify barriers, supports, and unmet needs as well as recommendations. Research questions were, Is the content of the HEAP–R valid? and Does the HEAP–R have a significant association with the previously validated HEAP?

METHOD: Using a mixed methods design, the content validity study examined the HEAP–R via a review of theoretical underpinnings, literature review, and expert review. Participants were seven invited experts in home modifications and dementia care identified through publications and presentations. To establish a content validity index (CVI), the experts participated in an online survey with Likert scale questions and space for narrative responses. Data analysis of the survey responses was a computation of the CVI as described by Lynn (1986) and qualitative analysis of open-ended questions.

The concurrent validity study sought to examine the evidence that the HEAP–R concurs with the HEAP. This was crucial because the HEAP–R is a revision of an existing tool. A naturalistic observation design informed the methods for this study, which was completed in participants’ private homes. Participants were 21 dyads consisting of a person with dementia and his or her caregiver who were recruited through local dementia programs and support groups in Texas and Florida. To be included, participants needed to be a primary caregiver or a person with a diagnosis of dementia, ambulatory, English speaking, and living in the home being assessed. Analysis was completed with Pearson correlation coefficients across total domains. Institute review board approval was obtained for both studies.

RESULTS: The results of the literature review are available in a related publication (Struckmeyer & Pickens, 2016). The overall CVI was .86. A CVI of .78 or higher is considered to indicate content validity with responses from seven participants (Lynn, 1986). Three themes emerged: (1) the need for definition of domain terms, (2) the need for clarity in filling out sections of the form, and (3) the need for more space for comments.

In the CVI study, Pearson correlation coefficients for the HEAP and HEAP–R by domain were as follows: hazards, r = .792, p < .0005; adaptations, r = .742, p < .0005; visual cues, r = .000, p = 1.00; clutter, r = .843, p < .0005; and comfort, r = .958, p = .000. The CVI scores exceeded expectations and indicate that the HEAP–R has excellent content validity. As a result of themes that emerged, a one-page quick start guide was developed.

The concurrent validity of the HEAP and HEAP–R domains of hazards, adaptations, clutter, and comfort were strong. The domain of visual cues was not significant. One limitation of the concurrent validity study is that the same researcher did each assessment, so findings from the HEAP–R may have influenced HEAP results.

CONCLUSION: As the number of people with dementia continues to rise, so will the need for occupational therapy services that promote aging in place, such as home modifications. This study provides evidence to support the validity of the HEAP–R for use in practice. The American Occupational Therapy Association has identified home assessment as a critical area for research.

References

Gitlin, L. N., Schinfeld, S., Winter, L., Corcoran, M., Boyce, A. A., & Hauck, W. (2002). Evaluating home environments of persons with dementia: Interrater reliability and validity of the Home Environmental Assessment Protocol (HEAP). Disability and Rehabilitation, 24, 59–71. https://doi.org/10.1080/09638280110066325

Lynn, M. R. (1986). Determination and quantification of content validity. Nursing Research, 35, 382–386. https://doi.org/10.1097/00006199-198611000-00017

Struckmeyer, L. R., & Pickens, N. D. (2016). Home modifications for people with Alzheimer’s disease: A scoping review. American Journal of Occupational Therapy, 70, 7001270020. https://doi.org/10.5014/ajot.2015.016089