Housing Accessibility Methodology Targeting Older People: Reliable Assessments and Valid Standards

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Older people have more functional limitations than younger people and they form
a segment of the population that is more dependent on mobility devices than other
age groups. Since they spend most of their time at home, their dwelling is an
important environmental arena for performing everyday activities. Barriers in the
environment can limit or hinder activity performance. Therefore, older people are
sensitive to the accessibility of the environment. To ensure housing accessibility,
it is critical that professionals are provided with valid and reliable assessment instruments
to identify accessibility problems before the planning of housing intervention
strategies. It is also critical that housing standards addressing accessibility
intended to accommodate people with functional limitations are valid in the sense
that their definitions truly support accessibility. However, there is a paucity of valid
and reliable assessment instruments targeting housing accessibility, and in-depth
analysis of factors potentially impacting on reliability in complex assessment situations
is remarkably absent. Moreover, the knowledge base informing the housing
standards appears to be vague. We may therefore reasonably question the validity of
the housing standards addressing accessibility.
This thesis addresses housing accessibility methodology in general and the reliability
of assessment and the validity of standards targeting older people with functional
limitations and a dependence on mobility devices in particular. The overarching
aim of the thesis was to develop and explore methods applicable for improving
housing accessibility assessments and to explore feasible approaches to create housing
standards that truly support accessibility and accommodate older people. A
main methodological contribution of the present thesis is the development of the
content-valid Nordic HE instrument which is deemed sufficiently reliable in Nordic
countries, and the recommendations for in-depth examination of inter-rater
agreement for the improvement of reliability. A second main contribution of the
present thesis is that it explores the consequences of the housing standard definitions
in terms of accessibility and provides estimates of the proportion of dwellings
considered accessible and the proportion of persons defined as having accessibility
problems. Collectively, these results have the potential to improve and influence
research, practice and policy in a global context for the benefit of the health and
well-being of older people with functional limitations. Moreover, the results provide
new knowledge and invite reflections on central concepts and methodology
relevant to psychometrics and research on person-environment fit.
Original languageEnglish
Place of PublicationLund
PublisherLunds University
Number of pages86
ISBN (Print)9789187189951
Publication statusPublished - 15 Mar 2013


  • occupational therapy
  • environmental interaction
  • handicapped people
  • occupational therapy
  • person-environment fit
  • public health


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