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 forma segment of the population that is more dependent on mobility devices than otherage groups. Since they spend most of their time at home, their dwelling is animportant environmental arena for performing everyday activities. Barriers in theenvironment can limit or hinder activity performance. Therefore, older people aresensitive to the accessibility of the environment. To ensure housing accessibility,it is critical that professionals are provided with valid and reliable assessment instrumentsto identify accessibility problems before the planning of housing interventionstrategies. It is also critical that housing standards addressing accessibilityintended to accommodate people with functional limitations are valid in the sensethat their definitions truly support accessibility. However, there is a paucity of validand reliable assessment instruments targeting housing accessibility, and in-depthanalysis of factors potentially impacting on reliability in complex assessment situationsis remarkably absent. Moreover, the knowledge base informing the housingstandards appears to be vague. We may therefore reasonably question the validity ofthe housing standards addressing accessibility.This thesis addresses housing accessibility methodology in general and the reliabilityof assessment and the validity of standards targeting older people with functionallimitations and a dependence on mobility devices in particular. The overarchingaim of the thesis was to develop and explore methods applicable for improvinghousing accessibility assessments and to explore feasible approaches to create housingstandards that truly support accessibility and accommodate older people. Amain methodological contribution of the present thesis is the development of thecontent-valid Nordic HE instrument which is deemed sufficiently reliable in Nordiccountries, and the recommendations for in-depth examination of inter-rateragreement for the improvement of reliability. A second main contribution of thepresent thesis is that it explores the consequences of the housing standard definitionsin terms of accessibility and provides estimates of the proportion of dwellingsconsidered accessible and the proportion of persons defined as having accessibilityproblems. Collectively, these results have the potential to improve and influenceresearch, practice and policy in a global context for the benefit of the health andwell-being of older people with functional limitations. Moreover, the results providenew knowledge and invite reflections on central concepts and methodologyrelevant to psychometrics and research on person-environment fit.
Original languageEnglish
Place of PublicationLund
PublisherLunds University
Number of pages90
ISBN (Print)9789187189951
Publication statusPublished - 15 Mar 2013
Externally publishedYes
SeriesFaculty of Medicine doctoral dissertaion series


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


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