Development of an Assessment Tool for Vertical Accessibility in Spanish Homes

Abstract

Universal accessibility is one of the most active lines of action among the steps to mitigate and compensate the restriction in participation and the limitation of activity in people with disabilities. Occupational therapists often work in a person's natural environment to assess and intervene in occupational performance. In addition to being a tool for evaluating the accessibility of individuals who visit community health professionals, especially nursing staff, this resource can significantly improve patient care and outreach efforts. Objective: The main aim of this study was to create and validate an instrument to measure the limitations in the activity of each person related to the vertical accessibility of their home. Design: The methodology of this work is a psychometric design. This is a process of construct validation of a vertical accessibility scale through confirmatory factor analysis. Methods: The scale construction is carried out following a content validation process, involving the participation of five expert occupational therapists, and the analysis of their contributions using the Attribute Agreement Analysis. In this process, Fleiss Kappa statistical analysis is used, and Kendal's W is included due to the utilisation of ordinal variables. For the construct validation of the tool, the most suitable process is followed, an Exploratory Factor Analysis, and subsequent Confirmatory Factor Analysis using Global Absolute Adjustment indices for all the subscales of the test. The analysis of the indicators was performed using the weighted least squares (DWLS) estimation method. An initial test of 63 items distributed into four subscales was configured based on the different determined accessibility spaces: (a) exterior areas and access to the building/living space; (b) horizontal mobility inside the building and common areas; (c) vertical mobility of the building/living spaces and (d) access to and the entrance door as well as the interior of the living spaces. Results: Once the analysis has been carried out with the absolute fit indices obtaining excellent values, the validation process is concluded and the final scale with 48 items is finalised. This validation process allows us to affirm that it is a useful and viable tool to evaluate accessibility. No public or patient contribution.