Assessment and analysis of housing accessibility: An instrument for individual or population-level housing interventions to support health

The home environment is a primary context for daily activities, especially among older adults and persons with disabilities. Functional and age-related decline can generate problems in relation to certain environmental features, necessitating modifications or other supports to maintain physical and psychosocial health. Determining appropriate housing interventions is best served using a person-environment fit approach, which considers both environmental barriers and functional limitations in measuring the magnitude of accessibility problems within the home. In the U.S., there are few valid and reliable instruments utilizing this approach, resulting in interventions focused on either the person or their environment, but not the holistic person-environment interaction. In response, this study aimed to adapt the Swedish Housing Enabler (HE) for valid use in the U.S. and investigate its inter-rater agreement. Statistical analyses of fifty pairwise home assessments show the environmental component of the U.S. HE to be sufficiently reliable (κ = 0.410, percentage of agreement = 81%) for the region of study. A valid and reliable U.S. HE can inform appropriate individual-level housing interventions based on a resident’s functional profile. On a population level, the instrument can strengthen national surveys measuring housing quality by including indicators of accessibility that threaten independent living. Both approaches have the potential to improve the suitability of U.S. housing stock, the majority of which is considered inaccessible for persons with functional limitations. Future studies are needed that investigate the instrument’s reliability in other regions of the country to further validate its use and strengthen its applicability in policy and practice.