Strategies for evaluation of housing adaptations - Accessibility, usability and ADL dependence

Abstract: Housing adaptation is a common intervention, in Sweden granted by municipal authorities, and performed in order to remove environmental barriers and enhance daily activities. In spite of increasing costs, efficient strategies for evaluation of the intervention are lacking. In this thesis, occupational therapy clients living in a south Swedish municipality and receiving housing adaptation grants were followed over time in a housing adaptation process. The overarching aim was to generate knowledge useful for development of strategies for evaluations of housing adaptations. A multi-dimensional methodology for assessing and analysing housing accessibility, usability in housing, and ADL dependence on the client level was developed, optimised, and applied. In particular, the Usability in My Home instrument developed in this thesis represents a novel approach to assessment in relation to housing adaptations. A complex pattern of improvements and declines over time was found. Accessibility and usability improved, and dependence in the activity of bathing decreased. The prevalence of functional limitations and dependence on mobility devices among clients increased, while the number of environmental barriers in their homes declined. Even if several outcome dimensions remain to be investigated, the methodology seems useful for systematic evaluation of housing adaptations, and implementations for practice and research on client, group and population levels are discussed. The results have practical implications for occupational therapy and for public planning of accessible and usable housing. Recommendations useful for practitioners aiming at evaluating housing adaptations are given, and further research needs are outlined.