Reliability and validity of the Home Environmental Assessment Protocol-Revised

This dissertation examined the initial content validity, concurrent validity, inter-rater reliability, and test-retest reliability of the Home Environment Assessment Protocol – Revised. The Home Environment Assessment Protocol –Revised (HEAP-R) is a home assessment for persons with dementia and their caregivers. The domains assessed included hazards, adaptations, visual cues, clutter, and comfort. Content validity was established by seven experts through a content validity index (CVI). The result was an overall CVI of .98. A few minor changes were made to the HEAP-R form and a quick start guide with definitions was developed. Concurrent validity was established through the administration of both the HEAP and the HEAP-R with 21 caregiver/person with dementia dyads at homes in Florida and Texas. This resulted in strong correlations for the domains of hazards (r =.792) and adaptations (r = .742). Correlations were strong for the domains of clutter (r = .843), and comfort (r = .958). The two tools did not correlate for the domain of visual cues. Reliability was examined by 24 occupational therapists who scored the HEAP-R by viewing videos of 10 home environments. Inter-rater reliability was poor across all domains, hazards (α = .300), adaptations (α = .234), visual cues (α = .201), and clutter (α = .252). Test-retest reliability showed strong agreement for the domains of hazards (r = .820), adaptations (r = .887), and clutter (r = .696). The domain of visual cues showed moderate (r = .487) test-retest reliability. To address theoretical relevance, follow-up phone calls resulted in 19 caregiver responses. This provided guidance for future research using the HEAP-R as a clinical tool in the homes of persons with dementia and their caregivers. Relative mastery scores showed that caregivers viewed the assessment process as efficient and effective, and were satisfied with the process. Caregivers did want more education and resources for home modifications and caregiving.