0
Participation and
Environmental Factors
Measures For TTBI
Rehabilitation
Susan Magasi
Allen Heinemann
Noelle Carlozzi
1
Presentation Overview
1. Developing a measure of community
participation after rehabilitation
2. Evaluating the feasibilit...
Developing a Measure of
Community Participation after
Rehabilitation
Susan Magasi
3
Presentation Objectives
(1) Describe ways to assess participation
(2) Evaluate the psychometric properties of community
en...
5
International Classification of Functioning
Disability and Health
Barriers
Facilitators
Body Functions
&
Structures
Acti...
Project Task Overview
1. Conduct literature review
2. Conduct focus groups with
consumers, caregivers,
providers, payers, ...
Construct Development:
Stakeholder Focus Groups
•Consumers (5)
–Chicago, IL
–Englewood, CO
•Caregivers (6)
–Chicago, IL
–E...
Focus Group Questions
1. What does the word “participation” mean to you?
a) What does it mean “to participate”
b) Why is p...
Qualitative Analytic Procedures
• Analyses and interpretation
• Open coding of data by 2
researchers, including team
membe...
10
Focus Group Input
Consumers “It means to make some sort of contribution in life”
“Working and living”
“It's important t...
11
What We Learned: Participation Values
Participation
Values
Choice &
Control
Access &
Opportunity
Personal &
Societal
Re...
Community Participation Indicators
Version 1
• Source Material
– Focus group thematic codes
– Comprehensive literature rev...
CPI Version 1: Content Organization
• Engagement (frequency, duration of activities)
• Economic / productive (5 items)
• S...
Rating Scale Analysis of
Enfranchisement Items
• BRFSS addendum N = 912
• Self-identified disability = 51%
• Person separa...
Conclusions: Participation enfranchisement
constitutes a new, previously unmeasured aspect
of participation - one that add...
Community Participation Indicators
Version 2
• 20 engagement items
• Frequency of activity
• Importance of activity
• Eval...
17
18
19
Enfranchisement Items
• Retained 8 thematic domains
• Expanded from 19 to 48 items
• Cognitive testing with consumers
• Ne...
21
22
Round 3 Data: Sample Characteristics
• N = 1163
• Source
– Panel survey: 51%
– Community sites: 31%
– Former inpatients...
Results: Activity Patterns
• Activity Categories
• Social activities
• Productive activities
• Low frequency activities
• ...
Social Activities
0%
20%
40%
60%
80%
100%
Spend time w
family
Keep in touch
w family
Get out &
about
Keep in touch
w frien...
‘Productive’ Activities
0%
20%
40%
60%
80%
100%
Work Child care Home
maintenance
Household
finances
Volunteer Learn
35+ h
...
0%
20%
40%
60%
80%
100%
Hobbies Active
recreation
Religious
activities
Support
Groups
Entertainment Community
organization...
27
Percent of Important Activities
Performed Often Enough
Mean = 55%
SD = 28
N = 1149
Scoring Decision
Activities and Activity Importance
• Avoid creating a “busy-ness” index
• Personal preferences, opportuni...
Rating Scale Analysis of
Enfranchisement Items
 Began with all 48 items
 Used exploratory factor analysis to identify nu...
Involvement in Life Situations
Summary Statistics
• Person Information
• How well do items differentiate the people?
• Ver...
Item (hardest to easiest to endorse) Measure
Model
SE
Infit
MnSq
I spend time doing things that improve my
community
.89 ....
Control over Participation
Summary Statistics
• Person Information
• How well do items differentiate the people?
• Very we...
Control over Participation
Item Statistics (15 retained items)
33
Item (Hardest to easiest to endorse) Measure
Model
SE
In...
People with More Severe Disabilities Report
Less Involvement in Life Situations
Known Groups Validity Evidence
People with More Severe Disabilities
Report Less Control over Participation
Known Groups Validity Evidence
Conclusions
1. Participation as measured by activity frequency, evaluation
and enfranchisement items is not a unidimension...
Feasibility of Measuring
Community Participation
after Rehabilitation
Discharge
Allen Heinemann
Presentation Objectives
1. Evaluate the feasibility of measuring community
participation after inpatient rehabilitation
2....
• Sample Recruitment
• Outcomes Management Systems and Analysis staff invited
discharged adult inpatients to complete stud...
Results
 Of the 457 patients who agreed to participate in the study,
124 (27%) completed the survey.
 Of the 124 patient...
223 11080 44
0
50
100
150
200
250
IVR (Phone) Internet
No
Yes
Response Rate by Telephone and
Internet
41
11.58
16.36
-5 0 5 10 15 20 25 30
IVR (Phone)
Internet
Time (days)
Mean Days to Complete Survey (p=0.049; small effect
Day...
66 56
10
20
30
40
50
60
70
80
90
IVR (Phone) Internet
Age(years)
Mean difference p<0.0005; medium effect
Average Age: Phon...
Results Highlights, continued
 Subjects who completed the CAT by phone
completed the survey sooner than those who
complet...
Conclusions
• CAT administration of participation items by phone
and internet is feasible and cost-effective for
collectio...
Acknowledgements
• Outcomes Management
• Tom Snyder and OMSA Staff
• Brian Arnold
47
For More
Information
Developing Environmental
Factor Measures for
Persons with TBI, Stroke
and SCI
Noelle Carlozzi
Presentation Objectives
• Understand environmental factors and how they
influence participation
• Describe efforts to deve...
ICF Environmental Factors Taxonomy
Products and
Technology
Natural
Environment/
Human-Made
Changes to
Environment
Services...
State-of-the-Art Measurement
• Many ways to assess environmental
factors
• Recent measurement advances are not
captured by...
RRTC Project to Develop Environmental
Factor Measures (TBI, Stroke, & SCI)
• Allen W. Heinemann, PhD
• Rehabilitation Inst...
RRTC Project Progress
• Year 1
– Analyzed existing focus group data
– Reviewed environmental factors literature and
curren...
54
Conceptual Framework
Economic
Quality of Life
Systems
Services and
Policies
Built and Natural
Environment
Assistive
Tec...
Binned and Winnowed Items
55
Domain Binned Winnowed Draft Items
Economic Quality of Life 42 35 44
Systems, Services &
Poli...
Economic Quality of Life
Financial influence on:
• Satisfaction with income level
• Comfortable living situation
• Adequat...
Economic Quality of Life
Sample Items:
• I can afford to eat out when I want.
• I can afford to pay my bills.
• I have del...
Systems, Services, and Policies
Affect on participation:
• Home
• Community
• Work
Five sub-sets:
• Managing health
• Livi...
Systems, Services, and Policies
Sample Items:
• My community offers support groups I can use.
• My community offers inform...
Built and Natural Environment
Features of:
• Home
• Buildings
• Outdoors
How much difficulty do you have...?
• Environment...
Built and Natural Environment
Sample Items:
• How much difficulty would you have feeling safe in your home
during an emerg...
Assistive Technology
Four sub-sets:
• Mobility
• Personal care
• Vision/Hearing
• Communication
Includes:
• Availability
•...
Assistive Technology
Sample Items:
• My device is easy to use.
• My device is reliable.
• My device gives me more control ...
Access to Information & Technology
• Devices and technology to transmit and
receive information
– cell phone, land lines, ...
Sample Items
• I have easy access to the internet if I want to use it.
• My telephone is easy to use.
• Information about ...
Social Environment
Social Support:
• Companionship
• Emotional Support
• Informational Support
• Instrumental Support
Perc...
Social Environment
Sample Items:
• The people in my life are willing to accommodate my disability.
• People are patient wh...
Cognitive Interviewing
• 5 people per impairment group
• Interviews were recorded for transcription
purposes
• Follow-up q...
My doctors, nurses and other health care professionals
give me written information in ways I can understand.
Health care p...
My doctors, nurses and other health care professionals
give me written information in ways I can understand.
Health care p...
My doctors, nurses and other health care professionals
give me written information in ways I can understand.
Health care p...
Cognitive Interviewing
In case of a natural disaster, I can get
the information I need easily.
In case of a health emergen...
Cognitive Interviewing
In case of a natural disaster, I can get
the information I need easily.
In case of a health emergen...
Cognitive Interviewing
In case of a natural disaster, I can get
the information I need easily.
In case of a health emergen...
Preliminary Pilot Test Results
75
Domain/
Rating Scale
Categories
N of
Items
Reliability
(Criterion <.8)
Misfitting Items
...
Preliminary Pilot Test Analyses, cont.
76
Domain/Rating
Scale Categories
N of
Items
Reliability
(Criterion
<.8)
Misfitting...
Preliminary Pilot Test Analyses, cont.
77
Domain/
Rating Scale
Categories
N of
Items
Reliability
(Criterion <.8)
Misfittin...
ECON QOL DATA?
78
Relevance to TBI
79
80
Next Steps
• Complete Data Analysis
– Explore dimensionality of domains
– Explore differential item functioning by impa...
Acknowledgments
Rehabilitation Research and Training Center on
Improving Measurement of Medical
Rehabilitation Outcomes (H...
Upcoming SlideShare
Loading in...5
×

Participation and Environmental Factors Measures For TBI Rehabilitation

505

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
505
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
5
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Some overlaps to ICF but more direct application to categories people with disabilities framed as most influencing their participation choice and control; item sets developed for each.Systems IS THE SAME; Natural and Built is the sameSocial Environment overlaps with support and relationships and attitudesEcon is newTechnology is split in 2
  • Did transportation get binned with something else…?
  • Transcript of "Participation and Environmental Factors Measures For TBI Rehabilitation"

    1. 1. Participation and Environmental Factors Measures For TTBI Rehabilitation Susan Magasi Allen Heinemann Noelle Carlozzi 1
    2. 2. Presentation Overview 1. Developing a measure of community participation after rehabilitation 2. Evaluating the feasibility of computer- adapted administration of a participation measure with discharged rehabilitation patients 3. Measuring the Impact of the Environment on Home, Community and Work Participation for People with Cognitive Disabilities 2
    3. 3. Developing a Measure of Community Participation after Rehabilitation Susan Magasi 3
    4. 4. Presentation Objectives (1) Describe ways to assess participation (2) Evaluate the psychometric properties of community enfranchisement items and develop an item bank that is suitable for computer adaptive testing (CAT) (3) Explore the validity of a composite participation score and measures of community enfranchisement 4
    5. 5. 5 International Classification of Functioning Disability and Health Barriers Facilitators Body Functions & Structures Activities & Participation Environmental Factors Functions Structures Capacity Performance
    6. 6. Project Task Overview 1. Conduct literature review 2. Conduct focus groups with consumers, caregivers, providers, payers, policy makers 3. Develop items and rating scales to operationalize participation 4. Conduct cognitive interviews with consumers and general public 5. Revise items, rating scales 6. Pilot test participation instrument 7. Refine instrument 8. Collect population data from persons with and without disabilities 9. Refine instrument 10. Collect and analyze population data from persons with and without disabilities (Behavioral Risk Factor Surveillance System) 11. Refine instrument 13. Collect 3rd round of data, augmented with panel sample 14. Evaluate CPI as part of routine post-discharge follow- up assessment - underway 6
    7. 7. Construct Development: Stakeholder Focus Groups •Consumers (5) –Chicago, IL –Englewood, CO •Caregivers (6) –Chicago, IL –Englewood, CO •Rehabilitation professionals (4) –Chicago, IL –Englewood, CO •Payers (1) –Insurance Research Group •Policy Makers (2) –Federal: Washington, DC –State: Chicago, Illinois •Total Participants –18 groups –138 participants 7
    8. 8. Focus Group Questions 1. What does the word “participation” mean to you? a) What does it mean “to participate” b) Why is participation important to you? 2. What areas of everyday life are most important to you? a) If taken away, what areas would you miss most/would be the biggest loss to you? 3. What issues or barriers most affect your participation? 4. What are your biggest supports to participation? 5. What recommendations do you have for improving participation opportunities for people with disabilities? 8
    9. 9. Qualitative Analytic Procedures • Analyses and interpretation • Open coding of data by 2 researchers, including team members with disabilities • Topical coding to identify key emerging themes • Detailed coding of • individual data within groups • comparative analysis across individuals • across stakeholder groups •Codes represent • Content themes • Narrative stories & examples • Areas of agreement and differences on specific issues •End product • Participation item pool that reflects the themes and concerns & priorities of multiple stakeholders 9
    10. 10. 10 Focus Group Input Consumers “It means to make some sort of contribution in life” “Working and living” “It's important to socialize” “Just being able to do the things that you enjoy” Care-givers “Just doing what you want to do” “Being able to go to the store, to school, being able to do all of the things that normal people do” Providers “It goes beyond just daily living activities” “What you want when you want with who you want” “You are seen as having something to give” Payers “Allowed to fail, take on challenge” “Lack of information can be as isolating as any physical barrier” Policy Makers “Just the stuff we do and take for granted”
    11. 11. 11 What We Learned: Participation Values Participation Values Choice & Control Access & Opportunity Personal & Societal Responsibilities Having an Impact & Supporting Others Social Connection, Inclusion & Membership Meaningful Engagement/ Being a Part of • Hammel J, Magasi S, Heinemann AW, Whiteneck G, Bogner J, Rodriguez E. What does participation mean? An insider perspective from people with disabilities. Disability and Rehabilitation, 30:19,1445-1460. • Magasi S, Hammel J, Heinemann AW, Whiteneck G, Bogner J. Participation: A comparative analysis of multiple rehabilitation stakeholders’ perspectives. Journal of Rehabilitation Medicine, 41, 936-944, 2009.
    12. 12. Community Participation Indicators Version 1 • Source Material – Focus group thematic codes – Comprehensive literature review • Content Domains – Productive roles (student, worker, and homemaker) – Social roles (spouse or partner, family member, caregiver, caregiver to children or aging parents, relationships with adults and friends – Community roles (volunteer, civic, political, organization, or community group member) 12
    13. 13. CPI Version 1: Content Organization • Engagement (frequency, duration of activities) • Economic / productive (5 items) • Social (5) • Community (11) • Evaluation (agreement, satisfaction) • Economic / productive (4) • Social (5) • Community (1) • Enfranchisement • 19 items • 4-point rating scale 13
    14. 14. Rating Scale Analysis of Enfranchisement Items • BRFSS addendum N = 912 • Self-identified disability = 51% • Person separation reliability = .77 (marginal) • Rating scale • Too easy to endorse items • Item targeting on sample • Mistargeted • Ceiling effect • Item statistics • No misfitting items • No evidence of differential item functioning • Disability vs. nondisability samples • Assessing only frequency of activities ignores appraisal of importance • Revision Decision • Expand enfranchisement items • Assess activity importance, evaluation 14
    15. 15. Conclusions: Participation enfranchisement constitutes a new, previously unmeasured aspect of participation - one that addresses subjective perceptions rather than objective performance - with items that are clearly distinct from more generalized satisfaction with participation. The 19 enfranchisement items describe aspects of participation that may prove useful in characterizing longer-term rehabilitation outcomes.
    16. 16. Community Participation Indicators Version 2 • 20 engagement items • Frequency of activity • Importance of activity • Evaluation of activity frequency • 48 enfranchisement items • Higher “ceiling” sought • Revised rating scale – from 4 to 5 agreement categories 16
    17. 17. 17
    18. 18. 18
    19. 19. 19
    20. 20. Enfranchisement Items • Retained 8 thematic domains • Expanded from 19 to 48 items • Cognitive testing with consumers • New rating scale – All the time – Frequently – Sometimes – Seldom – Almost never 20
    21. 21. 21
    22. 22. 22 Round 3 Data: Sample Characteristics • N = 1163 • Source – Panel survey: 51% – Community sites: 31% – Former inpatients: 18% • Median age = 53 yr (+ 17) • Women = 49% • Race – Caucasian 72% – African-American 12% • Hispanic 7% • Self-report 72% • Impairments – Mobility 63% – Mental 23% – Hearing 14% – Vision 13% – Learning 11% – Communication 9% • Disability Severity
    23. 23. Results: Activity Patterns • Activity Categories • Social activities • Productive activities • Low frequency activities • Activity Importance • Yes / No 23
    24. 24. Social Activities 0% 20% 40% 60% 80% 100% Spend time w family Keep in touch w family Get out & about Keep in touch w friends Spend time w friends Social activities 7 days 5-6 days 3-4 days 1-2 days None
    25. 25. ‘Productive’ Activities 0% 20% 40% 60% 80% 100% Work Child care Home maintenance Household finances Volunteer Learn 35+ h 20-34 h 10-19 h 5-9 h 1-4 h None
    26. 26. 0% 20% 40% 60% 80% 100% Hobbies Active recreation Religious activities Support Groups Entertainment Community organizations Civic activities 5+ d 4 d 3 d 2 d 1 d 0 d Low Frequency Activities
    27. 27. 27 Percent of Important Activities Performed Often Enough Mean = 55% SD = 28 N = 1149
    28. 28. Scoring Decision Activities and Activity Importance • Avoid creating a “busy-ness” index • Personal preferences, opportunities, environmental factors influence activity patterns • Report descriptive information about activity patterns • Evaluate utility of “percent of important activities performed often enough” 28
    29. 29. Rating Scale Analysis of Enfranchisement Items  Began with all 48 items  Used exploratory factor analysis to identify number of subdomains in half the sample  Used confirmatory factor analysis to demonstrate reproducibility in the second half of the sample  Used rating scale analysis with subdomains to evaluate unidimensionality and reliability 1. Involvement in life situations 2. Control over participation 29
    30. 30. Involvement in Life Situations Summary Statistics • Person Information • How well do items differentiate the people? • Very well • Reliability .87 • Item Information • How well do the people differentiate the items? • Exceptionally well • Reliability 1.00 30
    31. 31. Item (hardest to easiest to endorse) Measure Model SE Infit MnSq I spend time doing things that improve my community .89 .04 1.03 I have a say on decisions in my community .61 .03 1.15 I am actively involved in my community .60 .03 .71 I assume leadership roles in organizations .55 .03 1.34 I have influence in my community .39 .03 .84 I participate in a variety of activities .01 .03 .95 I contribute to the well-being of my community -.11 .03 .71 I regularly seek out new challenges -.11 .03 1.09 I contribute to society -.18 .03 .81 People see my potential -.43 .03 .97 I spend time helping others -.43 .03 1.10 I feel safe participating in community activities -.77 .04 1.23 People count on me -1.02 .04 1.19 Involvement in Life Situations Item Statistics (13 retained items)
    32. 32. Control over Participation Summary Statistics • Person Information • How well do items differentiate the people? • Very well • Reliability .87 • Item Information • How well do the people differentiate the items? • Exceptionally well • Reliability 1.00 • Item Fit • I speak up for myself (Infit Mean Square=1.41) 32
    33. 33. Control over Participation Item Statistics (15 retained items) 33 Item (Hardest to easiest to endorse) Measure Model SE Infit MnSq I am able to go out and have fun .75 .04 .97 I actively pursue my dreams and desires .74 .04 .89 I have opportunities to make new friends .72 .04 1.19 I do important things with my life .45 .04 .96 I live my life fully .42 .04 .81 I live my life the way that I want .36 .04 .97 I participate in activities when I want .10 .04 .85 I participate in activities that I choose .08 .04 1.11 I do things that are important to me -.14 .04 .68 I am in control of my own life -.25 .04 1.00 I speak up for myself -.29 .04 1.41 I have choices about the activities I do -.52 .04 .92 I have control over how I spend my time -.57 .04 1.08 I have the freedom to make my own decisions -.74 .04 1.04 I take responsibility for my own life -1.09 .05 1.23
    34. 34. People with More Severe Disabilities Report Less Involvement in Life Situations Known Groups Validity Evidence
    35. 35. People with More Severe Disabilities Report Less Control over Participation Known Groups Validity Evidence
    36. 36. Conclusions 1. Participation as measured by activity frequency, evaluation and enfranchisement items is not a unidimensional construct • Don’t model activity frequency, importance and evaluation in a composite measure • Individuals’ preferences and opportunities vary greatly • Personal preferences determine individual’s participation profile 2. Involvement in and control over participation are distinct constructs that can be measured reliably • Expanded set of community enfranchisement items contains 2 distinct item sets that are suitable for item banking and computer adaptive administration 3. Construct validity of involvement in and control over participation is promising 36
    37. 37. Feasibility of Measuring Community Participation after Rehabilitation Discharge Allen Heinemann
    38. 38. Presentation Objectives 1. Evaluate the feasibility of measuring community participation after inpatient rehabilitation 2. Compare the efficacy of telephone vs. web-based data collection 3. Explore the relationship between functional status and the three aspects of community participation 4. Explore demographic, impairment, and rehabilitation variables as they relate to community participation
    39. 39. • Sample Recruitment • Outcomes Management Systems and Analysis staff invited discharged adult inpatients to complete study instruments after they completed a 1-month post-discharge telephone satisfaction survey. • Survey administration • Patients chose to complete the survey on a secure web site or using an interactive voice response system. • Questions were administered using a computer-adaptive testing (CAT) algorithm based on calibration of the items relating to involvement in life situations and control over participation • Data analysis • Participation data from the CAT were matched to de-identified inpatient data and analyzed using SPSS software. Method 39
    40. 40. Results  Of the 457 patients who agreed to participate in the study, 124 (27%) completed the survey.  Of the 124 patients who completed the survey, 66% did so by phone and 34% by internet.  Completion rates were similar for both modes of completion.  Subjects who agreed to participate were younger than those who did not agree to participate.  Subject who completed the survey by phone were older than those who completed the survey by internet. 40
    41. 41. 223 11080 44 0 50 100 150 200 250 IVR (Phone) Internet No Yes Response Rate by Telephone and Internet 41
    42. 42. 11.58 16.36 -5 0 5 10 15 20 25 30 IVR (Phone) Internet Time (days) Mean Days to Complete Survey (p=0.049; small effect Days to Complete the Instrument 42
    43. 43. 66 56 10 20 30 40 50 60 70 80 90 IVR (Phone) Internet Age(years) Mean difference p<0.0005; medium effect Average Age: Phone vs. Internet 43
    44. 44. Results Highlights, continued  Subjects who completed the CAT by phone completed the survey sooner than those who completed the survey by the internet.  Older adults reported doing enough of their important activities than did younger adults.  Functional status as measured by the FIM was unrelated to involvement, control, or important activities performed often enough. 44
    45. 45. Conclusions • CAT administration of participation items by phone and internet is feasible and cost-effective for collection of post-rehabilitation outcome data. • Older subjects prefer the telephone to the internet. • The three measures of community participation are not related to FIM scores, indicating that they are measuring a unique aspect of a patients’ experience. • Further studies are needed to evaluate the validity and reliability of participation scores. 45
    46. 46. Acknowledgements • Outcomes Management • Tom Snyder and OMSA Staff • Brian Arnold
    47. 47. 47 For More Information
    48. 48. Developing Environmental Factor Measures for Persons with TBI, Stroke and SCI Noelle Carlozzi
    49. 49. Presentation Objectives • Understand environmental factors and how they influence participation • Describe efforts to develop measures of environmental factors that influence participation • Discuss preliminary findings using these measures in TBI
    50. 50. ICF Environmental Factors Taxonomy Products and Technology Natural Environment/ Human-Made Changes to Environment Services, Systems, and Policies Attitudes Support and Relationships 50
    51. 51. State-of-the-Art Measurement • Many ways to assess environmental factors • Recent measurement advances are not captured by the current environmental factors measures • Future work is needed to develop “smart tests” that can assess environmental factors using state-of-the-art measurement development techniques (IRT and CAT) 51
    52. 52. RRTC Project to Develop Environmental Factor Measures (TBI, Stroke, & SCI) • Allen W. Heinemann, PhD • Rehabilitation Institute of Chicago • David Tulsky, PhD • University of Michigan • Noelle Carlozzi, PhD • University of Michigan • Pam Kisala, MA • University of Michigan • Sofia Garcia, PhD • Northwestern University • Beth Hahn, MA • Northwestern University • Susan Magasi, PhD • Northwestern University • Jin-Shei Lai, PhD • Northwestern University • David Gray, PhD • Washington University • Holly Hollingsworth, PhD • Washington University • Joy Hammel, PhD • University of Illinois at Chicago
    53. 53. RRTC Project Progress • Year 1 – Analyzed existing focus group data – Reviewed environmental factors literature and current measures – Developed conceptual framework – Pooled, binned, winnowed, wrote items • Year 2 – Completed several rounds of cognitive testing – Completed pilot data collection – Data analysis in progress 53
    54. 54. 54 Conceptual Framework Economic Quality of Life Systems Services and Policies Built and Natural Environment Assistive Technology Access to Information and Technology Social Environment Environmental Factors
    55. 55. Binned and Winnowed Items 55 Domain Binned Winnowed Draft Items Economic Quality of Life 42 35 44 Systems, Services & Policies 411 35 40 Built & Natural Environment 684 88 75 Assistive Technology 178 104 24 Access to Information & Technology 112 37 32 Social Supports & Attitudes 710 59 65 Total 2212 358 280
    56. 56. Economic Quality of Life Financial influence on: • Satisfaction with income level • Comfortable living situation • Adequate and affordable health services • Adequate and affordable food • Affordable community recreational activities • Family and friend financial assistance 56
    57. 57. Economic Quality of Life Sample Items: • I can afford to eat out when I want. • I can afford to pay my bills. • I have delayed getting health care because I couldn’t pay for it. • I have access to extra money in case of an emergency. 57
    58. 58. Systems, Services, and Policies Affect on participation: • Home • Community • Work Five sub-sets: • Managing health • Living situation • Community participation • Work • Transportation 58
    59. 59. Systems, Services, and Policies Sample Items: • My community offers support groups I can use. • My community offers information on low or no cost activities and things to do. • Disability accommodation services and supports are available at my work or school. • Public transportation in my area is reliable. 59
    60. 60. Built and Natural Environment Features of: • Home • Buildings • Outdoors How much difficulty do you have...? • Environmental ? • Non-environmental ? 60
    61. 61. Built and Natural Environment Sample Items: • How much difficulty would you have feeling safe in your home during an emergency? • The difficulty I have feeling safe is due to problems getting out or getting help in an emergency. (yes – no) • How much difficulty do you have hearing sounds such as voices and music in buildings in your community? • The difficulty I have hearing sounds is due to background noise. (yes – no) 61
    62. 62. Assistive Technology Four sub-sets: • Mobility • Personal care • Vision/Hearing • Communication Includes: • Availability • Quality • Impact 62
    63. 63. Assistive Technology Sample Items: • My device is easy to use. • My device is reliable. • My device gives me more control over my daily activities. • My device allows me to participate in activities that I enjoy. 63
    64. 64. Access to Information & Technology • Devices and technology to transmit and receive information – cell phone, land lines, computer, email, and internet services • Usability of this information/technology – ability to access and understand information, literacy, transparency, information finding 64
    65. 65. Sample Items • I have easy access to the internet if I want to use it. • My telephone is easy to use. • Information about community resources is easily available to me if I need it. • In case of a health emergency I can get the information I need easily. 65 Access to Information & Technology
    66. 66. Social Environment Social Support: • Companionship • Emotional Support • Informational Support • Instrumental Support Perceived Positive & Negative Disability-related Attitudes & Behaviors: From: • Family/Friends • Community • Society / Public Including: • Acceptance • Stigma • Marginalization 66
    67. 67. Social Environment Sample Items: • The people in my life are willing to accommodate my disability. • People are patient when I take extra time to do things because of my disability. • Criminals see people with disabilities as easy targets. • Because of my disability, my family complains that I am too needy. • Society respects the need for disability accommodations. • Society limits my opportunities because of my disability. • People with disabilities are encouraged to participate in my community. 67
    68. 68. Cognitive Interviewing • 5 people per impairment group • Interviews were recorded for transcription purposes • Follow-up questions were asked intentionally after each question • Comprehension • Opinions • Recommendations 68
    69. 69. My doctors, nurses and other health care professionals give me written information in ways I can understand. Health care providers’ elicited too narrow a response; ‘Doctors and nurses’ named explicitly. My health care providers give me written information in ways I can understand. 69 Cognitive Interviewing
    70. 70. My doctors, nurses and other health care professionals give me written information in ways I can understand. Health care providers’ elicited too narrow a response; ‘Doctors and nurses’ named explicitly. My health care providers give me written information in ways I can understand. 70 Cognitive Interviewing
    71. 71. My doctors, nurses and other health care professionals give me written information in ways I can understand. Health care providers’ elicited too narrow a response; ‘Doctors and nurses’ named explicitly. My health care providers give me written information in ways I can understand. 71 Cognitive Interviewing
    72. 72. Cognitive Interviewing In case of a natural disaster, I can get the information I need easily. In case of a health emergency, I can get the information I need easily. ‘Emergency’ was too broad; broke item up into personal health/environmental. In case of an emergency, I can get the information I need easily. 72
    73. 73. Cognitive Interviewing In case of a natural disaster, I can get the information I need easily. In case of a health emergency, I can get the information I need easily. ‘Emergency’ was too broad; broke item up into personal health/environmental. In case of an emergency, I can get the information I need easily. 73
    74. 74. Cognitive Interviewing In case of a natural disaster, I can get the information I need easily. In case of a health emergency, I can get the information I need easily. ‘Emergency’ was too broad; broke item up into personal health/environmental. In case of an emergency, I can get the information I need easily. 74
    75. 75. Preliminary Pilot Test Results 75 Domain/ Rating Scale Categories N of Items Reliability (Criterion <.8) Misfitting Items Weakly Correlated Items Residual Variance (Criterion <10%) CFA Results Access to Information & Technology/4 25 .82 10 fax 11 phone easy 11 phone easy use 12 phone reliable 17 radio available 18 radio reception 10.2% Multidimensional Assistive Technology- Mobility/5 14 .73 9 Replace device None 12.2% Multidimensional Assistive Technology- Personal Care/4 14 .66 26 Variety places None 15.0% Multidimensional Built & Natural/5 18 .72 None 4 conversations @ home 15 hear sounds outdoors 7.6% Good
    76. 76. Preliminary Pilot Test Analyses, cont. 76 Domain/Rating Scale Categories N of Items Reliability (Criterion <.8) Misfitting Items Weakly Correlated Items Residual Variance (Criterion <10%) CFA Results Systems Services Policies: Health/4 11 .72 None 3 Emergency medical 11.2% Pending Systems Services Policies: Home/4 20 .84 22 Food None 9.4% Pending Systems Services Policies: Community/4 11 .85 37 Legal None 7.2% Pending Systems Services Policies: Work, Learn, 4 12 .75 . 43 Library 51 SSDI 43 Library 9.4% Pending Systems Services Policies: Transport/4 11 .74 57 Air travel 58 Car access None 12.9% Pending Systems Services Policies: Alt Transport/4 8 .59 None None 11.7% Pending
    77. 77. Preliminary Pilot Test Analyses, cont. 77 Domain/ Rating Scale Categories N of Items Reliability (Criterion <.8) Misfitting Items Weakly Correlated Items Residual Variance (Criterion <10%) CFA Results Social Environment: Personal/4 26 .95 24 Encouraged 32 Criminals 34 “Special” 63 Unhelpful 64 Public 32 Criminals 64 Public 5.7% Pending Social Environment: Societal/4 56 .94 70 Criminals 78 Underestimates 70 Criminals 8.2% Pending Economic Quality of Life/5 37 .92 17 Meds 26 Utilities 33 6 months 34 Improve 36 $ important 13 HVAC 17 Meds 26 Utilities 34 Improve 36 $ important 4.8% 0.1
    78. 78. ECON QOL DATA? 78
    79. 79. Relevance to TBI 79
    80. 80. 80 Next Steps • Complete Data Analysis – Explore dimensionality of domains – Explore differential item functioning by impairment group • Field Testing – Recruit 200 participants with TBI, 200 with Stroke, and 200 with SCI (N=600) – Administer EF items banks, legacy measures, newly developed social participation measures (TBI-QOL) and traditional neuropsychological measures
    81. 81. Acknowledgments Rehabilitation Research and Training Center on Improving Measurement of Medical Rehabilitation Outcomes (H133B090024) Rehabilitation Research and Training Center on Measuring Rehabilitation Outcomes and Effectiveness (H133B040032) 81
    1. A particular slide catching your eye?

      Clipping is a handy way to collect important slides you want to go back to later.

    ×