An Item Bank to Measure Systems, Services, and Policies: Environmental Factors Affecting People with Disabilities

Publication date: Available online 14 July 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jin-Shei Lai, Joy Hammel, Sara Jerousek, Arielle Goldsmith, Ana Miskovic, Carolyn Baum, Alex W.K. Wong, Jessica Dashner, Allen W. Heinemann
ObjectivesTo develop a measure of perceived Systems, Services, and Policies facilitators (Chapter 5 of the International Classification of Functioning, Disability, and Health) for people with neurological disabilities and evaluate the influence of perceived SSP facilitators on health-related quality of life.DesignA mixed-methods approach was used to develop items, refine them through cognitive interviews, and evaluate their psychometric properties. Confirmatory Factor Analysis (CFA) including one-factor CFA and bi-factor analysis were used to evaluate unidimensionality of items. Rasch analysis was used to identify misfitting items. Correlational and analysis of variance methods were used to evaluate construct validity.SettingCommunity-dwelling individuals participated in telephone interviews or traveled to the academic medical centers where this research took place.ParticipantsParticipants had a diagnosis of spinal cord injury, stroke or traumatic brain injury. They were age 18 or older and English speaking.InterventionNot applicableMain Outcome MeasureAn Item Bank to Evaluate Environmental Access and Support Levels of Services, Systems, and Policies for People with DisabilitiesResultsWe identified a general factor defined as "access and support levels of the Services, Systems and Policies at the level of community living" (abbreviation, SSP) and three local factors defined as "Health Services," "Community Living," and "Community Resources." The SSP measure correlated moderately with Participation measures: CPI – Involvement, CPI-Control over Participation, NeuroQOL - Ability to Participate, NeuroQOL – Satisfaction with Role Participation, PROMIS Ability to Participate, PROMIS Satisfaction with Role Participation, and PROMIS –Isolation.ConclusionsThe measure of Systems, Services and Policy facilitators contains items pertaining to health services, community living, and community resources. Investigators and clinicians can measure perceptions of SSP resources reliably with the items described here. Moderate relationships between SSP facilitators and PROMIS and CPI variables provide support for the measurement and theory of environmental influences on social functioning related to participation.



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