Frequently asked questions
... and their answers
What is the Enabler concept?
“The Enabler” was originally published as an idea that was supposed to serve as a basis for the design of accessible housing and public environments. The design of the Enabler concept makes it clear that accessibility problems arise in the relation between the individual and the environment. Methods based on the Enabler concept make predictive, objective, and norm-based assessment and analysis of accessibility problems in the physical environment possible.
Assessments and analyses are carried out in several steps. The first (Step 1) concerns functional limitations in an individual or a group/population. To assess functional limitations as regards mobility, perception, and dependence on mobility aids, an interview is conducted in combination with observation (15 assessment items). The assessment results in a “functional profile”. If the assessment instead concerns a group/ population, the 15 items are used to determine a functional profile at group level. The basis for a functional profile at group level consists of epidemiological data in combination with experience of work with clients from different diagnosis and user groups. Step 2 involves a detailed environmental assessment comprising a large number of assessment items; the environmental part of the Housing Enabler comprises 188 items. The third step is to calculate a total score, that is, a quantification of the degree of accessibility problems in a particular case. The total score predicts the load caused by a particular combination of functional limitations and environmental design, thus giving a predictive measure of the degree of accessibility problems. The higher the score, the greater the accessibility problems. The analysis makes it clear that accessibility is a relative concept, since problems only arise when environmental design is put in relation to an individual or group/population with functional limitations. This means that the total score is always 0 if the individual or population has full functional capacity, whatever the design of the environment.
It is important to notice that any assessment based on the Enabler concept yields an objective, professional, normbased, and predictive result. In order to capture subjective, user-oriented data, another kind of instrument must be used.
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Who invented the Enabler concept?
The concept was developed by Professor Edward Steinfeld as he worked with research into issues of accessibility that gradually led to the housing standards of the American National Standards Institute (ANSI). The original publication was published in 1979. Professor Steinfeld is now with the IDEA Center, University at Buffalo, N. Y., US.
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Who can benefit from the Enabler concept?
The Housing Enabler is above all intended for use in occupational therapy: in clinical practice, in research and development, and in education. Although it requires the competence of an occupational therapist to achieve a complete, valid, and reliable assessment and analysis with Enabler instruments as developed by Iwarsson et al., other professional groups may benefit from the instrument. The result of assessments based on the Enabler concept can be used, for example, as a basis for planning and discussion in the building process and in the handicap movement. Assessment instruments based on the Enabler concept can be used in practice and education, and they are efficient for quality development of accessibility assessments.
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What is the Housing Enabler?
The first versions of the instrument were called the Enabler, but since the concept has subsequently been used as a basis for developing the method for the assessment and analysis of other parts of the physical environment, the present instrument is now called the Housing Enabler. The Housing Enabler is the first reliable and valid assessment instrument based on the Enabler concept, and still the only of the Enabler instruments that has reached the standards allowing it for common use.
The Housing Enabler begins with a descriptive part concerning individual or group data and housing standard. This is followed by the first step of the actual Enabler assessment, which means that an interview is conducted in combination with observation, with the aim of assessing the individual's functional limitations (15 items). The second stage, the environmental assessment, comprises 188 items concerning the home and its immediate vicinity. These are divided into sections for the outdoor environment, entrances, indoor environment, and communication. In Step 3, pre-defined points for the various assessment items in the environmental assessment are used to calculate a total score predicting the degree of accessibility problems in a particular case.
A study was carried out to test inter-rater reliability, with 77 Swedish occupational therapists taking part. The results showed that the instrument has high or very high reliability. Moreover, during the course of the study the definitions and instructions were successively clarified, which led to improvements in the content validity of the instrument. Since 1994, the Housing Enabler is in use by occupational therapists in empirical studies, in tuition, and in working practice.
In 2000, a software for more efficient analysis of Housing Enabler data was launched, Housing Enabler 1.0.
It is important to notice that a Housing Enabler assessment yields an objective, professional, normbased, and predictive result. In order to capture subjective, user-oriented data, another kind of instrument must be used.
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Is it possible to assess other parts of the physical environment than the housing environment by use of the Housing Enabler?
Autumn 1997 saw the start of an interdisciplinary project intended to develop knowledge of the demands that different traffic solutions make of the individual, so that it will be possible to assess which traffic systems are optimal for different groups of users. Currently, the environmental assessment section of the Enabler concept is being developed to cover the travel chain by public transport. By definition, travel chains comprise extensive parts of the private as well as the public environment. This work is done in collaboration between the Department of Clinical Neuroscience and the Department of Technology and society at Lund Institute of Technology. Ms Gunilla Jensen is a doctoral student doing major parts of this work, under tuition of associate professor S. Iwarsson and professor A. Ståhl.
Furthermore, the Enabler concept can be used as a basis for assessing and analysing accessibility problems in public facilities. Work is currently in progress to develop and test environmental assessment sections for public places.
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Do you have to use the software Housing Enabler 1.0?
In cases where there is no need for a quantitative measure of the degree of accessibility problems, the presentation of the results and the analysis can be based on the introductory description, the assessments of functional limitations including dependence on mobility aids (Step 1), and the environmental assessment (Step 2). Taken together, these parts of the Housing Enabler constitute a systematic and qualified checklist.
As soon as you want to proceed and use Stage 3 of the method, i. e. calculating the total score, you are strongly recommended to use the software. However, it is possible to calculate this step manually, but it is time consuming and given the amount of data the risk of miscalculations is obvious. A large number of analyses can be performed by use of the Housing Enabler 1.0 program, e. g.:
- The most prevalent functional limitations, including dependence on dependence on mobility aids, at individual or group level.
- The most prevalent problematic environmental details, at individual or group level, for a particular home or a housing area/district.
- The details in the environment which cause most accessibility problems in a particular home or a housing area/district, at individual or group level.
- Comparisons of accessibility in different housing alternatives on the basis of a profile of functional limitations including dependence on mobility aids, at individual or group level.
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Are the pre-defined scores of Step 3 valid?
According to Steinfeld et al., the points have been established on the basis of many years' practical experience of work with accessibility issues and after discussions with a long series of experts and users, which has improved the content validity. Detailed validation on empirical grounds would appear to be an almost unreasonable task, above all in view of the infinite number of possible combinations of functional limitations and details in the physical environment. As part of Iwarsson et al.'s work of developing the environmental assessment section for use in other parts of the physical environment, however, introductory attempts will be made to validate the scoring. Studies so far have shown that the instrument has high content validity and moreover external validity both in relation to the Swedish National Board of Housing's surveys of implemented adaptation measures, and in relation to results from internationally published studies in the field. Ongoing studies on covariation between objective, norm-based Housing Enabler analyses and results of users' subjective rating of accessibility problems will give more knowledge about the validity. It is important to note, however, that assessments based on the Enabler concept, despite the degree of detail, only give crude predictive results.
In the course of the work we have found in detailed analyses that there are some inconsistencies in the scoring, but we have chosen to retain the grading in the original instrument. In the present version the inconsistencies that have become obvious during several years' work with the instrument have been changed in accordance with the principles stated in the 2000 version of the book Housing Enabler. In relation to the amount of material that the assessment comprises and the often high scores it generates, a discrepancy of a few points because of possible inconsistencies is of marginal significance. This of course means that the degree of accessibility problems should be stated in terms of relatively large differences in points. Only after further studies will we be able to give recommendations as to the accuracy with which rating results should be reported.
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How high is a normal Housing Enabler score?
An important part of the development of standardized methods of assessment and analysis is the establishment of normal values, insofar as they are relevant for the instrument in question. Since the Housing Enabler involves rating both an individual/population and a housing environment, it would require extensive work to arrive at normal values. The question is what can be considered “normal” as regards accessibility. Besides variations between individuals depending on age, gender, diagnosis groups, and the like, there are great variations in housing environment between different parts of Sweden, between town and country, between different types of dwelling, etc. A large number of empirical studies are needed if we are to establish normal values, if this is at all possible and meaningful. Perhaps 0 should be regarded as the normal value, since this is the total score in all cases where the individual does not show any of the functional limitations assessed by the instrument.
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Can only occupational therapists use the Housing Enabler?
The approach is primarily suited to competence in occupational therapy. For rating at individual level, the rater must be able to perform systematic data collection with the combination of interview and observation technique that an occupational therapist normally uses in practical work with patients. Rating at group level requires current knowledge of the combinations of functional limitations that are most common in different diagnosis groups, and preferably a basic knowledge of epidemiology and statistics.
The environmental analysis requires a familiarity with assessing physical barriers in the built environment and up-to-date knowledge of standards and functional demands from the point of view of accessibility.
In conclusion, the rater must be familiar with the procedures as described above. If he or she is not an occupational therapist, the kind of competence required must be achieved. A straightforward answer is that it is difficult for persons outside the profession of occupational therapy to administer Step 1 in a reliable and valid way, while Step 2 could be administered by architects or technicians as well. If different professions are involved, we strongly encourage close co-operation, especially when it comes to the analysis.
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Do you have to attend a special training course to use the Housing Enabler?
For reliable administration of the Housing Enabler and correct data processing, it is recommended that the rater should contact the authors for special training. The instrument is comprehensive, which means that it needs not only training but also practice and experience before one masters the instrument well enough to be aware of its advantages. The courses are very popular, and in our experience necessary to really prepare the rater for efficient use of the methodology. However, anybody who fulfils the requirements as specified under the question Can only occupational therapists use the Housing Enabler? is allowed to try to use the instrument, without any formal authorisation. In such cases, it is very important that the user takes full responsibility for informing his or her clients that the result of the assessment and analysis might have low reliability and validity.
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What kind of equipment is required for a Housing Enabler assessment?
To be able to carry out the rating, one must have access to this manual, including rating forms, a rule, and the handbook Bygg ikapp handikapp, second edition comprising current Swedish accessibility norms, or corresponding guidelines for the relevant country. Rating forms may be copied freely for one's own use or printed from the files that are copied to the computer hard disk when the Housing Enabler 1.0 program is installed. Original forms in A4 format may also be ordered at cost price from S. Iwarsson. In addition, with the aid of the program one can print a short version of the rating forms. Scores can be calculated manually, but access to a computer with the program Housing Enabler 1.0 is strongly recommended.
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Where can I read more about the Enabler concept and the Housing Enabler?
The book Housing Enabler and the software Housing Enabler 1.0 are available in Swedish as well as in English. (For price information, check the pricelist) Furthermore, other publications are available in scientific journals and several other books.
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This page was last updated 2001-12-05
Webmaster Björn Slaug