Ongoing projects related to the Enabler concept and Housing Enabler

The Housing Enabler and related products have been and are applied in numerous research and development projects, in Sweden and in several other countries. All projects have their Principal Investigators, acting in their capacity as researchers employed by universities or similar authorities. In projects involving product development, Slaug Enabling Development is engaged as a sub-contractor.


Nordic Housing Enabler

The ultimate goal of this project is to establish national versions of the Housing Enabler in Denmark, Finland, and Iceland, preserving characteristics allowing for valid cross-national comparisons. First, the Housing Enabler will be translated into Danish, Finnish, and Icelandic, and adapted to the respective countries' legislation on housing design. Secondly, the translated and adapted versions will be tested for aspects of feasibility and reliability in the respective national contexts. When it comes to methodology for the accomplishment of this project, Iwarsson's research team has extensive experiences and specific competence. During a three-year project funded by the European Commission, systematic methodology for trans-lation, adaptation, and implementation of cross-national versions of the Housing Enabler was developed. Thus, this project is part of a continuous developmental process supporting cross-national implementation of research-based methodology into practice contexts. Since extensive experiences already have been gained, the proposed project has considerable poten-tial to create possibilities for practice implementation in the Nordic countries. The intention is to support quality development and efficiency in housing adaptation case manage-ment and housing provision for senior citizens and persons with disabilities, with unique possibilities to make cross-national comparisons as a positive spin-off effect

Susanne Iwarsson, Tina Helle, Aiala Pikkarainen, Gregers Gregersen, A-G Hansen, Björn Slaug, Arne Johannisson, Carita Nygren

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Housing adaptation planning - Implementing research-based methodology in community praxis

The aim of the project was to demonstrate and implement scientific methods for the assessment and analysis of the physical environment in connection with housing adaptations in municipal activity. All the occupational therapists in Kristianstad municipality were trained to carry out data collection and analysis with the Housing Enabler instrument. Housing adaptation cases were successively registered in a common database in order to provide material on which to base decisions as part of the municipal housing provision for people with functional disabilities. The project also aimed to improve the quality of occupational therapists' handling of housing adaptation cases. Dissemination of information inside and outside the municipality has been an important component, for example, to the public works department, to builders, property owners and pensioners' organizations. The project has generated important knowledge about possibilities and challenges in processes intended to translate research methods into practical activity. The challenges concerned, for example, the use of IT, attitudes to R&D and the translation of collected data into information of practical use for planning. In order to penetrate the problem further, focus group interviews were also held with the occupational therapists. Politicians and officials in the municipal care department are very satisfied with the project and its results, and it has been decided that the method will continue to be used after the end of the project.

During the project the technology for data collection has also been further developed and made more effective. A specific interface for data entry of Housing Enabler assessments on palm computers has been launched and taken into practice.

The project closed at the end of 2005 and the results were presented at a well-attended conference in Kristianstad in January 2006. Data processing and scientific publication will continue in 2006. The results are expected to stimulate the development of cooperation between researchers and practitioners, which in the long term should be able to have a positive effect on quality in municipal health care and matters such as housing provision.

Susanne Iwarsson, Agneta Fänge, Björn Slaug, Ralf Risser, Arne Johannisson

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Towards environments supportive for activity and health - Development of physical accessibility assessment instrument

Swedish legislation has long prescribed that the physical environment should be accessible and useable by everyone. There are still deficiencies, and there is a great need for reliable methods of assessment and analysis as a basis for community planning. The project aims to develop methods for assessment and analysis of accessibility problems, to hasten the development of supportive environments for activity and health in order to achieve the vision of "a society accessible for everyone". The target group is persons with functional disabilities, both young and old, and the project was confined to the public outdoor environment and public places in the immediate surroundings in the community. The project also involves developing concepts and theories. The project has four parts, all based on the Enabler concept; three parts for developing assessment instruments and methods of analysis and one part for software development. The parts are based on analyses of existing data material, while users and professional experts will participate in new data collection in the form of participant observation and focus group interviews. The first results of the project will be presented in 2006.

Susanne Iwarsson, Gunilla Carlsson, Agneta Ståhl, Agneta Fänge, Carita Nygren, Oliver Schilling, Björn Slaug

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Evidence-based housing adaptations

The aim is to develop a standardised, evidence-based housing adaptation (HA) case management model, and to test this new approach in real municipality contexts. The aim is also to generate further knowledge on the effects of HA on client and municipality level. The new model will comprise evidence-based procedures for assessment, analysis, certification, intervention and evaluation, targeting structures, processes and outcomes on client, professional and administrative levels. In order to develop the model data will be collected by document analysis, e.g. HA certifications, invoices, and municipality files, a postal questionnaire survey, as well as by expert panels and work-shops engaging user organizations, HA clients, case managers, etc. Ongoing HA cases will be strategically selected, and investigated in-depth, combining interviews, document analyses, etc. Thereafter, a full scale controlled trial will be accomplished. HA cases in a trial municipality will be managed according to the new model, while another municipality, applying ordinary HA case management practices will be used as control district. In each municipality client level data on usability and ADL dependence will be collected at home visits to 200 clients prior to HA, and at three times after. Effects on the municipality level are e.g. number and costs of HA, and time requirement. A new wave of case studies will be conducted. Effect comparisons will be computed on client as well as municipality levels.

Susanne Iwarsson, Agneta Fänge, Katarina Lindberg, Björn Slaug, Ralf Risser

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The significance of the physical housing environment for dependence in activities of daily living - The Hässleholm Home & Health Study

A selection of old people in ordinary housing in the municipality of Hässleholm was followed for ten years (1994/95-2004/5), with the overall aim of investigating the association between different aspects of housing and health. At baseline the 133 subjects were aged 75-84. Those who could be reached for follow-up have been interviewed/assessed using quantitative methods on a further two occasions, after six (n=72) and ten years (n=34). After ten years, 14 people moreover took part in a qualitative in-depth interview study. The data collection for the project is thereby completed, but data from the ten-year follow-up have not yet been analysed. The results show that there are environmental obstacles in all dwellings. Among the most common, for example, the washbasin was placed at a height for standing, with an S-bend, cabinet or other obstacle underneath, and kitchens lacking a place to sit while doing kitchen work. The environmental obstacles that caused most accessibility problems included: lack of support handles in rooms for hygienic functions, high-placed wall cabinets and deep floor cabinets in kitchens, and steps and high thresholds in the entrance hall. At the six-year follow-up almost all reported that they were satisfied with their housing, and few people had plans to move. The occurrence of environmental obstacles was fairly unchanged over time, while increased occurrence of functional limitations and use of mobility aids meant that accessibility problems increased in scope. Already at baseline, statistically certain associations were found between accessibility problems in the home and dependence on help in activities of daily living (ADL) and between subjective well-being and accessibility problems. The follow-up after six years showed that both ADL dependence and accessibility problems had increased and that associations between these variables were found, as at baseline, in the subgroup of people living in homes with the most accessibility problems. The results can be used for planning housing and supportive measures for the elderly, for example, in the form of housing adaptation, providing assistive devices, home rehabilitation, home health care and home help.

Susanne Iwarsson, Carita Nygren, Git Wilson, Gunilla Carlsson

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Methods for the evaluation of accessibility, performance of daily activities and well-being in relation to housing adaptations.

The purpose of this project is to develop strategies for the evaluation of the effects of housing adaptations, and to explore the relationships between housing accessibility, dependence in daily activities, and subjective well-being. In forthcoming studies, knowledge on the relations between subjective and objective accessibility assessments will be generated, providing the basis for further validation of the methods used. The study district is Kristianstad, a local municipality with 74.000 inhabitants, in rural as well as urban areas. During home-visits during housing adaptation processes, prior to and twice after intervention, the occupational therapists in the district collect data. They have had special training for the administration of the four instruments previously described. Among the 700 persons receiving housing adaptation grants in Kristianstad during one year, applying specific inclusion criteria, 131 were consequently included during an 18 months period.

Agneta Fänge, Susanne Iwarsson

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Longitudinal studies of relationships between health, functional capacity, activity, participation, and environmental factors in an elderly general population.

In 1994/95, baseline data collection was performed on home-visits to 133 persons aged 75 to 84, in ordinary housing in the local municipality of Hässleholm. The Housing Enabler, the revised version of the ADL Staircase, and the Gothenburg Quality of Life Instrument were administered at home-visits. The main finding was that dependence in ADL correlated highly significantly with housing accessibility problems. The results revealed significantly more disability in the group in which high environmental demand was identified, supporting Lawton's docility hypothesis. The results indicated that physical environmental measures such as housing adaptations most likely have the effects intended (Iwarsson & Isacsson, 1997a; Iwarsson et al., 1998). With these results, a potential public health problem of relevance for occupational therapy has been defined: housing accessibility problems covary with the prevalence of ADL disability in the elderly population.

During 2000/01 a follow-up has been conducted. After identification of the respondents still alive and living in the district (N=90), an occupational therapist collected data on home-visits, using the same instruments as before with the subjects possible to reach (N=72). Data analysis in progress allows for longitudinal studying of relationships between health, functional capacity, activity, participation, and environmental factors in an ageing population. Forthcoming, data will be used for studies comparing the factors at target between a general population and geriatric rehabilitation patient samples.

Susanne Iwarsson, Git Wilson

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Development of methods for public transportation accessibility assessments.

The aim of this project is to develop knowledge about the demands different transportation alternatives put on individuals with functional limitations, in order to assess the optimal design of different transportation systems in relation to different groups of users. The first studies of this project concerned the development of a pilot version of the Travel Chain Enabler, an instrument for the assessment of accessibility in the travel chain (Iwarsson, Carlsson & Ståhl, 2000; Carlsson, Iwarsson & Ståhl, in press). In a study currently running, elderly travellers with functional limitations have been recruited from among the people habitually travelling by Special Transportation Service buses. By the use of focus group interviews with elderly people with similar functional limitations further validation of the Travel Chain Enabler instrument will be accomplished.

Gunilla Carlsson, Susanne Iwarsson, Agneta Ståhl

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Development of methods for accessibility assessments in public places – The Public Environment Enabler.

The Enabler Concept can be used as a basis for assessing and analysing accessibility problems in public places. The aim of this project is to develop and test environmental assessment sections for public places which will be usable for “tailored” assessments. The goal is to provide an extensive pool of environmental items, covering most of the physical environment in public places, for assessments in accordance with the Enabler Concept. To date, a minor study of the interrater reliability of a pilot version of the Public Environment Enabler has been accomplished, demonstrating promising results.

Pia Hovbrandt, Gunilla Carlsson, Susanne Iwarsson, Agneta Ståhl

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Assessment of person-environment relations in terms of accessibility problems – Methodological and theoretical aspects.

During several years, the process of developing instruments for accessibility assessments has been running. The main focus of this project is further methodological development based on the Enabler Concept, in collaboration between Iwarsson's research team and a research team at Lund Technical University (Iwarsson & Ståhl, 1999). Recently, the revised version of the Housing Enabler (Iwarsson & Slaug, 2000) was published, along with a soft-ware intended for more efficient data analyses (Slaug & Iwarsson, 2000). Instruments based on the Enabler Concept produce objective norm based data. Another intention of this project is to develop instruments allowing for the assessment of subjective aspects of accessibility problems. So far, two different approaches have been applied, targeting 1) user's subjective apprehension of accessibility problems (Fänge & Iwarsson, 1999) and 2) user's priorities among public facilities (Fänge, Iwarsson & Persson, in press). Forthcoming studies will focus the relationships between objective and subjective dimensions of the phenomena, generating further knowledge on theoretical and methodological issues in the field as well as knowledge directly applicable in societal planning. Furthermore, software applications will be subsequently developed, supporting the methodological development within this project.

Susanne Iwarsson, Agneta Ståhl, Björn Slaug, Gunilla Carlsson, Agneta Fänge

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Enabling Autonomy, Participation, and Well-Being in Old Age: The Home Environment as a Determinant for Healthy Ageing, ENABLE-AGE.

The main aim of the ENABLE-AGE project is to examine the home environment as a determinant for autonomy, participation, and well-being in very old age in a longitudinal perspective. More specifically, e. g. to explore country specific housing-related societal support as represented in personal situations; to provide an update of housing policies and legislation; to provide a home assessment standard methodology; to provide policy recommendations in housing issues across the EU. The novel scope of this project is to explicitly consider subjective and objective person-environment relationships as important determinants to healthy ageing, in a European perspective. A macro level update on housing policies (the ENABLE-AGE Update Review) will support the project process, integrated with the knowledge generated by the ENABLE-AGE Survey Study (N=2000) and the ENABLE-AGE In-Depth Studies (N=200).

A wide range of well-proven measurements will be administered at home-visits with very old people, randomly sampled in five partner countries. The design is longitudinal, comprising two measurement points (T1 and T2) with a one-year interval. For the qualitative ENABLE-AGE In-Depth Studies, 200 in-depth interviews followed by consultation interviews with a sub-sample (n=60) will be effectuated. The synthesis of results from the different parts of the project will provide the basis for producing a Home Assessment Methodology Package and policy recommendations and guidelines in housing policies for use across the EU. Results will concern national and comparative data sets and reports at T1 and for T2-T1, the Home Environment Assessment Package, final reports and scientific publications presenting new knowledge on transactional processes involving objective and subjective housing circumstances as determinants for healthy ageing in terms of autonomy, participation, and well-being, especially as concerns very old people. Furthermore, the results will underfeed theoretical development within the field. The results will be disseminated at scientific as well as practical levels in order to underfeed the provision of updated housing policies and service provision across Europe.

Susanne Iwarsson, Frank Oswald, Hans-Werner Wahl, Heidrun Mollenkopf, Andrew Sixsmith, Zsuzsa Széman, Signe Tomsone, Judith Sixsmith, Synneve Dahlin Ivanoff

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This page was last updated 2008-10-24
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