Evaluation of the Home Environment Assessment for the Visually Impaired (HEAVI): an instrument designed to quantify fall-related hazards in the visually impaired

BACKGROUND To (1) develop and refine the Home Environment Assessment for the Visually Impaired (HEAVI), and (2) determine the interrater reliability of this instrument, which was designed to quantify the number of fall-related hazards in the homes of individuals with visual impairment. METHODS Twenty homes of community-dwelling adults were included in this study. Each home was graded by an occupational therapist (OT) and two non-expert (NE) graders. Seventy-three HEAVI items were evaluated in eight rooms, for a total of 185 potential hazards per home (some items were assessed in multiple rooms). Pairwise and three-way agreement between graders was evaluated at the item, room, and home level using Krippendorff's alpha and intraclass correlation coefficients (ICC). Additionally, the most hazardous home locations and items were determined by comparing the mean and standard deviation of the number of hazards by room and grader. RESULTS Of the 73 items, 45 (62%) demonstrated at least moderate agreement overall and for each OT/NE pair (Krippendorff's alpha >0.4), and remained in the final instrument (a total of 119 potential hazards per home as some items were assessed in multiple rooms). Of these 119 potential hazards, an average of 35.7, 33.2, and 33.3 hazards per home were identified by the OT and NE graders, respectively. Moderate to almost perfect agreement on the number of hazards per home and number of hazards per room, except the dining room, was found (ICCs of 0.58 to 0.93). Bathroom items were most often classified as hazards (>40% of items for all graders). The item classes most commonly graded as hazardous were handrails and lighting (>30% of items). CONCLUSION Our results indicate that NE graders can accurately administer the HEAVI tool to identify fall-related hazards. Items in the bathroom and those related to handrails and lighting were most often identified as hazards, making these areas and items important targets for interventions when addressing falls.