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

Objectives To develop a measure of perceived systems, services, and policies facilitators (see Chapter 5 of the International Classification of Functioning, Disability and Health) for people with neurologic disabilities and to evaluate the effect of perceived systems, services, and policies facilitators on health-related quality of life. Design Qualitative approaches to develop and refine items. Confirmatory factor analysis including 1-factor confirmatory factor analysis and bifactor analysis to evaluate unidimensionality of items. Rasch analysis to identify misfitting items. Correlational and analysis of variance methods to evaluate construct validity. Setting Community-dwelling individuals participated in telephone interviews or traveled to the academic medical centers where this research took place. Participants Participants (N=571) had a diagnosis of spinal cord injury, stroke, or traumatic brain injury. They were 18 years or older and English speaking. Interventions Not applicable. Main Outcome Measures An item bank to evaluate environmental access and support levels of services, systems, and policies for people with disabilities. Results We identified a general factor defined as “access and support levels of the services, systems, and policies at the level of community living” and 3 local factors defined as “health services,” “community living,” and “community resources.” The systems, services, and policies measure correlated moderately with participation measures: Community Participation Indicators (CPI) – Involvement, CPI – Control over Participation, Quality of Life in Neurological Disorders – Ability to Participate, Quality of Life in Neurological Disorders – Satisfaction with Role Participation, Patient-Reported Outcomes Measurement Information System (PROMIS) Ability to Participate, PROMIS Satisfaction with Role Participation, and PROMIS Isolation. Conclusions The measure of systems, services, and policies facilitators contains items pertaining to health services, community living, and community resources. Investigators and clinicians can measure perceptions of systems, services, and policies resources reliably with the items described here. Moderate relations between systems, services, and policies facilitators and PROMIS and CPI variables provide support for the measurement and theory of environmental effects on social functioning related to participation.