Development and Psychometric Evaluation of the Low Vision Individuals’ Home Modification Questionnaire: Psychometric Study

Document Type : Original Articles


1 Assistant Professor, Department of Rehabilitation Sciences, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran

2 Lecturer, Department of Rehabilitation Sciences, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran

3 Associate Professor, Department of Health Information Technology, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Health Sciences Research Center, Addiction Institute, Sari, Iran



Introduction: Visual impairment makes individuals dependent on tools in their daily activities. Home modifications are one of the important methods for increasing the independence of individuals with visual impairments as all individuals frequently interact with their home environment in their everyday lives. This study was an endeavor to develop the Home Modification and Improvement Questionnaire for visually impaired people and study its psychometric characteristics".
Materials and Methods: A cross-sectional study of questionnaire development and validation was conducted. The structure of the questionnaire was completed in 3 stages, defining the structure, creating items, and determining the format. The instrument was validated in the 3 stages of assessing the items, checking the face, content, and structural validity, and reliability of the retest-test, and performing a pilot study of the instrument. Exploratory factor analysis was performed to calculate the validity of the construct. The Kaiser-Meyer-Olkin test was used for factor analysis and the correlation between questions was evaluated using Bartlett's test.
Results: Exploratory factor analysis with varimax rotation yielded 3 factors (light, color, and home architecture) with eigenvalues of greater than 1 and factor loadings of greater than 0.3. Cronbach's alpha coefficients (index of internal consistency) of the scales of performance, knowledge, and attitude were 0.81, 0.88, and 0.69, respectively (P ≤ 0.001). The intra-class correlation coefficients (ICCs), as the measure of test-retest reliability, of the scales of performance, knowledge, and attitude were 0.82, 0.87, and 0.78, respectively.
Conclusion: Living comfortably at home for low vision individuals requires the consideration of the 3 elements of light, color, and home architecture and establishment of a planned and organized atmosphere. The current questionnaire can be utilized as a quantitative tool to evaluate the attitude, knowledge, and performance of this population's families in terms of their contribution to addressing the needs of this population.


Main Subjects

  1. Bourne RRA, Adelson J, Flaxman S, Briant P, Bottone M, Vos T, et al. Global Prevalence of Blindness and Distance and Near Vision Impairment in 2020: Progress towards the Vision 2020 targets and what the future holds. Invest Ophthalmol Vis Sci 2020; 61(7): 2317.
  2. Afshari M, Moosazadeh M, Barzegari S, Abedini E, Salimi SS. Prevalence of blindness and low vision in Iran: A systematic review and meta-analysis. Ophthalmic Epidemiol 2018; 25(4): 288-96.
  3. Renaud J, Bedard E. Depression in the elderly with visual impairment and its association with quality of life. Clin Interv Aging 2013; 8: 931-43.
  4. Ribeiro MV, Hasten-Reiter Junior HN, Ribeiro EA, Juca MJ, Barbosa FT, Sousa-Rodrigues CF. Association between visual impairment and depression in the elderly: a systematic review. Arq Bras Oftalmol 2015; 78(3): 197-201.
  5. Lage JB, Nascentes GAN, Pereira K. Influence of the home environmental affordances in the mobility of children with low vision mobility: functional skills and caregiver assistance. Rev Bras Oftalmol 2016; 75(4): 290-5.
  6. Lopez D, McCaul KA, Hankey GJ, Norman PE, Almeida OP, Dobson AJ, et al. Falls, injuries from falls, health related quality of life and mortality in older adults with vision and hearing impairment--is there a gender difference? Maturitas 2011; 69(4): 359-64.
  7. Evans JR, Smeeth L, Fletcher AE. Risk of admission to a nursing home among older people with visual impairment in Great Britain. Arch Ophthalmol 2008; 126(10): 1428-33.
  8. Mennem TA, Warren M, Yuen HK. Preliminary validation of a vision-dependent activities of daily living instrument on adults with homonymous hemianopia. Am J Occup Ther 2012; 66(4): 478-82.
  9. Wahl HW, Becker S, Burmedi D, Schilling O. The role of primary and secondary control in adaptation to age-related vision loss: A study of older adults with macular degeneration. Psychol Aging 2004; 19(1): 235-9.
  10. Pynoos J, Steinman BA, Nguyen AQ. Environmental assessment and modification as fall-prevention strategies for older adults. Clin Geriatr Med 2010; 26(4): 633-44.
  11. McCullagh MC. Home Modification: How to help patients make their homes safer and more accessible as their abilities change. AJN the American Journal of Nursing 2006; 106(10): 54-63.
  12. Johansson K, Lilja M, Petersson I, Borell L. Performance of activities of daily living in a sample of applicants for home modification services. Scand J Occup Ther 2007; 14(1): 44-53.
  13. Rooney C, Hadjri K, Mcallister K, Rooney M, Faith V, Craig C. Experiencing visual impairment in a lifetime home: An interpretative phenomenological inquiry. J Hous Built Environ 2018; 33(1): 45-67.
  14. Riazi A, Ying Boon M, Bridge C, Dain SJ. Home modification guidelines as recommended by visually impaired people. Journal of Assistive Technologies 2012; 6(4): 270-84.
  15. Shahsavar Z, TAN B. Developing a questionnaire to measure students' attitudes toward the course blog? Turk Online J Distance Educ 2012; 13(1): 200-10.
  16. Nemoto T, Beglar D. Developing Likert-Scale Questionnaires. In: Sonda N, Krause A, editors. JALT2013 Conference Proceedings. Tokyo, Japan: JALT; 2014.
  17. Massof RW. Likert and Guttman scaling of visual function rating scale questionnaires. Ophthalmic Epidemiol 2004; 11(5): 381-99.
  18. Ebadi A, Taghizadeh Z, Montazeri A, Shahvari Z, Tavousi M, Bagherzadeh R. Translation, development and psychometric properties of Health Related Measures-Part 2: Construct validity, reliability and responsiveness. Payesh 2017; 16(4):445-55. [In Persian].
  19. Taherdoost H. Validity and reliability of the research instrument; how to test the validation of a questionnaire/survey in a research. International Journal of Academic Research in Management 2016; 5(3): 28-36.
  20. Wilson FR, Pan W, Schumsky DA. Recalculation of the critical values for Lawshe's Content Validity Ratio. Meas Eval Couns Dev 2012; 45(3): 197-210.
  21. Burton LJ, Mazerolle SM. Survey instrument validity part I: Principles of survey instrument development and validation in athletic training education research. Athl Train Educ J 2011; 6(1): 27-35.
  22. Almanasreh E, Moles R, Chen TF. Evaluation of methods used for estimating content validity. Res Social Adm Pharm 2019; 15(2): 214-21.
  23. Zareiyan A, Ebadi A, Sharifnia H. Testing process in health, design and psychometrics. 3rd. Tehran, Iran: Jamenegar Publications; 2022. p. 320. [In Persian].
  24. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 2007; 60(1): 34-42.
  25. Boel A, Navarro-Compan V, van der Heijde D. Test-retest reliability of outcome measures: data from three trials in radiographic and non-radiographic axial spondyloarthritis. RMD Open 2021; 7(3): e001839.
  26. Clause C. Content validity: Definition, index and examples [Online]. [cited 2016]; Available from: URL:
  27. Michael RS. Measurement: Reliability and validity. Y520 Strategies for Educational Inquiry. 2004.
  28. Gilbert GE, Prion S. Making sense of methods and measurement: Lawshe's Content Validity Index. Clin Simul Nurs 2016; 12(12): 530-1.
  29. Tilden VP, Nelson CA, May BA. Use of qualitative methods to enhance content validity. Nurs Res 1990; 39(3): 172-5.
  30. Davis LL. Instrument review: Getting the most from a panel of experts. Appl Nurs Res 1992; 5(4): 194-7.
  31. McHorney CA, Tarlov AR. Individual-patient monitoring in clinical practice: Are available health status surveys adequate? Qual Life Res 1995; 4(4): 293-307.
  32. Stark SL, Somerville E, Keglovits M, Smason A, Bigham K. Clinical reasoning guideline for home modification interventions. Am J Occup Ther 2015; 69(2): 6902290030p1-8.
  33. Copolillo A, Ivanoff SD. Assistive technology and home modification for people with neurovisual deficits. NeuroRehabilitation 2011; 28(3): 211-20.
  34. Duffy MA. Making life more livable: Simple adaptations for living at home after vision loss. New York, NY: American Foundation for the Blind; 2002.
  35. Brahm KD, Wilgenburg HM, Kirby J, Ingalla S, Chang CY, Goodrich GL. Visual impairment and dysfunction in combat-injured servicemembers with traumatic brain injury. Optom Vis Sci 2009; 86(7): 817-25.
  36. Digre KB, Brennan KC. Shedding light on photophobia. J Neuroophthalmol 2012; 32(1): 68-81.
  37. Evans JR, Fletcher AE, Wormald RP. Causes of visual impairment in people aged 75 years and older in Britain: An add-on study to the MRC Trial of Assessment and Management of Older People in the Community. Br J Ophthalmol 2004; 88(3): 365-70.
  38. Pedretti LW, Early MB. Occupational therapy: Practice skills for physical dysfunction. 5th St. Louis, MO: Mosby; 2001.