CHAPTER 84: IN-HOME OCCUPATIONAL PERFORMANCE EVALUATION (I-HOPE)

Description

The In-Home Occupational Performance Evaluation (I–HOPE) is an assessment developed to target activities performed in the home that are essential for aging in place whereby a multistep procedure establishes current activity patterns, identifies activities that are difficult but important to the older adult, and identifies the environmental barriers that influence specific activities (Stark, Somerville, & Morris, 2010). It does this by inventorying current and desired activity patterns using photographic images as visual cues that the client views as activity cards. Content for the cards are considered activities that occur naturally in the home and during assessment they serve as a visual cue to recall current and previous participation in those activities and include such items as carrying items, getting in or out of bed, opening jars, talking on the phone, reading/writing, washing and drying clothes, getting dressed, opening or closing doors, getting in or out of the car, preparing a meal, and ironing clothes. During assessment the activity cards are viewed and sorted by the client into four categories of occupational performance: (1) I do not do and don’t want to do; (2) I do now with no problem; (3) I do now with difficulty; and (4) I do not do but would like to do (Stark et al., 2010). The result is that activities that are important, difficult, or impossible to perform within the client’s current context are able to be identified and prioritized. The unique scoring system is also able to determine the magnitude of the environment’s influence on those performance activities deemed important. The I–HOPE includes 44 stimulus cards and can be completed in less than 30 minutes. A revised version by Keglovits, Somerville, and Stark (2015) combines 8 new activities as well as the removal of several activities to create a final card sort deck of 43 activities. The revised version uses a similar but more complex scoring system in which data produces the same four sub-scores relative to activity participation, performance, satisfaction, and severity of environmental barriers.

Psychometrics

Early research into the original I-HOPE items by Stark et al. (2010) found internal consistencies for the various subscales to be r = 0.85 for participation, 0.78 for satisfaction, 0.77 for performance, and 0.77 for severity of environmental barriers. That research also established good reliability as intra-class correlation coefficients (ICCs) of the I–HOPE subscales were 0.99 for participation, 0.94 for performance, 1.0 for satisfaction, and 0.99 for environmental barriers. The measure was also found to correlate positively with the Functional Independence Measure scale—daily activities subscale at r = 0.53 and with the satisfaction with performance of daily activities subscale at r = 0.43. Also, the two were negatively correlated relative to the environmental barrier severity subscale at r = –0.46. ICCs of the I–HOPE subscales also showed good reliability for activity participation at 0.99, whereas performance was 0.94, satisfaction 1.0, and environmental barriers at 0.99. That study also found that a comparison of pre- and post-test scores showed significant change (5.70 to 7.38) suggesting good discriminant ability of the measure. A study by Keglovits et al. (2015) found that all subscales of the revised I-HOPE demonstrated good internal consistency with a range of α = 0.82 to 0.90 and like the original ICCs were also high with a range of 0.94 to 1.0 demonstrating good reliability.

Advantages

Both I-HOPE versions are relatively easy to administer, require no special training, and are unique in that they use a photographic picture interface with the client allowing him or her to decide on his or her ability to engage in home-bound occupations as well as which of those occupations are deemed important. Information purveyed also addresses the person–environment fit when performing daily activities in the home (Keglovits et al., 2015).

Disadvantages

There is a limited amount of peer-reviewed research pertaining to the I-HOPE in support of its use in clinical practice. Another potential limitation is the fact that the client must be evaluated in his or her current living environment which is in contrast to a number of other assessments (Stark et al., 2010).

Administration

During assessment of the revised I-HOPE the client first views stimulus activity cards (> 40) and is then asked to sort the cards into 1 of 5 performance categories, such as those that he or she would like to do but are problematic. Next, an activity participation score is produced, which is the proportion of difficult activities divided by the total number of activities. This is followed by a sorting activity where the stimulus cards are ranked from most to least important. Then, using the 10 most problematic activities, the subject provides ratings relative to performance, satisfaction, and self-efficacy along variable 5-point Likert scales (1 to 5), where higher scores suggest better ability. In the final step, the clinician observes and rates client performance relative to the identified problem areas as well as those environmental barriers that make performance difficult or unsafe (Keglovits et al.,2015).

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