CHAPTER 88: MEASURE OF THE QUALITY OF THE ENVIRONMENT (MQE)
Description
The Measure of the Quality of the Environment (MQE) is a standardized measure based on the Disability Creation Process model and is designed to evaluate the influence that environmental factors have on occupational performance by exploring such issues as the quality of a person’s participation and his or her functional capabilities (Fougeyrollas, Tremblay, Noreau, St-Onge, & Dumont, 2006). Administered as a self-report questionnaire, the person is asked to estimate the impact the environment exerts upon his or her daily life through an examination of his or her successes and failures relative to their occupational performance within those environments (Fougeyrollas, Noreau, St-Michel, & Boschen, 2008). The MQE comprises six domains: (1) social support and attitudes, (2) income, labor, and income security, (3) government and public services, (4) equal opportunities and political orientations, (5) physical environment and accessibility, and (6) technology. The MQE has 109 questions, 40 of which address the physical environment in which the subject is presently operating and 69 that address his or her social environment (Fougeyrollas et al., 2008). An example vignette of the MQE includes a list of situational factors intended to explore the influence of such things as winter climatic conditions (snow, ice, cold); public transportation services in the community (schedule, stops, frequency, route); work hours and social networks (support from others); income (availability, financial programs, services); and physical accessibility (Fougeyrollas et al., 2008). Each item is rated along a 7-point Likert scale ranging from -3 major obstacle to +3 major facilitator where unique criteria relative to obstacles and facilitators are used for each item. The MQE can be completed in less than 30 minutes with higher scores associated with better occupational performance within client context. A short 26-item version is also available that uses the same scoring system and can be completed in less than 10 minutes.
Psychometrics
Test-retest reliability results of a study done with young adults with cerebral palsy (n = 28) showed that 85% of the items obtained an agreement above 60%, whereas a test-retest reliability study done by its creators showed moderate to high kappa’s for 57% of the items (Fougeyrollas et al., 2008). A convenience sample of persons aged 40 to 97 years (n = 51) 6 months post-discharge from an intensive functional rehabilitation unit found the association between the total MQE barrier scores and the Assessment of Life Habits scores to be significant at 0.42, although, results showed that the MQE category support and attitudes was not statistically significant and was considered an outlier in the study (Rochette, Desrosiers, & Noreau, 2001). A study of persons over 65 years of age (mean age: 80.7 years) who had been registered for home-based rehabilitation (n = 91) found that the top facilitators chosen on the MQE were support from members of the family, 76 (83.5%); television media services, 76 (83.5%); health services, 70 (76.9%); and rehabilitation services, 66 (72.5%), whereas the top barriers to occupational performance were family situation, 16 (17.6%); rehabilitation services, 15 (16.5%); the availability of businesses, 12 (13.2%); and the attitudes of the service providers, 11 (12.1%) (Vik, Nygard, & Lilja, 2007).
Advantages
The MQE is based on the conceptual model of the Disability Creation Process and both a short and long versions are available (26 and 109 items). It has also been translated into several languages, which suggests cross-cultural relevance. There is an interactive website (in French that can be translated) dedicated to the MQE that is maintained by the International Network on the Disability Creation Process (INDCP).
Disadvantages
There is a limited amount of direct peer-reviewed research available regarding the assessment. Also, there is a lack of established norms as well, and because its results only yield an item score the clinician must interpret domain and total scores according to clinical judgment.
Administration
During assessment the client is asked to consider situational vignettes and then decide if the item facilitates or hinders occupational performance. An example item asks the person to consider his or her abilities and personal limits and to indicate to what extent the following influences affect his or her daily life: the attitudes of family, friends, and colleagues (Fougeyrollas et al., 2008).
TABLE 88-1
SCORING CONTINUUM OF THE MEASURE OF THE QUALITY OF THE ENVIRONMENT
| -3 | Major obstacle; completely prevents accomplishment of the activity |
| -2 | Medium obstacle; largely hinders accomplishment of the life activity |
| -1 | Minor obstacle; mildly hinders accomplishment of a life activity or slightly increases its level of difficulty |
| 0 | No influence |
| 1 | Minor facilitator; compensates a little for the impairments or disabilities and allows partial accomplishment of the life activity or slightly decreases its difficulty |
| 2 | Medium facilitator; partially compensates for the impairments or disabilities and allows partial accomplishment of the life activity or accomplishment with difficulty |
| 3 | Major facilitator; fully compensates for the impairments or disabilities and allows full accomplishment of the life activity without constraint nor difficulty |
Adapted from Fougeyrollas, P., Noreau, L., St-Michel, G., & Boschen, K. (2008). Measure of the Quality of the Environment—version 2.0 (pp. 4-7). Quebec, Canada: RIPPH/INDCP.
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