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Development and Initial Validation of the Observer-Rated Housing Quality Scale (OHQS) in a Multisite Trial of Housing First

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Abstract

Quality of housing has been shown to be related to health outcomes, including mental health and well-being, yet “objective” or observer-rated housing quality is rarely measured in housing intervention research. This may be due to a lack of standardized, reliable, and valid housing quality instruments. The objective of this research was to develop and validate the Observer-Rated Housing Quality Scale (OHQS) for use in a multisite trial of a “housing first” intervention for homeless individuals with mental illness. A list of 79 housing unit, building, and neighborhood characteristics was generated from a review of the relevant literature and three focus groups with consumers and housing service providers. The characteristics were then ranked by 47 researchers, consumers, and service providers on perceived importance, generalizability, universality of value, and evidence base. Items were then drafted, scaled (five points, half values allowed), and pretested in seven housing units and with seven raters using cognitive interviewing techniques. The draft scale was piloted in 55 housing units in Toronto and Winnipeg, Canada. Items were rated independently in each unit by two trained research assistants and a housing expert. Data were analyzed using classical psychometric approaches and intraclass correlation coefficients (ICC) for inter-rater reliability. The draft scale consisted of 34 items assessing three domains: the unit, the building, and the neighborhood. Five of 18 unit items and 3 of 7 building items displayed ceiling or floor effects and were adjusted accordingly. Internal consistency was very good (Cronbach’s alpha = 0.90 for the unit items, 0.80 for the building items, and 0.92 total (unit and building)). Percent agreement ranged from 89 to 100 % within one response scale value and 67 to 91 % within one half scale value. Inter-rater reliability was also good (ICCs were 0.87 for the unit, 0.85 for the building, and 0.93 for the total scale). Three neighborhood items (e.g., distance to transit) were found to be most efficiently rated using publicly available information. The physical quality of housing can be reliably rated by trained but nonexpert raters using the OHQS. The tool has potential for improved measurement in housing-related health research, including addressing the limitations of self-report, and may also enable documenting the quality of housing that is provided by publicly funded housing programs.

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Notes

  1. Scholars Portal is a service of the Ontario Council of University Libraries (OCUL), which provides a stable, integrated search platform to facilitate discovery and access to digital academic literature within multiple disciplines (WLU, 2012). At the time of the search (Spring 2012), the Scholars Portal electronic journal collection included more than 20 million articles from over 8,000 academic journals, published by major distributors and presses (Western Libraries, 2010).

  2. We recognize that there is no ideal term to refer to all individuals with prior or recent lived experience of homelessness and/or mental illness; in this article, for brevity, we use the term “consumer.”

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Acknowledgments

Thanks to K. Mason, C. Kelly, and C. Issak (for assisting with ethics submissions, recruitment, and supervision of local field teams); T. Bischoff for assistance with attribute reduction; A. Ladd, D. Powell, and R. Galston for site assessments; F. Weinstock and L. Stewart (who served as our housing experts); and D. Streiner (for comments on the analysis).

We also thank Jayne Barker (2008–2011), Ph.D., and Cameron Keller (2011–present), Mental Health Commission of Canada At Home/Chez Soi National Project Leads, the National Research Team, the five site research teams, the site coordinators, and the numerous service and housing providers, as well as persons with lived experience, who have contributed to this project and the research. This research has been made possible through a financial contribution from Health Canada. The views expressed herein solely represent the authors.

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Authors and Affiliations

  1. Departments of Psychiatry and Community Health Sciences, University of Calgary, 1215 – 39 Ave., SW, Calgary, Alberta, T2T 2K6, Canada

    Carol E. Adair

  2. Mental Health Commission of Canada, Calgary, Alberta, Canada

    Brianna Kopp

  3. Department of Criminology, Wilfrid Laurier University, Brantford, Ontario, Canada

    Jennifer Lavoie

  4. Institute of Urban Studies, University of Winnipeg, Winnipeg, Manitoba, Canada

    Jino Distasio

  5. Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto, Ontario, Canada

    Stephen W. Hwang, Muznah Ahmad & Naveed Ahmed

  6. Mental Health Commission of Canada, Toronto, Ontario, Canada

    Aimee Watson

  7. Centre for Addiction and Mental Health, Toronto, Ontario, Canada

    Scott Veldhuizen & Paula Goering

  8. Community Services Department, Regional Municipality of Niagara, St. Catharines, Ontario, Canada

    Katherine Chislett

  9. Department of Humanities, Social Science and Social Justice, University of Toronto, Toronto, Ontario, Canada

    Jijian Voronka

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  1. Carol E. Adair
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  2. Brianna Kopp
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  3. Jennifer Lavoie
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  4. Jino Distasio
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  5. Stephen W. Hwang
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  6. Aimee Watson
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  7. Scott Veldhuizen
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  8. Katherine Chislett
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  9. Jijian Voronka
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  10. Muznah Ahmad
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  11. Naveed Ahmed
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  12. Paula Goering
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Correspondence to Carol E. Adair.

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Adair, C.E., Kopp, B., Lavoie, J. et al. Development and Initial Validation of the Observer-Rated Housing Quality Scale (OHQS) in a Multisite Trial of Housing First. J Urban Health 91, 242–255 (2014). https://doi.org/10.1007/s11524-013-9851-6

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  • DOI: https://doi.org/10.1007/s11524-013-9851-6

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