Validação e análise das propriedades clinimétricas do Measure of the Quality of Environment (MQE) para avaliar o impacto dos fatores ambientais na funcionalidade de pessoas idosas comunitárias

Abstract

INTRODUCTION: Aging is a natural and multifactorial process. In light of this, comprehensive assessment strategies are essential to adequately monitor the aging process. The International Classification of Functioning, Disability, and Health (ICF) advocates for the evaluation of functioning beyond the perspective of body functions. However, to date, no measurement tool is available to assess the impact of environmental facilitators or barriers on the Brazilian elderly population. The *Measure of the Quality of the Environment* (MQE) assesses the physical, social, and attitudinal environment, measuring both facilitators and barriers. Nonetheless, its measurement properties have not been tested in the elderly population. OBJECTIVES: To analyze the validity and reliability of the MQE in evaluating factors related to the physical, social, and attitudinal environment of community-dwelling older adults. METHODS: This is a psychometric, cross-sectional study. Older adults aged 60 years or older, of any sex, and residing in the community were recruited. Exclusion criteria included moderate to severe cognitive impairment, disabling comorbidities preventing participation in community activities, and speech impairments that hindered interview participation. Participants were assessed for clinical and demographic variables, including physical capacity vulnerability measured by the Vulnerable Elders Survey-13 (VES-13). The interview was conducted by a trained professional. On the first day, data collection included the MQE, clinical-demographic data, and all study questionnaires. MQE was re-administered 5 to 7 days later. Each MQE item score ranges from -3 to +3, where the final score comprises, positive values reflecting the average of facilitating items and negative values representing the average of environmental barriers. Preliminary convergent validity was estimated using Spearman’s correlation coefficient by analyzing the association between the MQE and measures of disability in older adults in Brazil: WHODAS-B.O and the ICF Core Set for physical health in older adults. The hypothesis proposed was that disability and environmental factors would correlate. Preliminary reliability was analyzed using the test-retest method with 30 participants, employing the Intraclass Correlation Coefficient (ICC2,1). RESULTS: The sample included 100 participants, 81% female, with a mean age of 68.28±5.8 years, and 64% without vulnerability in physical capacity. Functioning analysis using the ICF Core Set revealed high prevalence of problems in “quality of sleep (b1343)” and “sensation of pain (b280),” reported by 82% and 61% of participants, respectively. Regarding the MQE, environmental facilitators had a median score of 2.71 [2.00–3.86], while environmental barriers scored a median of 2.30 [0–3.0]. The primary barriers identified were “noise or sound intensity,” while the main facilitators were “assistive devices and adaptations and objects of use.” The MQE demonstrated adequate content validity, with clarity of language and theoretical relevance for older adults. The MQE also exhibited appropriate intra-rater reliability for the facilitators score (ICC2,1=0.74) and the barriers score (ICC2,1=0.80). Convergent validity revealed weak but significant correlations between the total facilitator score of the MQE and the WHODAS-B.O score, as well as correlations between specific MQE facilitator domains (e.g., technology, political systems, and income) and the environmental facilitators estimated by the ICF Core Set for physical health. Additionally, the MQE technological barriers domain correlated with the environmental barriers of the ICF Core Set. CONCLUSION: The MQE demonstrated adequate content validity and intra-rater reliability for use with community-dwelling older adults. However, convergent validity was partially supported.