Mohsenpour Amir, Biddle Louise, Krug Katja, Bozorgmehr Kayvan
Bielefeld University, School of Public Health, Department of Population Medicine and Health Services Research (AG2), Universitätsstraße 25, 33615, Bielefeld, Germany.
Heidelberg University Hospital, Department of General Practice and Health Services Research, Section for Health Equity Studies and Migration, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
SSM Popul Health. 2020 Dec 31;13:100725. doi: 10.1016/j.ssmph.2020.100725. eCollection 2021 Mar.
Housing is an important health determinant, in particular for asylum seekers and refugees (ASR) living in state-provided accommodation and struggling for residential autonomy. However, few validated objective measurement tools exist to measure housing quality in the sense of the deterioration of the housing environment. We aimed to construct and validate an instrument to enable resource-efficient monitoring of and health research on such housing quality. After considering existing theoretical frameworks on housing effects on health, we constructed an easily applicable tool measuring the degree of "Small-area Housing Environment Deterioration" (SHED), based on the "Broken Windows" - index. In a validation study, we tested SHED index's objectivity and reliability, measuring inter-/intra-rater reliability and internal consistency and discussed its strengths and limitations by means of cognitive testing. We ran a field-test as part of a population-based, cross-sectional refugee health survey in a random sample of 58 shared accommodation centers across 44 districts of the German federal state of Baden-Wuerttemberg, enabling us to test index applicability and convergence with ASR's satisfaction with their living place. The new SHED index provides a validated and field-tested measure of deterioration of small-area housing environment with substantial reliability. Serving both researchers and policy-makers, SHED offers an easily applicable index to support epidemiological analyses on housing as a contextual and social determinant of health as well as evidence-informed decision making in questions of housing policies.
住房是一个重要的健康决定因素，对于居住在国家提供的住所中并为居住自主权而挣扎的寻求庇护者和难民（ASR）来说尤其如此。然而，从住房环境恶化的角度来看，几乎没有经过验证的客观测量工具来衡量住房质量。我们旨在构建并验证一种工具，以便对这种住房质量进行资源高效的监测和健康研究。在考虑了关于住房对健康影响的现有理论框架之后，我们基于“破窗”指数构建了一个易于应用的工具，用于测量“小区域住房环境恶化”（SHED）的程度。在一项验证研究中，我们测试了SHED指数的客观性和可靠性，测量了评分者间/评分者内的可靠性和内部一致性，并通过认知测试讨论了其优点和局限性。作为德国巴登-符腾堡州44个区58个共享住宿中心随机抽样的基于人群的横断面难民健康调查的一部分，我们进行了实地测试，这使我们能够测试该指数的适用性以及与ASR对其居住场所满意度的一致性。新的SHED指数提供了一种经过验证和实地测试的小区域住房环境恶化测量方法，具有很高的可靠性。SHED既服务于研究人员，也服务于政策制定者，它提供了一个易于应用的指数，以支持将住房作为健康的背景和社会决定因素的流行病学分析，以及在住房政策问题上基于证据的决策。
