The Gerontologist
Vol. 42, No. 1, 39–50
Copyright 2002 by The Gerontological Society of America
A Social–Cognitive Model to Predict the Use
of Assistive Devices for Mobility and Self-Care
in Elderly People
Marc Roelands, MA,1 Paulette Van Oost, PhD,1 AnneMarie Depoorter, MD,2
and Ann Buysse, PhD1
Purpose: To provide insight into the contribution of psychological variables in understanding use and nonuse of assistive devices (ADs) for self-care and mobility. Design and
Methods: A survey on a representative sample of 491
community-dwelling elderly people in Flanders was conducted. A theoretical model of the factors predicting the use
of ADs was tested with path analysis. Results: The possession and use of 32 ADs were found to be bivariately related to intention to use ADs, awareness of ADs, attitude
toward AD use, subjective norm regarding AD use, self-efficacy concerning AD use, and socio-demographic characteristics. In regression analyses the intention to use ADs was
found to be related to self-efficacy concerning AD use, attitude toward AD use, and subjective norm regarding AD
use. Implications: This study suggests that a social–cognitive model of human behavior can be helpful in explaining
the use of ADs. The model can suggest measures to be developed aiming to improve the introduction of ADs.
The prevalence of AD use has been estimated in
the general population in the United States (LaPlante,
Hendershot, & Moss, 1992; Mann, Hurren, & Tomita, 1993). In the age group of 65 to 74 years old,
22% of the U.S. population use mobility ADs, which
increases in the age group of 75 years old and older
to 43%. The type of AD used by elderly persons has
been investigated in 76-year-old Swedish people:
Grab rails (16% of total population) and canes
(15%) were used by the largest proportion of the
population (Sonn & Grimby, 1994).
To explain and predict the use of ADs, models that
incorporate many factors involved in the use of ADs,
including social and psychological factors, have been
proposed on the basis of clinical evidence or literature
review (Rogers & Holm, 1992; Scherer & McKee,
1989). We believe, however, that these important
models could benefit from both empirical/methodological improvements, such as appropriate data-analytic techniques, and theoretical improvements. A
more established theoretical background would allow
an effective protocol to be developed to introduce
ADs in a more structured way by taking crucial variables into consideration. Several social–cognitive
models of human behavior have been described that
predict human behavior quite adequately. They emphasize the role of attitudes, subjective norms, behavior intention, self-efficacy (Ajzen, 1991; Bandura,
1997), and awareness (McGuire, 1985).
Key Words: Socioeconomic status, Self-efficacy, Attitude,
Care, Planned behavior
During the last few decades assistive devices (ADs)
for self-care and mobility have been developed to improve the fit between the competency of elderly persons and the demands of the environment. Examples
of ADs are wheelchairs, shower seats, and sock aids.
They are intended to improve the autonomy and
quality of life of elderly persons in a cost-effective
way. Furthermore, they are prescribed with the aim
of influencing the quality and cost of social care and
health care in a positive way by lowering the need for
intramural care (de Klerk & Huijsman, 1995).
A Social-Cognitive Model of the Use of ADs
A tentative model can be described, incorporating
some of the factors that are involved in communitydwelling elderly persons’ use of ADs. The framework is
the social–cognitive theory of planned behavior (Ajzen,
1991). The theory of planned behavior takes into consideration the influence of personal evaluations (attitudes), perceived social pressure (subjective norm), and
perceived behavioral control in predicting the intention
to perform a specific behavior. The predictors are understood as expectations weighted by personal values.
It is therefore also referred to as an expectancy value
model (Ajzen & Fishbein, 1980). It has been used suc-
This study was funded by Flemish Government Grant 174BG998.
We gratefully acknowledge the assistance of Hilde Merckx and Marianne DeGrave in the data collection.
Address correspondence to Marc Roelands, Ghent University, Faculty
of Psychology, Dunantlaan 2, 9000 Ghent, Belgium. E-mail: marc.
[email protected]
1
Ghent University, Faculty of Psychology, Research Group Ageing
Studies, Belgium.
2
Free University of Brussels, Public Health Care, Belgium.
Vol. 42, No. 1, 2002
39
cessfully in understanding and predicting health-related
behaviors such as alcohol consumption (Conner, Warren, Close, & Sparks, 1999), uptake of a cervical smear
test (Bish, Sutton, & Golombok, 2000), condom use
(Gagnon & Godin, 2000), dietary behavior (Povey,
Conner, Sparks, James, & Sheperd, 2000), the adoption of hormone replacement therapy (Legare, Godin,
Guilbert, Laperriere, & Dodin, 2000), and exercise adherence (Rhodes et al., 1999). An overview can be
found in Armitage and Conner (2000). When adapted
to the use of ADs, the following concepts can be organized at four levels. In the context of the presence of
disabilities (disabilities are understood as activity limitations; see World Health Organization, 1980), the intention to use ADs (Level 2) is the most direct determinant of the actual use of ADs (Level 1). The intention to
use ADs is determined by the following proximal variables (Level 3): the person’s attitude toward the use of
ADs, the AD self-efficacy, and the subjective norm regarding ADs. Bandura (1997, p. 3) described self-efficacy as “beliefs in one’s capabilities to organize and execute the courses of action required to produce given
attainments.” Ajzen and Madden (1986) stated that the
self-efficacy concept is similar to the perceived-behavior-control concept in their theory of planned behavior.
Perceived behavior control is defined as the person’s belief as to how easy or difficult the performance of a behavior is likely to be. Because self-efficacy beliefs are
specific regarding activity domain, we prefer the term
assistive devices self-efficacy, which is used in our
model.
The subjective norm refers to a person’s perception
of the strength of significant others’ expectations to use
ADs and the will to conform to these expectations, and
has been proposed as a factor influencing the decision
to use ADs or ask for personal help (Scherer & McKee,
1989). The theory of planned behavior does not include background variables, as it is assumed that individual characteristics affect the central concepts in the
model indirectly by shaping beliefs and evaluations
(Ajzen & Fishbein, 1980). Following McGuire (1985),
we included awareness as distal variable (Level 4).
70 and 89 years old in 1999, (c) were communitydwelling, and (d) own a telephone. Exclusion criteria
were severe hardness of hearing, severe cognitive dysfunctioning, and a general health level that hampers
an interview. Severe impairment of sight was an exclusion criterion because this hampers the measurement
of several variables. Only Dutch-speaking persons
were included. The sample was limited to persons between 70 and 89 years old because in the age group of
people 90 years and older refusal and exclusion were
expected to be high because of high morbidity. Moreover, exclusion was expected to increase because of
lack of a telephone. The group of persons under 70
years is too healthy for the purpose of this study,
which would require a considerably larger sample.
The required sample size was estimated to be
about 500 persons. For statistical reasons the sample
ought to be large enough to include at least 20 individuals of each gender with severe disabilities on the
basis of the assumption that AD use is related to disability. The prevalence of most disabilities is lowest
in men and is about 10% or higher (Demarest et al.,
1998). Taking into consideration the distribution of
gender in the population and assuming that AD use
is related to disabilities, it could be calculated that
the smallest groups in the study include 20 persons if
the sample size is 500 (500 persons 0.4 men 0.1
disabilities).
We opted for a representative sample to allow extrapolation of the descriptive data toward the population. An indirect or two-stage sample selection was
used to limit the geographic dispersion. In the first
stage, a limited number of municipalities were randomly sampled. Because a connection between health
behavior and socioeconomic status (SES) has been
established (Lynch, Kaplan, & Salonen, 1997;
Stronegger, Freidl, & Rasky, 1997) and to avoid a
loss of representativeness regarding this important
variable—which could occur because of the relatively
small number of municipalities selected—the sample
of municipalities was stratified by SES. A typology of
all municipalities in Flanders, on the basis of the
equipment of the houses and supplemented with
some financial indicators, was available (Thomas &
Vanneste, 1997), and was chosen for two reasons.
First, the equipment of the houses is considered to be
a good indicator of the SES of a population (Thomas
& Vanneste, 1997). Second, the quality of the house
is a measure of the environment in which AD is used.
Six types are distinguished, of which five can be
found in Flanders. The municipalities were selected
as follows (Deliens, 1998). A random sample of municipalities was selected within each stratum. To
make the sample self-weighting, which avoids conversion of the results to the population, the population size had to be taken into consideration. A municipality could receive 0, 1, or more sample points.
A sample point consists of 14 effective persons and
2 14 persons who were on the reserve list. The 40
sample points were distributed over the strata of municipalities in proportion to the size of their population. Within these strata, sample points were distrib-
Objectives
This study aimed to provide insight into the contribution of psychological variables in understanding
AD use and nonuse. The objectives of this study were
threefold: (a) to describe the possession and use of ADs
in community-dwelling elderly adults in Flanders; (b)
to describe community-dwelling elderly persons’
awareness of ADs, their attitudes toward the use of
ADs, their subjective norm regarding the use of ADs,
and their self-efficacy concerning the use of ADs; and
(c) to test the link between these determinants and
AD use in a social–cognitive model of AD use.
Methods
Sample Selection
The population was defined by the following criteria: (a) people living in Flanders who (b) were between
40
The Gerontologist
uted using a systematic drawing to warrant random
selection. If a municipality received no sample points,
this implied that it was not included in the sample of
municipalities.
In the second stage, in each of these municipalities
a random sample of people born between January 1,
1910, and December 31, 1929, was selected, using
the population register provided by the municipalities. Of the 35 municipalities that were originally
contacted, 2 refused to cooperate for reasons of protection of privacy and were replaced at random
within the same stratum. Persons who could not be
contacted after three attempts or refused to cooperate were replaced by the next person on the randomly ordered list from the random sample in the
municipality until this sample was exhausted.
Five subscales were developed to measure the
awareness of groups of ADs (those that help with
dressing, washing, mobility, going to the toilet, bed
transfer) and five subscales were developed to measure the use by groups of ADs. The items can be
found in the table on awareness. In the scale on mobility the personal alarm system was not included.
The Cronbach’s alphas of the awareness scales were
acceptable, taking into account the dichotomous nature of the items: .57, .53, .74, .54, and .54, respectively. The Cronbach’s alphas of the scales relating to
AD use were .05, .25, .38, .12, and .43, respectively.
Attitudes Toward AD Use.—The Attitudes Toward
Assistive Devices Scale (AADS) consists of 12 items
that measure the opinions of community-dwelling elderly persons on different aspects regarding ADs: the
substitution of care, the financial aspect of care, and
the perceived effect on privacy. The items are listed
in the table on attitudes. To increase the internal consistency of the scale to measure the multidimensional
concept, while keeping it short, we first slightly modified the 21 items that were developed by de Klerk
and Huijsman (1993) regarding wording and presented them to community-dwelling elderly persons.
Twelve items could be retained using factor analysis
on the 21 items (Roelands, Van Oost, & Depoorter,
1999). An example of an item is “When using ADs
you are less dependent on others.” We chose a Likert
scale with 5 points from 5 (totally agree) to 1 (totally
disagree). A total score was calculated. The theoretical minimum score on this interval scale is 12, the
maximum score is 60. A high score indicates a positive attitude. The scale has high face validity. Comparison with established measures of attitudes toward ADs to estimate the validity is hampered by a
lack of these measures. The internal consistency was
.61, which is sufficient.
To further elaborate on the attitude toward the
use of ADs, we developed a scale within the expectancy-value model of attitude, measuring attitude according to the guidelines of Ajzen and Fishbein
(1980). Six modal salient beliefs about the consequences of AD use were obtained from the literature
(de Klerk & Huijsman, 1995; Sonn & Grimby,
1994), regarding autonomy, stigmatization, efficiency,
speed of performance, care substitution, and safety.
An example of an item is “If I use ADs other people
will think I am old and sick.” The strength of the belief could be indicated on a bipolar Likert scale with
5 points from 5 (totally agree) to 1 (totally disagree).
All respondents also valued the personal importance
of these beliefs. An example of an item is “To what
extent is it important to you that other people do not
think you are old and sick?” For each belief the person evaluated on a bipolar, 5-point Likert scale
whether this consequence was 5 (very important) to
1 (very unimportant) to her or him. The product of
the level of agreement regarding a consequence and
its evaluation was calculated for each perceived consequence. A total score of the six products was calculated. A high score indicates that positive conse-
Data Collection Procedure
Once selected, the person was informed of his or
her selection by letter. Thereafter, the researcher contacted the person by telephone to ask for his or her
consent and to make an appointment. Trained interviewers, using a standardized questionnaire to interview elderly persons at home, did the data collection.
The response categories were presented to the interviewee.
Instruments
Awareness, Possession, and Use of ADs.—The Assistive Devices Awareness Scale (ADAS) has been developed by the authors to measure awareness of ADs
and possession and use of ADs (Roelands, Van Oost,
Buysse & Depoorter, in press). Thirty-two ADs were
chosen on the basis of their prevalence in patients of
home nurses, as reported by a sample of nurses. The
32 ADs were presented visually by using photographs and mentioning their names. For every AD,
the person was asked some interrelated questions.
First, the person was asked whether he or she possessed it or not. If the person did possess the AD, he
or she was asked whether he or she used it (code 2)
or not (code 1). If the person did not possess the AD,
he or she was asked whether he or she knew of its existence (code 3) or not (code 4). Because of the interdependency of the concepts of awareness, use, and
possession and because of the attention that has been
given to the smoothness of the interaction during the
interview some calculations are necessary to arrive at
the dichotomies of “aware or not,” “use or not,”
and so forth. To calculate the scale for awareness of
supply, we recoded the answer for every AD in two
categories: aware (codes 1, 2, and 3) versus not
aware (code 4). To calculate the scale for the possession of AD, we recoded the answer for every AD in
two categories: possessed (codes 1 and 2) versus not
possessed (codes 3 and 4). To calculate the scale for
the use of the AD, we recoded the answer for every
AD in two categories: use of AD (code 2) versus not
used (codes 1, 3, and 4). The minimum score on the
three interval scales is 0, the maximum score is 32.
Cronbach’s alpha was .86, .68, and .50, respectively.
Vol. 42, No. 1, 2002
41
quences are expected. The scale ranges from 6 to
150. The reliability of this interval scale was sufficient: Cronbach’s alpha was .58.
intention to do this at all) to 5 (I certainly have the
intention to do this) was used. A total score was calculated, with a high score indicating a high intention
to use ADs. The interval scale ranges from 3 to 15.
To optimize the distribution of the scores, we performed a square root transformation. This score was
used in the analysis. The reliability of this scale was
good: Cronbach’s alpha was .71.
Subjective Norm on AD Use.—The Subjective Norm
on Assistive Devices Scale (SNADS) was developed
for the study to predict the subjective norm regarding
the use of ADs. The scale measures with one item the
significant others regarding the use of ADs (partner,
children, friends, general practitioner, nurse, and
other professional caregiver), with six items on the
normative beliefs, and with six items on the motivation to comply with the beliefs. There is one item per
significant other measuring the normative belief and
one item measuring motivation to agree with that
significant other. An example of a normative belief
item is “Do you think that your partner thinks you
should use assistive devices in case you cannot perform an activity on your own?” A bipolar, 5-point
Likert scale ranging from 5 (totally agree) to 1 (totally disagree) was used. An example of the motivation to comply items is “To what extent would you
allow yourself to be guided by the opinion of your
partner?” The unipolar, 5-point Likert scale ranged
from 5 (very strongly) to 1 (very little). The product
of the strength of the normative belief and the corresponding motivation to comply was calculated for
each normative belief, ranging from 1 to 25. A total
score of the six products was calculated. A high score
indicates a high subjective norm. The interval scale
ranges from 6 to 150. Cronbach’s alpha was not
computed as the assumption of internal consistency
does not hold for this linear composite score.
SES.—As a measure of the SES of the person, we
used the objective income (“What is the net income
of the household?”; Demarest et al., 1998).
Functional Status.—Functional status was measured
with two instruments. A subscale of the Dutch version
of the Short Form-36 (SF-36) measured physical functioning (Aaronson et al., 1998). The scale on physical
functioning consists of 10 items on a 3-point Likert
scale, with 10 being totally unlimited, 5 being a bit limited, and 0 being seriously limited. With our scoring, a
high score indicates a high level of physical functioning.
Cronbach’s alpha was .93 in this study, a value that
was also found by Gandek and colleagues (1998).
An activities of daily living scale (ADL scale) was
included, too. It consists of two scales. One is the
Katz Scale (Katz & Akpom, 1976), which is a measure of functional status, more specifically a measure
of the need for care. Our version of the Katz Scale is
the official version that is used for financing Belgian
home nursing care. It consists of six items: dressing,
washing, indoor mobility, eating, continence, and going to the toilet. Each item has four particular response categories, the content of which depends on
the specific item. Moreover, in this study, six items
were added, giving valuable information regarding
disabilities in instrumental ADL (IADL; shopping,
cleaning, washing clothes, ironing, cooking, and
managing the housekeeping). Four response categories are provided to measure IADL that differ from
the Katz Scale: (a) “is completely independent regarding . . .” (b) “is independent regarding . . ., except for some aspects” (c) “is dependent regarding . . .,
but can perform some aspects” and (d) “is totally dependent regarding . . ..” The minimum score on the
total 12 items of the interval scale is 12; the maximum is 48. A high level of functional status results in
a high score. The internal consistency as a measure
of reliability was good: Cronbach’s alpha was .87 in
this sample.
Self-Efficacy Regarding AD Use.—The self-efficacy
regarding the use of ADs was measured with three
items we developed, each presenting increasing barriers. The introduction was “What do you think about
yourself in these situations? Assume that you possess
an assistive device.” The items were “You want to
use the AD when you cannot perform the activity
alone,” “You want to use the assistive devices every
time if required by the situation,” and “You want to
use the AD, even if it is tiring and difficult sometimes.” A 5-point Likert scale ranging from 1 (I
know I cannot do it) to 5 (I know I can do it) was
used. A total score was calculated, with a high score
indicating high self-efficacy. The interval scale ranges
from 3 to 15. The reliability of this scale was good:
Cronbach’s alpha was .78.
Statistical Analysis
Intention to Use ADs.—The intention to use ADs
was measured with three items we developed, presenting increasing levels of intention. The introduction was “What would you do in the following situations? Assume you possess an assistive device.” The
three items were: “Would you use the assistive device
when you cannot perform the activity alone?” “Would
you use the assistive device every time if required by
the situation?” and “Would you use the assistive
device, even if it is tiring and difficult sometimes?” A
5-point Likert scale ranging from 1 (I do not have the
To test for differences (regarding age, gender, and
SES) between nonparticipants—those refusing participation—and participants, we used 2 analyses. In
this analysis age was dichotomized in 10-year age
groups. The differences between the different normative beliefs and between the perceived consequences
were tested with paired-sample t tests to ascertain if
the differences between normative beliefs or between
perceived consequences could be accepted as real differences, indicating a hierarchy. The differences re42
The Gerontologist
Table 1. Sociodemographic Characteristics of the Sample,
Flanders, 1999 (N 491)
garding awareness and use by specific groups of ADs
between persons with and without a specific disability were tested with independent-sample t tests. Levene’s test was used to test for equality of variances.
With path analysis, using correlations, partial correlations, and linear regression analysis, the relation
was tested between the distal variable awareness of
AD, the proximal variables of attitudes, self-efficacy,
and subjective norm, and the intention to use ADs.
Furthermore, regression analysis tested the relation
between the intention to use ADs and functional status (measured with the ADL scale) as independent
variables and the use of ADs as the dependent variable. The scale scores of the Intention to Use AD
Scale were square root transformed because the data
were skewed to the right. The distribution was ameliorated toward a more normal one. These results
were the only ones that could benefit from a transformation. All analyses were performed with SPSS
for Windows 7.5 (SPSS Inc., Chicago, IL).
Statistic
Characteristic
Gender
Women
Living Arrangement
Alone
Only with partner
With others
Education
Until 14 years old or less
More than elementary school
Age
Number of Living Children
Functional Status
SF-36 subscale
ADL scale
M
SD
%
51.9
31.2
53.0
15.9
47.2
52.8
76.2
2.3
5.02
1.93
65.4
41.28
29.3
7.34
Note: SF-36 Short Form–36 (Dutch version); ADL activites of daily living.
Results
The Sample
and only about 3% of variance was explained by
SES. Therefore, we conclude that regarding the concepts in the study clustering is minimal or absent.
One thousand four hundred nineteen people between 70 and 89 years old, who were living in
Flanders, were contacted by letter and were asked by
phone to participate in the study (see Methods). The
selection criteria were met by 1,019 persons. The
main causes of exclusion were having no telephone
(38%), having a disease or impairment (21%), being
unfindable or unattainable (17%), and being admitted to a care facility or hospital (14%); 528 of the
1,019 persons refused to be interviewed. The main
reason for refusal was a lack of interest (34%); many
gave no reason for refusing (51%). Four hundred
ninety-one persons, or 48.2%, were willing to participate and were interviewed. Age is lacking for the inhabitants of one municipality, as this municipality
did not communicate the date of birth. The respondents did not differ significantly from the persons
who refused participation regarding SES of the municipality 2(4, N 1019) 6.16, p .05 and age
2(1, N 1004) 0.10, p .05. More women refused to cooperate than men 2(1, N 1019) 4.50, p .05. Of the women who satisfied the inclusion criteria, 54.1% refused; the refusal rate was
47.4% in men. The demographic characteristics of
the sample are presented in Table 1.
Sample selection in surveys can result in clustering
of the respondents. We conducted a series of eight
one-way analyses of variance (ANOVA) to check
whether there was homogeneity within groups regarding eight key concepts that were due to SES of
the municipality (the stratification variable). Four
ANOVAs were not significant (possession, use, perceived consequences, and self-efficacy) and the intergroup coefficient omega was below .10, so less than
1% of variance in these key variables was explained
by the SES of the municipality. Four ANOVAs were
significant (intention, awareness, social norm, and
attitude), but omega remained between .15 and .19,
Vol. 42, No. 1, 2002
The Possession and Use of ADs
The majority of the community-dwelling people
aged between 70 and 89 possessed (89.9%) and used
(80.6%) at least one of the 32 ADs. More specifically,
the respondents possessed between 0 and 21 devices
of the 32 ADs that were investigated; the mean number was 3.11 (SD 2.52). Table 2 presents the possession and use for each AD. The respondents used
between 0 and 11 ADs of the 32 that were investigated; the mean number was 1.95 (SD 1.69).
The absolute nonuse of specific ADs that community-dwelling people already possessed was rather
low for most ADs (Table 2). It was highest regarding
the cane (22.2% of elderly persons possessed one,
but did not use it), the toilet seat (15.9%), and the
long shoehorn (15.6%). The relative nonuse, or the
proportion of people that possess a specific AD but
do not use it out of the total number of persons that
possess this AD, varied between 0% and 100% (Table 2). The mean nonuse of an AD people possessed
was 51% over the 32 ADs.
Regarding going to the toilet and bed transfer,
there was a tendency toward the use of more ADs by
people with the specific disability (any level of assistance needed in, respectively, going to the toilet and
bed transfer, as measured with the respective items of
the Katz Scale), compared with persons without this
disability (no personal assistance or AD needed; Table 3). After a Bonferroni adjustment for multiple
comparisons, the differences between persons with
and without a disability were significant only for mobility (independent-sample t test: p .005). The difference regarding a disability in washing was in the
opposite direction; persons without this disability
tended to use more ADs compared with persons with
43
Table 2. Awareness, Possession, and Use of the Supply of 32 Assistive Devices in Community-Dwelling Elderly Persons, Flanders, 1999
(N 491)
Aware
Assistive Device
Washing
Bath seat
Bath support rails
Sponge on a handle
Anti-slip mat
Going to Toilet
Handle in toilet
Commode
The raised toilet seat
Incontinence material
Feeding
Special cutlery
Dressing
Long shoehorn
Button hook
Elastic shoe laces
“Easy shoes”
Sock aid
Bed-Related Activities
Hydraulic hospital bed
Free standing lifting pole
Bed raiser
Adjustable back support in bed
Removable bed rail
Mobility
Chair raiser
Lifting seat
Hoist
Cane
Crutch
Walking frame
Rollator
Wheelchair
Electric wheelchair
Grab rails in the room
Doorframe ramp
Staircase lift
Personal alarm system
Possess
Use
Relative Nonuse
%
n
%
n
%
n
71.6
56.4
47.2
94.3
346
274
228
459
9.5
12.0
14.1
56.7
46
58
68
276
4.3
9.9
11.8
49.5
89.2
91.7
54.5
94.6
430
443
262
455
20.2
22.9
4.6
7.1
97
111
22
34
33.9
163
0.6
95.8
29.5
21.1
54.1
19.8
460
140
101
258
95
90.0
94.6
38.8
64.2
55.9
26.5
16.1
52.6
99.2
98.3
94.8
73.9
99.0
92.9
67.2
32.8
78.0
75.2
%
n
21
48
57
241
54.7
17.5
16.3
12.7
25
10
11
35
15.4
7.0
1.5
3.1
74
34
7
15
23.8
69.4
67.4
56.3
23
77
15
19
3
0.0
0
52.0
2.1
1.7
9.0
1.0
250
10
8
43
8
36.4
0.4
1.3
7.3
0.4
175
2
6
35
2
30.0
81.0
41.2
18.9
60.0
75
8
2
8
3
429
452
185
307
267
3.8
3.5
3.1
12.0
2.3
17
17
15
57
11
2.3
0.8
2.5
5.9
0.8
10
4
12
28
4
39.5
77.1
19.4
50.8
65.2
7
13
3
29
7
126
78
252
478
469
454
354
473
444
322
157
373
341
0.2
0.2
0.6
41.7
13.5
4.4
2.8
7.1
0.6
5.9
0.4
0.6
3.1
1
1
3
201
64
21
13
34
3
28
2
3
15
0.0
0.2
0.0
19.5
5.5
0.6
1.5
3.1
0.0
4.6
0.2
0.2
3.1
0
1
0
94
26
3
7
15
0
22
1
1
15
100
0.0
100
53.2
59.3
86.4
46.4
56.3
100
22.0
50.0
66.7
0.0
1
0
3
107
38
18
6
19
3
6
1
2
0
this disability. The difference between persons with
and without a disability regarding dressing was not
significant.
100
3
People with a disability regarding dressing or
washing (any level of assistance needed in, respectively, dressing and washing, as measured with the
respective items of the Katz Scale) tended to have a
slightly lower level of awareness of the specific groups
of ADs compared with persons without this specific
disability (no personal assistance or AD needed; independent-sample t test; Table 3). After a Bonferroni
adjustment for multiple comparisons, these differences were not significant. An equal level of awareness was found in persons with and without a specific disability regarding mobility, bed transfer, and
going to the toilet.
Intention to Use ADs
The mean intention score was 12.54 (SD 2.19,
minimum 4, maximum 15). The intention to
use an AD if they could not perform an activity on
their own was high: They thought that they would
use an AD every time if required by the situation,
and they thought they would continue to use the AD,
even if it was tiring and difficult (Table 4).
Awareness of the Supply of ADs
Attitudes Toward the Use of ADs
The mean number of ADs people were aware of
was 20.51 of the 32 ADs that were presented (mode 19, SD 5.49, minimum 1, maximum 32).
Twelve of the 32 ADs were known by about 90% or
more of elderly persons (Table 2). Nine ADs were
known by less than 50% of the persons.
On the basis of the 12-item scale, we found that the
attitude toward the use of ADs of community-dwelling elderly adults was positive. The mean total score
on the scale was 45.07 (minimum 28, maximum 58; SD 5.45). The item scores are presented in Ta44
The Gerontologist
Table 3. Awareness and Use of Assistive Devices in
Community-Dwelling Elderly Persons With and Without Specific
Disabilities, Flanders, 1999
Persons
Without
Disability
Disability
Awareness
Mobility
Bed transfer
Washing
Dressing
Going to
toilet
Use
Mobility
Bed transfer
Washing
Dressing
Going to
toilet
Persons With
Disability
Independent
Samples t test
With
Bonferroni
Adjustment
n
M
SD
n
M
SD
t
df
423
467
429
452
7.98
3.23
2.73
2.17
2.26
1.27
1.07
1.24
68
21
61
37
7.88
3.43
2.18
1.76
2.18
1.29
1.35
1.16
0.343
0.712
3.048
1.983
489
486
71.0
487
9 3.56 0.73
1.031
488
481 3.23 0.93
423
467
429
452
0.20
0.04
0.78
0.45
0.48
0.21
0.77
0.57
481 0.25 0.50
68
21
61
37
1.44
0.57
0.48
0.46
Table 4. Intention to Use Assistive Devices (ADs), Subjective
Norm Regarding the Use of Assistive Devices, and Self-Efficacy
Regarding the Use of Assistive Devices, Flanders, 1999
Item
3.083
488
*p .005.
ble 5. The agreement with the opinion that ADs are a
good solution to certain problems was high. These
community-dwelling elderly people expected increased
autonomy when using ADs and believed in the potential of ADs to substitute care. They thought that
the use of ADs would make someone less dependent
on personal assistance, and they expected that by using ADs they would be able to remain longer at
home when they become more in need for care. In
general, the elderly persons subscribed to the opinion
that care substitution has its limits and the use of
ADs could not exclude personal help. Elderly persons valued the control they maintain over their lives
when using ADs. The agreement with the belief that
if they had an AD they could do things their own
way was high.
Negative effects were expected to a lesser degree.
The belief that the respondents feel handicapped
when using ADs was not greatly supported. The respondents rather disagreed with the statement that
ADs are developed by people who know nothing
about elderly persons. Opinions regarding the effects
of the use of ADs on loneliness differed widely. Although the belief that ADs foster loneliness was supported by some, nearly as many disagreed. Willingness to pay for the AD was quite high. Willingness to
invest in ADs and agreement with the statement that
elderly persons can contribute to the costs of an AD
when they need one were rather high. The opinion
that they would like to have an AD, provided they do
not have to pay for it themselves, did not receive
much support.
The attitudes were also measured with the scale of
perceived consequences of the use of ADs (Table 6).
The community-dwelling elderly adults particularly
expected increased safety and efficiency. Secondly
Vol. 42, No. 1, 2002
M
SD
Intention
1. I would use an AD if I could
not perform an activity on
my own
5
4.30 0.89
2. I would use an AD every
time if required by the
situation
5
4.43 0.79
3. I would continue to use the
AD, even if it is tiring and
difficult
4
3.82 1.06
Subjective Norm
General practitioner
15
12.24 10.24
Children
5
9.44 10.12
Partner
0
8.75 10.26
Nurse
0
3.91 7.98
Friends
0
1.79 5.32
Self-Efficacy
1. I can use an AD when I
cannot perform the activity
on my own
5
4.05 0.80
2. I can use the AD every time
if required by the situation
4
4.16 0.76
3. I can continue to use the
AD, even if it is tiring and
4
3.81 0.91
difficult
Notes: For Intention scale, 1 I do not have the intention to
do this at all; 5 I certainly have the intention to do this. For
Self-Efficacy scale, 1 I know I cannot do it; 5 I know I can do it.
0.95 10.550* 72.5
0.93 2.645 20.1
0.70
2.948 488
0.61 0.128 487
9 0.78 0.67
Mode Median
they expected autonomy, followed by speed of performance. Care substitution and stigmatization were
least expected. The differences between all pairs of
means were significant (paired-sample t test: p .001), except for the difference between stigmatization and care substitution, and between efficiency
and safety.
Safety and autonomy were both valued most highly
in the context of the performance of ADLs. Efficiency
was the second most valued. The elderly persons valued
to the same degree care substitution, stigmatization,
and speed of performance. The differences between all
pairs of means were significant (paired-samples t test:
p .01), except for the difference between autonomy
and safety and between stigmatization, care substitution, and speed of performance.
The product of the degree to which one agrees
with a perceived consequence on the one hand and
the personal valuation of the importance of this consequence on the other is a measure of the importance
of each attitude for this person (Table 6). The most
important attitude was the perceived increase in
safety, and the second most important attitudes were
autonomy and efficiency. Less important attitudes
are, in decreasing order, increased speed of performance, care substitution, and stigmatization. The
differences between all pairs of means were significant (paired-samples t tests: p .01), except for the
difference between autonomy and efficiency.
The mean total score was 95.14 (minimum 29,
maximum 150; SD 20.18).
45
Table 5. Attitudes Toward Assistive Device (AD) Use in Community-Dwelling Elderly Persons: Mode, Mean, and Standard Deviation of
the Items of the Attitude Scale, Flanders, 1999
Item
1. By using ADs I would be able to remain longer at home when I become more in need for care
2. The use of ADs could not exclude personal help
3. I would dare to rely totally on ADs
4. The use of ADs would make someone less dependent on personal assistance
5. I would like to have an AD, provided I do not have to pay myself
6. ADs foster loneliness
7. Elderly persons can contribute to the costs of an AD when they need one
8. ADs are a good solution to certain problems
9. If I had an AD I could do things my own way
10. ADs are developed by people who know nothing about elderly persons
11. I feel handicapped when using certain ADs
12. I am willing to invest in ADs
Mode
M
SD
5
4
4
5
2
4
4
5
5
2
4
4
4.57
3.52
3.51
4.46
2.52
2.87
3.62
4.72
4.35
2.32
3.06
4.07
0.74
1.11
1.27
0.80
1.24
1.27
1.01
0.51
0.82
1.07
1.31
1.05
Note: 1 totally disagree; 5 totally agree.
Subjective Norm Regarding the Use of ADs
reliable scale, the AADS. Moreover, significant relations were expected between the proximal variables
and the more distal variable awareness of ADs. Finally, a relation between the intention to use ADs
and functional status on the one hand and the use of
ADs on the other was expected. After standardization of the raw scores in z scores of all variables that
were included in the model to be tested, the relations
were tested with two regression analyses and three
correlations. The beta and p values are presented in
Table 7. Awareness was found to be significantly
correlated to attitudes (Pearson r .17, p .001)
and subjective norms (Pearson r .16, p .001),
but not to self-efficacy. Direct effect of awareness on
the intention to use ADs was investigated with the
partial correlation between awareness and intention,
The general practitioner was mentioned most often (by 63.4% of the respondents) as the person
whose opinion is valued regarding the use of ADs,
closely followed by the children (52.8%) and the
partner (47.2%). Nurses (21.3%) and friends (12.3%)
were mentioned less. Only 4.1% of the elderly persons mentioned that they did not value anybody’s
opinion regarding the use of ADs.
The product of the perceived strength of a significant other’s expectation to use ADs on the one hand
and the motivation to comply with this expectation
on the other is a measure of the strength of a normative belief for this person. The most important normative belief concerned the general practitioner, and
the second most important normative belief concerned the children and the partner (Table 4). In order of importance, the other important normative
beliefs concerned the nurse and friends. The differences between all pairs of means were significant
(paired-samples t test: p .0005), except for the difference between the normative beliefs regarding the
partner and the children. The mean subjective norm
was 36.13 (SD 23.41).
Table 6. Perceived Consequence of Assistive Device (AD) Use,
Valuation of the Perceived Consequence, and Attitude Toward
AD Use in Community-Dwelling Elderly Persons, Flanders, 1999
Consequence
Perceived Consequence
Safety
Efficiency
Autonomy
Speed of performance
Care substitution
Stigmatization
Valuation of Perceived Consequence
Safety
Efficiency
Autonomy
Speed of performance
Care substitution
Stigmatization
Attitude
Safety
Efficiency
Autonomy
Speed of performance
Care substitution
Stigmatization
Self-Efficacy Regarding the Use of ADs
The mean self-efficacy score, obtained with the
three-item scale, was 12.02 (SD 2.06, minimum 3, maximum 15). Elderly persons believe they can
use an AD when they cannot perform the activity on
their own, they believe they can use the AD if this is
required by the circumstances, and they believe they
can continue to use the AD, even if it is tiring and
difficult (Table 4).
A Model of the Use of ADs
The model was tested with path analysis, testing
significant and nonsignificant relations. Specific, significant relations were expected between the proximal variables of attitude, subjective norm, and selfefficacy on the one hand and intention to use ADs on
the other. The attitude was measured with the most
Mode
M
SD
5
5
5
4
3
4
4.49
4.45
4.16
3.96
3.01
3.00
0.77
0.71
1.04
1.02
1.23
1.32
5
5
5
4
4
5
4.75
4.36
4.77
3.31
3.48
3.35
0.61
0.81
0.60
1.27
1.33
1.51
21.41
19.59
20.00
13.39
10.91
9.81
4.76
5.22
5.81
6.61
6.61
6.29
Notes: For perceived consequence: 1 totally disagree; 5 totally agree. For valuation of perceived consequence: 1 very
unimportant; 5 very important.
46
The Gerontologist
controlled for attitude, subjective norm, and self-efficacy. It was expected to be nonsignificant and
proved to be so. All expected relations within the
core of the model were confirmed, although the relationship was often small. It is important to note that
the scores on the functional-status instrument and
the measure of the use of ADs are positively related,
which means that the concepts are negatively related.
The significant relations are presented in Figure 1.
helpful, not only to compensate for disabilities, but also
to increase efficiency and safety in nondisabled persons. Even more problematic is the finding that the
presence of specific disabilities, which is an obvious
reason to use ADs, did not result in the use of more
of the relevant ADs, except regarding mobility. Another topic of concern is the extent of the nonuse of
ADs that elderly persons already possess. The proportion of the number of people that possess a specific AD but do not use it varies considerably from
one AD to another. It can be hypothesized that the
nonuse of canes, toilet seats, and long shoehorns can
be attributed to the fact that these cheap ADs are
passed on from one generation to the next and are
stored until a person becomes disabled and needs them.
But more expensive ADs are not used either, which is
a waste of resources. Examples are the hydraulic hospital bed, the walking frame, the rollator, the manual
wheelchair, the electric wheelchair, and the staircase
lift. This finding suggests the need for improvement
of follow-up. Although this finding is based on a
small numbers of persons, we found nonuse for each
of the 32 ADs, which supports the reliability of this
result. The presence of disabilities is an obvious reason to use ADs: The data show that persons with disabilities regarding mobility, bed transfer, and going
to the toilet used more ADs specific to these activities
than did persons without these disabilities.
Before people can develop an attitude toward ADs,
they need to be aware of them. This study showed a
good awareness in the community-dwelling elderly regarding the existence of ADs that have been available
for decades. These relate to mobility and transfer: the
wheelchair, the parrot, the cane, and crutches; for
washing: the anti-slip mat; regarding dressing: the
long shoehorn; regarding going to the toilet: the toilet
chair and incontinence material. Many people also
possess these ADs. But some ADs regarding mobility
that have been developed more recently were also
known to most elderly persons, for example, the hydraulic hospital bed, a grip in the toilet, and the walking frame. This may be due to their presence in hospitals and rehabilitation centers. They are also well
known to home nurses. But a lower level of awareness
of 21 other ADs was found. These ADs may nevertheless increase the comfort and safety of elderly persons,
and consequently their quality of life. Moreover, it
was expected that persons with a disability would be
more aware of the specific AD that would be relevant
to increase their functional level than would persons
Discussion
In this study we described the possession and use
of ADs for self-care and mobility in a random sample
of community-dwelling elderly persons between 70
and 89 years old in Flanders. We were especially interested in the ability of psychological variables to
explain the use of ADs. Knowing them would suggest measures to be developed that could probably
improve the introduction process of ADs. The concepts of the theory of planned behavior were operationalized in the context of AD use. We described the
possession and use of ADs in community-dwelling elderly persons as they are related to the intention to
use ADs, awareness of ADs, attitudes toward AD
use, the subjective norm regarding AD use, and selfefficacy concerning AD use. We found that the use of
ADs was indeed partially predicted by the intention
to use ADs when controlling for functional status,
and that the intention to use ADs was explained by
the concepts of the model. Therefore, this study suggests that a social–cognitive model of human behavior can be helpful in explaining the use of ADs. The
findings are discussed in the following section.
Because the study focused on ADs for self-care
and mobility in the general elderly population, almost all ADs were low tech, and many had already
existed for quite a long time. The use of ADs was not
exceptional. Almost all community-dwelling persons
between 70 and 89 years possessed and used at least
one of the 32 ADs for self-care and mobility. Elderly
persons possess and use ADs especially regarding
taking a bath and mobility. Notwithstanding these
positive findings, the study revealed that many ADs
were not possessed and used by a substantial proportion of elderly persons. ADs that have been developed more recently in particular (e.g., the personal
alarm system, a device to pull on socks) were not
possessed by the majority of elderly persons between
70 and 90 years of age, although these ADs can be
Table 7. Path Analysis of Assistive Devices (ADs) Use (N 491)
Model
Dependent variable
Independent variable
1
R2 .310
F(3,468) 71.455***
Intention to use ADs
2
R2 .159
F(2,478) 46.281***
The use of ADs
Attitudes (AADS)
Self-efficacy
Subjective norm
Functional status
Intention to use ADs
.170***
.469***
.091*
.398***
.121**
Regression
Note: AADS Attitudes Toward Assistive Devices Scale.
*p .05; **p .01; ***p .001.
Vol. 42, No. 1, 2002
47
Figure 1. A social cognitive model of assistive device (AD) use in older persons.
without this disability, as the acquisition of a disability would trigger a search for information. This was
not confirmed by the data. The findings suggest an
equal level of information regarding all groups of ADs
in people with specific disabilities.
In accordance with other studies, we found that
the attitude of community-dwelling elderly people
was rather positive toward the use of ADs. A clear
order emerged. The finding that elderly persons do
not use ADs solely with the aim of increasing autonomy (Sonn & Grimby, 1994) was confirmed. The elderly persons in particular expected safety and efficiency as consequences of AD use, even more than,
in descending order, autonomy and speed of performance. They also valued safety in the context of
ADL highest, together with autonomy. They valued
efficiency as secondary.
The elderly persons expected that AD use would
substitute personal care at home and substitute intramural care by home care. But they thought that the
substitution of care is limited and that AD use would
not preclude personal help.
For health care workers introducing ADs, the consequences that should be emphasized are not only the
increase in autonomy but the increased efficiency
and safety, too. Because people expect these consequences and value them highly, these aspects of ADs
can facilitate their introduction. The effect on care
substitution and on stigmatization should be discussed in greater depth with disabled persons, but
with some caution as negative attitudes can be expected, and in general these consequences are valued
less. Increased feelings of loneliness when using ADs
because of the decreased help from other people were
expected by some. This negative aspect of ADs deserves further consideration.
The subjective norm regarding the use of ADs was
found to be a small yet significant determinant of the
intention to use ADs. General practitioners and relatives are the most important significant others. Their
willingness and cooperation was found to be important for successful introduction of ADs.
Data analysis was improved compared with preceding studies by using techniques that controlled for
other variables. Social cognitive variables were orga-
nized in a social cognitive model of AD use. The previously developed model to describe the use of ADs
(Roelands et al., in press) was modified in accordance
with the theory of planned behavior and proved to be
of some significance. Functional status was confirmed as an important determinant of the use of
ADs, which is evident because it is a prerequisite for
using ADs. The model on the psychological variables
increases the variance in the use of ADs that is explained. Intention to use ADs was determined especially by self-efficacy regarding the use of ADs, but
the relative importance of the variables should be
considered fully, as we discuss below. Intention to
use ADs was also determined by the attitude toward
the use of ADs and to a lesser extent by the subjective norm regarding the use of ADs. The role of
awareness regarding ADs and attitudes toward the
use of ADs were confirmed. But the partial correlations showed that because of the inclusion of more
proximal factors in the model, awareness of ADs became a more distal factor and was positively correlated with the attitude toward the use of ADs and the
subjective norm.
The psychological variables in the model predicted
a moderate amount of variance in intention to use
ADs, but intention to use ADs and functional status
predicted a rather small amount of variance in use of
ADs. We can hypothesize that in use of ADs factors
at other levels are involved, too. Some will act as barriers, others as facilitators. Some of these factors can
be summarized as network factors, for example, aspects of AD supply by health care services (e.g.,
costs, sensitivity of needs screening, quality of AD introduction process, extent and quality of supply),
and availability of personal help regarding ADLs and
IADLs. The model presented in this article focuses
only on psychological factors involved in use of ADs.
The predictive power of other factors should be evaluated in intervention studies and studies comparing
health care systems to allow further optimalization
of AD use by older persons.
A complex sample-selection procedure was used
to obtain a representative distribution of age, sex,
and SES (at municipal level). It is very likely that the
sampling strategy resulted in a representative sample
48
The Gerontologist
of elderly persons living in Flanders to be contacted.
Nevertheless, some results suggest some selection bias
in the final sample in favor of men. The gender ratio
in Flanders in this age group is 57.7% women and
42.3% men, as it is 51.9% women and 48.1% men
in the sample of respondents. Three mechanisms may
be involved. First, as lack of a telephone is probably
related to SES and a correlation has been established
between being an older woman and low SES, perhaps more women were excluded. Second, it is well
known that disabilities are more common in women.
Third, more women refused to cooperate, which may
be because of the procedure, because most of the telephone calls to obtain consent were done by a male
researcher, although it was mentioned that the actual
interviewer would be a woman. Nevertheless, the deviation from the distribution of the person’s sex in
the population was rather small, and effects on the
descriptive data are therefore minimal. The representativeness of the sample regarding physical functioning can be estimated by comparing the SF-36 subscale score of the people aged between 75 and 89 in
this study (N 290) with a representative sample of
community-dwelling and institutionalized people
aged 75 and older in the Belgian National Health Interview Survey (BNHIS; N 195). When people are
not disabled in any of the 10 types of activities, they
have a score of 100, the minimum score is 0. The
mean level of functioning is similar between the two
samples (BNHIS: M 57.8; this study: M 59.6). A
one-sample t test did not reveal any significant differences between this sample and the BNHIS, t(289) 1.027. The comparison of functional status with another representative sample, and the comparison of
age and SES of the municipality between respondents
and persons who refused, indicate that the respondents are a representative sample of the communitydwelling persons between 70 and 89 years old in
Flanders, taking into account the exclusion criteria,
most of which are common in surveys.
Many instruments were developed for this study
to measure the concepts that were introduced. The
PCAD, the SEAD, and the IAD were sufficiently reliable, although there was some room for improvement. The reliability of the instruments and the relations in the model could increase if some adaptations
were done. First, the beliefs were specified as related
to devices for self-care and mobility. This was sufficient for this study as the model was confirmed. It is,
however, likely that a person’s self-efficacy, perceived
consequences and intention to use depend on the specific AD. A second reliability issue relates to the evaluation component of the attitude beliefs. As discussed by Young, Lierman, Powel-Cope, Kasprzyk,
and Benoliel (1991, p. 142) regarding the theory of
planned behavior, “in asking a respondent to evaluate an item . . . one assumes that the respondent
holds an absolute opinion about that belief and that
it is possible to make this evaluation acontextually.” It is, however, likely that this opinion depends
on related factors such as the activity and the AD
concerned. For example, “to perform activities indeVol. 42, No. 1, 2002
pendently with an AD” can be considered very unimportant if it regards self-care, but very important regarding mobility. A third reliability issue is especially
important in lower educated elderly people. It has already been mentioned (Mullen, Hersey, & Iverson,
1987; Young et al., 1991) that the format of the attitude questionnaire can pose a conceptual challenge
to participants. The evaluation items are similar to
the belief items and the respondents may perceive
them as the same, resulting in feelings of frustration.
With some respondents, we had the impression that
they fell back on response sets.
In general, the intention of elderly persons to use
ADs was high, but some caution is required. The
high level of intention may also be due to a socially
desirable response. Although showing a positive attitude regarding the use of ADs was always avoided,
and this was strongly stressed during the training of
the interviewers, it is not entirely impossible that the
presentation of the study or the items was not totally
neutral. The socially desirable response, if and to the
degree it occurred, would also decrease the relationships in the model.
Some caution is necessary regarding the interpretation of the correlations between variables and their determinants and consequently regarding the interpretation of the relative weights of the determinants to
predict a variable (the s). In the theory of planned behavior the correspondence between the variables regarding action, target, context, and time elements is
essential to be able to predict behavioral intentions
and behavior (Ajzen & Fishbein, 1980, p. 56). It
seems to us that the rather low betas in the model on
the use of ADs can be increased by improving the correspondence between the measures. Where correspondence was high, so too was the self-efficacy (intention
correlation) beta. Although it has been mentioned that
this high correlation between two successive similar
scales that follow one another in the questionnaire
may be due to a response set, the different response
categories slightly reduce the effect. An improvement
in the correspondence would also challenge the relative importance of the variables in predicting the intention to use ADs. Moreover, an improved correspondence would probably increase the predictive
validity of the intention to use ADs. The correspondence could be increased by being more specific regarding the context of using ADs (e.g., when one is
alone, when it is free of charge), the target (e.g., to increase autonomy or safety or efficiency), the time elements (every time when it is required or sometimes),
and also regarding the object of the behavior under
consideration. We assume that the relative weights of
the concepts differ depending on the specific AD.
The low number of ADs in the subscales related to
AD use and the dichotomous nature of the individual
items limited the internal consistency of the scales. The
finding that AD use is related to presence of specific
disabilities requires confirmation with larger subscales.
A social–cognitive model of the use of ADs was
empirically tested in community-dwelling elderly
persons. Finally, the validity and usefulness of this
49
model should be evaluated in intervention studies,
which could develop and evaluate protocols to introduce ADs in a more structured way. We expect that
interventions meant to increase the intention to use
ADs and the use of ADs, when required by the functional status and wanted by the person with disabilities, to increase their effectiveness, should take these
variables into consideration. These concepts and the
model could also be evaluated in specific populations
(e.g., persons with arthritis or dementia, persons living in institutions) and for specific ADs.
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Appendix
Perceived Consequences of the Use of Assistive
Devices (AD) Scale
Using AD has some consequences. To which degree do you agree
with the following statements?
Totally agree
5
Rather agree
4
Don’t know
3
Rather disagree
2
Totally disagree
1
• By using AD I can do things independently and I don’t need help.
• By using AD other people will think I am old and sick.
• By using AD it goes faster.
• By using AD it goes easier.
• By using AD the nurse or home carer doesn’t visit me anymore.
• Using AD gives me a sense of security.
To what extent is it important to you that . . .
Very important
5
Rather important
4
Not important, not unimportant 3
Rather unimportant
2
Very unimportant
1
• you can do activities independently and you don’t need help?
• other people do not think you are old and sick?
• an activity goes fast?
• an activity goes easy?
• the nurse or home carer doesn’t visit you anymore?
• you have a sense of security?
50
The Gerontologist