Abstract
BackgroundDecentralisation of social support and budget cuts spurred interest in outcome-oriented payment systems in the Netherlands. Hence, measurement of relevant outcomes, such as self-reliance and participation, is needed. The Impact on Participation and Autonomy (IPA) questionnaire for rehabilitation clients was adapted for social support, called IPA-MO, and its validity and reliability were tested among social support clients in eight municipalities in 2014 and 2016.MethodsThe total research sample comprised of 4120 persons. Homogeneous subgroups were distinguished based on 1) disability and 2) age. Exploratory factor analysis (PCF) was used to identify domains for IPA-MO. Model fit was assessed with Confirmatory Factor Analysis (CFA) using structural equation modelling.ResultsPCF revealed that the IPA-MO model consists of all five original IPA domains: Autonomy indoors, Family role, Autonomy outdoors, Social life and relations, and Work and education. As a result of new items added, a new, sixth domain was developed: Financial autonomy. Due to high non-response on Work & education, construct validity was first tested for a five-domain IPA-MO model. The composition of the IPA-MO domains showed slight differences: the item on ‘mobility indoor’ shifted from Autonomy indoors (IPA) to Family Role in IPA-MO. The item on reciprocity shifted from Social Life and relations (IPA) to Autonomy outdoors (IPA-MO). Internal reliability was confirmed for all domains (Cronbach’s alpha >.80). CFA showed acceptable construct validity of the five-domain IPA-MO model for the social support population (CFI .936, TLI .925, SRMR .051), all age groups and most disability-based groups. Construct validity including Work & education was tested for 234 participants. Then, PCF revealed six domains and the model fit was acceptable (CFI .915, TLI .903, SRMR .067).ConclusionsIPA-MO is a valid and reliable instrument to assess outcomes of social support. Further research on the domain Financial autonomy is needed. Social-support clients are numerous and dispersed and, in spite of the best intentions, hard to involve widely in policy processes. A valid outcome measure offers municipalities possibilities to gain insight in social costs and benefits of new policies. Outcome measurement also allows to contract bundled-services of providers, thereby changing the incentives for providers from increasing production to much needed innovation. Taking the perceptions of autonomy and participation of social-support clients as the acid test for the effectiveness of social support policies, may prove a serious game-changer in politics.
Highlights
Under the Dutch Social Support Act (“Wet maatschappelijke ondersteuning – Wmo”), public social-support services have progressively been transferred to local governments
1) validation of the original Impact on Participation and Autonomy (IPA) for 4 domains: Autonomy indoors, Family role, Autonomy outdoors and Social life and relations Validation is based on the entire research sample; 2) validation of the original IPA for 5 domains, including Work and education. This analysis is based on the group of participants that responded to all items on Work and education (n = 234); the adjusted IPA questionnaire with the new items on income (3a-c) was tested
For the 5-domain model the analysis is based on the group of participants that responded to all items on Work and education (N = 234)
Summary
Under the Dutch Social Support Act (“Wet maatschappelijke ondersteuning – Wmo”), public social-support services have progressively been transferred to local governments. Government policies should foster an enabling environment, and their support should strengthen people’s ability to participate This is a major change from the past, when government policy was oriented towards taking over the care for these people, based on the assumption that inactivity is a logical consequence of impairments [4]. This change in national policies is in line with the paradigm change introduced by the WHO in 2001 with the ratification of the International Classification of Functioning, Disability and Health (ICF) [5]. The Impact on Participation and Autonomy (IPA) questionnaire for rehabilitation clients was adapted for social support, called IPA-MO, and its validity and reliability were tested among social support clients in eight municipalities in 2014 and 2016
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