Development and Preliminary Psychometrics of a Scale Measuring Community Integration: A Community Based Participatory Approach

Background: Adults with serious mental illness are presumed to have lower levels of community integration, but no assessment tool has garnered broad support, limiting systematic investigation. This study employed community based participatory research strategies to partner with a director in a mental health organization for the development of a psychometrically sound scale to measure community integration that is appropriate for program evaluation, endorsed by providers as clinically relevant, and useful for consumers in developing meaningful treatment plans.

Methods: The study employed an exploratory sequential mixed methods design. A group of consumer providers (n=5) and non-consumer providers (n=5) took part in two focus groups each, (total of four): round one to identify and define community integration and round two to refine the definitions of major domains. Focus groups were transcribed verbatim and analyzed in NVivo qualitative software using thematic analysis. Five domains were identified, and 96 items were developed to measure the domains. A combined focus group (n=10) with the original research participants was conducted to evaluate these five domains and each scale item. Three research experts also reviewed the material. This refinement process resulted in four domains and 75 items. Mental health providers (n=10) were trained to administer the scale, which they administered to 50 consumers. Twenty consumers completed the scale twice for assessment of test-retest reliability using pairwise correlation. A final focus group was conducted with the 10 providers who administered the scale to solicit feedback about the implementation process and scale content.

Results: There were four domains of community integration: Physical describes physical housing and geographic space a person occupies as well as the variety and frequency of activities in which a person engages. Social refers to satisfaction in quality and frequency of interactions with others and the size and variety of people within one’s social network. Psychological describes having a sense of belonging, safety, and trust in others while contributing to one’s self-defined community. Capabilities and volition refers to having access to opportunities, the ability to engage in valued activities and hold important social roles, and exercising self-determination and choice in engagement with the larger society. We removed 25 scale items with restricted variance (n=21) and high correlations (>.70) with other items (n=4). The final scale contains 50 items with a Cronbach’s alpha of .95 (subscales between .85 and .90); test-retest reliability was .90.

Implications: Preliminary findings suggest the 50-item scale is reliable; useful and relevant for administrators, providers, and consumers; and feasible to implement in agencies. Providers endorsed the scale as a promising tool to promote conversation for treatment planning. Consumers expressed gratitude for the opportunity to discuss important concerns often overlooked in clinical encounters. Agency administrators voiced enthusiasm for the measure’s ease and appropriateness for program evaluation. The scale honors social work’s commitment to client-centered research and provides a standard metric to inform policy makers and providers about the effectiveness of services to address the holistic outcome of community integration.