Table 3.
Safety assessment measure: Scales, items, and content validity
| Scale and Associated Item Pool (n = 126 total items) | I-CVI | Mean | Activity/Cause | Primary Harm to: |
|---|---|---|---|---|
| Cognitive Capacity (n = 21 items) | ||||
| Crosses street inappropriately (e.g., does not look, misinterprets walk signs, misjudges traffic) | 100% | 3.96 | Transportation | Self |
| Mistakenly takes wrong dose of medication (e.g. too little, takes twice) | 100% | 3.96 | Medical Management | Self |
| Forgets to take prescribed medication (e.g. seizure, diabetes, high blood pressure) | 100% | 3.92 | Medical Management | Self |
| Uses other people’s prescribed medications (e.g. pain, sleep) | 100% | 3.92 | Medical Management | Self |
| Does not know when an injury or illness requires medical care (e.g. deep cut, chest pain) | 100% | 3.77 | Medical Management | Self |
| Leaves cooking food unattended | 100% | 3.67 | Fire/Burns | Self. Property |
| Forgets to use mitt or towel when picking up hot items | 100% | 3.63 | Fire/Burns | Self |
| Leaves flammable items too close to fire (e.g. paper bag near burner) | 96% | 3.74 | Fire/Burns | Self, Property |
| Forgets to turn off appliances (e.g. stove, iron, space heater) | 96% | 3.74 | Fire/Burns | Self, Property |
| Does not respond to emergency alarms (e.g. smoke, carbon monoxide, weather) | 93% | 3.81 | Emergency Response | Self |
| Sets stove burner too high | 93% | 3.30 | Fire/Burns | Self, Property |
| Does not follow emergency procedures | 89% | 3.76 | Emergency Response | Self |
| Forgets to avoid foods that cause allergic reaction | 85% | 3.30 | Eating | Self |
| Unable to find way if lost in the community | 82% | 3.44 | Avoid Harmful Others | Self |
| Forgets to lock doors and windows when leaving home | 74% | 2.85 | Money, Possessions | Property |
| Misuses microwave (e.g. puts metal objects inside, burns food) | 74% | 2.81 | Electric, Equipment | Property |
| Loses wallet or purse | 67% | 2.81 | Money, Possessions | Property |
| Forgets to put medications away | 62% | 2.76 | Poisoning | Others |
| Forgets to put sharp objects away (e.g., scissors, knives) | 62% | 2.71 | Sharp Objects | Others |
| * Does not react appropriately to warning signs (e.g. wet floor, construction, etc.) | NR | NR | Avoid Harmful Others | Self |
| * Does not check surroundings before walking through a parking lot | NR | NR | Transportation | Self |
| Visuomotor Capacity (n = 14 items) | ||||
| Loses balance when walking up or down stairs | 100% | 3.85 | Falls | Self |
| Does not move to an exit in an emergency | 100% | 3.81 | Emergency Response | Self |
| Loses balance getting in or out of tub | 100% | 3.74 | Falls | Self |
| Loses balance getting in and out of car | 96% | 3.67 | Falls | Self |
| Loses balance while getting on or off toilet | 96% | 3.63 | Falls | Self |
| Loses balance when attempting to stand from a sitting position | 96% | 3.56 | Falls | Self |
| Loses balance when reaching forward | 96% | 3.41 | Falls | Self |
| Trips on things (e.g., curbs, objects, uneven surfaces) | 93% | 3.38 | Falls | Self |
| Loses balance when walking on fiat surfaces | 93% | 3.59 | Falls | Self |
| Loses balance when carrying objects | 93% | 3.52 | Falls | Self |
| Trips when walking in low lit areas | 93% | 3.41 | Falls | Self |
| Loses balance when dressing | 89% | 3.44 | Falls | Self |
| * Bumps into walls, objects, or people | NR | NR | Transportation | Self, Property |
| * Trips when walking in well lit areas | NR | NR | Falls | Self |
| Wheelchair Use (n = 6 items) | ||||
| Uses wheelchair in potentially dangerous environments (e.g. street, rough terrain) | 93% | 3.78 | Wheelchair Use | Self |
| Does not follow wheelchair precautions (e.g. locking brakes, wearing seatbelt, keeping fingers away from spokes, etc.) | 89% | 3.59 | Wheelchair Use | Self |
| Uses wheelchair without required assistance | 85% | 3.58 | Wheelchair Use | Self |
| Moves too fast in wheelchair | 81% | 3.27 | Wheelchair Use | Self, Others |
| Loses control of wheelchair (e.g. tips wheelchair) | 81% | 3.12 | Wheelchair Use | Self |
| * Backs up without checking for people or objects | NR | NR | Wheelchair Use | Self, Others |
| Risk Perception (n = 17 items) | ||||
| Stands on unstable objects (e.g. chair with wheels, top step of ladder, cardboard box) | 100% | 3.85 | Falls | Self |
| Rides in a motor vehicle driven by someone who has been drinking or doing drugs | 100% | 3.77 | Transportation | Self |
| Inappropriately reveals personal information (e.g. bank acct number, social security number) | 100% | 3.73 | Money, Possessions | Property |
| Easily influenced to do risky behaviors | 96% | 3.63 | Avoid Harmful Others | Self, Property |
| Falls asleep while smoking | 93% | 3.85 | Fire, Burns | Self, Property |
| Invites strangers into home | 93% | 3.67 | Avoid Harmful Others | Self, Property |
| Operates equipment while drowsy (e.g., power tools, lawnmower) | 93% | 3.63 | Electric, Equipment | Self |
| Meets in person with strangers found on the internet | 93% | 3.58 | Avoid Harmful Others | Self, Property |
| Goes alone in dangerous areas (e.g. high crime, poorly lit areas) | 89% | 3.65 | Avoid Harmful Others | Self, Property |
| Jumps or dives into a body of water without knowing depth | 85% | 3.62 | Recreation | Self |
| Goes with stranger (e.g., gets in car, goes to home) | 85% | 3.60 | Avoid Harmful Others | Self, Property |
| Swings objects without looking for others in path (e.g., clubs, yard equipment) | 85% | 3.31 | Recreation and Equip. | Others, Property |
| Goes on slippery surfaces | 82% | 3.37 | Falls | Self |
| Easily tricked into giving strangers money | 81% | 3.19 | Avoid Harmful Others | Property |
| Readily gives money to family or friends without considering consequences | 78% | 3.04 | Money, Possessions | Property |
| Approaches unknown animals | 74% | 3.00 | Avoid Harmful Others | Self |
| Does not prepare for weather (e.g. dress warm on a cold day, wear sunscreen on sunny day) | 67% | 2.73 | Recreation | Self |
| Compliance Failures with Safety Recommendations (n = 20 items) | ||||
| Refuses to take prescribed medications (e.g., seizure, diabetes, high blood pressure) | 100% | 3.96 | Medical Management | Self |
| Drives motor vehicle against recommendations | 100% | 3.89 | Transportation | Self, Others |
| Does not wear a helmet when recommended (e.g. bicycle, scooter, motorcycle) | 100% | 3.77 | Transportation | Self |
| Does not follow precautions when using electrical equipment (e.g. power tools, kitchen appliances) | 100% | 3.73 | Electric, Equipment | Self, Property |
| Does not follow precautions when using fire | 100% | 3.69 | Fire, Burns | Self, Property |
| Does not follow precautions when using sharp devices | 100% | 3.48 | Sharp Objects | Self |
| Uses firearms against recommendations | 96% | 3.78 | Firearms | Self, Others |
| Operates recreational vehicle (e.g. golf cart, boat, jet ski) against recommendations | 96% | 3.63 | Recreation | Self, Others |
| Climbs against recommendations (e.g., stool, ladder, stairs) | 93% | 3.62 | Falls | Self |
| Ignores advice to seek medical care | 93% | 3.48 | Medical Management | Self |
| Participates in sports or recreational activities against recommendations | 93% | 3.46 | Recreation | Self |
| Does not follow precautions on warning labels | 93% | 3.33 | Medical/Fire, Burns | Self |
| Is not responsible with firearms | 91% | 3.61 | Firearms | Self, Others |
| Does not wear a seatbelt | 85% | 3.44 | Transportation | Self |
| Does not follow exercise precautions (e.g. runs in severe heat, lifts too much weight) | 85% | 3.37 | Recreation | Self |
| Goes on amusement park rides (e.g. roller coaster) against recommendations | 85% | 3.22 | Recreation | Self |
| Ignores important diet restrictions for medical condition (e.g. diabetes, swallowing disorder) | 82% | 3.42 | Medical/Eating | Self |
| Goes in water without recommended supervision (e.g., bath, pool, natural body of water) | 82% | 3.35 | Medical/Recreation | Self |
| Does not follow precautions when using chemical solutions (e.g. mixing cleaning products, insecticide in closed space) | 78% | 3.40 | Poisoning | Self |
| Does not use recommended safety equipment (e.g., walker, safety rails, shower chair) | 74% | 3.20 | Falls | Self |
| Self Regulation (n = 20 items) | ||||
| Physically attacks strangers | 100% | 3.89 | Aggressive, Violent | Self, Others |
| Easily provoked into physical fight | 100% | 3.78 | Aggressive, Violent | Self, Others |
| Makes unwelcome physical contact with others | 100% | 3.73 | Sexual | Self, Others |
| Keeps doing activities after being told to stop | 100% | 3.62 | Falls/Transportation | Self |
| Physically abuses family members or caregivers | 96% | 3.81 | Aggressive, Violent | Self, Others |
| Exchanges in sex for goods (e.g., money, drugs, cigarettes; pays for sex) | 96% | 3.69 | Sexual | Self, Others |
| Engages in unsafe sex (e.g., unprotected sex, one night stands, multiple partners) | 96% | 3.69 | Sexual | Self, Others |
| Shoves or pushes others | 93% | 3.48 | Aggressive, Violent | Self, Others |
| Physically abuses animals | 92% | 3.58 | Aggressive, Violent | Self, Animals |
| Wanders | 89% | 3.48 | Avoid Harmful Others | Self |
| Makes unwelcome sexual remarks | 89% | 3.33 | Sexual | Others |
| Throws, hits, or kicks objects in anger | 89% | 3.26 | Aggressive, Violent | Self, Others |
| Gambles excessively | 88% | 3.20 | Money, Possessions | Self, Property |
| Verbally abuses others | 85% | 3.52 | Aggressive, Violent | Others |
| Sends abusive or obscene messages (e.g. email, text, voicemail) | 85% | 3.31 | Aggressive, Violent | Self, Others |
| Tries to eat non-food items | 85% | 3.11 | Poisoning | Self |
| Cannot stop spending money | 84% | 3.12 | Money, Possessions | Self, Property |
| Verbally abuses family and friends | 81% | 3.36 | Aggressive, Violent | Self, Others |
| Takes other people’s things | 81% | 3.28 | Aggressive, Violent | Self, Others |
| Provokes animals | 74% | 2.93 | Avoid Harmful Others | Self, Animals |
| Motor Vehicle Operation (n = 19 items) | ||||
| Does not stop at red lights or stop signs | 100% | 3.89 | Transportation | Self, Others |
| Texts messages while driving | 100% | 3.89 | Transportation | Self, Others |
| Does not yield when required (e.g. for pedestrians, before merging onto road) | 100% | 3.85 | Transportation | Self, Others |
| Does not look out for pedestrians or bicyclists | 100% | 3.85 | Transportation | Self, Others |
| Changes lanes without looking | 100% | 3.78 | Transportation | Self, Others |
| Operates motor vehicle when on sedating medications | 100% | 3.78 | Transportation | Self, Others |
| Backs up without looking | 93% | 3.78 | Transportation | Self, Others |
| Easily distracted when driving | 93% | 3.77 | Transportation | Self, Others |
| Talks on cell phone while driving | 93% | 3.70 | Transportation | Self, Others |
| Operates motor vehicle when drowsy | 93% | 3.63 | Transportation | Self, Others |
| Misjudges turns (e.g. hits curbs, goes too wide) | 89% | 3.58 | Transportation | Self, Others |
| Reacts slowly to changing traffic (e.g., missing traffic signs, not braking soon enough) | 89% | 3.54 | Transportation | Self, Others |
| Drives too closely behind other vehicles | 89% | 3.52 | Transportation | Self, Others |
| Makes illegal turns | 87% | 3.63 | Transportation | Self, Others |
| Drives too fast (15 + MPH over limit) | 83% | 3.33 | Transportation | Self, Others |
| Gets lost when driving | 81% | 3.33 | Transportation | Self |
| * Drifts out of lane | NR | NR | Transportation | Self, Others |
| * Impulsively exits or makes turns (e.g. crosses multiple lanes, swerves at last minute) | NR | NR | Transportation | Self, Others |
| * Forgets where he or she is going | NR | NR | Transportation | Self |
| Child Caretaking (n = 9 items) | ||||
| Leaves children unattended (e.g., left alone in home, in bath, in park) | 100% | 4.00 | Multiple | Self, Others |
| Drives with child in the car after using alcohol or drugs | 100% | 3.96 | Transportation | Self, Others |
| Physically harmful to children | 100% | 3.93 | Aggressive, Violent | Self, Others |
| Does not buckle child in seatbelt, car seat, or booster seat | 100% | 3.85 | Transportation | Self, Others |
| Allows small child to ride in the front passenger seat | 96% | 3.65 | Transportation | Self, Others |
| Verbally harmful to children | 93% | 3.74 | Aggressive, Violent | Self, Others |
| * Leaves child in car while running errands | NR | NR | Poisoning | Self, Others |
| * Does not seek medical help when child is injured or ill | NR | NR | Medical Management | Self, Others |
| * Carries child despite physical limitations | NR | NR | Falls | Self, Others |
Each SAM item was rated for its relevance to preventing unintentional injury or harm as follows: 1 = not at all important; 2 = somewhat important; 3 = very important; 4 = critically important. I-CVI = Item Level-Content Validity Index (the percentage of stakeholders who rated an item as very or critically important; Mean = Average of Item Level Content Validity Ratings; ‘*’ = items added as a result of feedback from the health provider focus groups or family interviews. NR = not rated because they were newly generated from feedback during the focus group and consumer rating sessions