title: Development and cognitive testing of the Nottwil Environmental Factors Inventory in Canada, Switzerland and the USA.
abstract: OBJECTIVE
  To develop and pre-test the Nottwil Environmental Factors Inventory (NEFI), a questionnaire assessing the perceived impact of environmental factors on specific areas of participation (productive life, social life, and community life) experienced by people with spinal cord injury.
  
  
  METHODS
  Thirty-seven participants with spinal cord injury in Canada, Switzerland and the USA.
  
  
  METHODS
  A first draft of the NEFI was developed based on a new theoretical model, the International Classification of Functioning, Disability and Health (ICF) Core Sets for spinal cord injury, and expert consultation. Three rounds of cognitive testing were conducted to examine participants’ comprehension of the conceptual framework and items, to identify challenges in cross-cultural measurement, and iteratively to refine the questionnaire.
  
  
  RESULTS
  Participants were able to differentiate well between environmental factors influencing productive life and those influencing social life or community life, but not between environmental factors influencing social life and community life. Items intended to capture avoidance of participation due to barriers or overcoming of obstacles were generally well understood.
  
  
  CONCLUSIONS
  For people with spinal cord injury, the NEFI may help to identify limiting and helpful environmental factors, while considering avoiding and overcoming behaviours. Quantitative validation and exploration of the possible use of the NEFI in other diagnostic groups is recommended.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Juvalta
authors.forename: Marcel W M
authors.initials: MW
authors.lastname: Post
authors.forename: Susan
authors.initials: S
authors.lastname: Charlifue
authors.forename: Luc
authors.initials: L
authors.lastname: Noreau
authors.forename: Gale
authors.initials: G
authors.lastname: Whiteneck
authors.forename: Frédéric S
authors.initials: FS
authors.lastname: Dumont
authors.forename: Jan D
authors.initials: JD
authors.lastname: Reinhardt
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004781:Environmental Exposure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D013557:Switzerland; D014481:United States