1. Introduction
Falling is one of the leading causes of death, injury, and functional limitations among older people [1, 2]. The consequences of falls include physical injuries, fear of falling, and partial or complete inactivity that can dramatically affect the lives of older people y [3, 4]. Evaluating home risks is a key component of managing the risks of falling among older people living in the community and requires appropriate tools to assist therapists in falls risk screening. Home risks are identified through home safety checklists, many of which are valid and reliable. Among the available tools, we used the Home Falls and Accidents Screening Tool (HOME FAST) to detect the elderly people who are at the high risk of falling or experienced a fall at home [5, 6]. Self-report and self-assessment are in line with the client-centered approach to interventions [7, 8]. This study aimed to prepare a self-report version of the HOME FAST for the elderly Iranian population.
2. Materials and Methods
After obtaining ethical clearance from the Research Ethics Committee of Iran University of Medical Sciences, the HOME FAST self-report design process was begun. The study was a non-experimental study performed in different areas of Tehran. In this regard, first, the Persian version of this tool was examined with the help of 5 occupational therapists and psychometrics experts. Twenty-five items were broken down into several questionsand each question was subdivided into several intelligible questions. Then, to evaluate its content validity, a panel of 10 occupational therapists in geriatrics (6 women and 4 men with at least older people years of experience) from Iran University of Medical Sciences and Tabriz University of Medical Sciences examined the questions. Five older adults were randomly pre-tested to assess the face validity of the tool, and they were asked to examine the questionnaire in terms of comprehensibility and clarity for examining how seniors interpret each item and provide clear and orderly instruction. To evaluate the concurrent validity and degree of agreement between the therapist and the elderly, the scores of the Self Report (SR) version provided by the elderly were compared with the scores obtained from the Health Professional (HP) version, using the Spearman test. The obtained data were analyzed in SPSS V. 16.
3. Results
In this study, the participants consisted of 64 people aged over 60 years (35 men and 29 women). Thirty (46.9%) participants had a history of falling in the past year; 13 lived alone, 49 with family, and 2 with caregivers. During 4 sessions with experts (each taking 3 hours), 25 items were provided; 15 main questions and 75 sub-questions were answered by “Yes” or “No”. Assessing the content validity of the tool, the agreement among 10 experts should be above 62%, and it was calculated according to the content validity ratio formula [30]. The results showed that out of the 80 items in the questionnaire, their agreement in 73 items was above 0.6. Since the questionnaire is designed for older people and requires minimal subjective judgment and a simple understanding of concepts and sentences, it is advised to include all items in the questionnaire. The consensus among the experts was significant, and their opinions were homogeneous; so, it is worth mentioning that the designed questionnaire is valid in terms of content. The results of the Spearman test showed that the correlation between SR and HP versions was r =0.95 and P<0.001. According to the statistical data and the results presented in Table 3 , absolute repeatability) SEM =0.25 (indicates good test-retest reliability of the designed tool, since it is less than 10% of the total score. Moreover, the relative repeatability (ICC =0.99) indicates its good test-retest reliability, since the values are greater than 0.8.
4. Conclusion
The designed Home FAST-SR tool had good validity and reliability and could be used in epidemiological studies or to examine all nursing homes because of the lack of therapeutic force. By using this tool, if multiple hazards are identified, more detailed studies can be recommended.
Ethical Considerations
Compliance with ethical guidelines
This study obtained its ethical clearance from the Research Ethics Committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.93.1055403).
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors' contributions
All authors had contribution in preparing this paper.
Conflicts of interest
The authors declare no conflict of interest.
Acknowledgements
The authors would like to thank all seniors, who participated in the study and members of the Faculty of Occupational Therapy at Iran University of Medical Sciences.
 

1. Stevens JA, Burns E. A CDC compendium of effective fall interventions: What works for community-dwelling older adults. New York: Centers for Disease Control and Prevention; 2015.
2. NIH Senior Health. Fulls and older adults: Causes and risk factors. Tehran: National Institute on Aging; 2013.
3. Engel L, Chudyk AM, Ashe MC, McKay HA, Whitehurst DG, Bryan S. Older adults' quality of life–exploring the role of the built environment and social cohesion in community-dwelling seniors on low income. Social Science & Medicine. 2016; 164:1-11. [DOI:10.1016/j.socscimed.2016.07.008] [PMID]
4. Khajavi D, Farrokhi A, Jaberi-Moghaddam AA, Kazemnejad A. [Effect of strength and balance training program on maintaining balance and quality of life in older male adults with fear of fall (Persian)]. Iranian Journal of Ageing. 2016; 11(2):270-9.[DOI:10.21859/sija-1102270]
5. Atwal A, McIntyre A. Occupational therapy and older people. Hoboken: Wiley and Blackwell; 2013. [DOI:10.1002/9781118782835]
6. Karlsson MK, Vonschewelov T, Karlsson C, Cöster M, Rosengen BE. Prevention of falls in the elderly: A review. Scandinavian Journal of Public Health. 2013; 41(5):442-54. [DOI:10.1177/1403494813483215] [PMID]
7. Obrist S, Rogan S, Hilfiker R. Development and evaluation of an online fall-risk questionnaire for nonfrail community-dwelling elderly persons: A pilot study. Current Gerontology and Geriatrics Research. 2016; 2016(1520932):1-16. [DOI:10.1155/2016/1520932] [PMID] [PMCID]
8. Rein T. Causes of falling and fall risk : Falls in older people, prevention and management. Baltimore: Sydney Health Professions; 2005.
9. Palumbo P, Palmerini L, Bandinelli S, Chiari L. Fall risk assessment tools for elderly living in the community: Can we do better? PLOS One. 2015; 10(12):e0146247. [DOI:10.1371/journal.pone.0146247] [PMID] [PMCID]
10. Chiu T, Oliver R, Ascott P, Choo L, Davis T, Gaya A. Safety assessment of functionand the environment for rehabilitation: SAFER-HOME version 3 manual. Toronto: Comprehensive Rehabilitation & Mental Health services, 2006.
11. Stone E, Skubic M, Rantz M, Abbott C, Miller S. Average in-home gait speed: Investigation of a new metric for mobility and fall risk assessment of elders. Gait & Posture. 2015; 41(1):57-62. [DOI:10.1016/j.gaitpost.2014.08.019] [PMID]
12. Mackenzie L, Byles J, Higginbotham N. Reliability of the HOME Falls and Accidents Screening Tool (HOME FAST) for measuring falls risk for older people. Disability and Rehabilitation Journal 2002; 24(5):266-74. [DOI:10.1080/09638280110087089]
13. Mackenzie L, Byles J, Higginbotham N. Professional perceptions about home safety: cross-national validation of the HOMEFalls and Accidents Screening Tool (HOME FAST). Journal of Allied Health. 2002; 31(1):22-8. [PMID]
14. Mackenzie L, Byles J, D’Este C. Longitudinal study of the HOME Falls and Accidents Screening Tool (HOME FAST) to predict falls in older community dwelling people. Australian Journal Ageing 2009; 28(2):64-9. [DOI:10.1111/j.1741-6612.2009.00361.x] [PMID]
15. Maghfouri B, Hassani Mehraban A, Taghizade G, Aminian G, Jafari H. [Validity and reliability of persion version of home falls and accident screening tool in Iraniaian elderly (Persian)]. Modern Rehabilitation, 2012; 5(4):9-14.
16. Maghfouri B, Hassani Mehraban A, Taghizade Gh, Jafari H. [Internal and reliability assessment of the Persian version of the home falls and accidents screening tool (Persian)]. Iranian Rehabilitation Journal. 2013; 11:18.
17. Metzelthin SF, Daniëls R, van Rossum E, de Witte LP, van den Heuvel W, Kempen GI. The psychometric properties of three self-report screening instruments for identifying frail older people in the community. BMC Public Health. 2014; 10:176. [DOI:10.1186/1471-2458-10-176] [PMID] [PMCID]
18. Qureshi H. Self-assessment: how does it work, is it effective, and how can it be promoted? New York: Research in practice for adults; 2009.
19. Wilson CC, Netting FE. Comparison of self and health professionals' ratings of the health of community-based elderly. The International Journal of Aging and Human Development. 1987; 25(1):11-25.[DOI:10.2190/EB8E-TAG0-1T89-C5RG] [PMID]
20. Latham NK, Mehta V, Nguyen AM, Jette AM, Olarsch S, Papanicolaou D, et al. Performance-based or self-report measures of physical function: Which should be used in clinical trials of hip fracture patients? Archives of Physical Medicine and Rehabilitation. 2008; 89(11):2146-55. [DOI:10.1016/j.apmr.2008.04.016] [PMID]
21. Stukenberg W, Dura J, Kiecolt-Glaser J. Depression screening validation in the elderly: Community dwelling population. Journal Consulting Clinical Psychology, 1990; 2(2):134-8. [DOI:10.1037/1040-3590.2.2.134]
22. Shumway-Cook A, Patla A, Stewart AL, Ferrucci L, Ciol MA, Guralnik JM. Assessing environmentally determined mobility disability: Self-report versus observed community mobility. Journal of the American Geriatrics Society. 2005; 53(4):700-4.[DOI:10.1111/j.1532-5415.2005.53222.x] [PMID]
23. Dubois MF, Raîche M, Hébert R. Assisted self-report of health-services use showed excellent reliability in a longitudinal study of older adults. Journal of Clinical Epidemiology. 2007; 60(10):1040-5. [DOI:10.1016/j.jclinepi.2006.12.011] [PMID]
24. Yang M, Ding X, Dong B. The measurement of disability in the elderly: A systematic review of self-reported questionnaires. Journal of the American Medical Directors Association. 2014; 15(2):150.e1-9. [DOI:10.1016/j.jamda.2013.10.004] [PMID]
25. Hilton K, Fricke J, Unsworth C. A comparison of self-report versus observation of performance using the Assessment of Living Skills and Resources (ALSAR) with an older population. British Journal of Occupational Therapy. 2001; 64(3):135-43. [DOI:10.1177/030802260106400305]
26. Morgan R, DeVito C, Stevens J, Branche C, Virnig B, Wingo P, et al. A self-assessment tool was reliable in identifying hazards in the homes of elders. Journal Clinical Epidemiology. 2005; 58(12):1252-9. [DOI:10.1016/j.jclinepi.2005.04.001] [PMID]
27. Fänge A, Iwarsson S. Physical housing environment: Development of a self-assessment instrument. Canadian Journal of Occupational Therapy. 1999; 66(5):250-60. [DOI:10.1177/000841749906600507] [PMID]
28. Mehraban A, Mackenzie L, Byles J. A self-report home environment screening tool identified older women at risk of falls. Journal of Clinical Epidemiology, 2011; 64(2):191-9. [DOI:10.1016/j.jclinepi.2010.02.013] [PMID]
29. Sherrington C, Lord SR, Vogler CM, Close JC, Howard K, Dean CM, et al. A post-hospital home exercise program improved mobility but increased falls in older people: a randomised controlled trial. PLOS One. 2014; 9(9):e104412. [DOI:10.1371/journal.pone.0104412] [PMID] [PMCID]
30. Mohamadbeigi A, Salehi N, Golmohamad A. [The validity and reliability of tools and various methods of measuring them in applied research in health (Persian)]. Journal of Rafsanjan University of Medical Sciences, 2015; 13(12):1153-70.
31. Williams JS, Kowal P, Hestekin H, O’Driscoll T, Peltzer K, Yawson A, et al. Prevalence, risk factors and disability associated with fall-related injury in older adults in low-and middle-incomecountries: results from the WHO Study on global AGEing and adult health (SAGE). BMC Medicine. 2015; 13:147. [DOI:10.1186/s12916-015-0390-8] [PMID] [PMCID]
32. Maghfouri B. Validity and reliability of persion Persian version of home falls and accident screening tool in Iraniaian elderly. [MSc. thesis]. Tehran: Iran University of Medical Sciences; 2011.
33. Kormos C, Gifford R. The validity of self-report measures of proenvironmental behavior: A meta-analytic review. Journal of Environmental Psychology. 2014; 40:359-71. [DOI:10.1016/j.jenvp.2014.09.003]
34. Krohn MD, Lizotte AJ, Phillips MD, Thornberry TP, Bell KA. Explaining systematic bias in self-reported measures: Factors that affect the under-and over-reporting of self-reported arrests. Justice Quarterly. 2013; 30(3):501-28. [DOI:10.1080/07418825.2011.606226]
35. Gorber SC, Tremblay MS. Self-report and direct measures of health: bias and implications. In: Shephard RJ, Tudor-Locke C, editors. The objective monitoring of physical activity: Contributions of accelerometry to epidemiology, exercise science and rehabilitation. Berlin: Springer Science; 2016. [DOI:10.1007/978-3-319-29577-0_14]