Original research
Environmental Barriers and Supports to Everyday Participation: A Qualitative Insider Perspective From People With Disabilities

https://doi.org/10.1016/j.apmr.2014.12.008Get rights and content

Abstract

Objective

To describe environmental factors that influence participation of people with disabilities.

Design

Constant comparative, qualitative analyses of transcripts from 36 focus groups across 5 research projects.

Setting

Home, community, work, and social participation settings.

Participants

Community-dwelling people (N=201) with diverse disabilities (primarily spinal cord injury, traumatic brain injury, and stroke) from 8 states.

Interventions

None.

Main Outcome Measures

Environmental barriers and supports to participation.

Results

We developed a conceptual framework to describe how environmental factors influence the participation of people with disabilities, highlighting 8 domains of environmental facilitators and barriers (built, natural, assistive technology, transportation, information and technology access, social support and attitudes, systems and policies, economics) and a transactional model showing the influence of environmental factors on participation at the micro (individual), mesa (community), and macro (societal) levels. Focus group data validated some International Classification of Functioning, Disability and Health environmental categories while also bringing unique factors (eg, information and technology access, economic quality of life) to the fore. Data were used to construct items to enable people with disabilities to assess the impact of environmental factors on everyday participation from their firsthand experience.

Conclusions

Participants with disabilities voiced the need to evaluate the impact of the environment on their participation at the immediate, community, and societal levels. The results have implications for assessing environmental facilitators and barriers to participation within rehabilitation and community settings, evaluating outcomes of environmental interventions, and effecting system and policy changes to target environmental barriers that may result in societal participation disparities versus opportunities.

Section snippets

Methods

This study involved secondary analysis of qualitative data from 5 projects,7, 13, 14, 15, 16, 17, 18, 19, 20 with people with diverse disabilities across different regions in the United States.14, 15, 16, 21, 22 The data served as the foundation for the development of new measures of participation: Community Participation Indicators,13, 14, 15 Participation Survey—Mobility,18 health-related quality of life (Spinal Cord Injury Quality of Life and Traumatic Brain Injury Qualitaty of Life),17, 22

Results

We identified 8 major categories of environmental factors that influence participation: built, natural, transportation, assistive technology, information and technology access, social support and societal attitudes, systems and policies, and economic environment (see fig 1). Participants described these environmental factors as facilitators and/or barriers, enabling and/or disabling participation in different participation contexts (see table 2). In some of the environmental categories, more

Discussion

This project fills a knowledge gap by providing a large-scale, multisite, qualitative examination of environmental barriers and supports that affect home, community, work, and economic participation, as assessed by participants with TBI, SCI, and stroke. Use of qualitative methods across studies allowed us to triangulate findings across samples and projects. These qualitative data set the groundwork for the development of items to assess environmental factors on participation and quality of life

Conclusions

This study highlights immediate, community, social, and societal environmental features that influence individual participation and societal enfranchisement of people with disabilities. Identification of these factors allows the development of a comprehensive, consumer-focused assessment of the environment that measures the impact of environment barriers and supports on participation and also could be used to then evaluate the effectiveness of environmental interventions and policies designed

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    Supported by the National Institute on Disability through a Rehabilitation Research and Training Center on Improving Measurement of Medical Rehabilitation Outcomes grant (grant no. H133B090024); Rehabilitation Research and Training Center on Measuring Rehabilitation Outcomes and Effectiveness (award no. H133B040032); National Institute on Disability and Rehabilitation Research (NIDRR) (Spinal Cord Injury-Quality of Life National Institute of Health R-01 [award no. 5R01HD054659; cofunded by the National Institute of Child Health and Human Development and National Institute of Neurological Disorders and Stroke]; Traumatic Brain Injury Quality of Life NIDRR Field-initiated grant [grant no. H133G070138]; Mobility Impaired Individuals with Secondary Conditions: Health, Participation and Environments [award no. R04/CCR714134]); Centers for Disease Control and Prevention; and the National Center for Complementary and Alternative Medicine and the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (award no. U54AR057951).

    Disclosures: none.

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