Environmental barriers and supports to everyday participation

A qualitative insider perspective from people with disabilities

Joy Hammel*, Susan Magasi, Allen Walter Heinemann, David B. Gray, Susan Stark, Pamela Kisala, Noelle E. Carlozzi, David Tulsky, Sofia F Garcia, Elizabeth A Hahn

*Corresponding author for this work

Research output: Contribution to journalArticle

81 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)578-588
Number of pages11
JournalArchives of physical medicine and rehabilitation
Volume96
Issue number4
DOIs
StatePublished - Apr 1 2015

Fingerprint

Disabled Persons
Focus Groups
Economics
International Classification of Functioning, Disability and Health
Social Participation
Technology
Independent Living
Self-Help Devices
Public Policy
Spinal Cord Injuries
Social Support
Rehabilitation
Stroke
Quality of Life
Outcome Assessment (Health Care)
Research

Keywords

  • Environment
  • Focus groups
  • Qualitative research
  • Rehabilitation
  • Social determinants of health
  • Social participation

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

Hammel, Joy ; Magasi, Susan ; Heinemann, Allen Walter ; Gray, David B. ; Stark, Susan ; Kisala, Pamela ; Carlozzi, Noelle E. ; Tulsky, David ; Garcia, Sofia F ; Hahn, Elizabeth A. / Environmental barriers and supports to everyday participation : A qualitative insider perspective from people with disabilities. In: Archives of physical medicine and rehabilitation. 2015 ; Vol. 96, No. 4. pp. 578-588.
@article{fa147507e9a9484fa489ee49f25453b5,
title = "Environmental barriers and supports to everyday participation: A qualitative insider perspective from people with disabilities",
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.",
keywords = "Environment, Focus groups, Qualitative research, Rehabilitation, Social determinants of health, Social participation",
author = "Joy Hammel and Susan Magasi and Heinemann, {Allen Walter} and Gray, {David B.} and Susan Stark and Pamela Kisala and Carlozzi, {Noelle E.} and David Tulsky and Garcia, {Sofia F} and Hahn, {Elizabeth A}",
year = "2015",
month = "4",
day = "1",
doi = "10.1016/j.apmr.2014.12.008",
language = "English (US)",
volume = "96",
pages = "578--588",
journal = "Archives of Physical Medicine and Rehabilitation",
issn = "0003-9993",
publisher = "W.B. Saunders Ltd",
number = "4",

}

Environmental barriers and supports to everyday participation : A qualitative insider perspective from people with disabilities. / Hammel, Joy; Magasi, Susan; Heinemann, Allen Walter; Gray, David B.; Stark, Susan; Kisala, Pamela; Carlozzi, Noelle E.; Tulsky, David; Garcia, Sofia F; Hahn, Elizabeth A.

In: Archives of physical medicine and rehabilitation, Vol. 96, No. 4, 01.04.2015, p. 578-588.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Environmental barriers and supports to everyday participation

T2 - A qualitative insider perspective from people with disabilities

AU - Hammel, Joy

AU - Magasi, Susan

AU - Heinemann, Allen Walter

AU - Gray, David B.

AU - Stark, Susan

AU - Kisala, Pamela

AU - Carlozzi, Noelle E.

AU - Tulsky, David

AU - Garcia, Sofia F

AU - Hahn, Elizabeth A

PY - 2015/4/1

Y1 - 2015/4/1

N2 - 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.

AB - 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.

KW - Environment

KW - Focus groups

KW - Qualitative research

KW - Rehabilitation

KW - Social determinants of health

KW - Social participation

UR - http://www.scopus.com/inward/record.url?scp=84925400336&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84925400336&partnerID=8YFLogxK

U2 - 10.1016/j.apmr.2014.12.008

DO - 10.1016/j.apmr.2014.12.008

M3 - Article

VL - 96

SP - 578

EP - 588

JO - Archives of Physical Medicine and Rehabilitation

JF - Archives of Physical Medicine and Rehabilitation

SN - 0003-9993

IS - 4

ER -