Contributors : Measuring the Environment David Gray, Ph.D. Holly Hollingsworth, Ph.D. The Community Health Environment Checklist Kerri Morgan, MS OTR/L presented to ICF 運用國際研討會 Susan Stark, Ph.D. August 2013 Jess Davinroy, OTD y, Jeff Cuthbert, MSOT Trish Welch-Saleeby, MSW Dana Sutter MSOT, OTR/L Mike Scheller, RPT Susy Stark, PhD, OTR OT Doctoral students OT Masters degree students Participation, Environment and Performance Laboratory, Program in Occupational Therapy Transactional Approaches of Introduction Conceptualizing • 19 million people (10% between 16 and 64) in the U.S. have a Person-Environment Fit disability (American Community Survey, 2011) • People with disabilities encounter barriers in society (physical ► The success of a persons participation in a given setting and attitudinal) (Gray and Hahn, 1997) is not dependent on a simple property of either the is not dependent on a simple property of either the person or their environment, it is a product of the two • Barriers decrease participation in community and quality of life (Lewin, 1951) (Stark, Hollingsworth, Morgan, & Gray, 2007) Participation, Environment and Performance Participation, Environment and Performance Laboratory, Program in Occupational Therapy Laboratory, Program in Occupational Therapy ICF Ecological Receptivity Health Condition ( disorder/disease ) ► Ecological Receptivity refers to the transactional relationship between the features of the community environment and the attributes of individuals with Body function & y Activities Participation p disabilities that influence his or her participation in di biliti th t i fl hi h ti i ti i structure (Limitation) (Restriction) community. (Impairment ) ► The features of community environments include the Environmental Personal political, economic, physical and social Factors Factors characteristics. Participation, Environment and Performance Participation, Environment and Performance WHO, 2001 Laboratory, Program in Occupational Therapy Laboratory, Program in Occupational Therapy 1
Purpose of the CHEC Reasons for Developing the Community Health Environment Checklists (CHEC) • The purpose of the CHEC is to provide an objective measure of the physical and social environment, • By identifying barriers and supports in the community including the features important to persons with environment, we can identify features that influence the disabilities participation of people with disabilities • The CHEC is a valid and reliable measure of • We wanted to focus on those features of most environmental accessibility and receptivity relevance to people with disabilities who have a • Scored dichotomously (Yes & N/A = 1 No = 0) mobility, hearing or visual impairment Participation, Environment and Performance Participation, Environment and Performance Laboratory, Program in Occupational Therapy Laboratory, Program in Occupational Therapy CHEC Development Procedures • Review existing literature on assessing receptivity • Methods • Key Informant Interviews • Focus Groups • Cognitive Mapping • Survey Draft • Feature Ranking by Individuals with Disabilities • Identifies Most Important Features • Development of Scoring • Interclass Correlations • Brief Training for Raters Participation, Environment and Performance Participation, Environment and Performance Laboratory, Program in Occupational Therapy Laboratory, Program in Occupational Therapy Problem Statement Research Question ► Problem Statement ► Research Question • Community environments are not designed to meet the needs of people • What are the characteristics or features of an environment that make it with disabilities. more or less receptive to people with mobility impairments? • Social participation is impacted by how people are able to use their • Social participation is impacted by how people are able to use their • Where do active community members with disabilities go? • Where do active community members with disabilities go? environments. ► Approach ► Purpose • Cognitive mapping identifies a person’s perception of their environment. • By identifying barriers and supports in the community environment, domains influencing social participation will be identified. Participation, Environment and Performance Participation, Environment and Performance Laboratory, Program in Occupational Therapy Laboratory, Program in Occupational Therapy 2
Cognitive Maps Design and Procedure (Lynch,1960) ► Design ► Means to represent perception of environment • Qualitative • Images and beliefs • In home interviews • Paths of travel and facilities used • Cognitive mapping • Cognitive mapping exercise • Member check (focus groups) *people with disabilities behave differently based ► Analysis on barriers and supports in the community • Constant comparative (Vujakovic and Matthews. 1994) method Participation, Environment and Performance Participation, Environment and Performance Laboratory, Program in Occupational Therapy Laboratory, Program in Occupational Therapy Participation, Environment and Performance Participation, Environment and Performance Laboratory, Program in Occupational Therapy Laboratory, Program in Occupational Therapy Findings: 22 Key Features Participants ► Distances to Enter Building • Crowding Accessible Parking • Floor Surfaces ► Inclusion Criteria ► Demographics ► Level Surfaces • Counters and ► Curb Cuts • Presence of a mobility • 25 people with mobility Merchandise ► Doors at Entrances limitation limitations • Accessible Places to Sit ► Signage for Accessible Paths to ► Signage for Accessible Paths to • Resided in St. Louis R id d i S L i • Mean age= 46.9 yrs. M 46 9 • Adequate Lighting Ad Li h i Entrances metropolitan area • Accessible Restroom • 14 female/ 11 male ► Doors Inside the Building • Drinking Fountain • Left home 2 ‐ 3x/ week • 13 Caucasian/ 10 African ► Loaner Scooters or • Accessible Phone American Wheelchairs • Drive ‐ through Window ► Signage for Accessible • stroke, SCI, CP, & post polio • Usability Elements ► Single Level • Rescue Assistance ► Maneuverable Spaces Participation, Environment and Performance Participation, Environment and Performance Laboratory, Program in Occupational Therapy Laboratory, Program in Occupational Therapy 3
Findings: 15 Key Destinations Discussion ► Receptivity is a blend of physical, social, and policy features of an environment ► Transportation ► Government Buildings ► Health Care Providers ► People with mobility impairments do ► Major Tourist ► Health Vendors Destinations identify features of the environment that y ► Professional Service ► f l ► Performance Venues increases/decreases receptivity. Providers ► Large Stores ► These features and characteristics are not ► Indoor Leisure ► Small Stores ► Outdoor Leisure adequately represented in existing ► Self Care Service ► Religious Facilities measures Providers ► Schools and Libraries ► Dining Establishments Participation, Environment and Performance Participation, Environment and Performance Laboratory, Program in Occupational Therapy Laboratory, Program in Occupational Therapy Goal of Study ► The goal of this study was to produce a CHEC Development concise instrument that would determine if a building’s physical features were ecologically valid from the perspective of individuals with p p mobility impairments and could predict their community participation. ► Used easily by quasi ‐ professionals (free of jargon) Participation, Environment and Performance Laboratory, Program in Occupational Therapy Instrument development Review by consultants ► Theoretical guidance and interview data ► Consultants suggestions: have contributed to the development of an evaluation procedure that will capture • Scaling (to weight items) receptivity more precisely in the • Make the form “user friendly” and not community environment y technical ► Developed to be used in 15 the • Make a “rule book” instead of a complicated destinations categories identified by scoring sheet respondents ► Evaluates the 22 features of the destinations identified by the respondents Participation, Environment and Performance Participation, Environment and Performance Laboratory, Program in Occupational Therapy Laboratory, Program in Occupational Therapy 4
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