Joy Hammel1, Susan Magasi2, Allen Heinemann3, David B Gray4, Susan Stark5, Pamela Kisala6, Noelle E Carlozzi7, David Tulsky8, Sofia F Garcia9, Elizabeth A Hahn10. 1. Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL; Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL. Electronic address: hammel@uic.edu. 2. Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL. 3. Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL. 4. Program in Occupational Therapy, Washington University, St Louis, MO. 5. Occupational Therapy, Neurology and Social Work, Washington University, St Louis, MO. 6. Department of Physical Therapy, University of Delaware College of Health Sciences, Newark, DE. 7. Center for Clinical Outcomes and Assessment Research, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Ann Arbor, MI. 8. Department of Physical Therapy, University of Delaware College of Health Sciences, Newark, DE; Kessler Foundation Research Center, West Orange, NJ. 9. Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL. 10. Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL.
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.
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.
Authors: Alex W K Wong; Sheryl Ng; Jessica Dashner; M Carolyn Baum; Joy Hammel; Susan Magasi; Jin-Shei Lai; Noelle E Carlozzi; David S Tulsky; Ana Miskovic; Arielle Goldsmith; Allen W Heinemann Journal: Qual Life Res Date: 2017-04-25 Impact factor: 4.147
Authors: S E Skeels; D Pernigotti; B V Houlihan; T Belliveau; M Brody; J Zazula; S Hasiotis; S Seetharama; D Rosenblum; A Jette Journal: Spinal Cord Date: 2017-10-10 Impact factor: 2.772
Authors: Sofia F Garcia; Elizabeth A Hahn; Susan Magasi; Jin-Shei Lai; Patrick Semik; Joy Hammel; Allen W Heinemann Journal: Arch Phys Med Rehabil Date: 2014-07-18 Impact factor: 3.966
Authors: Jagriti 'Jackie' Bhattarai; Jacob Bentley; Whitney Morean; Stephen T Wegener; Keshia M Pollack Porter Journal: Rehabil Psychol Date: 2020-04-16
Authors: Allen W Heinemann; Jin-Shei Lai; Alex Wong; Jessica Dashner; Susan Magasi; Elizabeth A Hahn; Noelle E Carlozzi; David S Tulsky; Sara Jerousek; Patrick Semik; Ana Miskovic; David B Gray Journal: Qual Life Res Date: 2016-05-20 Impact factor: 4.147