Workshop on Disability in America A New Look: Summary and Background Papers (2006) / Chapter Skim
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Appendix D How Does the Environment Influence Disability? Examining the Evidence--Julie J. Keysor
Appendix D How Does the Environment Influence Disability? Examining the Evidence--Julie J. Keysor
Pages 88-100
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From page 88... ...
If facilitative environments decrease disability, then policies and clinical interventions could be implemented to support the environmental elements that are conducive to minimizing disability and optimizing participation in daily life activities. Recent conceptual frameworks of disability highlight the important role of the environment in the disablement process; that is, people are believed to interact with their environments to produce disabilities (IOM, 1997; Teel et al., 1997)
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From page 89... ...
The second challenge is one of measurement, with three general approaches currently being used. The first approach assesses an individual's perceptions of the degree to which environmental factors influence his or her participation in daily life.
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From page 90... ...
selfassessment of the physical housing environment. CHIEF is a 24-item self-report instrument that assesses the frequency with which people encounter environmental barriers related to attitudes and support, services and assistance, physical and architectural domains, policies, and work and school and the impact of each environmental factor on daily life, as perceived by the individual (Whiteneck et al., 2004c)
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From page 91... ...
Shumway-Cook and colleagues developed an observational approach that corresponds to the Environmental Components of Mobility Questionnaire in which specific factors of the environment comprising the physical domain are assessed independently of a person's level of participation (Shumway-Cook et al., 2002)
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From page 92... ...
The community mobility domain assesses the extent to which a person's community has barriers such as uneven sidewalks and curbs without curb cuts. Basic mobility devices, communication devices, and transportation facilitators are assessed to indicate whether the respondent has a mobility or communication device and the type of transportation, irrespective of its use.
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From page 93... ...
TABLE D-1 Comparison of Approaches for Measurement of the Environment Approach Description Strengths Weaknesses Determination of Self-report assessment of the Seems to be a reliable approach for May create a statistical bias: perceived impact degree to which the environment people to self-report barriers and artificially correlated with disability influences participation; includes facilitators (participation) accessibility Perceived barriers or facilitators may not be actual elements of the individual's environment Determination of Self-report and observational Self-report and observational A time-consuming observational barriers approach that assesses the extent methods seem to be reliable method that is not feasible for encountered or to which barriers are avoided large epidemiological studies; avoided (perceived assessment is confounded by or actual)
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From page 94... ...
However, there were no differences between the two groups in the average distance walked; the rate of crossing streets with traffic lights; or the temperature, light conditions, and level of precipitation during a walk. Although this descriptive approach shows that people with mobility limitations do perceive that aspects of their environment limit or enhance their participation, it does not provide strong evidence showing how the environment influences disability.
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From page 95... ...
Physical and structural barriers were weakly correlated with physical independence, mobility, and occupation; services and assistance were weekly associated with physical independence, cognitive independence, mobility, occupation, and social integration; and the attitudinal domain and support were associated with physical independence and cognitive independence. The CHIEF subscales were more strongly associated with life satisfaction, accounting for approximately 10 percent of the variance in life satisfaction.
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From page 96... ...
On the other hand, more home mobility barriers were associated with less social and home participation, whereas more community barriers, more mobility technology facilitators, and more social support were associated with more social and home participation. With the exception of social support, however, environmental barriers and facilitators were not predictive of community participation and social and home participation at 6 months (Keysor et al., submitted for publication)
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From page 97... ...
In addition, individuals with mobility limitations seem to avoid physical barriers in the community, although their actual behavior patterns may differ from self-reported perceptions. Despite the findings that people with mobility limitations report the presence of barriers in their environment, it is not clear how the environment influences disability.
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From page 98... ...
Experimental clinical trials will also provide evidence of whether the manipulation of various aspects of the environment influences disability. The third and perhaps the most important challenge will be to implement complex analytical approaches in study designs.
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From page 99... ...
. Documenting environmental factors for preventing the handicap cre ation process: Quebec contributions relating to ICIDH and social participation of people with functional differences.
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From page 100... ...
. Environmental factors and their role in participa tion and life satisfaction after spinal cord injury.
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