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
List of abbreviations:
ICF (International Classification of Functioning, Disability and Health), SCI (spinal cord injury), TBI (traumatic brain injury)To read this article in full you will need to make a payment
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Article info
Footnotes
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.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Environmental Factors Item Development for Persons With Stroke, Traumatic Brain Injury, and Spinal Cord InjuryArchives of Physical Medicine and RehabilitationVol. 96Issue 4
- PreviewTo describe methods used in operationalizing environmental factors; to describe the results of a research project to develop measures of environmental factors that affect participation; and to define an initial item set of facilitators and barriers to participation after stroke, traumatic brain injury, and spinal cord injury.
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- PreviewThe ascendance of the World Health Organization's International Classification of Functioning, Disability and Heath (ICF) as the global standard for describing and characterizing aspects of disability has refocused attention on the role that environmental factors (EFs) have on the health and participation of people with disabilities, both as individuals and as a group. There has been a rise in the development of instruments designed to measure EFs alone and in relation to participation. Some instrument developers have used the ICF as a theoretical base for instrument development and to substantiate content validity claims.
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