Barriers, Facilitators, and Access for Wheelchair Users: Substantive and Methodologic Lessons from a Pilot Study of Environmental Effects

Neurology Report, Jun 2003 by Dutton, Lisa L

Barriers, Facilitators, and Access for Wheelchair Users: Substantive and Methodologic Lessons from a Pilot Study of Environmental Effects. Meyers AR, Anderson JJ, Miller DR, Shipp K, Hoenig H. Soc Sci Med. 2002;55(8):1435-1446.

The purpose of this pilot study was to examine the experiences of individuals using wheelchairs in terms of their success in reaching their reported destinations, barriers that were overcome and barriers that were not overcome en route, and facilitators to access. In addition, the researchers sought to compare the consistency of participants' daily responses to retrospective reports of destinations, barriers, and facilitators.

The initial sample included 28 participants who were wheelchair users and had used a wheelchair for 4 or more months. One participant completed only the baseline interview and 2 participants failed to complete the full series of daily interviews. Fifteen males and 13 females began the study. Their ages ranged from 24 to 79 years with a mean age of 47 (SD = 14.7) years. Thirteen of the participants were disabled secondary to a spinal cord injury and 3 were disabled secondary to multiple sclerosis. The remaining diagnoses were varied. Ten of the participants used motorized wheelchairs, 11 used manual wheelchairs, and 7 used a combination of both.

Subjects participated in a baseline interview, 28 daily interviews, and an exit interview. The daily interviews consisted of questions regarding destinations successfully and unsuccessfully reached, barriers overcome, barriers not overcome, and facilitators. The exit interviews also included questions regarding respondents' recollection of their experiences within the last 28 days. A list of specific destinations as well as internal, interpersonal, and external environmental barriers and facilitators was developed based on previous research and existing measurement tools. All interviews were conducted by phone.

Eighty percent or more of the respondents reported having successfully reached food stores, restaurants or bars, drugstores, and other kinds of stores or shops on one or more of the 28 days included in the study. The percentage of respondents reporting an unsuccessful attempt to reach a destination over the course of the study included: drugstores (32%), friends' or relatives' houses (28%), restaurants (28%), other places for recreation or leisure (24%), and work place (24%). Infrequently reported destinations, be they successfully or unsuccessfully reached, included dentists' or other health professionals' offices, libraries, sporting events, and parks.

The most frequently reported barriers that were overcome included: illness (68%), other people's rudeness (68%), bad weather or climate (64%), door handles or pressure (64%), narrow aisles (64%), and no ramps or ramps too steep (64%). The most frequently reported barriers that were not overcome included illness (44%), bad weather or climate (40%), limited strength or fitness (40%), lack of will or motivation (36%), and no ramps or ramps too steep (36%). Rarely or never reported barriers included air quality and unsafe neighborhoods. Among frequently reported facilitators were assistance from people (96%), accessible transportation (88%), assistive technology (88%), good morale (88%), and good weather (88%). In general, the exit interview report was consistent with the daily reports (average proportion of agreement = .81, SD = .11).

Over the course of the 28-day study, respondents were successful in reaching an average of 8.2 destinations (SD = 3.2) and unsuccessful in reaching an average of 2.3 destinations (SD = 2.1). In addition, on average, they overcame 11.8 barriers (SD = 7.2), did not overcome 5.0 barriers (SD = 3.5), and encountered 10.1 facilitators (SD = 2.2). T-tests indicted that those who were 50 years of age or older (19 of the participants) reported fewer successfully reached destinations (p

Methodologically, the researchers concluded that the high percentage of agreement between the daily and exit interviews indicated that these phenomena could be studied through monthly interviews without resulting in significant inaccuracies. Substantively, the authors concluded that efforts to eliminate environmental barriers, such as those supported by the Americans with Disabilities Act, continued to be warranted. While some barriers appeared to be such that they could be overcome by some individuals in certain instances, others, such as lack of ramps or ramps and curbs that were too high, appeared to be insurmountable. In addition, the development of policies that support personal assistance, assistive technology, and health and fitness for individuals who are wheelchair users also were recommended. Finally, these results suggested that there is a demonstrated need for programs that support civility in interactions between persons with disabilities and persons without disabilities.

Lisa L. Button, PT, PhD

The University of Findlay