Development of the Community Development of the Community Health Environment Checklist Health Environment Checklist Holly Hollingsworth Holly Hollingsworth Susan Stark Susan Stark Kerri Morgan Kerri Morgan David Gray David Gray Partial Support for this report was provided Partial Support for this report was provided by the Office on Disability and by the Office on Disability and Health at the Centers for Disease Control and Prevention (R04/CCR714134) Health at the Centers for Disease Control and Prevention (R04/CCR714134) for for a a grant titled “Mobility, Disabilities, Participation and the Environment.” grant titled “Mobility, Disabilities, Participation and the Environment.”
Transcript
Development of the Community Health Development of the Community Health Environment ChecklistEnvironment Checklist
Partial Support for this report was provided Partial Support for this report was provided by the Office on Disability and Health by the Office on Disability and Health at the Centers for Disease Control and Prevention (R04/CCR714134) at the Centers for Disease Control and Prevention (R04/CCR714134) for for a grant a grant
titled “Mobility, Disabilities, Participation and the Environment.”titled “Mobility, Disabilities, Participation and the Environment.”
Problem StatementProblem Statement
►Problem StatementProblem Statement Community environments are not designed to Community environments are not designed to
meet the needs of people with disabilities.meet the needs of people with disabilities. Participation is impacted by how people are Participation is impacted by how people are
able to use their environments.able to use their environments.
►PurposePurpose By identifying barriers and supports in the By identifying barriers and supports in the
community environment, domains influencing community environment, domains influencing social participation will be identified.social participation will be identified.
Research Question/ApproachResearch Question/Approach
►Research QuestionResearch Question What are the characteristics or features of an What are the characteristics or features of an
environment that make it more or less environment that make it more or less receptive to people with mobility impairments?receptive to people with mobility impairments?
►ApproachApproach We surrender our claim of objective expertise We surrender our claim of objective expertise
and respect the subjects expertise in their own and respect the subjects expertise in their own situations (Gilgun 1998) situations (Gilgun 1998)
Cognitive mapping was used to identify a Cognitive mapping was used to identify a person’s perception of their environment.person’s perception of their environment.
Design and ProcedureDesign and Procedure
► DesignDesign QualitativeQualitative In home interviewsIn home interviews Cognitive mapping Cognitive mapping
► Government BuildingsGovernment Buildings► Major Tourist Major Tourist
DestinationsDestinations► Performance VenuesPerformance Venues► Large StoresLarge Stores► Small StoresSmall Stores► Self Care Service Self Care Service
► TransportationTransportation► Health Care Health Care
ProvidersProviders► Health VendorsHealth Vendors► Professional Service Professional Service
ProvidersProviders► Indoor LeisureIndoor Leisure► Outdoor LeisureOutdoor Leisure► Religious FacilitiesReligious Facilities► Schools and LibrariesSchools and Libraries
Findings: 22 Key FeaturesFindings: 22 Key Features► Distances to Enter Building
Accessible Parking► Level Surfaces► Curb Cuts► Doors at Entrances► Signage for Accessible
Paths to Entrances► Doors Inside the Building► Loaner Scooters or
Individual questions that Individual questions that capture the presence of the capture the presence of the featurefeature
Scored dichotomously (yes Scored dichotomously (yes & N/A = 1 No = 0) & N/A = 1 No = 0)
Flexibility of the CHECFlexibility of the CHEC
► Receptivity can be characterized at the Receptivity can be characterized at the Community LevelCommunity Level Total CHEC Scores on a sample of Total CHEC Scores on a sample of
destinationsdestinations Receptivity of “ accessible restrooms” of Receptivity of “ accessible restrooms” of
entire community (features by destination)entire community (features by destination)► Receptivity can be characterized at the Receptivity can be characterized at the
Destination LevelDestination Level Total CHEC score of the destination or Area of Total CHEC score of the destination or Area of
a building (this building)a building (this building) Receptivity of features (seating)Receptivity of features (seating)
Review by consultantsReview by consultants►Consultants suggestions:Consultants suggestions:
Scaling (to weight items)Scaling (to weight items) Make the form “user friendly” and not Make the form “user friendly” and not
technicaltechnical Make a “rule book” instead of a Make a “rule book” instead of a
►Available to provide assistance in Available to provide assistance in determining scoredetermining score
►Resources on which rules are based:Resources on which rules are based: Based on the important descriptions of Based on the important descriptions of
the experts (people with mobility the experts (people with mobility limitations)limitations)
Consultants (experts in architecture, Consultants (experts in architecture, universal design, occupational therapy)universal design, occupational therapy)
Literature and standardsLiterature and standards
The RULE BOOKThe RULE BOOK
► ““can you get in, do can you get in, do what you need to do what you need to do and get out without and get out without much difficulty”much difficulty”
► Determine if “one” Determine if “one” accessible feature is accessible feature is present and evaluate present and evaluate that feature (e.g. the that feature (e.g. the accessible bathroom) accessible bathroom) (versus all features)(versus all features)
► Column 1 and 2 are the same as Column 1 and 2 are the same as the CHECthe CHEC
► The third column contains the rules The third column contains the rules for the corresponding item. for the corresponding item.
The GLOSSARYThe GLOSSARY► Items that are more difficult Items that are more difficult
or involve measurements or involve measurements have a visual picture for have a visual picture for clarification.clarification.
► Glossary items are Glossary items are numbered and arranged in numbered and arranged in alphabetical order.alphabetical order.
► Links to the glossary can be Links to the glossary can be found on the corresponding found on the corresponding item in the CHECitem in the CHEC
In the fieldIn the field► Evaluations are Evaluations are
completed during completed during “busy time”“busy time”
► TimeTime 5 minutes small 5 minutes small
buildingbuilding 90 minutes large 90 minutes large
buildingbuilding► 1-2 raters1-2 raters► Using Using
paper/pencil, PDA, paper/pencil, PDA, or Tablet PCor Tablet PC
Scaling and ScoringScaling and Scoring► Scored dichotomously Scored dichotomously
(yes & N/A = 1 No = 0) (yes & N/A = 1 No = 0) ► 22 Features weighted 22 Features weighted
based on ranking of based on ranking of “importance” of items “importance” of items (based on ranking study)(based on ranking study)
► Weights were Weights were transformed transformed monotonically monotonically to yield to yield the range of a the range of a destination score to be destination score to be from 0 to 100from 0 to 100
► Ranking StudyRanking Study 17 of the original 17 of the original
subjects (78 different subjects (78 different rankings by destination rankings by destination category)category)
Ranked each feature Ranked each feature based on directions based on directions “imagine the most “imagine the most accessible place for accessible place for you… “you… “
Features & WeightsFeatures & Weights
EntranceEntrance9.69.6
22
Curb CutsCurb Cuts8.68.6
55
Automatic DoorsAutomatic Doors8.68.6
55
Accessible BathroomAccessible Bathroom8.68.6
55
Elevator/Single LevelElevator/Single Level6.76.7
33
Distance to EntranceDistance to Entrance5.75.7
77
Accessibility features in Accessibility features in orderorder
5.75.777
Wide SpacesWide Spaces5.75.7
77
Floor SurfacesFloor Surfaces4.84.8
11
Lightweight DoorsLightweight Doors4.84.8
11
ParkingParking4.84.8
11
Spaces not CrowdedSpaces not Crowded3.83.8
55
Accessible places to sitAccessible places to sit3.83.8
Are there accessible parking spaces Are there accessible parking spaces with adequate widths and aisles for with adequate widths and aisles for a person with a mobility device to a person with a mobility device to get in and out of their car?get in and out of their car?
00
Are the accessible spaces located Are the accessible spaces located closest (or most central) to the closest (or most central) to the accessible entrance or accessible accessible entrance or accessible route with minimal traffic to cross route with minimal traffic to cross in order to enter the building?in order to enter the building?
11
Does the facility have an Does the facility have an enforcement procedure to ensure enforcement procedure to ensure that accessible parking is used by that accessible parking is used by only those who need it?only those who need it?
11
SubtotalSubtotal 22 3.23.2
3.2 = 2*4.81/32 of 3 Yes’s & Weight 4.81
EXAMPLE: CHEC Page 2EXAMPLE: CHEC Page 2
SECTION
FEATURE
ScoringScoring
►Scores are computed for each Feature Scores are computed for each Feature within each Section.within each Section.
►A Section score is the sum of the A Section score is the sum of the Feature scores.Feature scores.
►The total Destination score is the sum The total Destination score is the sum of the Section scores.of the Section scores.
►The scoring has been scaled such that The scoring has been scaled such that the highest Destination score is 100.the highest Destination score is 100.
Sampling StrategySampling Strategy► Identify the boundaries of a communityIdentify the boundaries of a community
PoliticalPolitical GeographicGeographic Identified by population of individuals with disabilitiesIdentified by population of individuals with disabilities
► Identify all possible destinations within the Identify all possible destinations within the community within each destination categorycommunity within each destination category
► Sample 10% of the destinations within each Sample 10% of the destinations within each destination categorydestination category
► If a “community” does not contain a destination If a “community” does not contain a destination within a category (e.g. hospital), use the closest within a category (e.g. hospital), use the closest destination of that type to the center of the destination of that type to the center of the community and rate that destinationcommunity and rate that destination
►Section I Entering the Building 0.72Section I Entering the Building 0.72 Level Surface 0.80Level Surface 0.80
►Section II Using the Building 0.95Section II Using the Building 0.95►Section III Restrooms 0.87Section III Restrooms 0.87►Section IV Amenities 0.86Section IV Amenities 0.86
CHEC: Environmental Feature Scores
0
10
20
30
40
50
60
70
80
90
100
Features for All Sites
Co
mp
lian
ce
Rural v. UrbanRural v. Urban
P=.08
P<.01
P=.12
P<.01
P<.01
Group Statistics
58 30.4929 7.04734 .92536
43 32.8116 6.18793 .94365
50 29.9647 6.08400 .86041
40 33.5537 5.42382 .85758
62 4.5797 4.00905 .50915
45 5.7179 3.46479 .51650
55 8.7850 3.54315 .47776
45 10.6410 2.94517 .43904
59 72.8493 15.62835 2.03464
45 81.7977 15.34053 2.28683
CityUniversity City, MO
Menomonie, WS
University City, MO
Menomonie, WS
University City, MO
Menomonie, WS
University City, MO
Menomonie, WS
University City, MO
Menomonie, WS
Section I Entering theDestination
Section II Using theDestination
Section III Restrooms
Section IV Amenities
Destination
N Mean Std. DeviationStd. Error
Mean
► Refine measure based on initial testing (CHEC 2.0)Refine measure based on initial testing (CHEC 2.0)► Validate instrument against gold standard (in process)Validate instrument against gold standard (in process)► Validate instrument against lived experience of Validate instrument against lived experience of
individuals with mobility impairmentsindividuals with mobility impairments► Develop formal training programDevelop formal training program► Develop web based data management and report Develop web based data management and report
generating software (identification of solutions as well generating software (identification of solutions as well as barriers)as barriers)
Next stepsNext steps
Limitations in flexibilityLimitations in flexibility
► Difficult to translate to different culturesDifficult to translate to different cultures Transportation differencesTransportation differences
► Only developed for persons with mobility Only developed for persons with mobility limitations – small sample sizelimitations – small sample size
► Value not in the final items but in the Value not in the final items but in the approach and methodapproach and method Groups interested in vision/hearing may want a Groups interested in vision/hearing may want a
versionversion International partners may wish to develop a International partners may wish to develop a
versionversion
Why use this measure?Why use this measure?
►Assesses the receptivity of the physical Assesses the receptivity of the physical environment from the perspective of environment from the perspective of persons with mobility impairmentspersons with mobility impairments
► Is brief, intuitive, and easy to administerIs brief, intuitive, and easy to administer ►Excellent internal consistencyExcellent internal consistency► Internal validityInternal validity►Email: [email protected]: [email protected]
