Community and social participation among adults with mobility impairments: A mixed methods study

doi:10.1016/j.dhjo.2016.05.006

Disability and Health Journal

Volume 9, Issue 4, October 2016, Pages 682-691

https://doi.org/10.1016/j.dhjo.2016.05.006 Get rights and content

Abstract

Background

Community and social participation is a complex phenomenon that is influenced by personal and environmental factors and is linked to a good quality of life and well-being. Individuals with mobility impairments are at risk of experiencing limitations in participating in community activities due to a wide range of factors.

Objective

To understand community participation as defined by adults with mobility impairments and to examine relationships among factors that influence community participation.

Methods

A mixed-methods study design was used. In-depth interviews of 13 adults with mobility impairments were conducted and themes related to community participation were identified. Data from the Americans' Changing Lives Survey were used to construct variables that mimic the themes from the qualitative phase and structural equation modeling was used to examine the relationships among those variables including community participation.

Results

Individuals with mobility impairments identified health and function, neighborhood factors and self-efficacy as possible factors influencing participation in community activities. Findings from the SEM suggest a strong causal pathway between health and function and community and social participation. Neighborhood factors and health and function had a significant impact on self-efficacy, and a possible indirect effect through self-efficacy on community and social participation.

Conclusions

Our study provides new empirical evidence that health and function have a significant impact on community and social participation. Our quantitative findings did not support the direct influence of neighborhood factors in community and social participation, yet these factors may have an indirect role by influencing the self-efficacy of individuals with mobility impairments.

Section snippets

Literature review

In 2013, more than 20 million American adults living in the community had an ambulatory limitation.³ Ambulatory or mobility limitations may occur because of accidents or injuries, age-related cognitive or physical changes, or early onset disability. Such limitations can compromise the ability to participate in activities within several domains: community, productivity, and social. Community activities include participation in leisure, volunteer, religious and civic activities. Participation in

Methods

We used a sequential, exploratory, mixed-methods design.²⁷ The first phase of the study involved the collection and analysis of qualitative data. The second phase built off of the results from the first phase, analyzing secondary, quantitative data. The primary purpose of the first qualitative phase was to use a phenomenological approach to examine what community and social participation meant for adults with mobility limitations and to understand the factors that shape their participation.²⁶

Qualitative analysis

The qualitative analysis addresses our first two research questions: (1) what activities do individuals with mobility impairments consider as community and social participation? and (2) what are the barriers and facilitators to community and social participation? Thirteen individuals with mobility limitations participated in the qualitative phase. The average age of participants was 52.4 (SD = 13.34) and 10 (77%) were female. Eight participants lived in suburban neighborhoods and four lived in

Discussion

Our first research question was to understand what activities individuals with mobility impairments considered as community and social participation. Findings from the qualitative phase of the study indicate that leisure activities, socialization activities, volunteering, and to some extent, work, are considered important indicators of community participation for persons with mobility limitations. These findings were later supported by the factor analysis in the quantitative phase of the study.

Conclusion

Despite these limitations, our study provides new empirical evidence that health and function have a significant impact on community and social participation. Although our quantitative findings did not support the direct influence of neighborhood factors on community and social participation, environmental factors may have an indirect role by influencing the self-efficacy of individuals with mobility impairments. Improving the perceptions of self-efficacy and health and function of persons with

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Several limited their travel as a result. Sundar et al. (2016) suggested that self-efficacy and participation have a “complex reciprocal relationship in which self-efficacy influences participation but participation experience also influences self-efficacy” (p. 3). This was the case among respondents in this study—those who were more comfortable asking for help and had developed higher self-efficacy were more likely to report using transportation and to talk optimistically about travel; those who were not comfortable asking for help, demonstrating low self-efficacy, did it less and used transportation less, which reinforced negative feelings about their future travel prospects.
People with disabilities experience particular transportation challenges that arise from socializing while in transit. Completing or anticipating transportation-related social tasks, like asking drivers, fellow passengers, family/friends/caregivers, or passers-by for help, can impact one's health by influencing feelings of self-efficacy, stress, and perceived social isolation. These feelings may, in turn, affect travel behavior, which also has implications for health. This qualitative study sheds light on the role of transportation-related social interaction in travel behavior and health among adults with disabilities.
32 in-depth interviews were conducted with adults with disabilities living in the San Francisco Bay Area.
Respondents’ experiences interacting with others while using transportation influenced determinants of health including self-efficacy, stress, and perceived social isolation and connectedness. Findings from this study indicate that people with disabilities may change their travel behavior in response to these feelings. Individuals with low transportation self-efficacy or who have experienced stressful interactions may limit travel. This might pose a health risk by contributing to feelings of perceived isolation. Difficulties completing transportation-related social tasks and related health consequences may be especially pronounced among individuals who acquired disabilities relatively recently and/or in old age. Individuals with high transportation self-efficacy or who feel socially connected while traveling may travel more. This might promote health.
The social tasks associated with using transportation deserve more attention in literature on travel behavior and transportation planning, as they pose barriers to using transportation for some adults with disabilities and can affect travelers’ health. Offering travel training to people with acquired disabilities, and training drivers and educating riders about how to appropriately and effectively interact with passengers who require special assistance might improve transportation for, and associated health outcomes among, people with disabilities.
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At a more focused level, the characteristics of an individual’s neighborhood, including the ease of travel, can play an important role in facilitating community participation. Research by Sundar et al. (2016) indicates that the relationship between community participation and travel is reciprocal for persons with disabilities. That is, having strong connections in one’s neighborhood leads to a network of people to rely on for travel needs when disability prevents independent travel.
This paper utilizes newly available data from the 2017 National Household Travel Survey to examine travel patterns within the U.S. for persons with disabilities. Our analysis finds that having a disability is associated with lower odds of taking a trip for shopping, for social or recreational reasons, for running errands, or for going to work, even after controlling for other characteristics. Length of disability (less than 6 months, more than 6 months, or lifetime) is associated with the type of mobility aid used to support travel, some aspects of day-to-day travel, and the odds of taking a trip for errands, shopping, social, or recreational reasons. Those with a lifetime disability had lower odds of traveling for errands or shopping (OR = 0.68, p < 0.05) compared to those with a temporary or more recent onset of disability, all else constant. We discuss how these findings help to understand differences in economic and social participation among people with disabilities.
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The aim of this study was to determine the association between walking ability in a clinical setting (activity capacity), walking ability in a person’s daily environment (activity capability) and walking performance in daily life (activity performance), and the contribution of each activity construct to participation among people with multiple sclerosis (MS).
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Activity capacity, capability, and performance were assessed using the Six Minute Walk Test (6MWT), Twelve Item MS Walking Scale (MSWS-12), and steps/day measured using a pedometer worn for 6 days, respectively. Participation was assessed using the Impact on Participation and Autonomy questionnaire (IPA).
Distance walked on the 6MWT was associated with MSWS-12 score (β = −0.56, 95% CI −0.87 to −0.22) and steps/day (β = 129.49, 95% CI 48.48 to 207.57). MSWS-12 score was also associated with step count (β = −87.35, 95% CI −172.29 to −15.71). 6MWT distance was associated with the autonomy indoors subscale of the IPA (β = −0.02, 95% CI −0.04 to −0.01). No other activity measure was associated with participation.
Findings suggest that while activity capacity, capability and performance are related, activity is a poor predictor of participation. The strength of associations between constructs of activity, and activity and participation, however, are often small with wide confidence intervals, indicating that there is considerable uncertainty associated with effect estimates.
The impact of mobility limitations on health outcomes among older adults
2018, Geriatric Nursing
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Improvements in resilience have been associated with improvements in physical function32; social support with decreases in depression.14 Social and neighborhood participation, particularly activities outside of the house, have been shown to increase odds of recovery from mobility limitations, improve self-efficacy, reduce stress and increase physical activity levels.29,30 Falls rates among those with moderate and severe mobility limitation were increased by almost 3-fold compared to those with no limitations.
The purpose of this study was to stratify an older adult population for subsequent interventions based on functional ability, and to estimate prevalence, characteristics and impact of mobility limitations on health outcomes. In 2016, surveys were sent to a stratified random sample of AARP^® Medicare Supplement insureds; mobility limitations were defined using two screening questions. Responses were stratified to three mobility limitation levels. Multivariate regression models determined characteristics and impact on health outcomes. Among weighted survey respondents (N = 15,989), severe, moderate and no limitation levels were 21.4%, 18.4% and 60.3%, respectively. The strongest predictors of increased limitations included pain and poor health. Individuals with more severe limitations had increased falls, decreased preventive services compliance and increased healthcare utilization and expenditures. Utilizing two screening questions stratified this population to three meaningful mobility limitation levels. Higher levels of mobility limitations were strongly associated with negative health outcomes. Mobility-enhancing interventions could promote successful aging.
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: A portion of the work on this project was funded by the U.S. Department of Health and Human Services (DHHS) through the National Institute on Disability, Independent Living, and Rehabilitation Research (90RT5022-02-01) and the Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA through funding from the National Institutes of Health (UL1 TR001064). The findings do not necessarily represent the policy of DHHS and you should not assume endorsement by the Federal Government (Edgar, 75.620 (b)).

^e: Megan Pollack was a graduate student at the University of New Hampshire while the study was being conducted.

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Research PaperCommunity and social participation among adults with mobility impairments: A mixed methods study

Abstract

Background

Objective

Methods

Results

Conclusions

Section snippets

Literature review

Methods

Qualitative analysis

Discussion

Conclusion

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Ann Epidemiol

Soc Sci Med

Soc Sci Med

Disabil Health J

Arch Gerontol Geriatr

Arch Phys Med Rehabil

Behav Res Ther

International Classification of Functioning, Disability and Health (ICF)

Orthopedic impairment after medical rehabilitation: functional performance and satisfaction with community participation

Am J Phys Med Rehabil

Factors affecting measures of activities and participation in persons with mobility impairment

Disabil Rehabil

Neighborhoods, aging, and functional limitations

Neighb Health

Ecology and the aging process

Perceptions, behaviors, and satisfaction related to public safety for persons with disabilities in the United States

Crim Justice Rev

The role of neighborhood safety in recovery from mobility limitations findings from a national sample of older Americans (1996–2008)

Res Aging

Research Paper
Community and social participation among adults with mobility impairments: A mixed methods study