Author's School

School of Medicine

ORCID

https://orcid.org/0000-0002-6576-3872

Author's Department/Program

Rehabilitation and Participation Science

Language

English (en)

Date of Award

Spring 5-15-2023

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Chair and Committee

Kerri A. Morgan

Committee Members

Lisa Connor, Amy Eyler, Michelle Putnam, Susan Stark

Abstract

Adults living with a long-term physical disability experience difficulties living independently and participating in the community as they age. A combination of personal (e.g., fatigue) and environmental (e.g., transportation accessibility) factors influence these restrictions in participation. The impact of the built environment is a key aspect to consider when understanding community participation restrictions for adults aging with long-term physical disabilities (AAwPD) because these factors are often more modifiable. However, the processes by which the built environment impacts AAwPD are not well understood. Interventions targeting these factors to address the community participation needs of AAwPD are limited.

Research informing community-based organizations (CBO) that are well-positioned to serve AAwPD can help address their health and participation disparities. Previous research evaluating the influence of the built environment on the community participation of AAwPD is limited by primarily qualitative or cross-sectional data, a focus on a single diagnosis or disability group, and samples that lack racial and socioeconomic diversity. The purpose of this dissertation is to inform intervention development and service provision of CBO to improve the community participation of AAwPD by (1) characterizing the existing research knowledge of how built environments influence the community participation of AAwPD, (2) investigating how AAwPD perceive their surrounding built environments to influence their community participation, and (3) determining the quantitative associations between built environment factors and community participation for AAwPD.

Synthesis of the current state of evidence revealed heterogeneity in measurement tools and operationalizations of community participation as an outcome. In addressing the second aim of the dissertation, I conducted semi-structured interviews with 20 AAwPD to better understand their perceptions of the impact of the built environment across a spectrum of neighborhood socioeconomic disadvantage. Our findings highlighted the importance of built environments that foster a sense of belonging and personal safety.

Statistical modeling was then used to explore the quantitative relationships between community participation and built environment factors in a sample of 331 Missouri-dwelling AAwPD. Participation in social roles and activities was found to be significantly different across transportation mode and residential location—factors identified in the first two aims. However, personal factors (e.g., pain) were significantly more predictive of restricted participation than built or social environment factors. Finally, urban-dwelling participants primarily using paratransit reported the highest ability to participate in social roles and activities.

Together, these results demonstrate the significance of the objectively measured and subjectively perceived influence of built environment factors for the community participation of AAwPD. The work presented in this dissertation provides a new understanding of how community participation for AAwPD is shaped by supportive, safe, and accessible built environments. Our findings may inform researchers, CBO, and funding agencies in future intervention development and implementation.

DOI

https://doi.org/10.48765/a8jc-k613

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