Assessment of Environmental Enablers and Barriers as Related to Leisure versus Need

1. Assessment of Environmental Enablers and Barriers as Related to Leisure versus Need Anne Kramlinger, MSOT/SJulia Sanders, OTD/S Jaren Soelberg, MSOT/S Carolyn Slentz, MSOT/S  Elizabeth Williams, MSOT/S

3. Problem and Purpose • As of 2009 19,425,100 people in the United States reported having a disability affecting their mobility • Maslow's Hierarchy of Needs shows us that physiological needs must be met before a person can move to higher levels of need, desire, and self-actualization • Environment plays a major role in enabling or inhibiting accessibility and thus can affect one's ability to access and obtain food  • Purpose: This study utilizes the CHEC-M in hopes of gauging the accessibility of various grocery stores and restaurants in the St. Louis area. We theorized that buildings utilized for need would be more accessible than buildings utilized for leisure activities. It is hypothesized that restaurants in St. Louis will be found to be less accessible as measured by the CHEC-M than grocery stores in the same area.

4. Participants • 52 establishments were selected • 25 grocery stores (need) • 27 restaurants (leisure) • Inclusion • Anything under "grocery store" or "restaurant" in the phone book in the 2012 St. Louis metropolitan area • Exclusion • Safety • Distance

5. Figure 1. Locations of Grocery Stores used in the study.

6. Figure 2. Locations of Restaurants used in the study.

7. Table 1 Type of Grocery Stores and Restaurants Assessed

8. Type of Grocery Stores Assessed

9. Type of Restaurants Assessed

10. Outcome Measure • Community Health Environment Checklist - Mobility (CHEC-M) • 39-item survey that measures the accessibility of a building based on ADA guidelines and the relative importance to individuals with a disability

11. Data Collection – Inter-rater Reliability • Inter-rater reliability was established prior to beginning the study: • 93% • 2 grocery stores and 2 restaurants • Included “CHECin’ out the Lou” • After determining inter-rater reliability the CHEC-M was then used to assess the full sample of grocery stores and restaurants

12. Data Collection – The Sample • A random sampling of 52 buildings were taken from the 2012 St. Louis phone book • 25 Grocery stores - every 6th entry under the heading “grocery” • 27 Restaurants - every 50th entry under the heading “restaurant” • The grocery stores and restaurants chosen were then called to see if they were still in business. If they were no longer in business the building listed directly under it in the phone book was selected and included instead.

13. Data Collection • Each rater assessed 10 buildings selected on a regional convenience basis • The buildings were assessed during the time period of February-March 2012 • Each assessment took an average of 10 minutes to perform

14. Test Design and Data Analysis • Design • Cross-sectional between subjects design • Statistical Analysis • Each item either met accessibility requirements (1), did not meet accessibility requirements (0), and not applicable (1) • 6 Independent t-tests performed • We compared total CHEC-M scores (out of 100), which represented the accessibility of each grocery store or restaurant

15. Results Table 2 CHEC-M Raw Scores and Total by Building Type and by Subdomain Note: * indicates a significance of p<0.05.

16. Mean CHEC-M Scores by Subdomain

17. Results Table 3 Proposed Usability Ranking System for CHEC-M Subdomains (DACPRO)

18. Results Table 4 Frequency and Percentage of Restaurants and Grocery Stores Assessed Receiving Acceptable Accessibility Scores by Subdomain

19. Discussion • Statistical Insights • As expected, grocery stores are more accessible than restaurants in the St Louis metropolitan area • As a whole, bathrooms are the least accessible part of a grocery store or a restaurant • Current literature identifies that the need for food is directly related to occupational performance which impacts quality of life

20. Similar Research Findings • According to McClain, et. al. 1990 - Convenience stores (78%) are far less accessible than chain grocery stores (100%) • According to McClain, et. al. 1993 - Getting in the door of an establishment was not an obstacle (66% accessible); handicapped parking was (53%)

21. Adding to Current Knowledge • Grocery stores are significantly more accessible than restaurants (p = .005) as measured by the CHEC-M • Grocery store entrances are more accessible than restaurant entrances

22. Clinical Implications • In order to enhance accessibility, architectural modifications are needed • Both grocery stores and restaurants had ‘inaccessible’ scores • Leisure as food is not as accessible • Only 4% of restaurants had total usability in an acceptable range • Only 15% of restaurants had acceptable entrance scores • Grocery stores had very high scores and can be used as a model of acceptable entrance

23. Limitations • CHEC-M • Training • Rater reliability • One item’s reliability • May not be the most effective for comparing accessibility • ‘N/A’ is treated as a ‘yes’ during scoring • Wide outliers

24. Limitations

25. Limitations • Existing locations do not all match the phone book entries • CHEC-M • Training • Rater reliability • One item’s reliability • May not be the most effective for comparing accessibility • ‘N/A’ is treated as a ‘yes’ during scoring • Wide outliers in site selection

26. Limitations

27. Limitations • Existing locations do not all match the phone book entries • CHEC-M • Training • Rater reliability • One item’s reliability • May not be the most effective for comparing accessibility • ‘N/A’ is treated as a ‘yes’ during scoring • Wide outliers in site selection

28. Limitations

29. Future Work • Usability of restroom accessibility should be further researched • More studies should be done • Rural environments • Different socioeconomic areas • Other cities • The CHEC-HOH and CHEC-LV should be done

30. References • Erickson, W., Lee, C., von Schrader, S. (2010, March 17). Disability Statistics from the 2008 American Community Survey (ACS). Ithaca, NY: Cornell University Rehabilitation Research and Training Center on Disability Demographics and Statistics (StatsRRTC). Retrieved Feb 07, 2012 from www.disabilitystatistics.org. • Maslow, A. H. (1943). Conflict, frustration, and the theory of threat. Journal of Abnormal Psychology,38, 81-86. • McClain, L., Beringer, D., Kuhnert, H., Priest, J., Wilkes, E., Wilkinson, S., & Wyrick, L. (1993). Restaurant wheelchair accessibility. American Journal of Occupational Therapy, 47(7), 619-623. • McClain, L., & Todd, C. (1990). Food store accessibility. American Journal of Occupational Therapy,44(6), 487-491. • Imrie, R. O. B., & Kumar, M. (1998). Focusing on disability and access in the built environment. Disability & Society,13(3), 357-374. doi: 10.1080/09687599826687 • Stark, S., Hollingsworth, H. H., Morgan, K. A., & Gray, D. B. (2007). Development of a measure of receptivity of the physical environment. Disability & Rehabilitation, 29(2), 123-137. • Stark, S. & Sanford, J. (2005). Environmental enablers and their impact on occupational performance.. In C.H. Christiansen, C.M. Baum, & J. Bass-Haugen (Eds.), Occupational therapy: performance, participation, and well-being (pp. 298-331). Thorofare, NJ: SLACK Incorporated. • Vincent, G. K., Victoria, V. A. (2010). The next four decades: The older population in the United States: 2010 to 2050. Retrieved Feb 07, 2012 from http://www.census.gov/prod/2010pubs/p25-1138.pdf. • Wilcock, A. (1993). A theory of the human need for occupation. Occupational Science: Australia 1(1), 17-23.

31. Questions?