Development of the Community Health Environment Checklist

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Development of the Community Health Environment
Checklist

• Holly Hollingsworth
• Susan Stark
• Kerri Morgan
• David Gray

Partial Support for this report was provided by
the Office on Disability and Health at the
Centers for Disease Control and Prevention
(R04/CCR714134) for a grant titled Mobility,
Disabilities, Participation and the Environment.
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Problem Statement

• Problem Statement
• Community environments are not designed to meet
  the needs of people with disabilities.
• Participation is impacted by how people are able
  to use their environments.
• Purpose
• By identifying barriers and supports in the
  community environment, domains influencing social
  participation will be identified.

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Research Question/Approach

• Research Question
• What are the characteristics or features of an
  environment that make it more or less receptive
  to people with mobility impairments?
• Approach
• We surrender our claim of objective expertise and
  respect the subjects expertise in their own
  situations (Gilgun 1998)
• Cognitive mapping was used to identify a persons
  perception of their environment.

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Design and Procedure

• Design
• Qualitative
• In home interviews
• Cognitive mapping exercise
• Member check (focus groups)
• Analysis
• Constant comparative method

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Participants

• Inclusion Criteria
• Presence of a mobility limitation
• Resided in St. Louis metropolitan area
• Left home 2-3x/ week

• Demographics
• 25 people with mobility limitations
• Mean age 46.9 yrs.
• 14 female/ 11 male
• 13 Caucasian/ 10 African American
• stroke, SCI, CP, post polio

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Findings 15 Key Destinations

• Government Buildings
• Major Tourist Destinations
• Performance Venues
• Large Stores
• Small Stores
• Self Care Service Providers
• Dining Establishments

• Transportation
• Health Care Providers
• Health Vendors
• Professional Service Providers
• Indoor Leisure
• Outdoor Leisure
• Religious Facilities
• Schools and Libraries

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Findings 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 Wheelchairs
• Signage for Accessible Elements
• Single Level
• Maneuverable Spaces

• Crowding
• Floor Surfaces
• Counters and Merchandise
• Accessible Places to Sit
• Adequate Lighting
• Accessible Restroom
• Drinking Fountain
• Accessible Phone
• Drive-through Window
• Usability
• Rescue Assistance

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The CHEC

• Major sections
• Entering building
• Using the building
• Using restrooms
• Amenities
• Features
• 22 Features
• Captured the essence of the participants
  comments
• Items
• Individual questions that capture the presence of
  the feature
• Scored dichotomously (yes N/A 1 No 0)

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Flexibility of the CHEC

• Receptivity can be characterized at the Community
  Level
• Total CHEC Scores on a sample of destinations
• Receptivity of accessible restrooms of entire
  community (features by destination)
• Receptivity can be characterized at the
  Destination Level
• Total CHEC score of the destination or Area of a
  building (this building)
• Receptivity of features (seating)

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Review by consultants

• Consultants suggestions
• Scaling (to weight items)
• Make the form user friendly and not technical
• Make a rule book instead of a complicated
  scoring sheet

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Rule Book and Glossary

• Available to provide assistance in determining
  score
• Resources on which rules are based
• Based on the important descriptions of the
  experts (people with mobility limitations)
• Consultants (experts in architecture, universal
  design, occupational therapy)
• Literature and standards

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The RULE BOOK

• can you get in, do what you need to do and get
  out without much difficulty
• Determine if one accessible feature is present
  and evaluate that feature (e.g. the accessible
  bathroom) (versus all features)
• Column 1 and 2 are the same as the CHEC
• The third column contains the rules for the
  corresponding item.

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The GLOSSARY

• Items that are more difficult or involve
  measurements have a visual picture for
  clarification.
• Glossary items are numbered and arranged in
  alphabetical order.
• Links to the glossary can be found on the
  corresponding item in the CHEC

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In the field

• Evaluations are completed during busy time
• Time
• 5 minutes small building
• 90 minutes large building
• 1-2 raters
• Using paper/pencil, PDA, or Tablet PC

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Scaling and Scoring

• Scored dichotomously (yes N/A 1 No 0)
• 22 Features weighted based on ranking of
  importance of items (based on ranking study)
• Weights were transformed monotonically to yield
  the range of a destination score to be from 0 to
  100

• Ranking Study
• 17 of the original subjects (78 different
  rankings by destination category)
• Ranked each feature based on directions imagine
  the most accessible place for you

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Features Weights
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EXAMPLE CHEC Page 2
SECTION
FEATURE
2 of 3 Yess Weight 4.81
3.2 24.81/3
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Scoring

• Scores are computed for each Feature within each
  Section.
• A Section score is the sum of the Feature scores.
• The total Destination score is the sum of the
  Section scores.
• The scoring has been scaled such that the highest
  Destination score is 100.

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Sampling Strategy

• Identify the boundaries of a community
• Political
• Geographic
• Identified by population of individuals with
  disabilities
• Identify all possible destinations within the
  community within each destination category
• Sample 10 of the destinations within each
  destination category
• If a community does not contain a destination
  within a category (e.g. hospital), use the
  closest destination of that type to the center of
  the community and rate that destination

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University City, MO
City Hall CHEC Sites Reported destinations
visited by people with ml Overlap
Jeff Cuthbert, OTR cuthbertj_at_msnotes.wustl.edu
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Validation

• Menomenee, Wisconsin
• Rural environment
• 45 destinations rated
• 2000 sq ft 20,000 sq ft (3 - 27 minutes)
• CHEC score 21.2 (low)-100.0 (excellent)
  receptivity
• KR20 .92

• University City Missouri
• Urban environment
• 63 destinations rated
• 1,500 sq ft 20,000 sq ft (10-90 minutes)
• CHEC score 4.2 (poor)-97.2 (excellent)
  receptivity
• KR-20 .95

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Reliability

• Section I Entering the Building 0.72
• Level Surface
  0.80
• Section II Using the Building 0.95
• Section III Restrooms 0.87
• Section IV Amenities 0.86

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(No Transcript)
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Rural v. Urban
P.08
Plt.01
P.12
Plt.01
Plt.01
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Next steps

• Refine measure based on initial testing (CHEC
  2.0)
• Validate instrument against gold standard (in
  process)
• Validate instrument against lived experience of
  individuals with mobility impairments
• Develop formal training program
• Develop web based data management and report
  generating software (identification of solutions
  as well as barriers)

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Limitations in flexibility

• Difficult to translate to different cultures
• Transportation differences
• Only developed for persons with mobility
  limitations small sample size
• Value not in the final items but in the approach
  and method
• Groups interested in vision/hearing may want a
  version
• International partners may wish to develop a
  version

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Why use this measure?

• Assesses the receptivity of the physical
  environment from the perspective of persons with
  mobility impairments
• Is brief, intuitive, and easy to administer
• Excellent internal consistency
• Internal validity
• Email hollingsworthh_at_wustl.edu