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Universal Design & Health Promotion (UDHP) Webinar

September 9, 2009

Funded by CDC, NCBDDD, Disability and Health Branch, 5U59DD522742

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Panelists & Funding

James H. Rimmer, PhD Jennifer Gray-Stanley, PhD Jennifer Zimmerman, MA, PhD Candidate

University of Illinois at Chicago, Department of Disability & Human Development, Center for Health Promotion

“Examination of Instruments Used to Measure the Built Environment and Physical Activity” grant: Funded by the Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Disability and Health, Grant # 5U59DD522742

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Background

Dozens of instruments developed or under development but lack of integration/cohesion from previous studies/research.

Growing need for a synthesized and integrated assessment tool that measures the accessibility of the built environment inclusive of people with disabilities.

CDC Disability and Health professionals need more detail on specific instruments being used to design/redesign communities for general population.

Background

Limitations in the biological, psychological, and behavioral explanations of physical inactivity have led to examination of the built environment ...– Presence of accessible walking and bicycling paths– Community recreation– Transportation systems– Urban design characteristics

Background

Healthy communities provide supportive physical and social environments:– Sidewalks and parks– Aesthetically pleasing – Adequate street lighting and seating– Safety incl. protection from motor vehicles

Goal for all of us is Universal Design

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Livable Communities (1)

Opportunities for people of all abilities to be active & engaged in their communities

Accessible communities should be … – Walkable– Bikeable– Have accessible streetscapes (sidewalks, crosswalks)– Have accessible recreational opportunities (e.g., parks, pools)

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Livable Communities (2)

Inclusive population focus– People with physical and sensory disabilities (PWDs)

Mobility impairments Visual, auditory impairments

– People with ID, cognitive impairment e.g., CP, Down Syndrome

Other users– Users pushing baby strollers, delivery carts, grocery

carts, wheeled bags, cyclists with baby carrier

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UDHP Project Focus (1)

US communities using a variety of instruments to assess walkability, bikeability, and other built environment sub-domains.

– Domain overlap across instruments– Limited attention to instruments’ disability focus & UD potentiality

Growing # of instruments – Need to be catalogued for future synthesis & instrument

development– Users: consumers, professionals, & advocates in

public health, transportation, urban design & planning, & disability studies

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UDHP Project Focus (2)

1. Information on subject domain overlap across reviewed instruments

2. Reviews of included instruments, including instrument purpose, sub-domain areas, psychometrics, & contact information.

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Webinar Focus

1. Review instrument-specific information.

2. Identify subject domain overlap across instruments.– Community use of instruments – Development of new instruments

3. Identify relevance of instruments to PWD.

4. Discuss UD potentiality of instruments & sub-domains.

5. Show project website with technical assistance available.

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Project Methodology (1)

Built environment:– Community’s urban design, transportation, and

recreational options within a geographical space, which may impact individuals’ physical activity levels.

– e.g., land use, street and sidewalk/path networks, aesthetics.

– Additional dimensions: recreational areas and policy and planning

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Project Methodology (2)

Search strategy:– Literature searches

Medline, Ovid Social Sciences databases, Web of Science Citation database, Health and Psychosocial Instruments, Google Scholar

– Review articles– Professional contacts– Key words included:

measurement, instrument, assessment, tool, environment, environmental determinant, physical environment, built environment, physical activity, exercise, health promotion, walkability, bikeability

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Project Methodology (3)

Inclusion/exclusion criteria:– Included:

Environmental audits & perceived environmental measures of walkability and bikeability, recreational structures, and general built environment features impacting physical activity, such as roads, intersections, crosswalks, etc.

GIS environmental assessments of urban design qualities impacting physical activity, including population density, land use mix, etc.

Instruments specific to transportation and accessibility for people with disabilities.

Instruments with a track record of use in communities.

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Project Methodology (4)

Inclusion/exclusion criteria:– Excluded:

Instruments focusing exclusively on behavioral or physiological measurements related to physical activity in a geographical space (e.g., time spent exercising, or heart rate during exercise).

Instruments with insufficient psychometrics, validation information, & instrument development literature, which had no track record of use in communities.

Complete instrument not available through search strategy.

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Key Information Resources on UDHP Website

Instrument Abstractions

Instrument Checklist

Domain Summary Tables

Disability-Specific & Universal Design Tables

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Instrument Abstractions (1)

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Instrument Abstractions (2)

Brief summary of each instrument Name, author, & affiliated organizations Instrument purpose Instrument type

– Observational (audit)– Subjective/perceived– GIS-based

Geographical scale– Instrument specific– Community, school, workplace

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Instrument Abstractions (3)

Instrument development methods– Peer-reviewed literature– Sample– Validity & reliability

Key instrument sub-domains Considers disability issues Number items & length of instrument URL & contact information Definition & notes *Active Living Research has reviews on some of these

instruments (17).

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Instrument Checklist (1)

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Instrument Checklist (2)

Overview of all reviewed instruments (100) Instrument name, authors, development year Primary author field

– Health, planning, transportation Instrument type

– Observational (audit), subjective, GIS Validity & reliability information Considers disability issues

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Domain Summary Tables (1)

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Domain Summary Tables (2)

Indicates what instruments cover what domain & sub-domain areas.

Potential use:– Pinpoint existing instrument(s) which cover your

community assessment needs. – Review existing instrument(s) for new instrument

development.

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Domain Areas

1. Built Environment Infrastructure

2. Walkability

3. Bikeability

4. Recreation Sites & Structures

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Built Environment Infrastructure

Roads – Type, alignment, configuration, materials, slope & terrain,

width & condition

Curb cuts/ramps Intersection/crosswalk

– Intersection type, crosswalk features, signals/signs, timing

Traffic control Transportation & parking Policy & planning

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Walkability

Sidewalk/path– Presence, accessibility, materials, condition & maintenance,

obstructions & slip/trip hazards, width, length, slope

Walking safety– Traffic, crime

Pedestrian volume & speed Aesthetics & amenities Policy & planning

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Bikeability

Bicycle lane/path– Presence, materials, condition & maintenance,

obstructions, width, length, slope, continuity

Bicycling safety– Safety routes & enforcement, driver behavior

Policy & planning, education– Policy, promotion, training & education

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Recreation Sites & Structures

Recreation facility & fitness center Pools Parks Other

Policies & planning Amenities & resources

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Domain Overlap

Built environment infrastructure– Crosswalk signs & signals, features– Traffic volume & density– Parking availability

Walkability– Sidewalk/path presence, dimensions, condition & maintenance– Walking safety due to crime, traffic– Aesthetics & amenities

Bikeability– Bicycle lane/path presence– Resources– Education/training

Recreation Sites & Structures– Amenities & resources– Availability facilities

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Built Environment Domain Overlap

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Walkability Domain Overlap

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Bikeability Domain Overlap

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Recreation Sites & StructuresDomain Overlap

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Instruments Which Consider Disability Issues

29 instruments– At least 1 question/item per instrument

Relevant item content– Wheelchair accessibility– Accessible signage– Accessible crosswalk, pedestrian facilities– Attitudes towards PWDs– Accessible parking facilities

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Table: Disability-SpecificInstruments

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7 Universal Design Principles (1)

1. Equitable use Useful for individuals of diverse abilities

2. Flexibility in use Accommodates individual preferences &

abilities

3. Simple & intuitive use Easy to understand & use

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7 Universal Design Principles (2)

4. Perceptible information Communicates necessary information despite sensory abilities

5. Tolerance for error Minimizes hazards or accidental, unintended actions e.g., computer “undo function”

6. Low physical effort Used efficiently, comfortably, with a minimum of fatigue

7. Size & space for approach & use Appropriate size & space for reach, manipulation, & use,

regardless of physical ability

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Table: Universal Design Applicability

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Universal Design Recommendations (1)

Accessibility for multiple users– Wheelchair, mobility aid users– Users with visual impairments, blindness, cognitive

impairments– Older adults w/ mobility impairments and/or impaired judgment– Service delivery cart users– Baby stroller users– Bicyclists– Children

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Universal Design Recommendations (2)

Sidewalk/bicycle lane/path– Materials

Smooth, stable, even, & hard surfaces

– Condition & maintenance/trip-slipping hazards Catch hazard for dragging foot, walking aid Cracks, holes, bumps periodically repaired

– Width 10-foot width for shared paths, added width for turns

– Slope Flat & gentle, limited to a 5% grade

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Universal Design Recommendations (3)

Curb cut/ramp dimensions New curb ramp slope not > 8.33% grade & cross-slope not > 2%

grade

Crosswalk signage & signals– Visual, tactile, audible cues– Pictures, universal symbols, & colors

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Universal Design Recommendations (4)

Crosswalk features– Raised crosswalks, detectable boundaries between

sidewalk & street– Visual, tactile, & audible cues – Tactile ground surface indicators: luminance contrast – Crossing refuge island: 60-inch maneuverable space – Crossing timing: > 4-feet per second, pedestrian controls

increase crossing time, divided crossing distance

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Universal Design Recommendations (5)

Transportation– Public transit vehicles and stations with wheelchair

lifts and elevators, paratransit availability as needed

Parking– On-street parking: accommodate 8-foot vehicle & 5-

foot access aisle, allow for sidewalk access (ramp), some van accessible spots

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Universal Design Recommendations (6)

Recreation facilities & structuresAccessible entrance/exits, e.g., fishing piers,

fitness centers, boat docks, etc.

– AmenitiesBench height & width with arms & backs,

telephones w/ TTY access, accessible water fountains & toilets (ADAAG)

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Future Directions

Expansion of HEZAT AIMFREE - R3

– Data collection on barriers and solutions

CAT-based ideas

Building Health Empowerment Zones for People with Disabilities

James Rimmer, PhD, PI

Yochai Eisenberg, MUPP

Carol Braunschwieg, PhD

Robin Jones, COTA

Edward Wang, PhD

Vijay Vasudevan, MPHNIH Grant #R01HDO52891

Phase 1: Instrument Development

Outdoor Environment Assessment Tool– Developed through Delphi process– Combination of 5 instruments

SPACES, CHEC, CHIEF, ADAAG, FTA Transportation Assessment

9 expert raters in disability and environment fields

Items on HEZEAT

Slope of sidewalk Presence of curb cuts Level changes Broken sidewalk Sidewalk too narrow Obstacles Time to cross street

Large Curb Cut Slope

Fitness Centers

Sidewalks

Transportation

Grocery Stores

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Technical Assistance

UDHP website:– http://uic-chp.org/CHP_A9_UDHP_01.html

Forward questions to – 800-900-8086

or – jegray@uic.edu