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Many community-dwelling individuals living with a disability use mobility assistive technologies (MATs). MAT devices are generally beneficial for individuals with mobility impairments. However, less is known about the specific factors that may foster or deter mobility and community participation.
The purpose of this protocol is to describe the methodology for a study including three main objectives: (1) to understand the places people using MAT go and the things they do, (2) to identify perceived barriers and facilitators as well as users’ desired environmental modifications, and (3) to understand subjective and objective issues related to environmental accessibility.
A mixed-methods study was conducted in Vancouver and in Quebec City. Qualitative interviews were conducted to address all three objectives. In addition, Objective 1 was achieved through collection of global positioning system (GPS) data and activity diaries with 36 participants per site who represented six types of MAT users (ie, cane, walker, crutches, manual wheelchair, power wheelchair, and scooter). All participants were invited to take part in all aspects of data collection. PhotoVoice was used to address Objectives 2 and 3. Two environmental audits were used to address Objective 2. The Stakeholders’ Walkability/Wheelability Audit in Neighbourhood (SWAN) measured perceptions related to a variety of community environmental features associated with mobility and participation. A total of 24 participants were recruited to each study site for SWAN data collection. The Measure of Environmental Accessibility (MEA) was also used to objectively measure access to exterior and interior environments selected earlier in the project by the participants that could benefit from improvements.
Funding for this study was obtained from the Social Sciences and Humanities Research Council of Canada. Approval was obtained from the University of British Columbia Research Ethics Board and the
The use of a variety of methods to gather data on participation and mobility will allow a more holistic consideration of factors influencing mobility with a MAT device. This study will provide objective information about the mobility of participants and identify barriers and facilitators that impact their mobility and community participation. Through the mixed-methods approach employed in this study, we will gain a subjective evaluation of the participants’ neighborhoods, including personally meaningful information on environmental features that influence participants' everyday mobility and participation. We will also gain an objective evaluation of particular obstacles that community users of MAT identify as significant barriers to their ability to access public environments. We anticipate that these findings will help to identify a broad spectrum of solutions to improve the mobility and community participation of MAT users.
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In 2012, over 7% of Canadians aged 15 years or older (ie, approximately 1,971,800 individuals) reported having a mobility-related disability [
Unfortunately, there are a variety of issues related to the use of MAT, such as accessibility to buildings via doors, accessibility to restrooms [
There is a general understanding of the characteristics of MAT users’ mobility (ie, distances travelled and encountered obstacles); however, we know little about how MAT influences users’ community participation, here defined as “the involvement of people in a geographic community that includes mobility, daily activities, work, and social engagement” [
It is therefore critical to study MAT users’ mobility in a more comprehensive and in-depth manner in relation to their community participation. By identifying barriers to MAT users’ mobility, this study aims to create a more inclusive society for all. With this overarching goal, we present a mixed-methods study with the following objectives:
To understand the places MAT users go and the things they do.
To identify perceived barriers and facilitators as well as the users’ desired environmental modifications.
To understand subjective and objective issues related to environmental accessibility.
This project used a participatory approach [
To qualify for the study, participants must have lived in Metro Vancouver, New Westminster, or North Vancouver, British Columbia, or in Quebec City, Quebec, and the surrounding area. Participants were required to use a MAT as their primary means of mobility, which could have been a cane, walker, crutches, manual wheelchair, power wheelchair, or scooter. Participant demographics (ie, age, type of disability, job, gender, or technological affinity) were not considered as eligibility criteria to facilitate the recruitment procedure. Individuals were excluded from the study if they were unable to communicate in French or English or if they could not provide informed consent. People who lived in nursing homes or residential care facilities were also excluded from the study.
To address the above-mentioned objectives, a mixed-methods approach was proposed. All participants took part in a semistructured interview, provided demographic information, and completed the standardized measures. Participants also had the option to participate in three additional methods: (1) GPS tracking of participants’ movement in the community combined with an activity diary, (2) PhotoVoice, and (3) physical environmental audits (see
Participants’ mobility was recorded using a portable GPS (Travel Recorder XT, model BT-Q1000XT, Qstarz International Co). These data were supplemented with an Apple iPad mini (model ME280C/A, Apple Inc)-based activity diary app (ie, the customized Filemaker Go app) that allowed participants to describe the places they visited, their activities, the modes of transportation they used, and whether they were accompanied by others (see
Research questions and methods.
Methods | Study objectives | Subresearch questions |
GPSa mobility data + activity diary + qualitative interview | 1. Understand the places people go and the things they do | Where do people who use different types of MATb go? |
PhotoVoice (includes qualitative interviews and focus groups) | 2. Identify perceived barriers and facilitators as well as the users’ desired environmental modifications | What barriers to mobility and social participation do people who use different types of MAT encounter? |
|
3. Understand subjective and objective issues related to environmental accessibility | What changes would they like to see happen to improve their mobility and social participation? |
Adapted SWANc tool (subjective audit) + MEAd (objective audit) | 2. Identify perceived barriers and facilitators as well as the users’ desired environmental modifications | How walkable or wheelable is the selected block? What positive or negative elements are identified? |
aGPS: global positioning system.
bMAT: mobility assistive technology.
cSWAN: Stakeholders’ Walkability/Wheelability Audit in Neighbourhood.
dMEA: Measure of Environmental Accessibility.
To describe the sample, the research assistants also gathered quantitative data, including demographic information and the following outcome measures:
Hospital Anxiety and Depression Scale (HADS) [
Self-report Late-Life Function and Disability Instrument [
Life-Space Assessment (LSA) [
Mobility Device Use Confidence [
Social capital measure [
The data will also be combined with anxiety and depression data in predictive analyses and will be included in analyses to determine the influence of personal, MAT, and environmental factors on the activity spaces of people who use MAT using the GPS and trip diary data. Each method reported in this protocol requires separate analyses. To avoid bias, the interview guide (see
PhotoVoice is a community-based participatory research method through which participants are asked to record visual images that capture their lived experiences [
First, each participant took part in a training session on how to operate the camera feature of the app discussed in the previous method used. The training session allowed exchanges on ethical photo etiquette, specifically the importance of using a photo and video release form when taking pictures of other individuals. During the training session, participants worked with the researchers to identify potential images that they might purposefully set out to capture. Participants received a troubleshooting document for the provided device as well as the research assistants’ contact information in case of a problem with the devices and apps or an emergency. They were also provided with a folder containing a summary of the project and photo and video release forms for obtaining consent from individuals in their pictures.
Second, over a 2-week period, which could have been concurrent with the GPS data collection method, participants were asked to take pictures or videos of the mobility- and participation-related barriers and facilitators they encountered. They were encouraged to take the tablet with them at all times during this period. It was suggested that they use the app to record notes about each image, describing their reasons for taking it. At the end of the first week, the research assistants contacted the participants to check in and ask about any problems or difficulties the participants may have been experiencing.
Third, upon completion of the above-mentioned 2-week period, participants took part in an individual PhotoVoice interview to discuss their most significant photos (ie, a personal selection of a maximum of 10 images). The interviewer looked for common themes among the pictures, and discussed suggestions for improvements and how to facilitate them (see
Finally, PhotoVoice focus groups were held until a total of 24 participants per site were recruited for this method of data collection. However, 36 participants per site completed the PhotoVoice procedure excluding the focus group, as they could have also participated in the GPS tracking, activity diary, and qualitative interview phase or they could have been different participants. After 5-7 participants who used various types of MATs finished taking pictures, they were asked to take part in a group discussion about the photos they had taken and a PhotoVoice focus group was planned (ie, approximately three focus groups per site). Participants were not required to participate in the focus groups. Participants who completed focus groups took turns sharing the most important images they had previously selected during their individual PhotoVoice interview. Participants were asked the following questions about their images and videos: “Please describe the photo/video you have chosen.” “Why did you select this photo/video for the interview?” and “Where was the photo/video taken?” Then, the entire group was asked, “Do members of the group have questions or comments about this picture?” After the photos were shared, the group was asked the following questions:
“What common themes do you see among your photos/videos and which photos can be grouped in those themes?” (Group photo selection)
“If you wanted to see any improvements made based on the images/videos that you selected, what would those be?”
“How would you suggest these improvements should be made?”
“How could the images or videos you took be used to facilitate those improvements?”
Participants that were unable to attend the focus groups were able to access the results if they were interested. The themes identified by the groups were shared among participants to gain a sense of how the findings resonated. The PhotoVoice focus groups were audio-recorded and transcribed verbatim. Images were numbered and referenced in transcripts. Each focus group lasted 2-2.5 hours.
The transcribed interviews will be analyzed using thematic analysis [
At the end of the study, a photo exhibition will be held to celebrate the participants’ work and raise public awareness of relevant issues. Family, friends, relevant stakeholders, and the general public will be able to view the pictures and listen to the stories behind them. The exhibition will be held in local libraries, community centers, or other public venues. Participants interested in taking part in the photo exhibition will be asked to select photos from the previous focus groups and write captions to accompany them. If the participants prefer, captions can be written by the researchers and approved by email to ensure the captions match their interpretations. The participants’ photos and captions will be presented in full consultation with them. Participants will also be integrated in the planning process of the exhibition regarding the type of presentation and the date(s) and place at which the exhibition will take place.
Two instruments were used as environmental audits. The first, a modified version of the Seniors’ Walkability Audit in Neighbourhood, renamed the Stakeholders’ Walkability/Wheelability Audit in Neighbourhood (SWAN) [
The SWAN data collection procedure was divided into three parts. The first part consisted of training the participants in how to use the SWAN tool. During the training sessions for the SWAN, participants received a Google Maps image of their own neighborhood. They were asked to identify four segments that they wanted to assess using the tool. The participants chose their own segments according to the following criteria: (1) segments that represented their neighborhood and had environmental features that had barriers or facilitators to maneuvering around with their MATs and/or (2) segments on streets that they frequently traveled.
The research assistants ensured that selected segments were auditable within a 2-hour period (ie, the chosen segments were not too far from one another). The four segments did not necessarily have to be in close proximity to the participant’s house nor were they required to have automobile traffic. The selected segments could be
The second part of data collection with the SWAN consisted of user-led data collection for each of the selected segments. Each participant was accompanied by a research assistant during data collection who helped take pictures of environmental factors, while conducting simultaneous audits of the segments. If participants wanted to change a previously selected segment on the day of data collection, they were permitted to do so as long as the new segment was not located at a distance too far from the other three.
The third and last part of data collection with the SWAN was a community forum. Community forums were held to share preliminary findings with the SWAN study participants and stakeholders. Although, it was not mandatory for each participant to attend the community forum, they were encouraged to do so. Invited stakeholders were selected from citizen committees, advocacy groups, city planners, or other community organizations working in the fields of disability, accessibility, and mobility. Members of the advisory committee who serve in the study sites were also invited. These forums fostered dialogue and discussion around methods for facilitating knowledge translation of SWAN findings and identifying potential intervention sites and strategies in each city.
The second audit tool was the Measure of Environmental Accessibility (MEA) [
The protocol for this study was approved by the Research Ethics Boards at the University of British Columbia (approval number H15-01340), the
Funding for this study was obtained from the Social Sciences and Humanities Research Council of Canada. A summary of recruitment and completion of the different steps of the project can be found in
Recruitment and completion status of the study.
Study site | Participants recruited (N) | Participants, n (%) | |||
|
|
Completed GPSa tracking, activity diary, and qualitative interview | Completed PhotoVoice | Completed SWANb | Withdrew |
Metro Vancouver | 63 | 35 (56) | 32 (51) | 24 (38) | 3 (5) |
Quebec | 41 | 39 (95) | 40 (98) | 25 (61) | 1 (2) |
Total (both sites) | 104 | 74 (71.2) | 72 (69.2) | 49 (47.1) | 4 (3.8) |
aGPS: global positioning system.
bSWAN: Stakeholders’ Walkability/Wheelability Audit in Neighbourhood.
The purpose of this protocol is to describe the methodology for a study that includes three main objectives: (1) to understand the places people go and the things they do, (2) to identify perceived barriers and facilitators as well as the users’ desired environmental modifications, and (3) to understand subjective and objective issues related to environmental accessibility. Thus, this study should allow us to discover information regarding the following elements:
Describe how environmental factors influence the mobility and participation of people with disabilities using a variety of MATs.
Identify environmental and personal factors that influence mobility and participation among adults with mobility impairments.
Identify the changes these people would like implemented to improve their mobility and participation.
The use of a variety of methods to gather data on participation and mobility allows for a more holistic consideration of the factors influencing these outcomes. The GPS tracking, activity diaries, and qualitative interviews provide objective information on the whereabouts of the participants as well as their subjective reports about the activities they are participating in and the means of mobility and transportation they are using.
Second, the identification of barriers and facilitators to mobility and participation through PhotoVoice focuses on the participants’ preoccupations. An objective evaluation of the encountered obstacles judged as priorities of improvement when accessing public environments are performed from the results obtained though the PhotoVoice focus groups in Quebec City and the community forums in Vancouver via the MEA [
Finally, the photo exposition and the community forum will allow participants to be heard by referring to the collected data and the sharing of their daily reality with stakeholders, the general public, and other researchers to heighten awareness on the barriers and facilitators they commonly encounter. The participants will also be encouraged to contribute to the discussions to find solutions to the most common problems.
Foreseeable limitations of this study include challenges in recruiting users with different MAT devices. During the recruitment process, two MAT devices had to be integrated into the same group since too few participants using these MAT devices participated (ie, canes and crutches). More participants had to be recruited in Vancouver to attain the same number of overall participants as in Quebec City. This is due to the fact that fewer participants in Vancouver participated in more than one method (11/63, 17%, participants completed all three methods of data collection in Vancouver versus 25/41, 61%, in Quebec City). Also, the sample of convenience may influence generalizability of the findings. The cross-sectional nature of the data only allows the consideration of one moment in time, whereas mobility likely fluctuates due to a variety of factors.
Activity monitoring questions.
Interview guide for all participants.
PhotoVoice interview guide.
Peer-reviewer report from SSHRC.
global positioning system
Hospital Anxiety and Depression Scale
Life-Space Assessment
mobility assistive technology
Measure of Environmental Accessibility
Stakeholders’ Walkability/Wheelability Audit in Neighbourhood
None declared.