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.”
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.
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
person’s perception of their environment.
Design and Procedure
► Design
 Qualitative
 In home interviews
 Cognitive mapping
exercise
 Member check (focus
groups)
► Analysis
 Constant comparative
method
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
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
►
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
►
►
►
The CHEC
►
►
Major sections:
 Entering building
 Using the building
 Using restrooms
 Amenities
Features
 22 Features
 Captured the essence of the
participant’s comments
►
Items
 Individual questions that
capture the presence of the
feature
 Scored dichotomously (yes &
N/A = 1 No = 0)
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)
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
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
The RULE BOOK
►
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.
►
“can
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
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
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… “
Features & Weights
Entrance
9.62
Spaces not Crowded
3.85
Curb Cuts
8.65
Accessible places to sit
3.85
Automatic Doors
8.65
Accessible path/entrance marked
2.88
Accessible Bathroom
8.65
Accessibility Signage
2.88
Elevator/Single Level
6.73
Accessible Counters
2.88
Distance to Entrance
5.77
Lighting
1.92
Accessibility features in order
5.77
Accessible Phone
1.92
Wide Spaces
5.77
Accessible Drinking Fountains
1.92
Floor Surfaces
4.81
Area of Rescue
1.92
Lightweight Doors
4.81
Loaner Wheelchair/Scooter
0.96
Parking
4.81
Drive Through Window
0.96
EXAMPLE: CHEC Page 2
Site:
SECTION
OT Building
Section I
Yes
Notes
Score
ENTER
BUILDING
FEATURE
Accessible
parking
Are there accessible parking spaces
with adequate widths and aisles for
a person with a mobility device to
get in and out of their car?
0
Are the accessible spaces located
closest (or most central) to the
accessible entrance or accessible
route with minimal traffic to cross
in order to enter the building?
1
Does the facility have an
enforcement procedure to ensure
that accessible parking is used by
only those who need it?
1
Subtotal
2
2 of 3 Yes’s & Weight 4.81
3.2
3.2 = 2*4.81/3
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.
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
University City, MO
City Hall
CHEC Sites
Reported destinations
visited by people with ml
Overlap
Jeff Cuthbert, OTR cuthbertj@msnotes.wustl.edu
Validation
► University
Missouri
City
 Urban environment
► 63
destinations rated
 1,500 sq ft – 20,000
sq ft (10-90 minutes)
► Menomenee,
Wisconsin
 Rural environment
► 45
destinations rated
 2000 sq ft – 20,000 sq ft (3
- 27 minutes)
► CHEC score 21.2 (low)score 4.2
100.0 (excellent)
(poor)-97.2
receptivity
(excellent) receptivity
► KR20 = .92
► KR-20 = .95
► CHEC
Reliability
► Section

► Section
I
Entering the Building 0.72
Level Surface
II Using the Building
► Section III Restrooms
► Section IV Amenities
0.80
0.95
0.87
0.86
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Compliance
CHEC: Environmental Feature Scores
100
90
80
70
60
50
40
30
20
10
0
Features for All Sites
Rural v. Urban
Group Statistics
City
Section I Entering the University City, MO
Destination
Menomonie, WS
Section II Using the
University City, MO
Destination
Menomonie, WS
Section III Restrooms University City, MO
Menomonie, WS
Section IV Amenities University City, MO
Menomonie, WS
Destination
University City, MO
Menomonie, WS
58
43
50
Mean
30.4929
32.8116
29.9647
Std. Deviation
7.04734
6.18793
6.08400
Std. Error
Mean
.92536
.94365
.86041
40
33.5537
5.42382
.85758
62
45
55
45
59
45
4.5797
5.7179
8.7850
10.6410
72.8493
81.7977
4.00905
3.46479
3.54315
2.94517
15.62835
15.34053
.50915
.51650
.47776
.43904
2.03464
2.28683
N
P=.08
P<.01
P=.12
P<.01
P<.01
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)
►
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
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@wustl.edu