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.”
Environment.”
Problem Statement
► Problem
► Purpose
ƒ By identifying barriers and supports in the
community environment, domains influencing
social participation will be identified.
Research Question/Approach
► Research
Question
ƒ What are the characteristics or features of an
environment that make it more or less receptive
to people with mobility impairments?
► Approach
ƒ We surrender our claim of objective expertise
and respect the subjects expertise in their own
situations (Gilgun
(Gilgun 1998)
ƒ Cognitive mapping was used to identify a
person’s perception of their environment.
Participants
► Inclusion
Criteria
ƒ Presence of a mobility
limitation
ƒ Resided in St. Louis
metropolitan area
ƒ Left home 22-3x/ week
► Demographics
ƒ 25 people with mobility
limitations
ƒ Mean age= 46.9 yrs.
ƒ 14 female/ 11 male
ƒ 13 Caucasian/ 10 African
American
ƒ stroke, SCI, CP, & post
polio
Statement
ƒ Community environments are not designed to
meet the needs of people with disabilities.
ƒ Participation is impacted by how people are able
to use their environments.
Design and Procedure
► Design
ƒ Qualitative
ƒ In home interviews
ƒ Cognitive mapping
exercise
ƒ Member check (focus
groups)
► Analysis
ƒ Constant comparative
method
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
1
The CHEC
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
Flexibility of the CHEC
► Receptivity
can be characterized at the
Community Level
ƒ Total CHEC Scores on a sample of destinations
ƒ Receptivity of “ accessible restrooms” of entire
community (features by destination)
► Receptivity
can be characterized at the
Destination Level
►
Major sections:
ƒ Entering building
ƒ Using the building
ƒ Using restrooms
ƒ Amenities
Features
ƒ 22 Features
ƒ Captured the essence of the
participant’s comments
►
Items
ƒ Individual questions that
capture the presence of the
feature
ƒ Scored dichotomously (yes &
N/A = 1 No = 0)
Review by consultants
► Consultants
suggestions:
ƒ Scaling (to weight items)
ƒ Make the form “user friendly” and not
technical
ƒ Make a “rule book” instead of a
complicated scoring sheet
ƒ Total CHEC score of the destination or Area of a
building (this building)
ƒ Receptivity of features (seating)
Rule Book and Glossary
► Available
to provide assistance in
determining score
► Resources on which rules are based:
ƒ Based on the important descriptions of the
experts (people with mobility limitations)
ƒ Consultants (experts in architecture, universal
design, occupational therapy)
ƒ Literature and standards
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.
2
In the field
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
► Evaluations
are
completed during
“busy time”
► Time
ƒ 5 minutes small
building
ƒ 90 minutes large
building
► -1
2raters
paper/pencil,
PDA, or Tablet PC
► Using
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
►
Features & Weights
Ranking Study
ƒ 17 of the original subjects
(78 different rankings by
destination category)
ƒ Ranked each feature
based on directions
“imagine the most
accessible place for you…
“
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
Section I
FEATURE
Accessible
parking
► Scores
OT Building
Yes
Notes
Score
ENTER
BUILDING
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
Scoring
3.2
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.
3.2 = 2*4.81/3
3
University City, MO
Sampling Strategy
►
►
►
CHEC Sites
Reported destinations
visited by people with ml
Identify the boundaries of a community
Overlap
ƒ Political
ƒ Geographic
ƒ Identified by population of individuals with disabilities
►
City Hall
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
Jeff Cuthbert, OTR cuthbertj@msnotes.wustl.edu
Validation
► University
Missouri
City
ƒ Urban environment
► 63
destinations rated
ƒ 1,500 sq ft – 20,000
sq ft (10(10-90 minutes)
► CHEC
score 4.2
(poor)- 97.2
(excellent) receptivity
- 20 = .95
► KR
► Menomenee,
Menomenee,
Reliability
Wisconsin
ƒ Rural environment
► 45
destinations rated
ƒ 2000 sq ft – 20,000 sq ft (3
- 27 minutes)
► CHEC
score 21.2 (low)100.0 (excellent)
receptivity
► KR20 = .92
CHEC: Environmental Feature Scores
100
► Section
ƒ
I
Entering the Building 0.72
Level Surface
0.80
► Section
II Using the Building
► Section III Restrooms
► Section IV Amenities
0.95
0.87
0.86
Rural v. Urban
90
80
Group Statistics
Compliance
70
60
50
City
Section I Entering University City,
Destination
Menomonie, W
40
30
20
10
Section II Using thUniversity City,
Destination
Menomonie, W
Lo
Sp
El
ac
es
a n e v no
e r a to t C
r
r
W
he /S in ow d
el
g
ch l e ed
L
ai
r/S e ve
co l
C ot
ur e r
b
C
F
L ut
L i lo o ig h s
A
cc
gh r S
t
es
tw u r i n g
si
A e ig f ac
bl
ut
ht es
e
o
Dr
D
in m a oo
tic
ki
r
D s
A ng
A
cc cc Fo o or
e
s
es
s s un
t
s
A
i
a
cc
D ibl e bl e in s
is
es
ta pla Ph
si
on
nc c
bl
e
ity
e es
fe t o E to
at
s
A
ur n tr it
cc
an
es
es
ce
si
in
bl
o
e
E rd e
pa
W nt r r
th
an
id
/e
e
A nt
Sp c e
cc a n
e
a
A s s ce m ce
c c ib
s
a
i
es lty r k
si
e
bl S ig d
e
na
B
A
g
A
cc re a a th e
ro
es
s i o f R om
bl
es
e
Co cu
un e
te
P a rs
rk
in
g
0
Features for All Sites
Section III Restro University City,
Menomonie, W
Section IV Ameni University City,
Menomonie, W
Destination
University City,
Menomonie, W
N
Std. Error
Mean Std. Deviation Mean
58 30.4929
7.04734 .92536
43 32.8116
6.18793 .94365
50 29.9647
6.08400 .86041
40 33.5537
62 4.5797
45 5.7179
55 8.7850
45 10.6410
59 72.8493
45 81.7977
5.42382
.85758
4.00905 .50915
3.46479 .51650
3.54315 .47776
2.94517 .43904
15.62835 2.03464
15.34053 2.28683
P=.08
P<.01
P=.12
P<.01
P<.01
4
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
ƒ Transportation differences
► Only
developed for persons with mobility
limitations – small sample size
► Value not in the final items but in the approach
and method
ƒ Groups interested in vision/hearing may want a version
ƒ 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
5