Effects of Burden of Environmental
Inaccessibility and Perceived
Stigma on Social Participation and
Acceptance of Disability among
Adults with Physical Disability
Gloria Y. K. MA
Diversity and Well-being Lab
Department of Psychology
1
The Chinese University of Hong Kong
Aim of study
• To examine the mechanism of how environmental factors
would affect social participation and psychological adjustment in
people with physical disability (PWPD) in Hong Kong.
Environmental
Barriers
• Burden of
environmental
inaccessibility
• Perceived stigma
Social Participation
• Community
exposure
(objective)
• Social
enfranchisement
(subjective)
Psychological
Adjustment
• Acceptance of
disability
an important indicator of
adjustment to disability
Social Participation
“Involvement in Life Situations” in ICF by WHO
9 Domains of
Participation
•
•
•
•
•
•
•
1) learning and applying knowledge,
2) general tasks and demands,
3) communication,
4) mobility,
5) self-care,
6) domestic life,
7) interpersonal interactions and
relationships,
• 8) major life areas, e.g. education
and employment,
• 9) community, social and civic life.
Qualifiers
• Performance
• Capacity
** the focus is frequency
of “doing” and level of
functioning (Cummins & Lau,
2003).
3
Social
Participation
• “Doing in life situation” is merely “community exposure”
but not “full participation” (Cummins & Lau, 2003)
• It is the subjective feeling of sense of belonging to the
community that really contributes to one’s participation
and psychological wellbeing.
• Qualitative findings suggested that the core of social
participation was the subjective appraisal of their social
participation, the sense of being valued, and having
autonomy and control in societal activities (Brown, 2010;
Dijkers, 1998; Lysack et al., 2007).
4
1. Visibility of the non-typical body
movements, deformities, and/or use
of assistive devices may elicit
stereotypical signs of weakness and
dependence;
2. Unfriendly gaze by the public on the
street (Brown, 2010);
3. Public kindness, which is perceived by
PWPD as an patronizing and
embarrassing act (Cahill & Eggleston, 1988).
•
Perceived
stigma as a
major
attitudinal
barrier
Being devalued, unwelcomed by the society, and discriminated
against in employment and recreational activities (Brown, 2010; Gray,
Gould, & Bickenbach, 2003; Rimmer et al., 2004).
• Negatively associated with acceptance of disability (Li and Moore, 1998)
5
• Physical environment sets the
stage for social participation to
occur, affecting the success and
enjoyment of processes like
wayfinding and navigation.
Environmental
inaccessibility
as physical
barrier
• Environmental accessibility
= Broadly defined as whether the natural or built environment and
transportation system is physically accessible.
• Influence both the objective community exposure and the
subjective appraisal of social participation among PWD.
(Meyers, Anderson, Miller, Shipp, & Hoenig, 2002; Nilay Evcil, 2009; Putnam et al., 2003; Rimmer et
al., 2004; Schoell, 2009; Stark, Hollingsworth, Morgan, & Gray, 2007; Steinfeld and Danford, 1999)
6
• Difficult to do actual audit or recall
the number of barriers as required
by many instruments; although
they have their own advantages
• How they perceive the physical
accessibility and thus anticipated
burden may play important role
Burden of
inaccessibility
associated
with stigma
• Burden of environmental inaccessibility
 may not be localized in particular geographical location,
 nor whether he/she has carried out that activity before.
• Architectural buildings would create social experiences that
express or reinforce certain social values and perceptions towards
particular groups of people
(Cahill & Eggleston, 1988; Conell & Sanford, 1999; Iwarsson & Stahl, 2003; Joines, 2009; Robinson &
Thompson, 1999; Steinfeld & Danford 1999).
7
The Present Study
Sample
• 143 Chinese adults with physical disability from
10 NGOs serving people with disabilities in Hong
Kong in 2014.
• 56.0% male; mean age = 37.4 years, SD = 15.2,
range = 17-78 years
• 48.1% congenital; 51.9% acquired disability
• 71.5% participants were single
• 26.2% attained secondary 4-5 education
9
Instruments
Self-report questionnaire with scales having reliability of .7 or
above in Cronbach’s alpha.
Constructs
Measures
1. Burden of Environmental -- Access Subscale of Physical Disability Stress
Inaccessibility
Scale (Furlong & Connor, 2007)
-- 7 items from the Disabled Related Stress
Scale (Rhode et al., 2012)
-- 4 self-constructed items on transport
2. Perceived Stigma
7 items on perceptions of stigma (Brown, 2010)
3. Community Exposure
18 items adapted from the Participation
Objective, Participation Subjective (Brown et al.,
2004)
4. Social Enfranchisement
Participation Enfranchisement Scale (Heinemann
et al., 2011)
5. Acceptance of Disability
Acceptance of Disability Scale – Revised
(Grommes & Linkowski, 2004; Linkowski, 1971)
10
Statistical Analysis
• Structural equation modeling (SEM) was conducted to
examine the overall fit of the proposed model to the
observed variance/covariance matrices of the data using
the maximum likelihood method in EQS 6.1 for Windows.
• Goodness-of-fit was indicated by indices including CFI
and NNFI greater than .95, SRMR of .08 or below, and
RMSEA of .06 or below (Hu & Bentler, 1999)
11
Results
12
Results
• SEM showed satisfactory model fit of the proposed structural
model to the data: χ2 = 49.24, (df= 38, p = .10), χ2/df = 1.30,
GFI = .92, CFI = .98, NNFI = .98, SRMR = .04, RMSEA = .06.
-.29*
.51*
-.46*
-.27*
.59*
non-significant direct path
Figure 2. Standardized path loadings. *p < .05.
13
Results
• The model explained 65% of variance in acceptance of
disability.
• Significant direct association between environmental
inaccessibility and perceived stigma.
• Significant indirect effect of environmental inaccessibility on
acceptance of disability via perceived stigma and social
participation (B = -.21, β = -.49, p < .05).
• Independent samples t-test showed that participants having
congenital physical disability
-- had significantly better social enfranchisement than having
acquired physical disability; t (93) = 2.60, p < .05; and
-- had significantly higher acceptance of disability than
participants with acquired physical disability, t (92) = 2.56, p
< .05.
Discussion
15
Promoting
universal
design
The significant and direct
association between the burden
of environmental inaccessibility
and perceived stigma.
• New perspective of stigma
reduction through promoting
universal design
16
Perspective of
counselling
service
The significant and indirect effects
of burden of environmental
inaccessibility on acceptance of
disability through perceived stigma
and social participation
• Social experiences would influence
the perceptions of self and one’s
own disability (Li & Moore, 1998).
• Consistent with the notion of social
model of disability.
• Counselling services should adopt
macro perspectives to enhance
disability adjustment.
17
Personalized
counselling
services
• Acquired physical disability (e.g.
stroke) is generally a sudden and
drastic challenge to one’s life,
imposing intense stress and burden
to the person. They may face great
changes in daily life; and it may take
considerable duration of time to
gradually adapt to the social life.
• Counsellors should take into account
of both their clients’ nature of
disability and their social
experiences when designing
personalized counselling services.
18
• Cross-sectional sample and small
sample size;
• Findings may not be generalized
to people with all types of
physical disability (and other
disabilities);
Limitations
• No comparison on the effects of
actual physical barriers and the
burden of environmental
barriers.
19
• association of environmental
accessibility and stigmatization
• community exposure VS social
enfranchisement
Future
research
directions
• different dimensions of acceptance of disability
• effectiveness of different counselling therapeutic interventions
20
Acknowledgments
• The present study was funded by the I.CARE Programme
Research and Studies 2013-14, the Chinese University of
Hong Kong (reference no.: R01-13).
• We would like to express our heartfelt thanks to the
participating organizations and all participants.
• Research helpers and members of the Diversity & Wellbeing Laboratory in data collection, data analysis, and
peer support.
21
e-mail: gykma@psy.cuhk.edu.hk
Let’s build a truly barrier-free
society together!
22
References
Brown, M., Dijkers, M. P., Gordon, W. A., Ashman, T., Charatz, H.,
& Cheng, Z. (2004). Participation objective, participation
subjective: a measure of participation combining outsider and
insider perspectives. Journal of Head Trauma Rehabilitation, 19(6),
459-481.
Brown, R. L. (2010). Physical disability and quality of life: The
stress process and experience of stigma in a chronically-strained
population. Unpublished thesis.
Cahill, S. E., & Eggleston, R. (1988). Reconsidering the stigma of
physical disability: Wheelchair use and public kindness. The
Journal of Interdisciplinary History, 18(4), 591-613.
Conell, B. R., & Sanford, J. A. Research implications of universal
design. In: E Steinfeld, GS Danford (eds). Enabling Environments.
Measuring the Impact of Environment on Disability and
Rehabilitation. New York: Kluwer Academic/Plenum Publishers,
1999.
Cummins, R. A., & Lau, A., (2003). Community integration or
community exposure? A review and discussion in relation to
people with an intellectual disability. Journal of Applied Research
in Intellectual Disabilities, 16, 145-157.
23
References
Dijkers, M. (1998). Community integration: Conceptual issues and
measurement approaches in rehabilitation research. Topics in
Spinal Cord Injury Rehabilitation, 4(1), 1-15.
Furlong, M., & Connor, J. (2007). The measurement of disabilityrelated stress in wheelchair users. Archives in Physical Medicine and
Rehabilitation, 88(10), 1260-1267.
Gray, D. B., Gould, M., & Bickenbach, J. E. (2003). Environmental
Barriers and Disability. Journal of Architectural and Planning
Research, 20(1), 29-37.
Gray, D. B., Gould, M., & Bickenbach, J. E. (2003). Environmental
Barriers and Disability. Journal of Architectural and Planning
Research, 20(1), 29-37.
Groomes, D. A. G., & Linkowski, D. C. (2007). Examining the
structure of the Revised Acceptance Disability Scale. Journal of
Rehabilitation, 73(3), 3-9.
Heinemann, A. W., Lai, J-S., Magasi, S., Hammel, J., Corrigan, J. D.,
Bogner, J. A., & Whiteneck, G. G. (2011). Measuring participation
enfranchisement. Archives of Physical Medicine and Rehabilitation,
92(4), 564-571.
Hu, L. T., Bentler, P. M. (1999). Cutoff criteria for fit indexes in
covariance structure analysis: Conventional criteria versus new
alternatives. Structural Equation Modeling: A Multidisciplinary
Journal, 6(1), 1-55.
24
References
Iwarsson, S., & Stahl, A. (2003). Accessibility, usability and universal
design---positioning and definition of concepts describing personenvironment relationships. Disability and Rehabilitation, 25(2), 57-66.
Joines, S. (2009). Enhancing quality of life through universal design.
NeuroRehabilitation, 25, 313-326.
Li, L., & Moore, D. (1998). Acceptance of disability and its correlates.
The Journal of Social Psychology, 138(1), 13-25.
Linkowski, D.C. (1971). A scale to measure acceptance to disability.
Rehabilitation Counseling Bulletin, 14(4), 236-244.
Lysack, C., Komanecky, M., Kabel, A., Cross, K., & Neufeld, S. (2007)
Environmental factors and their role in community integration after
spinal cord injury. Canadian Journal of Occupational Therapy, 74, 243254.
Meyers, A. R., Anderson, J. J., Miller, D. R., Shipp, K., & Hoenig, H.
(2002). Barriers, facilitators, and access for wheelchair users:
Substantive and methodologic lessons from a pilot study of
environmental effects. Social Science & Medicine, 55, 1435-1446.
Nilay Evcil, A. (2009). Wheelchair accessibility to public buildings in
Istanbul.
Disability and Rehabilitation: Assistive Technology, 4(2), 76-85.
Putnam, M., Geenen, S., & Powers, L. (2003). Health and wellness:
People with disabilities discuss barriers and facilitators to well being.
Journal of Rehabilitation, 69, 37-45.
25
References
Rhode, P. C., Froehlich-Grobe, K., Hockemeyer, J. R., Carlson, J. A., &
Lee, J. (2012). Accessing stress in disability: Developing and piloting the
Disability Related Stress Scale. Disability and Health Journal, 5, 168-176.
Rimmer, J. H., Riley, B., Wang, E., Rauworth, A., & Jurkowski, J. (2004).
Physical activity participation among persons with disabilities.
American Journal of Preventive Medicine, 26(5), 419-425.
Robinson, J. W., & Thompson, T. (1999). Stigma and architecture. In
Steinfeld, E., & Danford, G. S. (Eds.), Enabling environments: Measuring
the impact of environment on disability and rehabilitation (pp. 251270). Dordrecht, Netherlands: Kluwer Academic Publishers.
Schneidert, M., Hurst, R., Miller, J., & Ustun, B. (2003). The role of
environment in the International Classification of Functioning,
Disability and Health (ICF). Disbility and Rehabilitation, 25(11-12), 588595.
Schoell, D. M. (2009). Moving vertically: A research method, grounded
in the social sciences, about the built environment's influence on social
integration. Unpublished Thesis. State University of New York at Buffalo.
Stark, S., Hollingsworth, H. H., Morgan, K. A., & Gray, D. B. (2007).
Development of a measure of receptivity of the physical environment.
Disability and Rehabilitation, 29(2), 123-137.
Steinfeld, E., & Danford, G. S. Theory as a basis for research on enabling
environments. In: Steinfeld, E., & Danford, G. S. (eds) Enabling
Environments. Measuring the Impact of Environment on Disability and
Rehabilitation. New York: Kluwer Academic/Plenum Publishers, 1999.
26