title: Barriers to activity and participation for stroke survivors in rural China.
abstract: OBJECTIVE
  To investigate environmental barriers reported by stroke survivors in the rural areas of China and to determine the impact of environmental barriers on activity and participation relative to demographic characteristics and body functioning.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Structured interviews in the participants' homes.
  
  
  METHODS
  Community-dwelling stroke survivors in the rural areas of China (N=639).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Activity and participation (Chinese version of the World Health Organization Disability Assessment Schedule 2.0), environmental barriers (Craig Hospital Inventory of Environmental Factors), neurological function (Canadian Neurological Scale), cognitive function (Abbreviated Mental Test), and depression (6-item Hamilton Rating Scale for Depression).
  
  
  RESULTS
  Physical/structural barriers are the major impediment to activity and participation for these participants (odds ratio, 1.86 and 1.99 for activity and participation, respectively; P<.01). Services/assistance barriers primarily impede participation rather than activity (odds ratio, 1.58 in participation; P<.05).
  
  
  CONCLUSIONS
  Physical/structural and services/assistance barriers were considered the dominant barriers to activity and participation for stroke survivors in the rural areas of China. Attitudinal/support and policy barriers did not emerge as serious concerns. To generate an enabling environment, physical/structural and services/assistance barriers are the environmental barriers to be decreased and eliminated first.
authors.affiliation: School of Nursing, Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.
authors.forename: Lifang
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. Electronic address: tbyan@hotmail.com.
authors.forename: Tiebin
authors.initials: T
authors.lastname: Yan
authors.affiliation: School of Nursing, Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.
authors.forename: Liming
authors.initials: L
authors.lastname: You
authors.affiliation: School of Nursing, Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Li
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001107:Architectural Accessibility; D002681:China; D003071:Cognition; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000534:rehabilitation*; D004777:Environment; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012424:Rural Population; D012737:Sex Factors; D012931:Social Environment; D058992:Social Participation; D012944:Social Support; D012959:Socioeconomic Factors; D000071939:Stroke Rehabilitation; D017741:Survivors
keywords: China; Environment; Rehabilitation; Social participation; Stroke