title: Environmental barriers and supports to everyday participation: a qualitative insider perspective from people with disabilities.
abstract: OBJECTIVE
  To describe environmental factors that influence participation of people with disabilities.
  
  
  METHODS
  Constant comparative, qualitative analyses of transcripts from 36 focus groups across 5 research projects.
  
  
  METHODS
  Home, community, work, and social participation settings.
  
  
  METHODS
  Community-dwelling people (N=201) with diverse disabilities (primarily spinal cord injury, traumatic brain injury, and stroke) from 8 states.
  
  
  METHODS
  None.
  
  
  METHODS
  Environmental barriers and supports to participation.
  
  
  RESULTS
  We developed a conceptual framework to describe how environmental factors influence the participation of people with disabilities, highlighting 8 domains of environmental facilitators and barriers (built, natural, assistive technology, transportation, information and technology access, social support and attitudes, systems and policies, economics) and a transactional model showing the influence of environmental factors on participation at the micro (individual), mesa (community), and macro (societal) levels. Focus group data validated some International Classification of Functioning, Disability and Health environmental categories while also bringing unique factors (eg, information and technology access, economic quality of life) to the fore. Data were used to construct items to enable people with disabilities to assess the impact of environmental factors on everyday participation from their firsthand experience.
  
  
  CONCLUSIONS
  Participants with disabilities voiced the need to evaluate the impact of the environment on their participation at the immediate, community, and societal levels. The results have implications for assessing environmental facilitators and barriers to participation within rehabilitation and community settings, evaluating outcomes of environmental interventions, and effecting system and policy changes to target environmental barriers that may result in societal participation disparities versus opportunities.
authors: Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL; Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL. Electronic address: hammel@uic.edu.
authors: Joy
authors: J
authors: Hammel
authors: Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL.
authors: Susan
authors: S
authors: Magasi
authors: Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors: Allen
authors: A
authors: Heinemann
authors: Program in Occupational Therapy, Washington University, St Louis, MO.
authors: David B
authors: DB
authors: Gray
authors: Occupational Therapy, Neurology and Social Work, Washington University, St Louis, MO.
authors: Susan
authors: S
authors: Stark
authors: Department of Physical Therapy, University of Delaware College of Health Sciences, Newark, DE.
authors: Pamela
authors: P
authors: Kisala
authors: Center for Clinical Outcomes and Assessment Research, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Ann Arbor, MI.
authors: Noelle E
authors: NE
authors: Carlozzi
authors: Department of Physical Therapy, University of Delaware College of Health Sciences, Newark, DE; Kessler Foundation Research Center, West Orange, NJ.
authors: David
authors: D
authors: Tulsky
authors: Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors: Sofia F
authors: SF
authors: Garcia
authors: Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors: Elizabeth A
authors: EA
authors: Hahn
mesh_terms: D001107:Architectural Accessibility; D006233:Persons with Disabilities / Q000523:psychology* / Q000534:rehabilitation; D004777:Environment; D006801:Humans; D064702:International Classification of Functioning, Disability and Health; D036301:Qualitative Research; D011788:Quality of Life; D012111:Residence Characteristics; D012656:Self-Help Devices; D058992:Social Participation; D012944:Social Support; D014186:Transportation; D014481:United States
keywords: Environment; Focus groups; Qualitative research; Rehabilitation; Social determinants of health; Social participation