Environmental Problems by Location & Activity

Introduction

Participation is a very complex, multifaceted construct with many antecedents and consequences associated with different types of participation. For people with impairments, the environment can facilitate participation or can present barriers to participation. It stands to reason that different activities of daily living are associated with different barriers based on the environment where the activity occurs. We used Ecological Momentary Assessment data to examine the barriers associated with participating in 15 daily activities.

Sample

The following results were generated from 139 individuals who completed at least half of the 84 EMA prompts over a two week period. Information about the sampling procedures and demographic characteristics can be found at the EMA Sample section. It is important to note that for this sample, respondents were at home for 69% of the measurement periods.

Measures

The Ecological Momentary Data included 12 options individuals could select to indicate their location including store, church, gym, healthcare office, business office, outside, restaurant, school, friend’s house, transportation, entertainment venue and other. Respondents also used 15 options to indicate the type of activity they were engaged in at the time of the prompt. Activities included community/volunteering, eating education, employment, family care-giving, financial management healthcare appointments household chores, shopping, recreation/leisure, religious activities, self-care, socializing visiting, transportation and other activity.  We asked respondents to indicate what they were doing and which, if any environmental conditions bothered them during the same time period including no problems, accessibility, allergens, air, climate, crowds, darkness, lights, noise, attitudes, room temperature, traffic , transportation and other.  We collected all variables contemporaneously. This categorization was based on the International Classification of Function (WHO, 2001).

Procedures

Samsung Galaxy Player

Detailed description of the EMA procedures can be found at Ecological Momentary Assessment Procedures. Briefly, individuals carried a Samsung Galaxy player (similar to an IPod) that prompted them six times a day for two weeks to report on their location, activity and associated experiences.

Data were analyzed for within person effects on each variable assessed relative to its value for the activity “resting.” Effects were adjusted for time of day and day of the week to control for temporal variation in activity engagement.

Results

We present results for locations and activities in Tables 1 and 2, respectively.  Inspection indicates substantial variability in the environmental conditions that potentially impact participation. These odds ratios indicate the likelihood of experiencing each of the barriers listed in the left column during the same time periods when respondents indicated being in the location and participating in each of the activities. The results reflect the association between each variable and each activity relative to being at home for location resting and are expressed as odds ratios. Home and Resting are selected because it they each have the lowest number of environmental conditions relative to the other locations and activities.  Only statistically significant results are presented.

Environmental conditions are assessed for the full measurement period prior to the prompt and may reflect either contemporaneous conditions with the location/activity reported or conditions experienced just prior to the activity.

Table 1

Fixed Effects Odds Ratios of Encountering Environmental Barriers Relative to RestingFixed effects multiple regression coefficients of barriers for each activity relative to resting. The barrier “none” by activity, community/volunteer p value of 0.44, eating p value of 0.73, education p value of 0.57, employment no entry, family/care giving p value of 0.64, financial management p value of 0.44, healthcare appointments p value of 0.28, household chores p value of 0.70. The barrier “access” by activity, community/volunteer p value of 7.25, eating no entry, education no entry, employment no entry, family/care giving p value of 2.38, financial management p value of 2.98, healthcare appointments p value of 3.56, household chores p value of 2.78. The barrier “allergens” by activity, community/volunteer no entry, eating no entry, education p value of 2.12, employment no entry, family/care giving p value of 2.64, financial management no entry, healthcare appointments no entry, household chores p value of 1.70. The barrier “air” by activity, community/volunteer no entry, eating no entry, education no entry, employment no entry, family/care giving no entry, financial management no entry, healthcare appointments p value of 2.32, household chores no entry. The barrier “climate” by activity, community/volunteer no entry, eating no entry, education no entry, employment no entry, family/care giving no entry, financial management no entry, healthcare appointments no entry, household chores p value of 1.59. The barrier “crowds” by activity, community/volunteer p value of 9.77, eating p value of 3.00, education no entry, employment p value of 4.25, family/care giving no entry, financial management p value of 4.84, healthcare appointments p value of 5.41, household chores no entry. The barrier “darkness” by activity, community/volunteer no entry, eating no entry, education no entry, employment p value of 0.22, family/care giving no entry, financial management no entry, healthcare appointments no entry, household chores no entry. The barrier “lights” by activity, community/volunteer no entry, eating no entry, education no entry, employment no entry, family/care giving no entry, financial management no entry, healthcare appointments no entry, household chores no entry. The barrier “noise” by activity, community/volunteer no entry, eating no entry, education no entry, employment no entry, family/care giving no entry, financial management no entry, healthcare appointments no entry, household chores no entry. The barrier “attitudes” by activity, community/volunteer no entry, eating no entry, education no entry, employment p value of 3.34, family/care giving p value of 2.27, financial management 2.95, healthcare appointments no entry, household chores p value of 1.74. The barrier “room temperature” by activity, community/volunteer no entry, eating no entry, education no entry, employment no entry, family/care giving no entry, financial management no entry, healthcare appointments no entry, household chores no entry. The barrier “traffic” by activity, community/volunteer p value of 3.58, eating no entry, education no entry, employment no entry, family/care giving no entry, financial management p value of 2.49, healthcare appointments p value of 7.30, household chores no entry. The barrier “transportation” by activity, community/volunteer no entry, eating 3.22, education no entry, employment p value of 3.47, family/care giving no entry, financial management 5.79, healthcare appointments 7.80, household chores p value of 1.89. The barrier “other” by activity, community/volunteer no entry, eating no entry, education no entry, employment no entry, family/care giving no entry, financial management no entry, healthcare appointments no entry, household chores no entry.

Fixed Effects Odds Ratios of Encountering Environmental Barriers Relative to Resting ContinuedFixed effects multiple regression coefficients of experiences for each activity relative to resting. The barrier “none” by activity, shopping p value of 0.28, recreation/leisure no entry, religious activities no entry, self-care no entry, socializing/visiting p value of 0.69, transportation p value of 0.35, other no entry. The barrier “access” by activity, shopping p value of 4.65, recreation/leisure no entry, religious activities p value of 2.99, self-care p value of 2.26, socializing/visiting no entry, transportation p value of 3.43, other no entry. The barrier “allergens” by activity, shopping p value of 4.65, recreation/leisure no entry, religious activities p value of 2.99, self-care p value of 2.26, socializing/visiting no entry, transportation p value of 3.43, other no entry. The barrier “air” by activity, shopping no entry, recreation/leisure no entry, religious activities no entry, self-care no entry, socializing/visiting no entry, transportation p value of 2.26, other no entry. The barrier “climate” by activity, shopping p value of 2.31, recreation/leisure no entry, religious activities no entry, self-care no entry, socializing/visiting no entry, transportation p value of 1.93, other no entry. The barrier “crowds” by activity, shopping p value of 23.22, recreation/leisure 2.19, religious activities p value of 2.19, self-care p value of 2.71, socializing/visiting p value of 3.57, transportation p value of 5.16, p value of 5.48. The barrier “darkness” by activity, shopping p value of 0.24, recreation/leisure no entry, religious activities no entry, self-care no entry, socializing/visiting p value of 0.28, transportation no entry, other no entry. The barrier “lights” by activity, shopping no entry, recreation/leisure no entry, religious activities p value of 0.13, self-care no entry, socializing/visiting no entry, transportation no entry, other p value of 2.11. The barrier “noise” by activity, shopping p value of 2.47, recreation/leisure no entry, religious activities no entry, self-care no entry, socializing/visiting no entry, transportation no entry, other no entry. The barrier “attitudes” by activity, shopping p value of 2.88, recreation/leisure p value of 1.69, religious activities no entry, self-care no entry, socializing/visiting no entry, transportation no entry, other no entry. The barrier “roomtemp” by activity, shopping no entry, recreation/leisure no entry, religious activities no entry, self-care no entry, socializing/visiting no entry, transportation p value of 0.42, other no entry. The barrier “traffic” by activity, shopping p value of 6.61, recreation/leisure no entry, religious activities p value of 2.80, self-care no entry, socializing/visiting p value of 1.91, transportation value of 7.03, other no entry. The barrier “transportation” by activity, shopping no entry, recreation/leisure no entry, religious activities no entry, self-care p value of 3.05, socializing/visiting p value of 3.20, transportation p value of 11.88, other no entry. The barrier “other” by activity, shopping no entry, recreation/leisure 0.38, religious activities no entry, self-care no entry, socializing/visiting no entry, transportation no entry, other no entry.

Discussion

As expected, the likelihood of encountering barriers varies by the type of activity people reported and by their location. Results presented here are exploratory. The size and even significance of the coefficients is fragile given the sample size. Nonetheless, they are useful for generating hypotheses for future research.