Universal Design & Health Promotion (UDHP) Webinar

1. Universal Design & Health Promotion (UDHP) Webinar September 9, 2009 Funded by CDC, NCBDDD, Disability and Health Branch, 5U59DD522742 1

2. Panelists & Funding James H. Rimmer, PhD Jennifer Gray-Stanley, PhD Jennifer Zimmerman, MA, PhD Candidate University of Illinois at Chicago, Department of Disability & Human Development, Center for Health Promotion “Examination of Instruments Used to Measure the Built Environment and Physical Activity” grant: Funded by the Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Disability and Health, Grant # 5U59DD522742

3. Background Dozens of instruments developed or under development but lack of integration/cohesion from previous studies/research. Growing need for a synthesized and integrated assessment tool that measures the accessibility of the built environment inclusive of people with disabilities. CDC Disability and Health professionals need more detail on specific instruments being used to design/redesign communities for general population.

4. Background • Limitations in the biological, psychological, and behavioral explanations of physical inactivity have led to examination of the built environment ... • Presence of accessible walking and bicycling paths • Community recreation • Transportation systems • Urban design characteristics

5. Background • Healthy communities provide supportive physical and social environments: • Sidewalks and parks • Aesthetically pleasing • Adequate street lighting and seating • Safety incl. protection from motor vehicles • Goal for all of us is Universal Design

6. Livable Communities (1) • Opportunities for people of all abilities to be active & engaged in their communities • Accessible communities should be … • Walkable • Bikeable • Have accessible streetscapes (sidewalks, crosswalks) • Have accessible recreational opportunities (e.g., parks, pools)

7. Livable Communities (2) • Inclusive population focus • People with physical and sensory disabilities (PWDs) • Mobility impairments • Visual, auditory impairments • People with ID, cognitive impairment • e.g., CP, Down Syndrome • Other users • Users pushing baby strollers, delivery carts, grocery carts, wheeled bags, cyclists with baby carrier

8. UDHP Project Focus (1) • US communities using a variety of instruments to assess walkability, bikeability, and other built environment sub-domains. • Domain overlap across instruments • Limited attention to instruments’ disability focus & UD potentiality • Growing # of instruments • Need to be catalogued for future synthesis & instrument development • Users: consumers, professionals, & advocates in • public health, transportation, urban design & planning, & disability studies

9. UDHP Project Focus (2) • Information on subject domain overlap across reviewed instruments • Reviews of included instruments, including instrument purpose, sub-domain areas, psychometrics, & contact information.

10. Webinar Focus • Review instrument-specific information. • Identify subject domain overlap across instruments. • Community use of instruments • Development of new instruments • Identify relevance of instruments to PWD. • Discuss UD potentiality of instruments & sub-domains. • Show project website with technical assistance available.

11. Project Methodology (1) • Built environment: • Community’s urban design, transportation, and recreational options within a geographical space, which may impact individuals’ physical activity levels. • e.g., land use, street and sidewalk/path networks, aesthetics. • Additional dimensions: recreational areas and policy and planning

12. Project Methodology (2) • Search strategy: • Literature searches • Medline, Ovid Social Sciences databases, Web of Science Citation database, Health and Psychosocial Instruments, Google Scholar • Review articles • Professional contacts • Key words included: • measurement, instrument, assessment, tool, environment, environmental determinant, physical environment, built environment, physical activity, exercise, health promotion, walkability, bikeability

13. Project Methodology (3) • Inclusion/exclusion criteria: • Included: • Environmental audits & perceived environmental measures of walkability and bikeability, recreational structures, and general built environment features impacting physical activity, such as roads, intersections, crosswalks, etc. • GIS environmental assessments of urban design qualities impacting physical activity, including population density, land use mix, etc. • Instruments specific to transportation and accessibility for people with disabilities. • Instruments with a track record of use in communities.

14. Project Methodology (4) • Inclusion/exclusion criteria: • Excluded: • Instruments focusing exclusively on behavioral or physiological measurements related to physical activity in a geographical space (e.g., time spent exercising, or heart rate during exercise). • Instruments with insufficient psychometrics, validation information, & instrument development literature, which had no track record of use in communities. • Complete instrument not available through search strategy.

15. Key Information Resources on UDHP Website • Instrument Abstractions • Instrument Checklist • Domain Summary Tables • Disability-Specific & Universal Design Tables

16. Instrument Abstractions (1)

17. Instrument Abstractions (2) • Brief summary of each instrument • Name, author, & affiliated organizations • Instrument purpose • Instrument type • Observational (audit) • Subjective/perceived • GIS-based • Geographical scale • Instrument specific • Community, school, workplace

18. Instrument Abstractions (3) • Instrument development methods • Peer-reviewed literature • Sample • Validity & reliability • Key instrument sub-domains • Considers disability issues • Number items & length of instrument • URL & contact information • Definition & notes • *Active Living Research has reviews on some of these instruments (17).

19. Instrument Checklist (1)

20. Instrument Checklist (2) • Overview of all reviewed instruments (100) • Instrument name, authors, development year • Primary author field • Health, planning, transportation • Instrument type • Observational (audit), subjective, GIS • Validity & reliability information • Considers disability issues

21. Domain Summary Tables (1)

22. Domain Summary Tables (2) • Indicates what instruments cover what domain & sub-domain areas. • Potential use: • Pinpoint existing instrument(s) which cover your community assessment needs. • Review existing instrument(s) for new instrument development.

23. Domain Areas • Built Environment Infrastructure • Walkability • Bikeability • Recreation Sites & Structures

24. Built Environment Infrastructure • Roads • Type, alignment, configuration, materials, slope & terrain, width & condition • Curb cuts/ramps • Intersection/crosswalk • Intersection type, crosswalk features, signals/signs, timing • Traffic control • Transportation & parking • Policy & planning

25. Walkability • Sidewalk/path • Presence, accessibility, materials, condition & maintenance, obstructions & slip/trip hazards, width, length, slope • Walking safety • Traffic, crime • Pedestrian volume & speed • Aesthetics & amenities • Policy & planning

26. Bikeability • Bicycle lane/path • Presence, materials, condition & maintenance, obstructions, width, length, slope, continuity • Bicycling safety • Safety routes & enforcement, driver behavior • Policy & planning, education • Policy, promotion, training & education

27. Recreation Sites & Structures • Recreation facility & fitness center • Pools • Parks • Other • Policies & planning • Amenities & resources

28. Domain Overlap • Built environment infrastructure • Crosswalk signs & signals, features • Traffic volume & density • Parking availability • Walkability • Sidewalk/path presence, dimensions, condition & maintenance • Walking safety due to crime, traffic • Aesthetics & amenities • Bikeability • Bicycle lane/path presence • Resources • Education/training • Recreation Sites & Structures • Amenities & resources • Availability facilities

29. Built Environment Domain Overlap

30. Walkability Domain Overlap

31. Bikeability Domain Overlap

32. Recreation Sites & StructuresDomain Overlap

33. Instruments Which Consider Disability Issues • 29 instruments • At least 1 question/item per instrument • Relevant item content • Wheelchair accessibility • Accessible signage • Accessible crosswalk, pedestrian facilities • Attitudes towards PWDs • Accessible parking facilities

34. Table: Disability-SpecificInstruments

35. 7 Universal Design Principles (1) • Equitable use • Useful for individuals of diverse abilities • Flexibility in use • Accommodates individual preferences & abilities • Simple & intuitive use • Easy to understand & use

36. 7 Universal Design Principles (2) • Perceptible information • Communicates necessary information despite sensory abilities • Tolerance for error • Minimizes hazards or accidental, unintended actions • e.g., computer “undo function” • Low physical effort • Used efficiently, comfortably, with a minimum of fatigue • Size & space for approach & use • Appropriate size & space for reach, manipulation, & use, regardless of physical ability

37. Table: Universal Design Applicability

38. Universal Design Recommendations (1) • Accessibility for multiple users • Wheelchair, mobility aid users • Users with visual impairments, blindness, cognitive impairments • Older adults w/ mobility impairments and/or impaired judgment • Service delivery cart users • Baby stroller users • Bicyclists • Children

39. Universal Design Recommendations (2) • Sidewalk/bicycle lane/path • Materials • Smooth, stable, even, & hard surfaces • Condition & maintenance/trip-slipping hazards • Catch hazard for dragging foot, walking aid • Cracks, holes, bumps periodically repaired • Width • 10-foot width for shared paths, added width for turns • Slope • Flat & gentle, limited to a 5% grade

40. Universal Design Recommendations (3) • Curb cut/ramp dimensions • New curb ramp slope not > 8.33% grade & cross-slope not > 2% grade • Crosswalk signage & signals • Visual, tactile, audible cues • Pictures, universal symbols, & colors

41. Universal Design Recommendations (4) • Crosswalk features • Raised crosswalks, detectable boundaries between sidewalk & street • Visual, tactile, & audible cues • Tactile ground surface indicators: luminance contrast • Crossing refuge island: 60-inch maneuverable space • Crossing timing: > 4-feet per second, pedestrian controls increase crossing time, divided crossing distance

42. Universal Design Recommendations (5) • Transportation • Public transit vehicles and stations with wheelchair lifts and elevators, paratransit availability as needed • Parking • On-street parking: accommodate 8-foot vehicle & 5-foot access aisle, allow for sidewalk access (ramp), some van accessible spots

43. Universal Design Recommendations (6) • Recreation facilities & structures • Accessible entrance/exits, e.g., fishing piers, fitness centers, boat docks, etc. • Amenities • Bench height & width with arms & backs, telephones w/ TTY access, accessible water fountains & toilets (ADAAG)

44. Future Directions • Expansion of HEZAT • AIMFREE - R3 • Data collection on barriers and solutions • CAT-based ideas

45. Building Health Empowerment Zones for People with Disabilities James Rimmer, PhD, PI Yochai Eisenberg, MUPP Carol Braunschwieg, PhD Robin Jones, COTA Edward Wang, PhD Vijay Vasudevan, MPH NIH Grant #R01HDO52891

46. Phase 1: Instrument Development Outdoor Environment Assessment Tool • Developed through Delphi process • Combination of 5 instruments • SPACES, CHEC, CHIEF, ADAAG, FTA Transportation Assessment • 9 expert raters in disability and environment fields

47. Items on HEZEAT • Slope of sidewalk • Presence of curb cuts • Level changes • Broken sidewalk • Sidewalk too narrow • Obstacles • Time to cross street

49. Large Curb Cut Slope

50. Fitness Centers