Universal Design in Housing in Australia: Getting to Yes

In Australia, the last frontier for universal design is mainstream housing. Developers in the private residential sector have consistently, and successfully, argued for the status quo to remain. Developers' claims of cost and lack of demand have swayed governments that are in favor of "letting the market decide". Disability- and age-specific housing and one-off projects have included many features that are considered universal design. So, the technical details are not an issue. The house-building sector in Australia consists of many parts, all held together by regulations and professional codes and norms of practice. Calls for accessible housing were heard by the Australian Government in 2010 and a set of voluntary guidelines were developed jointly by industry and disability advocacy groups. These became the "Livable Housing Design Guidelines". It was understood that industry needed time to reorganize to bring about the changes needed. Consequently, it was agreed to progressively introduce accessible features over ten years so that by 2020 all new homes should be built to a basic level of accessibility. However, it was obvious in 2017 that this goal was unachievable with voluntary guidelines. Mandating these guidelines has been shunned at every turn, but the need to mandate could no longer be ignored. Through community advocacy efforts, the body that regulates the National Construction Code has been brought to the negotiating table to discuss mandating basic access features in all new homes. This paper reports on the processes and progress of these negotiations and the outcomes to date.

Universal Access in Heritage Site: A Case Study on Jantar Mantar, Jaipur, India

One of the key requirements for an inclusive and sustainable society is that everyone should be able to participate in and enjoy the social, economic and cultural assets of that society. For some people, barriers exist which make visiting and using heritage buildings and places difficult or sometimes impossible. Making the built heritage more accessible in an appropriate and sensitive manner can increase awareness and appreciation of its cultural, social and economic value. The roots of universal access are grounded in equal opportunity, nondiscrimination and designing for diversity. Architects play an important role in creating accessibility awareness in the society. Thus it is important to impart 'universal design' teaching in architecture schools that will bring awareness amongst budding architects and planners who will respond to the need of diverse population and will create awareness in the society. This paper is and outcome of the academic exercise conducted for the Masters in Architectural Conservation Design Studio at the site of Jantar Mantar with diverse users and proposing solutions for physical and intellectual access to the site. The paper aims to develop awareness, sense of responsibility among students through universal design education for a heritage site and further discuss the possible universal design interventions at World Heritage Site of Jantar Mantar, Jaipur.

Universal Mosque/Masjid Design

As a public building, a mosque (or any prayer area for Muslims in public buildings) should remove all barriers that may confront persons with disabilities and hinder them from performing their religious rituals. A mosque is regularly used at least five times a day for praying, and for weekly events such as Jumu'ah (Friday prayers). Therefore, a mosque should be accessible for all. But in fact, persons with disabilities still find difficulties in accessing mosques. For example, the calling to prayer and Friday sermon (Khutba) through loudspeakers, is a problem for persons with hearing loss. Persons with physical disabilities, especially users of wheelchairs, walkers or crutches, have difficulties in several areas in the mosque, including the entrance, place of ablution, the lavatories and the area for removing shoes at the entrance to the prayer hall. People are not allowed to enter the place of ablution or prayer hall wearing shoes, people are also not allowed to enter with their personal mobility devices. This is so that dirt from outside does not get carried into the mosque. In order to understand the accessibility requirements for persons with disabilities in a mosque, we have to know the essential parts in the construction of the mosque and the mobility pattern that usually occurs in a mosque. In this paper, an accessibility checklist which has been developed on the basis of an analysis of accessibility requirements in mosques is presented.

Towards a Universal Design Evaluation for Assessing the Performance of the Built Environment

Universal Design is a recent and innovative strategy aimed at designing spaces that are as accessible and inclusive as possible. It considers the broadest range of users, and goes beyond the prescriptive approach of accessibility legislation. Theoretical research on this strategy is currently increasing, but the reliability of its principles remains limited in design practice and it struggles to guarantee performance-based knowledge to designers. Therefore, a practical evaluation method based on reliable performance criteria is required. The purpose of the research is to investigate which means, methods, and principles of Universal Design and Design for All are currently used to evaluate the accessibility and inclusion of the built environment. The paper describes a literature review aimed to select methodologies and reflect on instruments that are inherent to the thematic. The research's outcome is therefore the definition of both open issues and gaps in this field, which is based on the comparison of the studies analysed. In addition, the potential outlooks on the issue of Universal Design and Design for All evaluation are discussed. The current results provide a basis for further research on the development of evaluation and support tools for designers that are able to improve the accessibility and inclusion of the built environment, and the reliability of Universal Design performance criteria in design practice.

Towards a Decision Support System for Improved Accessibility in Multi-Family Housing: Co-Design of an Application for Environmental Barrier Inventory

The demand for accessible housing is increasing. More people are expected to live longer and live more years with reduced functional capacity in ordinary multi-family housing. To address this, detailed knowledge of accessibility problems in the existing housing stock and systems that could contribute to efficient collaboration between housing industry and authorities concerned is needed. This paper introduces a project with the overarching aim to develop and evaluate a new decision support system (DSS) to inventory and support decision-making for improved accessibility in multi-family housing in Sweden. The specific aim is to describe the initial app development phase and to investigate the design-team interactions and their impact on the outcome. The app will constitute the core part of the new DSS. This phase involved co-design to fit the practice context at target and meet users' needs and expectations. The co-design process served to identify user requirements to guide the development. Housing Enabler (an internationally acknowledged instrument for assessment and analysis of accessibility problems) was the methodological starting point. The prototype app enables professional inventory of environmental barriers and registration of subsequent work for accessibility improvements. A fully functional prototype of an app including an example apartment database is ready for usability studies and further iterative refinements.

Planning Accessibility Strategies and Connectivity for Malaysian Urban Built Environment

Access to our buildings relies to the accessibility of its external environment and the route taken. Developments and planning in urban areas has many several requirements and restrictions. Planning accessibility for Malaysian built environment is achievable by designing in compliance to the requirements enforced by authorities. Accessible design is commonly associated with providing facilities for Persons with Disabilities (PwDs), the issue that is often brought up is the inaccessibility of the external environment and lacking of seamless connectivity between buildings and the outdoor. The intention is to formulate accessibility strategies and work out planning process on how accessibility can be achieved. Universal Design will be the basis for the design and planning concept to accommodate all users to enjoy our urban built environment. It is notable that developed countries advances more in terms of implementing and enforcing accessibility measures via legislative and regulatory documents, government strategies and initiatives within its planning approach than the developing nations. The methodology will be looking into the establishment of strategies and measures of international and local planning policy, local and action plans of City of London as selected Local Authority to be analyzed its inclusive policy has been successfully implemented in their jurisdiction. The findings, discussions and result will be an outcome of generating a framework of accessibility strategies that is derived from interviews and government documents accordingly to targeted Malaysian urban areas focusing the City of Petaling Jaya and Putrajaya and how it can be improvised. Therefore, an interpretation of adopting accessibility planning strategies of developed country, to be adapted locally according to Malaysian legislation, culture and lifestyles.

Home Coming? A Story of Reassurance, Opportunity and Hope for Universally Designed Housing in Australia

This paper shows the complexity of housing and how it is the linch-pin for achieving economic, social and human rights imperatives. In Australia there are no minimum housing standards; the effect is now critical. In October 2017, a regulatory impact assessment was instructed, to consider Livable Housing Australia's Silver and Gold standards, for inclusion in the National Construction Code. A substantial research project provided a knowledge and evidence base of the policy perspective; an expanded statistical context; and detailed analyses of Silver, Gold and Platinum design levels. The policy perspective included greater economic focus. The effect on productivity, directly attributable to housing, is significant. 34 specific policy 'problems' were identified that could be solved or mitigated if acceptable standards of housing were introduced. It is reassuring that universal design has permeated all levels of government policy. The statistical context explored demographics, households, dwelling types; tenure; occupants; disability and carers. Detailed analyses challenged many common assumptions and re-framed accessible housing into a mainstream problem. 73% of all dwellings are separate houses and the average home has 3.1 bedrooms. There are tremendous opportunities for universally design-led mainstream solutions. The compliance gap analyses show which design features might cost more; have potential to be designed out; or be cost neutral. Many design features are cost neutral and arguably should be included within mandated standards. As there is a minimal gap between universal design standards and current housing, there is hope that all Australians will, one day, live in a universally designed home.

Spatial (E)quality from a User Perspective

Universal Design (UD) has gained global significance and is in the process of being interpreted and institutionalised in the Nordic Region. Hence a broader understanding of the theoretical basis and practical architectural applicability of UD is advancing. This paper builds a framework for understanding two current notions of UD and accessibility in Denmark. Implications are that understandings and motivations of UD and accessibility from architects' and users' perspective are asymmetrical. In collaborative relationships, UD and accessibility are seen from an architectural design perspective and a human rights perspective respectively. This influences the dialogue and cooperation of the two parties. Reflecting the possibility to further a comprehensive understanding of spatial implication of UD, this paper aims to contribute with a clarification and a discussion of the two perspectives. Within the architectural field, Disabled People's Organisations Denmark (DPOD) is one of the key actors in user participatory processes related to UD and accessibility, and the organisations play an important role in a Danish discourse. Through observations and interviews with DPOD user representation and practicing architects, the paper sheds light on the central notions of UD and accessibility - a spatial quality perception and a spatial equality perception. Along with qualitative research conducted at the Danish Building Research Institute, the on-going PhD research project "Generating Inclusive Built Environments through User Driven Dialogue in the Architectural Design Process" frames current thinking and discusses the process of advancing the dialogue, in direction of furthering both Spatial Quality and Spatial Equality.

The Relationship Between Housing Accessibility and Healthy Aging: The Case of Turkish Elderly Women

This study proposed Importance-Performance Analysis (IPA) as a tool to elicitate the requirements of elderly to age well and improve the accessibility of home environments. It aims to address the accessibility issues in a case housing environment and provide guidance and design recommendations to designers and architects, who generally have difficulty to obtain information on universally designed housing environments. First, healthy aging concept is introduced. Then, the role of housing accessibility in healthy aging is explored. Later, the methodology is presented. In the findings the importance and satisfaction ratings of 100 Turkish elderly women, which are selected from an exemplary housing environment of the most dense and busiest urban area in Ankara, are analysed. According to results, IPA could be an effective tool to decide how to meet accessibility requirements and maximize home satisfaction. Thus, this study contributes to the design literature by being a first study to explore the applicability of IPA technique in design discipline while eliciting elderly women expectations and accessibility requirements for healthy aging.

Good Intentions in Universal Design: A Global Challenge for Higher Education

It is not often that a high-level edict requires higher education centres to promote universal design through their programmes; however the recent United Nations Beijing Declaration and Action Plan (UNESCAP 2017) expressly states that, "academic institutions should provide training programmes on universal design for policymakers, building inspectors and contractors, as well as integrating universal design and accessibility into curricula related to architecture, urban planning, transport, civil engineering and other relevant academic branches". This is particularly timely in the Asia-Pacific region, where economies continue to show massive expansion of their built environments. This imperative to future-proof any development therefore is vital, especially considering the growing percentile of older people with their needs for safe and accessible living. Achieving these ends clearly implies a need both to educate professionals and to enact appropriate codes and standards, which in turn require the training of personnel to carry them out. Anticipating this need, Goal 3 of the United Nations Incheon Strategy (UNESCAP 2012) optimistically calls for "civil society involvement in conducting accessibility audits, creating guidelines and advocacy work to promote universal design" and "to enhance mechanisms for tracking its progress". While such good intentions are admirable, they will require radical steps to be achieved. The paper describes examples, including those from the writers' own experiences, outlining a range of practical methods which academics and teachers involved in inculcating universal design principles in both European and Asian centres, through their teaching, training and technology transfer, can positively support continued cooperation towards a more inclusive World for everyone.

Universal Design Building Standard for INDIA: A Critical Inquiry

Universal Design is now a global term, used to design a product or an environment which will be usable by large number of people without having a specialized design. However, accessible design is a design process in which the needs of people with disabilities are specifically considered. Building standards on accessibility contains scoping and technical requirements for accessibility to sites, facilities, building and elements by individual with disability. INDIA is also following its prescriptive types of various building standards for the creation of physical environment for people with disabilities. These building standards are based on western models instead of research based standards to serve Indian needs. These standards lack contextual connect when reflects in its application in the urban and rural environment. This study focuses on critical and comparative study of various international building standards and codes, with existing Indian accessibility standards to understand problems and prospects of concept of Universal Design building standards for INDIA. The result of this study is an analysis of existing state of Indian building standard pertaining to accessibility and future need of performance based Universal Design concept.

A Universal Design Perspective on Care Homes for Elderly People with and Without Dementia

Within the coming years considerable resources will be spent on designing assisted living facilities for elderly people with dementia. Traditionally care homes are designed for elderly with physical impairment. However, people with dementia have others and supplementary needs. An important challenge is therefore to identify differences and similarities in what makes supportive, pleasant environments for both groups. As the group of people with Alzheimer's disease is numerous, this paper focuses on characteristics related to Alzheimer's - typically difficulties related to orientation, coping with larger groups of residential units and a lack of ability to handle welfare technology. In these respects, care homes for people with dementia differ from other settings. However, people with dementia are known to be positively sensitive to a wide range of architectural qualities such as sensory experiences, atmosphere and access to green outdoor areas. The paper argues that since these qualities have importance for a wider group of elderly, the design of care homes in this respect can be considered as an example of universal design in general. Pointing out some similarities and differences in demands for elderly with and without dementia the paper raises the question in how far it might be possible to apply some architectural qualities to care homes in general. If possible, it may lift the quality of the physical environment and at the same time make fewer alterations necessary when care homes are changed to house other inhabitants. The analysis is based on existing literature combined with own studies.

Using MOOCs to Promote Digital Accessibility and Universal Design, the MOOCAP Experience

The recently completed Massive Open Online Course for Accessibility Partnership project (MOOCAP), had the twin aims of establishing a strategic partnership around the promotion of Universal Design and Accessibility for ICT professionals and of developing a suite of Open Educational resources (OERs) in this domain. MOOCAP's eight university partners from Germany, Norway, Greece, Ireland, the UK and Austria have a significant history in developing and providing courses in the domains of Universal Design and Accessibility, as well as leading research and advocacy roles within Europe. The MOOCAP project consisted of two phases: the development of an introductory MOOC on Digital Accessibility and the delivery of set of online courses with more in-depth and focused learning topics. During the lifetime of the project over 10,000 students signed up for these courses. This paper reflects on the challenges of creating and delivering MOOCs, especially in topics around Digital Accessibility and Universal Design. It considers the outcomes, impacts and legacies of the project. Based on our experiences of integrating these materials into our courses and on feedback and project evaluations, this paper will assess the potential of MOOCs to promote Universal Design for ICT and other professionals, while pointing up the possible trials and opportunities of such activities.

Universal Design in Architectural Education - Community Liaison on 'Live Projects'

The infusion of Universal Design principles into existing courses in architecture should become evident in any project work undertaken. 'Live project' is a term used to describe projects that engage the academic world with real-world groups/organizations. CCAE sees such projects as valuable exercises in a student's education, particularly, the practical experience of interaction with 'user-experts.' In 2016 Cork County Council approached CCAE with a proposal to promote age-friendly housing as part of their age-friendly initiative. CCAE developed this into a 'live project' for Year 2 architecture students, continuing the integration of UD into the curriculum. This helps students to identify the negative disabling aspects of ageing and show UD principles can be seen as commonplace. For their part, the County Council were able to expand their own thinking, availing of the less constrained ideas that students brought to their schemes. An approach to achieving the adoption of UD is to consider the Vitruvian definition of architecture as having 'commodity, firmness and delight'. From this, the aesthetic integration of features to benefit users of limited ability can be achieved without stigmatising anyone as being old or disabled. Now in its second year the project is being run in West Cork. The chosen site in Bantry town centre, has interesting challenges for the students to incorporate UD principles. This paper will present imaginative but viable projects as examples of student' responses to the challenges of designing housing solutions and will report on their ability to integrate age-friendly features at different scales.

Measuring Health-related Transportation Barriers in Urban Settings

Access to reliable transportation is important for people with chronic diseases considering the need for frequent medical visits and for medications from the pharmacy. Understanding of the extent to which transportation barriers, including lack of transportation, contribute to poor health outcomes has been hindered by a lack of consistency in measuring or operationally defining "transportation barriers." The current study uses the Rasch measurement model to examine the psychometric properties of a new measure designed to capture types of transportation and associated barriers within an urban context. Two hundred forty-four adults with type 2 diabetes were recruited from within an academic medical center in Chicago and completed the newly developed transportation questions as part of a larger National Institutes of Health funded study (ClinicalTrials.gov identifier: NCT01498159). Results suggested a two subscale structure that reflected 1) general transportation barriers and 2) public transportation barriers.

Perspectives of basic wheelchair users on improving their access to wheelchair services in Kenya and Philippines: a qualitative study

BACKGROUND

The United Nations has called for countries to improve access to mobility devices when needed. The World Health Organization has published guidelines on the provision of manual wheelchairs in less-resourced settings. Yet little is known about the extent to which appropriate wheelchairs are available and provided according to international guidelines. This study's purpose was to describe wheelchair users' experiences receiving services and acquiring wheelchair skills in urban and peri-urban areas of Kenya and the Philippines.

METHODS

Local researchers in Nairobi and Manila interviewed 48 adult basic wheelchair users, with even distribution of those who had and had not received wheelchair services along with their wheelchair. Recordings were transcribed in the local language and translated into English. The study team coded transcripts for predetermined and emergent themes, using Atlas-ti software. A qualitative content analysis approach was taken with the WHO service delivery process as an organizing framework.

RESULTS

Wheelchair users frequently described past experiences with ill-fitting wheelchairs and little formal training to use wheelchairs effectively. Through exposure to multiple wheelchairs and self-advocacy, they learned to select wheelchairs suitable for their needs. Maintenance and repair services were often in short supply. Participants attributed shorter duration of wheelchair use to lack of repair. Peer support networks emerged as an important source of knowledge, resources and emotional support. Most participants acknowledged that they received wheelchairs that would have been difficult or impossible for them to pay for, and despite challenges, they were grateful to have some means of mobility. Four themes emerged as critical for understanding the implementation of wheelchair services: barriers in the physical environment, the need for having multiple chairs to improve access, perceived social stigma, and the importance of peer support.

CONCLUSIONS

Interventions are needed to provide wheelchairs services efficiently, at scale, in an environment facilitating physical access and peer support, and reduced social stigma.

TRIAL REGISTRATION

Not applicable since this was a descriptive study.

Differences in Waiting List Prioritization Preferences of Occupational Therapists, Elderly People, and Persons With Disabilities: A Discrete Choice Experiment

OBJECTIVE

To compare the preferences of occupational therapists, elderly people, and adults with disabilities regarding prioritization criteria for occupational therapy waiting lists in home care.

DESIGN

Discrete choice experiment survey.

SETTING

Survey mailed to occupational therapists working in home care and community-dwelling elderly or disabled persons.

PARTICIPANTS

A sample (N=714) of home-based occupational therapists (n=241), elderly persons from a bank of research participants (n=226), and adults with physical disabilities recruited through community organizations (n=247).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The dependent variable was whether the referral scenario was prioritized or not in each question. The results were analyzed through logistic regression using conditional logit models.

RESULTS

Prioritization preferences differed between groups (P<.001). Occupational therapists most strongly prioritized people who had a few falls (odds ratio vs no falls, 48.7), whereas elderly people and adults with disabilities most strongly prioritized people who were unable to enter and exit the home (odds ratio vs no difficulty entering and exiting the home, 30.8 for elderly people and 16.8 for persons with disabilities.) CONCLUSIONS: Our results highlight the gap between the priorities of home-based occupational therapists and their target clientele. Although further inquiry is needed to inform priority setting, the findings emphasize the importance of public or patient involvement in decisions on waiting list prioritization.

Healthcare provider perceptions of accessible exam tables in primary care: Implementation and benefits to patients with and without disabilities

BACKGROUND

Recent healthcare mandates require availability of accessible medical exam equipment, which may reduce barriers to care for patients with disabilities (PWD). However, more research is needed to explore healthcare provider views on implementation and routine use of accessible equipment.

OBJECTIVE

This study qualitatively explored healthcare provider perceptions of: (1) daily use of accessible medical examination tables with PWD; and (2) recommendations for addressing challenges to using this equipment.

METHODS

Qualitative interviews and focus groups were conducted with physicians, nurse practitioners and registered nurses at a clinic where accessible examination tables were recently implemented in all clinic rooms. Data were coded and thematically analyzed by two researchers trained in qualitative methods.

RESULTS

A total of 17 providers participated in focus groups or interviews. Participants were mostly female (82%; N = 14), and registered nurses (47%; N = 8), but also included nurse practitioners (29.4%; N = 5), and physicians (23%; N = 4). Common themes were: (1) Ease of use and functionality of tables; and (2) Challenges with use and available training. Overall, providers reported satisfaction with the tables' ability to accommodate patients who are PWD, although they expressed challenges with functionally using the tables with specific populations, such as pediatric patients.

CONCLUSIONS

Healthcare organizations seeking to implement height-adjustable tables should account for structural requirements of the height-adjustable tables (e.g. accommodating clearance needed when planning room sizes). Practical recommendations and policies for integrating height-adjustable tables into routine clinical care are needed to ensure equitable care for PWD.

A case for inclusive design: Analyzing the needs of those who frequent Taiwan's urban parks

Taiwan's declining birthrate has resulted in an aging population, and the needs addressed by public facilities are changing along with the shifting population structure. Visitors to urban parks filled out 869 questionnaires on the topic of inclusive design. Structural equation modeling revealed that park patrons could be categorized as those with special needs, and the general public. The biggest difference between these two groups manifests in their disparate needs concerning outdoor primary service facilities, followed by facilities related to accessibility, automation and the functions performed in open areas. Difficulty with autonomous access was identified as the leading cause of exclusion. Based on the autonomous access principle, three inclusive needs levels were identified: safety (high priority), accessibility (moderately-high), and regular maintenance (average). Inclusive design in public parks aims to equalize usage by all sectors of society.

Gender and Age Differences in Levels, Types and Locations of Physical Activity among Older Adults Living in Car-Dependent Neighborhoods

BACKGROUND

A thorough understanding of gender differences in physical activity is critical to effective promotion of active living in older adults.

OBJECTIVES

To examine gender and age differences in levels, types and locations of physical activity.

DESIGN

Cross-sectional observation.

SETTING

Car-dependent urban and rural neighborhoods in Worcester County, Massachusetts, USA.

PARTICIPANTS

111 men and 103 women aged 65 years and older.

MEASUREMENTS

From 2012 to 2014, participants were queried on type, frequency and location of physical activity. Participants wore an accelerometer for 7 consecutive days.

RESULTS

Compared to women, men had a higher mean daily step count (mean (SD) 4385 (2122) men vs. 3671(1723) women, p=0.008). Men reported higher frequencies of any physical activity and moderate-to-vigorous physical activity, and a lower frequency of physical activity inside the home. Mean daily step counts and frequency of physical activity outside the home decreased progressively with age for both men and women. Women had a sharper decline in frequencies of self-reported physical activity. Men had a significant decrease in utilitarian walking, which women did not (p=0.07). Among participants who reported participation in any physical activity (n=190), more women indicated exercising indoors more often (59% vs. 44%, p=0.04). The three most commonly cited locations for physical activity away from home for both genders were streets or sidewalks, shopping malls, and membership-only facilities (e.g., YMCA or YWCA). The most common types of physical activity, performed at least once in a typical month, with over 40% of both genders reporting, included light housework, brisk walking, leisurely walking, and stretching.

CONCLUSION

Levels, types and location preferences of physical activity differed substantially by gender. Levels of physical activity decreased progressively with age, with greater decline among women. Consideration of these gender differences is necessary to improve the effectiveness of active living promotion programs among older adults.

Unlocking community capabilities for improving maternal and newborn health: participatory action research to improve birth preparedness, health facility access, and newborn care in rural Uganda

BACKGROUND

Community capacities and resources must be harnessed to complement supply side initiatives addressing high maternal and neonatal mortality rates in Uganda. This paper reflects on gains, challenges and lessons learnt from working with communities to improve maternal and newborn health in rural Uganda.

METHODS

A participatory action research project was supported from 2012 to 2015 in three eastern districts. This project involved working with households, saving groups, sub county and district leaders, transporters and village health teams in diagnosing causes of maternal and neonatal mortality and morbidity, developing action plans to address these issues, taking action and learning from action in a cyclical manner. This paper draws from project experience and documentation, as well as thematic analysis of 20 interviews with community and district stakeholders and 12 focus group discussions with women who had recently delivered and men whose wives had recently delivered.

RESULTS

Women and men reported increased awareness about birth preparedness, improved newborn care practices and more male involvement in maternal and newborn health. However, additional direct communication strategies were required to reach more men beyond the minority who attended community dialogues and home visits. Saving groups and other saving modalities were strengthened, with money saved used to meet transport costs, purchase other items needed for birth and other routine household needs. However saving groups required significant support to improve income generation, management and trust among members. Linkages between savings groups and transport providers improved women's access to health facilities at reduced cost. Although village health teams were a key resource for providing information, their efforts were constrained by low levels of education, inadequate financial compensation and transportation challenges. Ensuring that the village health teams and savings groups functioned required regular supervision, review meetings and payment for supervisors to visit.

CONCLUSIONS

This participatory program, which focused on building the capacity of community stakeholders, was able to improve local awareness of maternal and newborn health practices and instigate local action to improve access to healthcare. Collaborative problem solving among diverse stakeholders, continuous support and a participatory approach that allowed flexibility were essential project characteristics that enabled overcoming of challenges faced.

[Objective influencing factors of urban park accessibility]

Urban park accessibility is an important indicator to measure the level of urban modern development, and the harmonious relationships between people and land. It is meaningful for efficiently increasing urban park accessibility, fully providing services functions of urban park and promoting healthy development of cities to understand objective influencing factors of urban park accessibility and its extent of impact. The service area and service efficiency of urban parks in three-ring area of Shenyang City were evaluated basing on ArcGIS 9.3 software platform and network analysis methods. The regularity of the service area and service efficiency of urban parks changing with the urban park area, urban park shape and road network density were analyzed. The results showed that urban park area had significant positive correlation with service area and significant negative correlation with service efficiency. Urban park shape had significant positive correlation with service area and service efficiency. Road network density had significant negative correlation with service area of urban parks, but had no significant correlation with service efficiency. Based on the extent of impact on urban park service area, the importance of three influencing factors was in the order of urban park area> road network density > urban park shape. Based on the extent of impact on urban park service efficiency, the importance of three influencing factors was in the order of urban park area> urban park shape > road network density. Urban park area was the most important influencing factor for the service area and service efficiency of urban parks.

Exercise facilities for neurologically disabled populations - Perceptions from the fitness industry

BACKGROUND

People with neurological disabilities (pwND) face many barriers to undertaking physical activity. One option for exercise alongside formal physiotherapy is local fitness facilities but accessibility is often found wanting and gyms are seen as unwelcoming to pwND.

OBJECTIVE

The objective of this exploratory study was to investigate the perceptions of fitness facility managers with respect to exercise for pwND in a gym environment. The aim was to identify potential barriers to provision by the fitness industry for pwND.

METHODS

The participants included those who were in a position to influence provision at a policy level and those working at management level within fitness providers. A mixed methods approach was used: a quantitative questionnaire and 4 qualitative interviews. Descriptive and correlational analysis, thematic content analysis and concurrent triangulation analysis was undertaken.

RESULTS

Specially trained staff is perceived to be necessary to make fitness facilities accessible for pwND.

CONCLUSIONS

Ensuring the provision of specially trained staff to support pwND to exercise in gyms may be the main barrier to provision for this population. Investigation into the standard training of fitness professionals combining the expertise of neurological physiotherapists with that of fitness professionals to meet the needs of pwND would be advantageous.

Accessible Home Environments for People with Functional Limitations: A Systematic Review

The aim of this review is to evaluate the health and social effects of accessible home environments for people with functional limitations, in order to provide evidence to promote well-informed decision making for policy guideline development and choices about public health interventions. MEDLINE and nine other electronic databases were searched between December 2014 and January 2015, for articles published since 2004. All study types were included in this review. Two reviewers independently screened 12,544 record titles or titles and abstracts based on our pre-defined eligibility criteria. We identified 94 articles as potentially eligible; and assessed their full text. Included studies were critically appraised using the Mixed Method Appraisal Tool, version 2011. Fourteen studies were included in the review. We did not identify any meta-analysis or systematic review directly relevant to the question for this systematic review. A narrative approach was used to synthesise the findings of the included studies due to methodological and statistical heterogeneity. Results suggest that certain interventions to enhance the accessibility of homes can have positive health and social effects. Home environments that lack accessibility modifications appropriate to the needs of their users are likely to result in people with physical impairments becoming disabled at home.

Barriers to Leisure-Time Physical Activities in Individuals with Spinal Cord Injury

This study investigated the personal, environmental, and activity barriers to leisure-time physical activities (LTPAs) among individuals with spinal cord injury (SCI). A survey instrument was administered to 85 participants with SCI. Personal barriers to LTPAs included issues involving motivation, pain, scheduling, and financial resources. Environmental barriers marked the issues regarding availability and accessibility to specialized programs, activities, and professional services. Activity barriers included limitations in equipment, training, and personal skills required by the selected activities. Significant negative correlations were found between these barriers and the levels of physical activity and satisfaction with physical activity. While working with clients with SCI, occupational therapists should identify those LTPA barriers and possible solutions in order to establish individualized action plans for enhancing participation in LTPAs.

Risk assessment in ramps for heavy vehicles--A French study

This paper presents the results of a study dealing with the risk for heavy vehicles in ramps. Two approaches are used. On one hand, statistics are applied on several accidents databases to detect if ramps are more risky for heavy vehicles and to define a critical value for longitudinal slope. χ(2) test confirmed the risk in ramps and statistical analysis proved that a longitudinal slope superior to 3.2% represents a higher risk for heavy vehicles. On another hand, numerical simulations allow defining the speed profile in ramps for two types of heavy vehicles (tractor semi-trailer and 2-axles rigid body) and different loads. The simulations showed that heavy vehicles must drive more than 1000 m on ramps to reach their minimum speed. Moreover, when the slope is superior to 3.2%, tractor semi-trailer presents a strong decrease of their speed until 50 km/h. This situation represents a high risk of collision with other road users which drive at 80-90 km/h. Thus, both methods led to the determination of a risky configuration for heavy vehicles: ramps with a length superior to 1000 m and a slope superior to 3.2%. An application of this research work concerns design methods and guidelines. Indeed, this study provides threshold values than can be used by engineers to make mandatory specific planning like a lane for slow vehicles.

Local and Regional Authorities as Resources for Implementing Universal Design Policy in Norway

The municipalities and regional authorities are in general resources for achieving national goals. Their management and works are crucial to the development and implementation of Universal Design. Through several programmes, national authorities have worked for activating the local and regional levels. The results are visible. We can see a long-term national strategy to help make society accessible to everyone and prevent discrimination. Participating municipalities and regional authorities are now able to create their own policy and strategies and implement solutions. The national programs have involved interested and motivated municipalities. All the 18 counties in Norway have been involved more or less in different periods and the same with up to a third of the about good 400 municipalities.

Rogaland County Council and Universal Design

Rogaland Council has adopted Universal Design as an overriding principle for all planning and development in the county. Private stakeholders and public agencies collaborated in the development of a successful County Plan for Universal Design that has been recognised as an example of good practice by Norway's public authorities. The plan provides guidelines for both state and municipal planning and operations in several policy areas from public transport to educational and cultural buildings to sports and recreation areas. One of the main contributions of the plan is an evaluation methodology built on the "TEK-10" national standard, and developed with the participation of authorities, experts, staff from municipalities and representatives of organisations for people with disabilities. This method is used to assess the accessibility and compliance with Universal Design principles of different destinations. This information is then published in the dedicated website www.tilgjengelighet.no which serves as an information channel for the general public about accessibility to various locations in the county. A community engagement method has been developed for including user groups in the design process for both new buildings and renovation projects. Representatives for user groups are chosen by the Council's Disability Committee, and these help to inform the planning and construction process. The plan also emphasises the development of knowledge and skills in Universal Design through educational programmes for secondary schools and colleges as well as training opportunities for councillors. This paper summarises the plan's rationale and the progress made until now.

Wheeled Mobility Devices and Access to Buildings

Developments in the design of assistive equipment have a huge bearing on the built environment and the corresponding accessibility norms. The main goal of this study is to investigate the new accessibility standards for building entrance and elevators/lifts with respect to the evolution in wheeled mobility devices.

Standard Lavatories for Wheeled Mobility Device Users

In the contemporary world, building regulations and norms need to be updated to reflect the evolution in mobility devices. This research is suggesting new proposals for norms and standards for standard lavatories by taking the evolution in new wheeled mobility devices into account.

Universal Design in a Zoological Setting

Universal Design in planning for exhibiting animal collections for the public has been a part of the culture of one particular zoo in the US. This paper looks at the steps in designing a zoological park that is universally accessible to all visitors.

The General Opinion on Accessibility - Research About the Attitudes in Finland

The public discussion about accessibility in the built environment has been recently very ambivalent in Finland. Finnish Government programme includes 26 key projects and one of them links with deregulation of building legislation. In addition to this, according to the preliminary media analysis carried out by The Finnish Association of People with Physical Disabilities (FPD) the traditional media in Finland seems to give somewhat more support to those opposing accessibility than those supporting it. FPD wanted to find out people's attitudes towards accessibility and the possible disadvantages they see in promoting accessibility. The purpose was to get background information to influence on attitudes and to launch a positive attitude campaign. FPD commissioned a survey about the accessibility in built environment and find out that surprisingly, based on the survey, the opinions of the majority of people are not as negative as expected.

Do Performance-Based Codes Support Universal Design in Architecture?

The research project 'An analysis of the accessibility requirements' studies how Danish architectural firms experience the accessibility requirements of the Danish Building Regulations and it examines their opinions on how future regulative models can support innovative and inclusive design - Universal Design (UD). The empirical material consists of input from six workshops to which all 700 Danish Architectural firms were invited, as well as eight group interviews. The analysis shows that the current prescriptive requirements are criticized for being too homogenous and possibilities for differentiation and zoning are required. Therefore, a majority of professionals are interested in a performance-based model because they think that such a model will support 'accessibility zoning', achieving flexibility because of different levels of accessibility in a building due to its performance. The common understanding of accessibility and UD is directly related to buildings like hospitals and care centers. When the objective is both innovative and inclusive architecture, the request of a performance-based model should be followed up by a knowledge enhancement effort in the building sector. Bloom's taxonomy of educational objectives is suggested as a tool for such a boost. The research project has been financed by the Danish Transport and Construction Agency.

Teaching Universal Design in the Early Stages of a Design Curriculum: Involving End Users in a Student Project

Introducing Universal Design (UD) early in the design curriculum provides design students with a basic foundational understanding of the Universal Design principles and processes. Additionally, by guiding students on the application of the UD principles and process in designing a solution to a real-world need, students experienced the challenges and tradeoffs such design requires. In Spring 2016, teams of Sophomore-level Industrial Design students were assigned an educational exercise to solve a real-world problem of barriers experienced by people with disabilities during grocery shopping. Students employed the UD process in designing a shopping device enhanced with mobile/wireless enabled features that would be usable by a wide range of users. The shopping device had to function effectively and meet the needs of the general public (men, women, tall, short, etc) while simultaneously meeting the needs of users who have other physical and perceptual limitations such as mobility limitations and visual impairments. In this paper, we discuss the key steps of the educational exercise, as well as lessons learned for improving the exercise for future courses.

A South African Municipality Mapping the Way Forward for Social Inclusion Through Universal Design

Since becoming a democracy, South African legislation has changed. The South African Constitution and legislation governing the structures and mandate of the different spheres of government aim towards municipalities needing to become more developmental in the way it serves the community with a specific focus on the poor and vulnerable. It sets ideals to overcome the inheritance of the past. However, how to do this is sometimes still unclear. This paper is a case study illustrating how Stellenbosch Municipality overcame obstacles of perceived legislative restrictions, silo operations and antiquated thinking, working towards social inclusion for all its citizens. In moving away from disability accessibility and embracing universal access as a way in which to deliver basic services, Stellenbosch discovered the beginning of the process of overcoming the negative legacy of the past. Understanding the Universal Design principles and approach illustrated how South African municipalities can promote the concept of our rainbow nation as envisioned in the Constitution.

Universal Design and Continuing Professional Development for Architects: An Irish Case Study

The Tomar Resolution urged that all occupations working in the built environment be educated in the principles and measures of Universal Design in order to facilitate all people playing a full role in society. For Architects and Architectural Technologists, under-graduate education will continue to have a major role to play. At the same time in the Republic of Ireland, and in an ever-growing number of other jurisdictions, Continuous Professional Development (CPD) is a requirement for all Architects and Architectural Technologists and can significantly affect knowledge, skill and competence in a number of subjects including Universal Design. This paper looks at the results of a recent survey of Architects and Architectural Technologists practising in Ireland, architectural educators, and client bodies that sought to assess the following: 1. How inherent is Universal Design knowledge to current building design practice? 2. What are the current Universal Design education and training needs of Architects and Architectural Technologists practising in Ireland? 3. Which Universal Design themes and topics are of most interest to Architects and Architectural Technologists practising in Ireland? 4. To what extent does existing CPD for Architects and Architectural Technologists practising in Ireland address Universal Design topics? 5. What can motivate Architects and Architectural Technologists practising in Ireland to access Universal Design CPD? 6. What are the most effective means by which to deliver Universal Design CPD to Architects and Architectural Technologists practising in Ireland? The survey discussed in this paper is one phase of a longer study aimed at providing a research base for developing CPD in Universal Design for Architects and Architectural Technologists practising in Ireland.

Mobile App to Assess Universal Access Compliance

In terms of local legislation, South Africa has a handful of regulations that indirectly require Universal Access, which is then in itself largely described as facilities for people with disabilities. The most predominant set of regulations is the South African National Building Regulations, with a specific code which is deemed to satisfy standard titled South African National Standard (SANS) 10400 Part S: Facilities for Persons with Disabilities. Revised in 2011, this building regulation offers some technical guidelines specific to built infrastructure, and largely for people with functional mobility limitations. The description of the term "functional mobility limitations" in the context of this paper refers to people who make use of mobility aids to assist with their functionality in an environment, for example people who use walking aids (sticks, canes or walkers) and people who use wheelchairs. Albeit lacking in specifics around the requirements for other areas of functional limitations, including people who are blind, people who are deaf, and people with cognitive limitations, the SANS 10400 Part S is, to date, the most effective regulatory requirement in the country to assist with making facilities more accessible. With only a few experts in South Africa working in the field, the ability to offer clients Universal Access Reviews in terms of basic compliance with the SANS 10400 Part S is limited by two major factors. Firstly, the costs associated with employing experts in the field to review infrastructure is mostly too exorbitant for clients to carry. Secondly, the amount of time taken to perform reviews onsite and then collate the information into a coherent report for the client is far too long. These aspects result in a gap between clients wanting to meet the requirements, and being able to have the work completed in a reasonable amount of time. To overcome the challenge of larger institutions and organizations wanting to have their facilities reviewed in terms of compliance with National Building Regulations, within a tight budget as well as within minimal timeframes, an innovative mobile application was developed by Universal Design Africa. This App heralds the dawn of a new method to measure universal access compliance. The operation and format of this technology and its application could be adapted to meet all forms of compliance and information gathering, including international regulations and best practice.

Interactive Universal Design Kiosks: Explanations About Social Inclusion Features in Architectural Design

This paper details a set of self-supporting and illuminated panels that work together but independently in order to emphasize the explanation of building features and activities that are based on Universal Design guidelines. The exhibition is based on two structures that are arranged in semi-circles (A and B). They are integrated to form a carpeted path where the visitor will be gradually exposed to the concepts related to the principles of Universal Design. Following the sequence of three-dimensional objects and swivelling box elements that support the tactile information on the subject, it is expected that visitors become familiar with each of the principles being demonstrated. Operated by a control system consisting of keys with colour signage, textures and high relief, the panel on the control table allows the user to choose information about paired relationships between some of seven principles contained in printed images about the architectural design on the set of panels. The effectiveness of the composition can be verified by the time people remain enough to hear, see and touch the kiosks for all the information, or by successive visits users make to the setting.

The "Free from Housing Accessibility Problems" App

The present study concerns the development of a computerized tool targeting housing accessibility issues. A user-centered approach involving professionals from the housing sector and senior citizens from four European countries resulted in a fully functional prototype of a mobile application (app) including an apartment database. The app raises awareness on housing accessibility and has the potential to support decision making and strengthen all citizens regardless of functional capacity to be more active in their endeavors for a satisfying housing solution. Further refinements and additional features are needed to enhance the potential benefits; they include addressing potential challenges facing senior citizens, developing interactive features that allow users to provide input and adapting to different national contexts to make the app applicable for the European market.

Universal Design as a Booster for Housing Quality and Architectural Practice

Norwegian central government has for the last decade increasingly focused on universal design. Fundamental changes in the Norwegian building code and corresponding regulations in 2010 give an apparently clear framework for the implementation of accessibility and universal design. However, it seems that neither increased awareness of accessibility requirements and universal design, nor compliance with the building code guarantees improvement of housing quality and usability. The Norwegian regulations have gone further in the direction of performance requirements than most other countries. This applies to all types of requirements, including requirements for usability, functionality and accessibility. Hardly any specifications are to be found in the regulations. Ideally, this lack of specifications should give designers the opportunity to develop innovative answers and hence to respond to different contexts and needs. Still, many architects and builders ask for clear specifications, in order to simplify and speed up design processes and make control of solutions easier. Many architects understand guidelines as minimum requirements, and are thus reproducing the identical solutions without considering the context and the needs of the users. They see accessibility as another regulatory pressure and requirements as restrictions rather than positive incentives. However, there are examples of designers who have internalised the regulatory framework and thus are able to create and integrate inclusive design in their daily work. Based on recent research conducted by SINTEF Building and Infrastructure and financed by the Norwegian State Housing Bank, this paper presents examples of practice where dwellings have been developed within a framework of universal design. Focus of the research has been on the approach of the design team and their understanding and use of the regulatory framework in order to create better homes in dialogue with the building authorities. Main objectives are to: - Contribute to better understanding of universal design as a tool and a method to improve housing quality and usability - Investigate the conditions for developing dwellings with innovative and functional solutions in compliance with the building code - Discuss challenges in interpreting the requirements and in taking the needs of various resident groups into account.

Universal Mosque/Masjid Design

As a public building, a mosque (or any prayer area for Muslims in public buildings) should remove all barriers that may confront persons with disabilities and hinder them from performing their religious rituals. A mosque is regularly used at least five times a day for praying, and for weekly events such as Jumu'ah (Friday prayers). Therefore. a mosque should be accessible for all. But in fact, persons with disabilities still find difficulties in accessing mosques. For example, the calling to prayer and Friday sermon (Khutba) through loudspeakers, is a problem for persons with hearing loss. Persons with physical disabilities, especially users of wheelchairs, walkers or crutches, have difficulties in several areas in the mosque, including the entrance, place of ablution, the lavatories and the area for removing shoes at the entrance to the prayer hall. People are not allowed to enter the place of ablution or prayer hall wearing shoes, people are also not allowed to enter with their personal mobility devices. This is so that dirt from outside does not get carried into the mosque. In order to understand the accessibility requirements for persons with disabilities in a mosque, we have to know the essential parts in the construction of the mosque and the mobility pattern that usually occurs in a mosque. In this paper, an accessibility checklist which has been developed on the basis of an analysis of accessibility requirements in mosques is presented.

Experimental Studies of Wheelchair and Walker Users Passing Through Doors with Different Opening Force

Users of walkers and users of different categories of wheelchairs tested doors with different opening force, aiming to reveal the limit that these groups of people could manage on an everyday basis. 94.7% of the wheelchair users reported that a door opening force of 30 N was acceptable, while as 92.1% of this group described 40 N as acceptable. Similarly, 100% of the walker users reported that a door opening force of 30 N was acceptable, while as 87,5% of this group described 40 N as acceptable.

Can We Build Inclusion?

Inclusion of children with special needs in kindergartens and preschools may be approached from different angles. This paper raises the question of whether the physical framework of kindergartens makes any difference for daily life at the kindergarten at all, and whether it can support inclusion of some children with special needs. Hence the title - can we build inclusion? In the literature of Universal Design, accommodation and design features seldom reflect the less visible disabilities. The paper is based on a research project initiated to investigate how more or less space influences daily pedagogical practice in general. Twelve interviews were conducted with experienced teachers from twelve different kindergartens with different amounts of space, varying from a ratio of 2.1 m² play area per child to 5.5 m². The results indicated that, for a group of children with special needs in particular, the amount of space is crucial. This group consisted of children who were socially very extrovert, and who maybe were noisy, easily provoked, and quick to get involved in arguments with other children. Alternatively, children in the group were very restrained and withdrawn in social interaction. Based on the answers in the interviews, we found support for answering the question in the title in the affirmative; we can build inclusion! This is because the teachers' experience indicated that, if there was sufficient space per child, there were fewer conflicts and the children managed to stay in the same activity for a much longer period. Sufficient space made it possible to divide the children into smaller groups, and use any secluded space. Therefore, it was much easier for other children to include some children with special needs. Accordingly, we can say that, sufficient space per child and an adequate layout and furnishing of the kindergarten is an advantage for all children. This is a clear example of Universal Design in which architectural solutions that are good for one specific group are also beneficial for all children.

From Visions to Practical Policy: The Universal Design Journey in Norway. What Did We Learn? What Did We Gain? What Now?

The national policy in Norway have since the last part of the 1990-ies been organized in programs that erected actions including national authorities, municipalities, regional authorities and private enterprises. What have we gained by our national activities to mainstream inclusive and accessibility policy for persons with reduced capability through the principles of Universal Design? Have we made society accessible to everyone and prevented discrimination. Are the results visible? We can measure results on several sectors, inter alia public buildings, outdoor areas, central communication hubs, public transport and the occurrence plans for Universal Design in municipalities and regions. Through several programs and action plans the Norwegian government has developed a sectoral approach for including persons with disabilities in the society. The majority of ministries have participated in these plans. Local initiatives, local councils for disabled people, and later on municipalities and county administrations were supported by national authorities as complements to regulations and laws. In addition, guidelines and assisting funds were used. The main objective was to redefine the national policy, using better defined national goals and introducing Universal Design to replace accessibility as the basic tool. The mainstreaming of the accessibility policy, where Universal Design was included in relevant sectors and activities, was a crucial part of the strategy. The national policy was organized in programs that erected actions focusing on how to reach, inspire and include municipalities and regional authorities in their own struggle for Universal Design. Through the mainstream approach ministries have both earmarked economic transfers to their own agencies and used steering documents guide to these agencies how to implement Universal Design in their advisory services, in practicing laws and regulations and in their own planning and building activities.

Facilitating the Concept of Universal Design Among Design Students - Changes in Teaching in the Last Decade

This short paper describes and reflects on how the teaching of the concept of Universal Design (UD) has developed in the last decade at the Institute of Design at the Oslo School of Architecture and Design (AHO). Four main changes are described. Firstly, the curriculum has evolved from teaching guidelines and principles to focusing on design processes. Secondly, an increased emphasis is put on cognitive accessibility. Thirdly, non-stigmatizing aesthetics expressions and solutions that communicate through different senses have become more important subjects. Fourthly the teaching of UD has moved from the second to the first year curriculum.

Accessibility Videos

It can be difficult to understand accessibility, if you do not have the personal experience. The Accessibility Centre ESKE produced short videos which demonstrate the meaning of accessibility in different situations. Videos will raise accessibility awareness of architects, other planners and professionals in the construction field and maintenance.

Universal Design and Social Sustainability in the City: The Case Study of Tehran Iran

Following the proposal of Universal Design in 1974, a public society was founded in Iran in 1981, in order to aid the disabled victims of the Iran-Iraq war. Official authorities have also made legislation on this topic. During the last three decades many efforts have been made to apply this concept in public spaces. Unfortunately these have not succeeded. It means despite the existence of inherent rules and regulations and the general will to apply the principles of Universal Design in Tehran, urban spaces are still an improper environment for the independent presence and movement of people with disabilities. This problem is considered a serious threat for social sustainability in Tehran. The main goal of this research is finding solutions for increasing social interaction and greater participation of people with disabilities in public spaces by applying Universal Design. The research is seeking to answer these questions: What is causing inefficiency in the regulation of Universal Design in Tehran? Why is social participation by people with disabilities limited in Tehran? Which factors are contributing to Universal Design in Tehran? The research is based on applied theory, field research methods and a mixed qualitative-quantitative approach. In addition, and the results include both empirical and functional solutions. The consequences show that many of problems are rooted in cultural issues. The people must attend to disability as a public concern which can involve everybody. They must comprehend that all the members of the society, regardless of their physical condition, have the right to use public facilities independently. The second problem is related to lack of any integrated approach to applying Universal Design. This research proposes some solutions such as preparation a Universal Design master plan, an integrated approach for implementation project in all organizations, and public education for improving citizens' knowledge about Universal Design.

Ensuring Universal Access to Eye Health in Urban Slums in the Global South: The Case of Bhopal (India)

Sightsavers is an international organisation working with partners in over 30 countries to eliminate avoidable blindness and help people with disabilities participate more fully in society. In the context of its Urban Eye Health Programme in Bhopal (India), the organisation launched a pilot approach aimed at developing an Inclusive Eye Health (IEH) model and IEH Minimum Standards. Accessibility audits were conducted in a tertiary eye hospital and four primary vision centres located within urban slums, addressing the accessibility of physical infrastructures, communication and service provision. The collection and analysis of disaggregated data inform the inclusion strategy and provide a baseline to measure the impact of service provision. Trainings of eye health staff and sensitisation of decision makers on accessibility, Universal Design, disability and gender inclusion are organised on a regular basis. A referral network is being built to ensure participation of women, people with disabilities and other marginalised groups, explore barriers at demand level, and guarantee wider access to eye care in the community. Finally, advocacy interventions will be developed to raise awareness in the community and mainstream disability and gender inclusion within the public health sector. Founded on principles of Universal Design, accessibility and participation, and in line with international human rights treaties, Agenda 2030 and the Sustainable Development Goals (SDGs), Sightsavers' IEH model ultimately aims to develop a sustainable, scalable and universally accessible system-strengthening approach, capable of ensuring more inclusive services to people with disabilities, women and other marginalised groups, and designed to more effectively meet the health needs of the entire population.

Interaction Design in the Built Environment: Designing for the 'Universal User'

Concepts of responsive architecture have to date largely involved response to environmental context, in order to mediate ambient environmental factors and modify internal conditions for the comfort of users, with energy efficiency and sustainability as the main impetus. 'Smart' buildings often address little other than technically functional issues, with any ideas of 'design' as a unifying factor being disregarded. At the same time, music and performance art have been in the vanguard of creating digital interaction that intimately involves the user in aesthetic outcomes, in the creation of what Umberto Eco describes as an 'Open Work'. Environments made responsive through embedment of computational technologies can similarly extend usability and user-centred design towards universality, through careful consideration of the relationship between person, context and activity, and of the continuous and ultimately transactional nature of human occupation of built environment. Truly 'smart' environments will learn from and through usage, and can be conceived and designed so as to maximise environmental 'fit' for a wider variety of users, including people described as being 'neurodiverse'. Where user response becomes a significant component in managing a smart environment, the transactional relationship between user and environment is made explicit, and can ultimately be used to drive interaction that favours ease-of-use and personalisation. Inclusion of affective computing in human interaction with built environment offers significant potential for extending the boundaries of Universal Design to include people with autism, people with intellectual disability, and users with acquired cognitive impairment, including that arising from dementia. The same users frequently have issues with sensory-perceptual sensitivity and processing. The resulting mismatch between their individual needs and abilities, and the environments they typically occupy, can give rise to states of chronic and acute anxiety. Analysis of the characteristics of such users gives rise to various 'personas', whose functional and psychosocial needs may be best met by responsive environments which take consideration of affective state, that is, of mood and emotion. Human-computer interaction which marries responsive architecture and affective computing offers a new paradigm for smart environments, which are intrinsically user-centred as a consequence. The technical complexity of designing such an environment must always be balanced by the absolute necessity of utilising Universal Design principles to reduce the underlying technological complexity to a usable interface. This paper is a preliminary exploration of the principles underlying the design of one such responsive environment: an interactive sensory room for children with autism spectrum disorders, (ASDs), which aims to promote relaxation and thus reduce anxiety.