Diabetes knowledge, self-efficacy and dietary, psychological and physical health barriers: Comparing young and usual-onset type 2 diabetes

AIMS

Young-onset (21-39 years old) type 2 diabetes (YOD) is associated with high complication rates and glycaemic levels, and poor self-management plays a significant role. Knowledge, skills and barriers influence self-management behaviours considerably. Therefore, this study assessed diabetes knowledge, self-efficacy and barriers (situational dietary barriers, physical health, mental health and diabetes-related distress) between participants with young and usual-onset (40-59 years old) (UOD) diabetes.

METHODOLOGY

A cross-sectional survey was conducted. Differences between YOD and UOD were analysed using bivariate analysis and effect sizes were estimated with Cohen's d. Differences were further adjusted by demographic factors (gender, ethnicity, marital status, educational level, income level) and diabetes duration.

RESULTS

A total of 409 (97 YOD, 312 UOD) participants were recruited. Participants with YOD had lower self-efficacy levels (adjusted B = -0.19, CI -0.35 to -0.03) and higher dietary barriers (adjusted B = 3.6, CI 2.1-5.1), lower mental health scores (adjusted B = -3.5, CI -5.7 to -1.4) and higher diabetes-related distress levels (adjusted B = 0.2, CI 0.2-0.4).

CONCLUSIONS

Our study found that participants with YOD faced more challenges with adapting to life with diabetes when compared with UOD. More effective self-management programmes are needed to support the multifaceted needs of adults with YOD.

Designing for inclusion in public playgrounds: a scoping review of definitions, and utilization of universal design

PURPOSE

Public playgrounds afford children and families important opportunities for outdoor play, social participation, and inclusion. Unfortunately, many children and families experience barriers to accessing, using, and being included in public playgrounds. Consequently, Universal Design (UD) is promoted for providing conceptual guidance for designing for inclusion in public playgrounds. However, a lack of research evidence means researchers have engaged in the ongoing interpretation of the UD concept and related non-discriminatory planning and design concepts. Therefore, the aim of this study was to examine how UD, and related concepts, are used in peer-reviewed articles concerning public playgrounds.

MATERIALS AND METHODS

A scoping review was conducted in November 2019, which identified 15 peer-reviewed articles that met the inclusion criteria.

RESULTS

Analysis revealed that the terms UD, inclusive design, accessibility, and usability are all being used to describe non-discriminatory planning and design concepts arbitrarily and without regard for higher or lower order concepts. Two broad interpretations were evident: (a) UD is synonymous with accessibility for some, and (b) UD is a higher-order concept that goes beyond accessibility for others. Nevertheless, findings highlight the utility of UD in underpinning the design of public playgrounds in many developed countries; however, the concept requires further clarity and specificity as it pertains to playground design and more pertinently inclusion in outdoor play.

CONCLUSIONS

We argue for further conceptual refinement to consolidate the importance and future application of UD for Play (UDP) in the design of public playgrounds that promote outdoor play, social participation, and inclusion.IMPLICATIONS FOR REHABILITATIONMost peer-reviewed journal articles reviewed fail to define what is meant by the term Universal Design.Of those that do provide a definition, the outcome of inclusion in play, or the application of Universal Design to enable play in public playgrounds was unclear.Research to date has mostly focused on related concepts, including accessibility and usability, with less emphasis on Universal Design.Recommend a tailored perspective of Universal Design for Play (UDP).

Relationship Between Community-Level Distress and Cardiac Rehabilitation Participation, Facility Access, and Clinical Outcomes After Inpatient Coronary Revascularization

BACKGROUND

Although disparities in cardiac rehabilitation (CR) participation are well documented, the role of community-level distress is poorly understood. This study evaluated the relationship between community-level distress and CR participation, access to CR facilities, and clinical outcomes.

METHODS

A retrospective cohort study was conducted on a 100% sample of Medicare beneficiaries undergoing inpatient coronary revascularization between July 2016 and December 2018. Community-level distress was defined using the Distressed Community Index quintile at the beneficiary zip code level, with the first and fifth quintiles representing prosperous and distressed communities, respectively. Outpatient claims were used to identify any CR use within 1 year of discharge. Beneficiary and CR facility zip codes were used to describe access to CR facilities. Adjusted logistic regression models evaluated the association between Distressed Community Index quintiles, CR use, and clinical outcomes, including one-year mortality, all-cause hospitalization, and acute myocardial infarction hospitalization.

RESULTS

A total of 414 730 beneficiaries were identified, with 96 929 (23.4%) located in the first and 67 900 (16.4%) in the fifth quintiles, respectively. Any CR use was lower for beneficiaries in distressed compared with prosperous communities (26.0% versus 46.1%, P<0.001), which was significant after multivariable adjustment (odds ratio, 0.41 [95% CI, 0.40-0.42]). A total of 98 458 (23.7%) beneficiaries had a CR facility within their zip code, which increased from 16.3% in prosperous communities to 26.6% in distressed communities. Any CR use was associated with absolute reductions in mortality (-6.8% [95% CI, -7.0% to -6.7%]), all-cause hospitalization (-5.9% [95% CI, -6.3% to -5.6%]), and acute myocardial infarction hospitalization (-1.3% [95% CI, -1.5% to -1.1%]), which were similar across each Distressed Community Index quintiles.

CONCLUSIONS

Although community-level distress was associated with lower CR participation, the clinical benefits were universally received. Addressing barriers to CR in distressed communities should be considered a significant priority to improve survival after coronary revascularization and reduce disparities.

Housing Accessibility at Home and Rehabilitation Outcomes After a Stroke: An Explorative Study

PURPOSE

To explore if aspects of the physical home environment are related to rehabilitation outcomes among community-living persons poststroke.

BACKGROUND

Research demonstrates that healthcare environments are important for high-quality care and that the design of the physical environment is associated with improved rehabilitation outcomes. However, relevant research focusing on outpatient care settings, such as the home, is sparse.

METHODS

In this cross-sectional study, data on rehabilitation outcomes, physical environmental barriers, and housing accessibility problems were collected during home visits of participants (N = 34), 3 months poststroke. Data were analyzed with descriptive statistics and correlation analysis.

RESULTS

Few participants had adapted their homes, and the relevance of the physical environment was not always discussed with the patient during discharge from the hospital. Accessibility problems were associated with suboptimal rehabilitation outcomes such as worse perceived health and recovery after stroke. Activities most restricted by barriers in the home concerned hand and arm use. Participants who reported one or more falls at home tended to live in houses with more accessibility problems. Perceived supportive home environments were associated with more accessible dwellings.

CONCLUSIONS

Many face problems adapting their home environments poststroke, and our findings highlight unmet needs that should be considered in the rehabilitation practice. These findings could be used by architectural planners and health practitioners for more effective housing planning and inclusive environments.

Architectural accessibility and perception of falls of elderly people in the peridomicile: mixed method

OBJECTIVE

To describe contents, structure and origin of social representations about falls by elderly people, the peridomiciliary structural conditions that predispose to falls, and to relate the implications of these empirical evidence on the routine of the elderly in the architectural context.

METHOD

Convergent mixed method by triangulation. Qualitative approaches(structural, n=195 and procedural, n=40of the Theory of Social Representations) and quantitative (descriptive sectional, n=183) were used. Elderly people enrolled in primary care were interviewed at home in 2018. Analysis techniques: categorical-thematic, prototypical, statistical, and deductive according to Leininger.

RESULTS

Categories of analysis: 1) Peridomicile: fall scenario and 2) Aging and vulnerability: risk of falls in peridomicile. The following environmental characteristics were precursors to falls: uneven floors, holes, unevenness and objects in the pathway. Feelings and behaviors allocated in the possible central core are associated, justifying falls, and determining their causes.

CONCLUSION

There was an association between the peridomiciliary architectural environment and the predictive characteristics of the risk of falls.

An alternative system to improve accessibility for wheelchair users: The stepped ramp

Ramps are one of the main solutions for people with motor disabilities to overcome small disparities in height, both across cities and inside buildings. To permit the autonomous use of ramps, they must satisfy specific requisites. In particular, the slopes must not be excessively steep but adhere to the values identified in regulations and validated by scientific research. In historic cities, however, the placement of ramps is often complicated by a lack of space required for their length. In Venice, in particular, its urban morphology often makes it impossible to conform to the required slopes. For this reason, a specific ramp, known as "stepped ramp", has been designed by technicians of the City of Venice with a steeper slope than allowed by regulations. It offers many possibilities but even some key problems. This paper presents a scientific analysis of ten different ramps to evaluate the structures that directly influence the feeling of comfort or discomfort of a wheelchair user with assistance, as well as the coefficients of friction of the different flooring surfaces. This study aims to understand objectively if this solution is efficient to improve accessibility in some specific circumstances, where it is not possible to follow the regulations using flat ramps.

'Frontrunners" Understanding of Universal Design in Architecture

In Denmark, the building sector is in a state of transition towards Universal Design (UD). Thus, UD has not yet completely found its way into the practice of architects and their clients. Legislation about accessibility has dominated. This paper studies understandings of UD through a discourse analysis based on a survey among professionals with experience and interest in UD and professionals who were expected to keep their fingers on the pulse of the profession's development. The findings illustrate the existence of five discourses: 1) Social sustainability, 2) Re-instatement of humans as a focal point, 3) It is not just about ramps, 4) Equality, and 5) Giving a voice. Across the discourses there exists a genuine attempt to legitimise and mainstream UD into the architectural practice, focusing on multisensory and architectural quality in the design of spaces for human diversity in all scales.

Universal Design in Primary Schools

The Norwegian building code give an apparently clear framework for the implementation of universal design (UD) in public buildings. However, it seems that neither increased awareness of UD, nor compliance with building regulations can so far guarantee equal use. Statistics and inspections reveal that there still are shortcomings as regards accessibility for many groups. Children with reduced mobility or impaired vision are better cared for than students whose needs are less documented. There is still a necessity for understanding the needs of other groups, such as children with hearing impairments, or other sensory challenges, children with social anxieties and those within the autism spectrum. A key part of achieving UD should be a design process where users' needs are in focus. Based on recent research carried out by SINTEF Building and Infrastructure and funded by the Directorate for Children, Youth and Families, this paper presents 1) Examples of practices where primary and lower secondary schools have been designed within a framework of UD, and 2) Important drivers for universal design during the design process. Recommendations will be proposed for further development of standardized tools. Findings indicate that opportunities to challenge the minimum requirements for UD within a conventional design process are few without having a supportive and competent client. The regulations and standards do not necessarily ensure inclusion and equal use. Low understanding about what UD entails in terms of user knowledge and involvement may be one reason. Norwegian standards for UD do not appear to be in significant use. Tools for UD often appear as checklists, based on the building regulations. The examples show that effective collaboration between the client and the architect plays a central role in the UD of schools. Architects not only need tools to think about usability at all design levels, but the ability to collaborate with the client and users in every phase.

Policies and Processes for Accessibility from a UD Perspective: The Integrated Approach Supported by the Friuli Venezia Giulia Region (IT)

With Regional Law no. 10 of 19 March 2018 (General principles and implementing provisions on accessibility), the Autonomous Region of Friuli Venezia Giulia has set itself the objective of improving urban accessibility throughout the regional territory, in order to guarantee equal conditions for everyone to enjoy open spaces and the built environment. The improvement of accessibility is conceived as a long-term objective, to be implemented in stages, according to an incremental development project model. Still today, when work is carried out to eliminate architectural barriers, designers adopt an approach that looks at the "barrier/disability" binomial, identifying "dedicated" solutions and tackling the problem of accessibility in relation to specific targets of users whose ability to access and use spaces and environments is assessed in relation to the capability of a person generically defined as "normally able". In contrast, in a barrier-free approach, designers are called upon to adopt a broader perspective, to look at the variety of people who make up a real community (extended user base), and to consider different physical conditions, ages, abilities and capacities (motor, sensory and cognitive), from the early stages of the project. In order to promote change and to impart this change of approach, the Autonomous Region of Friuli Venezia Giulia has envisaged integrated actions, aimed, as a whole, at accompanying the process that guides the project culture towards a progressive adherence to the methodological criteria of Universal Design, introducing, at the same time, support measures aimed at financing the Municipalities of the Region both for the preparation of barrier elimination plans (PEBAs) and the implementation of the interventions identified in those plans. Among the envisaged actions, the most important is a general accessibility mapping, which includes the adoption of a terminology system (accessibility ontology) integrated in a specific computer application, through which the municipalities will be able to detect architectural barriers, in a homogeneous way, over the entire regional territory.

Plans for the Removal of Architectural Barriers (PEBAs) from a UD Perspective. An Interdisciplinary Process in the Italian Region Friuli Venezia Giulia

It is more than thirty years since the Italian Law introduced the Plans for the Removal of Architectural Barriers (PEBAs). However, their implementation by municipalities is still limited, and accessibility is often understood as the result of the elimination of single physical obstacles, rather than the development of interconnected systems of urban spaces and collective equipment that are usable and inclusive according to Universal Design (UD) criteria. Since 2018, the Italian Friuli Venezia Giulia Autonomous Region has started a collaboration with the Universities of Trieste and Udine, in order to bring UD at the core of the implementation of the Regional Law no. 10/2018. This Law introduced significant innovations: the disposal of regional funds to support local administrations when drafting PEBAs; the delivery of a software application to facilitate the drawing of these plans; the establishment of a reference center in charge of training, information and consultancy activities on accessibility at a regional level (CRIBA); the delivery of a regional observatory for mapping and continuous monitoring of accessibility conditions and the implementation of PEBAs. The paper presents: i) an overview of the interdisciplinary work carried out by the Universities with the Region and CRIBA; ii) a focus on Universities' research activities and the current state of the collaboration process; iii) reflections on further research and its operational outcomes.

Universal Design in Exhibit

Universal Design has become more prevalent in the general use of architectural design buT has rarely been applied to exhibits. This paper features two manuals developed for exhibit accessibility that incorporate several principles of Universal Design.

Does Pure Contemplation Belong to Architecture? The Denied Ramps at the Church of San Salvatore in the Santa Giulia Museum in Brescia

This paper addresses the issue of balancing the two values underlying the accessibility and conservation of cultural heritage: its use and its protection. These values are often, wrongly, regarded as opposites, or as incompatible. The reason for this contrast originates in the way of understanding ancient architecture and in the value of the relationship between architecture and people. This issue is considered by presenting a recent case concerning the Museum of Santa Giulia in Brescia, a multi-layered complex that preserves evidence ranging from the prehistoric to the contemporary age, housed in a monastic complex of Longobard origin. The recent failure to build some ramps proposed for increasing accessibility to the church of San Salvatore, an integral part of the museum's itinerary, offers an opportunity to reflect on the need for better integration between different, and only apparently opposed, instances. The topic is dealt with by referring to the most recent disciplinary reflections in the field of conservation carried out in Italy with respect to the issue of accessibility to the cultural heritage, without neglecting juridical-normative aspects and international documents, such as the Faro Convention. This multidisciplinary reading aims to highlight the main significance of accessing cultural heritage, with reference also to the objectives of sustainable development and the human development of the individual and the reference community.

Higher Education and Universal Design in Tanzania. A New Model of Inclusion and Sustainable Development

The need to create a more inclusive society in Tanzania is confronted with a discrepancy between the aims of a regulatory framework, aimed at making Higher Education spaces inclusive, and the question of the right of access to built environments, particularly in universities. The study presents the pilot case of the RUCU's Learning Center for Disabilities to demonstrate that the combination of UDL, architectural accessibility and international cooperation can give impetus to new research and application themes, creating innovative models and good practices to be disseminated for a new shared awareness.

Perspectives on Accessibility and Its Users Amongst Practicing Danish Landscape Architects

This paper presents findings from 15 interviews of randomly selected Danish landscape architectural offices focusing on how these work with and understand accessibility. The paper finds that Danish landscape architects mostly understand accessibility and its users in relation to existing building regulations. Moreover, in finding that the informants possessed a limited professional vocabulary for understanding accessibility, the paper discusses the type of knowledge requested and by, and necessary for, Danish landscape architects to gain a more reflective understanding of accessibility and its users. Towards such ends, universal design can help the profession. However, with only a few informants mentioning ideas related to universal design, this indicates that more education is needed for universal design to provide a different perspective on accessibility and its users amongst Danish landscape architects.

Outside, Around, Inside. New Paths to Discover San Michele Castle (Cagliari, Sardinia)

In the framework of conservation and enhancement of cultural heritage, accessibility plays a crucial role. Architectural heritage peculiarities call for specific approaches: the same care must be adopted to improve accessibility to historic architecture, designing actions case by case. Starting from these considerations, the contribution is aimed to discuss the accessibility of fortified architecture, a not easily accessible heritage, to make it accessible both in a physical meaning as well as in cognitive, cultural and social. Particularly, the authors propose some reflections about alternative ways of usability for inaccessible architectures due to their typological configuration and as a consequence of previous conservation design. The case study is the medieval castle of San Michele in Cagliari (Sardinia), which was transformed several times during its life and restored at the end of the 20th century. The contribution analyses how a multidisciplinary approach is necessary for the formulation of effective accessibility solutions, especially in complex cases such as fortified architecture. This multidisciplinary approach must be accompanied by the widest possible consideration of the causes limiting accessibility, whether they are physical or related to motor, perceptive or cognitive disabilities.

Inclusive Path Through Pavia: A Study to Link the Langobardic Heritage

The Italian historic centers have an architectural and archeological heritage widespread in the urban structure, which is not always easily accessible due to the orography and materials the streets and the squares are paved with. The topic of the urban accessibility is extremely complex and not easy to solve, also because the removal and overcoming of the architectural and sensorial barriers that could alter the original layout and consolidated historical memory must be avoided. The research investigates the accessibility and usability conditions of the urban environment between the Langobardic building and archeological sites in Pavia (Italy) to identify pedestrian routes that can be covered by weak persons in autonomy or with the help of a companion. The analysis and synthesis of the urban environment produce some maps which report the level of accessibility of the streets and allow to identify the best route between the Langobardic masterpieces in the downtown. The adopted evaluation system is the result of an investigation methodology defined and consolidated over the years by the activities of a group of researchers from the University of Pavia and is independent of the heritage of Langobardic origin; the same methodology can also be used to other types of widespread heritage in the historic center of the city (Romanesque, Lombard Gothic, etc.). The same methodology can be exported to other historical centers and can constitute the tool for the promotion of the architectural and archaeological heritage.

A "Best Practice" for Inclusive Art Cities: The Case Study of the I-Access Project

The essay aims to illustrate the results of the I-Access Interreg Italia-Malta 2016-20 project, carried out by a partnership led by the Department of Architecture of the University of Palermo with the scientific coordination of Renata Prescia. The project involved the Vucciria district in Palermo and the Bijcceria district in Valletta. Within the framework of the products created (database, web platform, mobile apps, protocol, etc.), we would like to explain in this paper the measures taken to facilitate physical and cultural accessibility from the integrated point of view of restoration and exhibition design, that is, in particular measures to overcome architectural barriers, measures for cultural dissemination and measures of a museographic-communicative nature, including re-evocations of lost or dislocated monuments and artistic works. The proposal is designed as a method for historic urban areas that have similar problems to the district under study. The Vucciria, for example, despite its high density of monuments, has a low quality of life because many of its monuments, especially churches, are closed and therefore unusable and because there is little motivation for local people to engage with these monuments, partly because it is an evolving community. The proposal, therefore, provides for concrete actions to restore the memory of the inhabitants and to re-establish an identity bond with the context, with concrete implications for attracting widespread tourism to provide opportunities for renewal for the district. Project proposals included the installation of three urban totems, ten tactile maps associated with as many churches, and the design of two new access ramps to two churches. By being realized as smart additions in a contemporary and stimulating way compared to the interventions characterized by a solipsistic retour au passè and previously carried out in accordance with the philosophy of the current urban plan, they also become an educational opportunity for a dialoguing community.

Values-Based Conservation in Practice - Accessibility at Akershus Castle

Akershus Castle is one of Norway's most important historical monuments and is listed with the highest grade of protection. The earlier medieval castle from around the year 1300 is an arena for the Norwegian state and in use for such as government dinners and receptions. The castle is also an important tourist destination and is used for public events like concerts, etc. Until today, people in wheelchair have had to be carried into the buildings due to stairs and differences in levels inside. In the autumn of 2021 five measures that make large parts of the castle accessible, were completed. Making public buildings accessible has high priority in Norway. Having achieved this at Akershus Castle is of great symbolic value. During the process of defining the projects extent and measures the method values-based conservation was applied. This was done through involving several stakeholders in assessing and quantifying an array of values and criteria. On this basis it was possible to define the project, achieve the permits from the heritage authorities and get acceptance from the organisations representing people with disabilities. The result has been very well received by the public, stakeholders and by the cultural heritage authorities.

Manual wheelchair biomechanics while overcoming various environmental barriers: A systematic review

During manual wheelchair (MWC) locomotion, the user’s upper limbs are subject to heavy stresses and fatigue because the upper body is permanently engaged to propel the MWC. These stresses and fatigue vary according to the environmental barriers encountered outdoors along a given path. This study aimed at conducting a systematic review of the literature assessing the biomechanics of MWC users crossing various situations, which represent physical environmental barriers. Through a systematic search on PubMed, 34 articles were selected and classified according to the investigated environmental barriers: slope; cross-slope; curb; and ground type. For each barrier, biomechanical parameters were divided into four categories: spatiotemporal parameters; kinematics; kinetics; and muscle activity. All results from the different studies were gathered, including numerical data, and assessed with respect to the methodology used in each study. This review sheds light on the fact that certain situations (cross-slopes and curbs) or parameters (kinematics) have scarcely been studied, and that a wider set of situations should be studied. Five recommendations were made at the end of this review process to standardize the procedure when reporting materials, methods, and results for the study of biomechanics of any environmental barrier encountered in MWC locomotion: (i) effectively reporting barriers’ lengths, grades, or heights; (ii) striving for standardization or a report of the approach conditions of the barrier, such as velocity, especially on curbs; (iii) reporting the configuration of the used MWC, and if it was fitted to the subject’s morphology; (iv) reporting rotation sequences for the expression of moments and kinematics, and when used, the definition of the musculoskeletal model; lastly (v) when possible, reporting measurement uncertainties and model reconstruction errors.

Factors influencing participation among adults aging with long-term physical disability

BACKGROUND

People aging with long-term physical disability (AwPD) experience barriers to participation and independent living. There are currently limited evidence-based interventions that address issues regarding participation for people AwPD.

OBJECTIVE

This study examined factors influencing participation in personal and life activities among people AwPD to inform future interventions.

METHODS

A cross-sectional study within an ongoing, community-based cohort study of participation was conducted. A purposive sample of people AwPD aged 45-65, living with a physical disability for at least five years, and who speak English was recruited through disability organizations, aging organizations, and social media. Participants answered open-ended questions about what supports they needed to successfully participate in nine activity categories derived from the Health and Retirement Study participation items (e.g., employment, community leisure). A content analysis was conducted using NVivo to categorize responses, and member checking occurred with four additional people AwPD.

RESULTS

A total of 215 participants completed the survey. Eight categories of factors emerged from the data: physical environment factors, social factors, symptoms, economic factors, policy factors, body structure and functions, mental and emotional state, and temporal factors. Participant responses illuminated a combination of environmental and individual factors. Physical effects of disability and accelerated aging, such as pain and fatigue, paired with environmental factors, such as accessibility of transportation, were reported as influencing participation.

CONCLUSIONS

People AwPD experience a range of factors that substantially impact their ability to remain independent and participate in society. By identifying barriers to participation, new interventions addressing these barriers may be developed, resulting in more effective service provision, enhanced participation in personal and life activities, and improved health and well-being.

The Qualities of Architecture in Relation to Universal Design

Aesthetic experience of the built environment involves all our senses: the sight of colour and form; the echo in a room; the smell of wood; the touch of handrails; the refreshing cool air on the skin, and so on. However, the definition of universal design sets no criteria for aesthetics, only stating the functional requirements that need to be met. The term for many architects and planners is still too closely associated with legislations, regulations, and standards. Buildings designed by some of the pioneers of modern architecture have been briefly mentioned in relation to universal design: Le Corbusier and Frank Lloyd Wright's use of the ramp as an architectural element, Mies van der Rohe's plans, the fluent transition between inside and outside, through which people may move easily and effortlessly, and Alvar Aalto's design of details, such as door handles suitable for people of varying heights. However, their architectural works have greater potential as sources of inspiration with respect to moving buildings in a universal direction. Rem Koolhaas' innovative design for a client with reduced mobility and his library projects are examples of how a contemporary architect has used Le Corbusier's architecture as a source of reference. This paper refers to or includes works made by the above-mentioned architects to illustrate universal design and thereby discusses architectural qualities and aesthetics in relation to the needs of people with reduced mobility, vision and hearing.

How to Communicate Universal Design to Architects on a New Website? A Reflection on the Type of Knowledge Requested

Based on experiences with the development of a new research-based website on Universal Design meant to inspire and qualify the work of the Danish building sector, this paper examines the types of knowledge requested by professionals in the building sector when working with Universal Design. The Danish Transport, Construction and Housing Authority commissioned a website with the aim of increasing the building sector's knowledge of Universal Design and supporting a change in attitude towards universal design. The site is intended to function as a platform for disseminating knowledge about Universal Design that can support the regulatory system. The empirical material of the study consists of data from qualitative interviews with actors from the building sector and workshops with the advisory board of the website. The analysis shows that, on one hand, the sector requires good examples of Universal Design and knowledge about users and their needs and, on the other hand, it needs detailed help such as comprehensive checklists to ensure the appropriate process is undertaken. However, technical information about, for example, the gradient of a ramp, does not contribute to an architectural idea and will not change any mindsets in regard to Universal Design. This paper reflects on the duality of requests from the sector using the theoretical concept of liminality. The paper describes and argues for the chosen approach for the website, namely focusing on inspiring and assisting professionals in the building sector to enhance their level of knowledge and support a change in practice towards Universal Design.

Sociodemographic characteristics associated with physical activity barrier perception among manual wheelchair users

BACKGROUND

Individuals with disabilities are sub-optimally active and at increased risk for chronic diseases. Limited knowledge exists about how differences among wheelchair-dependent individuals may affect their perception of physical activity barriers.

OBJECTIVE

We examined whether the perception of physical activity barriers are associated with wheelchair user sociodemographic characteristics.

METHODS

Danish manual wheelchair users (MWCUs) (N = 181; 52.5% females, mean ± SD: age 48 ± 14 yrs) completed the 'Barriers to Physical Activity Questionnaire for People with Mobility Impairments' (BPAQ-MI) online. The BPAQ-MI queries physical activity barriers in four domains (intrapersonal, interpersonal, organizational, and community) and eight subdomains. Participant characteristics evaluated as potentially associated with physical activity barriers included age, sex, years in chair, body mass index (BMI), spinal cord injury (SCI) (if any), education, employment, and resident city size. Simple linear regression (step 1) and multiple regression models (step 2) were created to assess associations between MWCU characteristics and barriers.

RESULTS

Multiple regression models revealed that MWCUs who were obese, who did not complete high school, or were unemployed rated physical activity barriers higher across several subdomains (all r²≤0.226, p<0.05). Resident city size was associated with safety subdomain barrier impact (r²=0.039, p<0.05). Sex, age, years in chair and SCI were not associated with any barrier domains (all p ≥ 0.064).

CONCLUSIONS

Our results provide new evidence that MWCUs with BMI ≥30; who are not employed; or who only have completed high school, may need special consideration and resources to overcome distinct physical activity barriers. Behavioral strategies and interventions focusing on reducing physical activity barriers should be tailored to the individuals above.

Improving mental health and wellbeing in elderly people isolated at home due to architectural barriers: A community health intervention

OBJECTIVES

To explore the health effects of a community health intervention on older people who are isolated at home due to mobility problems or architectural barriers, to identify associated characteristics and to assess participants' satisfaction.

DESIGN

Quasi-experimental before-after study.

SETTING

Five low-income neighbourhoods of Barcelona during 2010-15.

PARTICIPANTS

147 participants, aged ≥59, living in isolation due to mobility problems or architectural barriers were interviewed before the intervention and after 6 months.

INTERVENTION

Primary Health Care teams, public health and social workers, and other community agents carried out a community health intervention, consisting of weekly outings, facilitated by volunteers.

MEASUREMENTS

We assessed self-rated health, mental health using the General Health Questionnaire (GHQ-12), and quality of life through the EuroQol scale. Satisfaction with the programme was evaluated using a set of questions. We analysed pre and post data with McNemar tests and fitted lineal and Poisson regression models.

RESULTS

At 6 months, participants showed improvements in self-rated health and mental health and a reduction of anxiety. Improvements were greater among women, those who had not left home for ≥4 months, those with lower educational level, and those who had made ≥9 outings. Self-rated health [aRR: 1.29(1.04-1.62)] and mental health improvements [β: 2.92(1.64-4.2)] remained significant in the multivariate models. Mean satisfaction was 9.3 out of 10.

CONCLUSION

This community health intervention appears to improve several health outcomes in isolated elderly people, especially among the most vulnerable groups. Replications of this type of intervention could work in similar contexts.

Wheeled Mobility Use on Accessible Fixed-Route Transit: A Field Study in Environmental Docility

Multiple field studies provide qualitative accounts of usability barriers experienced by users of wheeled mobility devices on public transit. This study aimed to examine these usability barriers from the theoretical perspective of Environmental Docility by quantifying the relationship between functional capabilities of wheeled mobility device users and ingress-egress performance on accessible fixed-route transit vehicles in an urban setting. Twenty-eight wheeled mobility users each completed three trips on a predetermined route through the local public transit system. Ingress and egress times, user-reported usability ratings and open-ended comments were analyzed. Regression analyses indicated significant interactions between age and minimum parallel-park length on ingress and egress times. Specifically, lower functional capability reflected in older age and less maneuvering ability predicted decreased performance (longer ingress-egress times), indicating less adaptability to environmental demands and agreement with the Environmental Docility Hypothesis. Usability ratings and comments revealed difficulty with negotiating access ramps and turning maneuvers in the vehicle interior and in proximity to other passengers. Despite compliance with accessibility standards, current design of transit vehicles present substantial usability barriers for wheeled mobility users. Environmental Docility provides a theoretical basis to identifying modifiable factors related to person and environment for improving usability of public transit for people aging and/or with mobility impairments.

Spatial accessibility of general inpatient care in Germany: an analysis of surgery, internal medicine and neurology

Improving spatial accessibility to hospitals is a major task for health care systems which can be facilitated using recent methodological improvements of spatial accessibility measures. We used the integrated floating catchment area (iFCA) method to analyze spatial accessibility of general inpatient care (internal medicine, surgery and neurology) on national level in Germany determining an accessibility index (AI) by integrating distances, hospital beds and morbidity data. The analysis of 358 million distances between hospitals and population locations revealed clusters of lower accessibility indices in areas in north east Germany. There was a correlation of urbanity and accessibility up to r = 0.31 (p < 0.001). Furthermore, 10% of the population lived in areas with significant clusters of low spatial accessibility for internal medicine and surgery (neurology: 20%). The analysis revealed the highest accessibility for heart failure (AI = 7.33) and the lowest accessibility for stroke (AI = 0.69). The method applied proofed to reveal important aspects of spatial accessibility i.e. geographic variations that need to be addressed. However, for the majority of the German population, accessibility of general inpatient care was either high or at least not significantly low, which suggests rather adequate allocation of hospital resources for most parts of Germany.

Developing Content for the Food Environment Assessment Survey Tool (FEAST): A Systematic Mixed Methods Study with People with Disabilities

Almost 1 in every 8 adults in the U.S. have a physical disability that impairs mobility. This participatory project aimed to identify and describe environmental and personal barriers to healthy eating among people with mobility impairments using a rigorous, structured mixed methodology. Community-dwelling adults with a self-reported mobility impairment (N = 20, M = 40.4 years old, 60% female) participated in nominal group technique focus groups. The Ecologic Model of Obesity grounded stimulus questions asked about barriers to obtaining and preparing healthy food. Participants emphasized common barriers across everyday settings—focusing, for example, on the ability to reach shelved food inside the home, navigating to and inside stores and restaurants, and using delivery services. Home environments often did not afford suitable spaces for food preparation and storage. Participants reported inadequate transportation and numerous additional barriers in many settings to be able to eat healthfully. Participants reported lack of accessible transportation and architectural barriers inside stores, restaurants, and their own homes, highlighting the need for efforts aimed at improving accessibility and usability. Findings support the use of the Ecologic Model of Obesity to guide research and suggest the need for improvement in assessment practices and policies that enhance access to healthy food.

An ergonomic comparison of three different patient transport chairs in a simulated hospital environment

The purpose of this study was to compare caregiver muscle activation and joint angles between two ergonomic transport chairs designed to mitigate discomfort and safety risks associated with patient transport, the Stryker® Prime TC and the Staxi® Medical Chair, and a depot wheelchair. Twenty-three caregivers completed level walking and ramped tasks with each device and an 84 kg manikin. Surface electromyography for the upper extremities and back muscles and motion data were collected. The Staxi showed a statistical trend for higher wrist extensor and flexor carpi ulnaris activity compared to the Stryker chair (p ≤ 0.078) and greater wrist flexion than the Stryker and depot chairs (p ≤ 0.004). The depot chair showed greater peak trunk flexion than the Stryker chair (p = 0.004). Overall results suggest that ergonomic chair design may improve joint positioning of the trunk and elbows when operating patient transport chairs over level and ramped surfaces.

Measuring Environmental Barriers: Validation and Cultural Adaptation of the Italian Version of the Craig Hospital Inventory of Environmental Factors (CHIEF) Scale

The study aimed to validate an Italian translation of the Craig Hospital Inventory of Environmental Factors (CHIEF) environmental assessment tool. The CHIEF scale was administered throughout Italy to 506 individuals who did not present with serious and/or disabling diseases. The results show an excellent interrelation between CHIEF scale items and the subscales. Furthermore, our analysis demonstrates that following repeated administration to the same participants, the instrument maintains excellent stability of each subscale for the frequency, magnitude, and impact of the barriers. This study demonstrates that the Italian version of the CHIEF scale is reliable for measuring environmental barriers. The findings show that the scale is suitable for the clinical and research fields to broaden our knowledge about this relevant yet poorly studied field.

Social Participation Among Adults Aging With Long-Term Physical Disability: The Role of Socioenvironmental Factors

Objective: This study examined the environmental barriers and facilitators that hinder or promote participation among adults aging with physical disabilities. Method: Data come from an ongoing study of 1,331 individuals aging with long-term physical disability (M = 65 years). Linear regression examined the association between individual and socioenvironmental factors and participation restrictions in work, leisure, and social activities. Results: Pain, fatigue, and physical functional limitations were significant barriers to participation for individuals aging with physical disability. Barriers in the built environment also reduced participation, net of health and functioning. Poor access to buildings was especially problematic for participation among individuals not using any mobility aid to get around. But for those using wheel or walking aids, environmental barriers had no adverse effect on participation. Discussion: These findings highlight the importance of disentangling the role of different environmental factors by distinguishing between assistive technology for mobility and the physical built environment, including their interactive effects.

Effects of applying a standardized assessment and evaluation protocol in housing adaptation implementation - results from a quasi-experimental study

BACKGROUND

Standardized, research-based strategies to guide the implementation and evaluate the effects of housing adaptations (HA) on client outcomes are rare. We hypothesized that, compared to ordinary practice, a standardized assessment and evaluation protocol for HA implementation would better maintain or improve client outcomes over 1 year.

METHOD

Using a cluster design, South Swedish municipalities were recruited to an intervention or control group. Data on activities of daily living, usability of the home, health related quality of life, and participation frequency and satisfaction were collected at home visits 1 month before the HA (baseline; T1), and at 3 (T2), 6 (T3) and 12 (T4) months after. In the intervention group (n = 112) data were collected according to a standardized protocol while in the control group (n = 129) ordinary routines were applied. Changes from baseline to subsequent time points were categorized as no deterioration (i.e. improvement or no change) or deterioration, for each outcome item separately. Differences in "no deterioration" between the groups were assessed using logistic regression.

RESULTS

Little effect of using the standardized protocol was detected. For activities of daily living, statistically significant differences between the groups were found for toileting (T1-T4; OR 3.14), dressing (T1-T4; OR2.89) and cooking (T1-T3 and T1-T4; OR 3.14). For usability of the home differences were found in personal hygiene (T1-T2; OR 2.32) using a wheelchair (T1-T2 and T1-T3; OR 9.50), picking up the mail (T1-T3; OR 4.06), and in participation, helping others (T1-T3 and T1-T4; OR 2.33 and 3.36).

CONCLUSION

The applied standardized protocol for HA implementation did not show any convincing effect, possibly due to the complexity of the intervention itself, and the implementation process. A process evaluation might generate in-depth knowledge about the reasons behind the findings.

TRIAL REGISTRATION

ClinicalTrials.gov . NCT01960582.

A Heuristic Approach to Overcome Architectural Barriers Using a Robotic Wheelchair

The Mobility Enhancement roBotic (MEBot) wheelchair was developed to improve the safety and accessibility of wheelchair users when facing architectural barriers. MEBot uses pneumatic actuators attached to its frame and six wheels to provide curb ascending/descending for heights up to 20.3 cm. To improve MEBot's application, this study used a heuristic approach with power wheelchair users to evaluate and improve the MEBot application at different curb heights. Wheelchair users were trained on MEBot's features to operate its curb ascending/descending application. Three trials were carried out with wheelchair users ascending and descending three curbs of different height. Quantitative variables were analyzed to improve the sequential steps to ascend/descend curbs. Additionally, the application's effectiveness and efficiency were measured by the number of completed tasks, change in seat angle, and task completion time. Results showed that participants completed each trial and applied alternative strategies to traverse different curb heights. Furthermore, results suggested the combination and/or re-arrangement of steps to reduce task completion time. MEBot demonstrated its effectiveness to ascend/descend different curb heights with a heterogeneous participant sample. Future work will incorporate participant's most efficient strategies to improve the ascending/ascending process and the efficiency of the MEBot application.

Factors influencing the community integration of patients following traumatic spinal cord injury: a systematic review

BACKGROUND

Spinal cord injury (SCI) is a high-cost disabling condition, which brings a huge number of changes in individual's life. The emphasis of rehabilitation has moved from medical administration to issues that affect quality of life and community integration. This systematic review was conducted to identify the factors associated with community reintegration of patients with spinal cord injury. .

METHODS

Google Scholar, PEDro, Pakmedinet, AMED, BIOMED central, Cochrane Library, MEDLINE, PsychoINFO, PUBMED, ScienceDIRECT, Scirus and Wiley Online Library databses were searched by using key words 'Spinal cord injury' 'Paraplegia' or 'Spinal Cord Lesion' or Tetraplegia. They were cross-linked with 'Community reintegration', 'Community participation' and 'Community access'. The methodological quality of the studies included was analysed by using McMaster University Tool and Thomas Tool. The data extracted included sample size, intervention, duration, results, outcome measures, and follow-up period.

RESULTS

A total of 11 relevant studies were located. The evidence extracted was classified into four groups; health-related barriers or facilitators, environment-related barriers or facilitators, psychological barriers and social barriers that are associated with community reintegration of such individuals.

CONCLUSIONS

The review revealed that there were more barriers in the form of health-related issues, personal and environmental, psychological and social issues that hinder the community reintegration of individuals with spinal cord injury compared to facilitators. Most studies identified special challenges related to environment in the sense of accessibility of home and public buildings and transportation. Removing barriers related to health, environment, and psychological and social factors can enhance community reintegration of such patients.

The Actual Demand for the Elimination of Architectural Barriers among Senior Citizens in Poland

The purpose of the study is to determine the actual demand for the elimination of architectural barriers among senior citizens in their place of residence and also in its immediate environment in Poland. The research covered a group of people in the post-productive age, living in the Lower Silesia voivodship in Poland. Different research methods were used in the study, primarily including the public opinion survey based on a questionnaire as well as statistical analyses. The cross-tabulation analysis of differences in quality characteristics was performed using Pearson's chi-square test (χ² test of independence) or Fisher's exact test, when the expected number was lower than five. As a post hoc analysis, checking the nature of differences between the studied groups, the analyses were carried out using the method by Baesley and Schumacker. For all analyses, the maximum permissible error class I α = 0.05 was adopted, whereas p ≤ 0.05 was considered statistically significant. The research revealed that a much larger group of people aged 55 and older suffers from mobility limitations than the ones resulting from disability certificates, thus confirming the assumption that along with the respondents' age, their mobility limitations intensify, resulting in the need for assistance while moving outside their houses/apartments.

Design and Development of a Mobile App for Accessible Beach Tourism Information for People with Disabilities

The global increase in the proportion of the population with disabilities has caused a greater awareness toward guaranteeing their use of public services. In particular, there is emphasis on the accessibility and inclusivity of tourism resources, to improve the enjoyment and well-being for people with motor disabilities. This paper presents a case study on accessibility to beaches in the Region of Murcia, Spain, which is one of the main tourist areas in the country. First, the most important elements that allow for the accessible use of beaches are analyzed and exposed in detail. Then, an extensive field-work in the area of interest has been carried out and its results are evaluated. Finally, the development of a new mobile app is described. The objective of this tool is to provide updated, accurate, and reliable accessibility information regarding the beaches. As a result, more than a third of the beaches analyzed had a high level of accessibility, while almost another third are totally inaccessible. The proposed application is a valuable tool, not only to help people with physical and motor disabilities, but also to raise awareness among local authorities to create and improve accessible services.

Meaningful occupations of young adults with muscular dystrophy and other neuromuscular disorders

BACKGROUND.

Youth with Duchenne muscular dystrophy (DMD) and other neuromuscular disorders are living well into adulthood and often need help engaging in meaningful occupations.

PURPOSE.

Our purpose was to explore enablers and barriers to engaging in meaningful occupations, from the perspectives of youth, parents, and practitioners.

METHOD.

This qualitative study involved 26 participants (11 parents, eight youth ages 19 to 28 [mean = 22.3 years], seven practitioners). Data were obtained from semistructured interviews and analyzed using an interpretive descriptive approach.

FINDINGS.

Youth with DMD and neuromuscular disorders engage in meaningful occupations in a variety of ways. Occupational enablers were supports and accommodations and self-care skills and coping strategies, while occupational barriers involved societal expectations of a normative adulthood, discrimination and inaccessible environments, lack of supports and resources, medical challenges, fatigue, lack of motivation, and social isolation and depression.

IMPLICATIONS.

Practitioners should work to uncover what youth consider important and connect them to appropriate resources so they can engage in meaningful occupations.

Self-reported difficulty and preferences of wheeled mobility device users for simulated low-floor bus boarding, interior circulation and disembarking

BACKGROUND

Low ridership of public transit buses among wheeled mobility device users suggests the need to identify vehicle design conditions that are either particularly accommodating or challenging. The objective of this study was to determine the effects of low-floor bus interior seating configuration and passenger load on wheeled mobility device user-reported difficulty, overall acceptability and design preference.

METHODS

Forty-eight wheeled mobility users evaluated three interior design layouts at two levels of passenger load (high vs. low) after simulating boarding and disembarking tasks on a static full-scale low-floor bus mockup.

RESULTS

User self-reports of task difficulty, acceptability and design preference were analyzed across the different test conditions. Ramp ascent was the most difficult task for manual wheelchair users relative to other tasks. The most difficult tasks for users of power wheelchairs and scooters were related to interior circulation, including moving to the securement area, entry and positioning in the securement area and exiting the securement area. Boarding and disembarking at the rear doorway was significantly more acceptable and preferred compared to the layouts with front doorways.

CONCLUSION

Understanding transit usability barriers, perceptions and preferences among wheeled mobility users is an important consideration for clinicians who recommend mobility-related device interventions to those who use public transportation. Implications for Rehabilitation In order to maximize community participation opportunities for wheeled mobility users, clinicians should consider potential public transit barriers during the processes of wheelchair device selection and skills training. Usability barriers experienced by wheeled mobility device users on transit vehicles differ by mobility device type and vehicle configurations. Full-scale environment simulations are an effective means of identifying usability barriers and design needs in people with mobility impairments and may provide an alternative model for determining readiness for using fixed route buses or eligibility for paratransit.

Services, systems, and policies affecting mobility device users' community mobility: A scoping review: Services, systèmes et politiques influençant la mobilité dans la communauté des utilisateurs d'aides à la mobilité : examen de la portée

BACKGROUND

Opportunities to travel from one place to another in the community, or community mobility, are especially important for mobility device users' ability to participate fully in society. However, contextual challenges to such mobility exist.

PURPOSE

This study summarizes the literature on existing community mobility barriers and facilitators of mobility device users created by services, systems, and policies as defined by the International Classification of Functioning, Disability, and Health (ICF).

METHOD

Arksey and O'Malley's approach for scoping studies was used for the review. The extraction chart was organized following the ICF, and frequency counts were used to report the data.

FINDINGS

The findings suggest that certain factors, such as transportation, open-space planning, and architecture and construction, influence community mobility opportunities. However, little attention has been paid to services, systems, and policies in the research literature, limiting the knowledge on the subject.

IMPLICATIONS

Further research is needed to examine the relationship between specific services, systems, and policies and mobility device users' mobility within their communities.

Mapping Out One's Own Paths Toward Work: Focus on Experiences of Return to Work After Spinal Cord Injury

Involving persons with spinal cord injury (SCI) as experts in their lives is important for research to design relevant health care interventions. The purpose of this study was to use photovoice methods to explore experiences of barriers and possibilities in return to work among working adults with SCI. The photovoice group consisted of six persons living with SCI that met weekly over 2 months to share and discuss photos related to return to work. Five themes were identified: (a) there is only one way, (b) welcome back-or not, (c) to be like anyone else-or to be perceived as someone else, (d) friction in the absence of clarity, and (e) finding integrated strategies for everyday life with work. Work was experienced as rewarding and viable, but due to lack of societal and workplace support, a need to map out one's own paths toward work was identified.

Breast cancer screening in women with cerebral palsy: Could care delivery be improved?

BACKGROUND

Women with disabilities (WWD) have reported lower mammography rates than the general population, however rates for women with cerebral palsy (CP) have not been specifically studied.

OBJECTIVE

To evaluate mammography rates in women with CP and to identify strengths and barriers with their screening experience.

METHODS

Women with CP 40 years or older (n = 118) participating in a prospective cross-sectional survey were queried regarding screening status, imaging modality, and accommodation needs and availability. Categorical variables were summarized and Chi-square testing used to assess factors contributing to screening compliance. The effect of functional factors on screening was evaluated using logistic regression.

RESULTS

77 women (65.3%) had mammograms within the past two years; 56 (47.5%) were screening mammograms. Severity of fine motor deficits was associated with lack of screening (OR 0.559, p = 0.019). 85 (72.0%) experienced positive staff attitudes. Facilities most often met needs for ramps, elevators, and/or wide doorways (92.9%), exam explanations (84.4%), and accessible parking (82.5%). Needs least often met included accommodations for standing (59.3%) or for difficulties with arm/shoulder positioning (57.1%), and wheelchair-accessible mammogram machines (59.1%).

CONCLUSIONS

The screening compliance rate for women with CP is low, although the 2-year mammography rate is comparable to that reported for WWD and the general female U.S.

POPULATION

Women were usually offered respectful care. Adequate physical accommodations during the procedure were reported less often than overall facility environmental accommodations. These findings demonstrate the need for improved screening rates in women with CP, and highlight areas for improving their screening experience.

Tools to Upgrade Facilities for All: How to Improve Business Dealing with Tourism

Providing quality services to any traveller requires constant efforts to ensure that tourist destinations, products, and services are accessible to all people, regardless of their health condition, physical limitations, gender, origin, age. This entails a collaborative process among all the interested parties: administrators, tourist agencies, tour operators, and end users, who expressing their points of view can objectively contribute to reach shared and effective solutions. A single visit destination can involve many factors, including access to information: the project A Region for All, promoted by Promoturismo FVG in collaboration with CRAD FVG and the University of Trieste, focused on this issue. Promoturismo FVG is a semi-public destination management organization. Its mission is to develop the regional tourism system collaborating with all the active subjects to improve the promotion and to optimize the resources by concentrating the efforts. The organization pursues its objectives by planning and organizing the offer through specific tourism products. In 2016 a mapping process has been started to investigate the usability of the relevant services to tourists / visitors with special needs along the itinerary of eight tourist centers of the Friuli Venezia Giulia region. To date, more than 200 facilities (bars, restaurants, pharmacies, cash machines…) have been detected. The paper will present the development of the work conducted by TrIAL - Trieste Inclusion &amp; Accessibility Lab at Department of Engineering and Architecture within the University of Trieste for the management of the mapping process. On the strength of the mapping experience developed during the previous project LabAc (Laboratory of Accessibility) for the Province of Trieste and the project Trieste for All for the Municipality of Trieste (from 2013 to 2016), the research group has adopted and set a series of digital tools, has identified specific indicators and has focused on an efficient return of data to Promoturismo FVG. The overall project is still ongoing: collected data have not yet been published by the organization. Overall monitoring and evaluation activities are still lacking and will be part of a future phase of research.

Availability and need of home adaptations for personal mobility among individuals with spinal cord injury

OBJECTIVE

To identify the availability and unmet need of home adaptations (HAs) among the Swiss population with spinal cord injury (SCI).

DESIGN

Cross-sectional study.

SETTING

Swiss Spinal Cord Injury Community Survey 2012.

PARTICIPANTS

Individuals aged 16 or older with chronic SCI living in Switzerland.

INTERVENTIONS

Not applicable.

OUTCOME MEASURES

The availability of ten HAs (self-report) was analyzed by sex, age, living situation, indoor mobility, SCI severity, SCI etiology and time since SCI. The unmet need (self-report of not having a HA but needing it) of HAs was analyzed by financial hardship.

RESULTS

Among the 482 study participants (mean age 55.2 years, standard deviation 15.0 years, 71.6% males), 85.1% had at least one HA. The most frequent HA was a wheelchair accessible shower (62.7%). Availability of HAs markedly varied with indoor mobility (e.g. 38.4% of participants using a wheelchair had a stair lift compared to 17.4% of those walking) and with SCI severity (e.g. 54.8% of those with complete paraplegia had a wheelchair accessible kitchen worktop compared to 26.0% of those with incomplete paraplegia). Unmet need was highest for adjustable kitchen worktops (78.7% of those with a need) and adjustable kitchen cabinets (75.7%) and lowest for wheelchair accessible showers (9.4%) and grab bars next to the toilet (8.5%). No significant differences in unmet need were found when stratifying for financial hardship.

CONCLUSION

Availability of HAs is dependent on indoor mobility and SCI severity. There is a considerable degree of unmet need for selected HAs, which couldn't be explained by financial hardship.

Housing Design for the Ageing: Struggle Toward Supporting Age-in-Place Instead of Special Housing for Seniors

With the global trend of population ageing, efforts are in progress in many countries to cope with the problems associated with it. As one grows older, his/her capabilities gradually deteriorate. What need to be done to mitigate mismatch of dwelling design, and to enable age-in-place? A comparative study of design guidelines in Japan, UK and USA is conducted to find out challenges and opportunities we are faced with. In Japan, design guidelines for the ageing society were proposed in the early 1990s, and they have been used ever since in several contexts. Although they were not mandatory, policy-linked incentives have worked to some extent. In the UK, Lifetime Homes concept has been formulated, and it seems to have gained momentum with its adoption in the Approved Document M. In the USA, Fair Housing Amendment Act in 1988 [5] introduced requirements on wheelchair accessibility on rental sector, and Visitability concept, less stringent than liveability, is being adopted in some localities. Although wheelchair accessibility is not the same as design for the ageing, most of the issues are shared. What are the problems we still face with, revealed from the survey? First is the time lag between acquisition of the dwelling versus one's senior years, which sometimes extends to 40 years. Second, many of the dwellings are already built with lower standards than desirable, not as new construction. Third, home modification quite often lacks financial support through government policy. This presentation will give some proposals toward improvement over the situation.

Clients' Approach to Universal Design - A Slow Change?

When new buildings do not comply with the accessibility requirements of the Danish Building Regulations, the main reason is often attributed to a lack of knowledge and prioritization. It is the experience of architectural firms that clients decide their own focus on accessibility during the design process, and also whether the level of accessibility should be higher than that stipulated in the Danish Building Regulations. Post-occupancy evaluations point out that when the client is particularly conscious of, or ambitious about, accessibility/Universal Design (UD), the result is a building with an extensive level of accessibility. Thus, the client is a key figure for the project and the level of ambition. Based on interviews with 15 Danish clients, this paper presents a characterisation of their conception of Universal Design. It is significant that, as a concept, UD has not gained currency among the clients that let their ambition level be defined by the Danish Building Regulations. In order to capture differences between clients, a description of the client's conception of users and designs is based on an analytical framework about the concepts of particular, universal, market and equality. The analysis shows that three conceptions about accessibility/UD can be characterized among the clients: 1) accessibility by design, 2) broad accessibility 3) added value. Above all, the findings show that a development is going on towards UD, although slowly.

Universal Design as a Technical Norm and Juridical Term - A Factor of Development or Recession?

Universal design was introduced as an ideological and technical concept in Norway in 1996 and was introduced in the first law in 2003. Since then universal design has replaced accessibility for people with disabilities in national policies, laws, regulations, standards, projects and everyday language. Accessibility is now used to characterize solutions made more exclusively for people with disabilities or when a high, general quality is not required. Few countries have made this extensive use of the concept of universal design and the concept has faced several challenges from lawmakers, architects, economists, user organizations, entrepreneurs and debaters. This paper reflects on some aspects of more than 20 years of extensive use of the concept of universal design and try to answer the question: Is universal design an academic invention with little extra positive impact compared to accessibility for people with disability, or does the concept defend its supposed role as a step towards a society with equal opportunities for all?

Achieving Success of "Accessible India Campaign" Through Universal Design Education in India

The Prime Minister, "Shri Narendra Modi" of India, launched "Sugamya Bharat Abhiyan" (Accessible India Campaign), on 3rd, December 2015. It is a nationwide flagship campaign for achieving universal accessibility for "Persons with Disabilities" and to create an enabling and barrier free environment, with a focus on three verticals; "Built Environment", "Public Transportation" and "Information and Communication Technologies" [1]. The Accessible India Campaign comprises of the following key components:- (i) Create Mass Awareness; (ii) Capacity Building; (iii) Interventions (Technology solutions, Legal framework, Resource generation); (iv) Leverage corporate sector efforts including CSR resources; (v) Leadership endorsements [1] . In the key components stated above two major components are; 1. Mass Awareness and 2. Capacity Building. To achieve both these components, the need is to develop a knowledge base through which stakeholders associated with built environment development and creation can be brought at one platform and awareness towards universal accessibility can be created among the people at large. Thus this study is an attempt to identify the possibilities to make the "Accessible India Campaign" a success through "Universal Design Education" and to establish and validate the need of universal design in making the "Accessible India Campaign" a success. The study attempts to establish the need of "Universal Design Education' in India. The need of a discipline with which the designers at all levels of design ranging from product, interiors, architecture and planning of built environment can create sustainable, accessible, living environment in India.

Universal Design, but at What Cost? A Case Study on Lifts in Norwegian School Competitions

In a larger perspective, this paper investigates architects' and contractors' attitude towards universal design in the competition phase of the largest school building projects. Three Design Build school competitions with negotiations and one limited architecture competition are examined in terms of to what degree the competitors are willing to invest in lifts. The Norwegian Building Code requires a lift in all public buildings with two or more storeys, and the lift should be easy to locate with its access close to the main entrance. However, a school building often has more main entrances, as the different age groups each tend to have their own entrances. This seems to put the competitors in a dilemma concerning the correct interpretation: Is it sufficient with simply the one lift at the official main entrance, or is it necessary with more lifts in connection with the entrances for the different age groups? The results show that despite the requirements in the Building Codes and the competition briefs, the competitors tend to prioritize lower bids in favor of optimal universally designed buildings. The results also show that any school design, with some reasonable effort, could reach a lift detour of maximum three minutes when using the calculation model applied in this research. However, from a lift user's point of view, any kind of detour may be experienced socially excluding and unacceptable.

Simulating Disability in Universal Design Teaching: A Critique - Abandoning Try-It-Yourself in Teaching Universal Design in Architecture

Blindfolding people and providing them with white cane or placing them in a manual wheelchair for 20-60 minutes is a much used and classic exercise when teaching architects and other professionals the basics of user needs related to disability. This method, called try-it-yourself, is the most prevalent method where universal design in taught in the Nordic region. While the exercise is often praised for ensuring an effective 'eye-opening' outcome, the ethical aspects, the absence of the users themselves or the possibilities of alternative methods for teaching user needs appear to be non-existing. The article is based on literature studies and 1:1 experience gained from our Master program in universal design, where the try-it-yourself exercise is analyzed and discussed. The article argues that the exercise, as opposed to its original intention, appears to increase disability stigma and ethical dilemmas. Hence, it needs to be challenged as the prevalent exercise used for teaching universal design and accessibility. The article also discusses alternative methods for teaching user needs. Furthermore, the article discusses the tacit cultural acceptance of the exercise, as well as the ethical dilemmas in the non-existing debate of what is actually being tried-yourself in the exercise. The article also presents possible reasons for the significant absence of an open critical debate about the pros and cons of the exercise, as it is being used non-critically in the Nordic region.