Читать книгу Aging People, Aging Places - Группа авторов - Страница 10
ОглавлениеAtiya Mahmood and Delphine Labbé
According to propositions of the ecological model of aging (Lawton and Nahemow, 1973), the environment plays a significant role in outcomes for older persons experiencing a decline in competence, such as limitations in their cognitive and physical functioning. Other scholars have also noted that the immediate home and neighbourhood environments become increasingly important for older adults, as they are less likely to be working or have the ability to access a variety of locations in the urban environment (Glass and Balfour, 2003). As a result of health issues faced in advanced age, very old people tend to decrease their action range and spend large portions of the day at home and the ‘immediate outdoor environment’ (Oswald et al, 2010, p 238). Research showed that the physical environment close to home (two to three city blocks) has a strong relationship with mobility and social participation among older adults, especially those with mobility disability (Clarke et al, 2011; Williams and Willmott, 2012; Chaudhury et al, 2016). Lack of accessibility in urban neighbourhoods due to poorly designed public spaces may prevent older adults from fully participating in society.
Multiple studies have documented the influence of environmental factors on the mobility and social participation of older adults and people with disabilities (Rosso et al, 2011; Hanson et al, 2013; Bigonnesse et al, 2018). For instance, Rosso and colleagues (2011) proposed that within the built environment, transportation systems (eg traffic-related street characteristics or walking paths), land-use patterns (eg density, proximity of amenities), and urban design (eg aesthetics or neighbourhood decay) affected the mobility of older adults. Another recent review of the literature (Bigonnesse et al, 2018) has highlighted that proximity and accessibility of destinations facilitated mobility for mobility device (MD) users, while sidewalks and street conditions, poorly designed or absent crosswalks, and traffic congestion were barriers to the neighbourhood environment. However, although empirical research in this area is growing, there is limited knowledge about which barriers or facilitators foster or deter mobility and social participation in the neighbourhood physical and social environment by older adults using MD (Botticello et al, 2014; Clarke, 2014; Harris et al, 2015).
This chapter presents the results of neighbourhood built-environment audits and photo elicitation from a study conducted in the Greater Vancouver Area in British Columbia (BC) to explore the barriers and facilitators encountered by older MD users.
Methods
Photovoice and environmental audits were the two participatory methods used in a mixed-method study entitled ‘Enabling Mobility And Participation among those with Disabilities (dEMAND)’. The dEMAND study was conducted in two provinces in Canada: BC and Québec. In BC, three cities/municipalities were included: Vancouver, North Vancouver, and New Westminster. This research was conducted as part of a multi-phase and multi-site study titled the Canadian Disability Participation Project.
Photovoice
For the photovoice data collection, the participants took pictures or videos of the mobility- and participation-related barriers and facilitators they encountered in their daily life over a two-week period. For each picture, they noted the location and reason for taking that picture. Individual interviews were then conducted with participants to discuss their most significant photographs, followed by focus group sessions with some participants to identify common themes from the pictures. The interviews and the focus groups data were analysed using an inductive thematic analysis approach (Braun and Clarke, 2006). Photographs and their associated quotes were grouped under identified themes, based on the focus group themes. A photo exhibit was developed that showcased pictures from the three cities around the themes. This exhibit was presented in community outreach events with different urban stakeholders.
‘Stakeholders’ walkability/wheelability audit in neighbourhood’ – SWAN
An easy-to-use neighbourhood environmental audit tool designed for older adults and persons with mobility called ‘Stakeholders’ Walkability/Wheelability Audit in Neighbourhood’ (SWAN) was used in this study. SWAN allowed participants to evaluate both objective and subjective features that affect their mobility and social participation within their neighbourhoods (Mahmood et al, 2019). The tool consisted of objective and subjective items across five domains: functionality, safety, appearance and maintenance, land use and supportive features, and social aspects. In this research, we used Forsyth’s (2015) summary of walkability, which includes dimensions such as being traversable (eg allow to go from one path to the other), compact (eg short distance between destination), safe, usable (eg sidewalks and crosswalks are in good condition), and supporting social interaction and physical activity for all pedestrians, including older adult or person with a disability. Based on the same dimensions, we defined wheelability as the extent to which the environment supports the ability to move around for a person who uses an MD with wheels (eg manual wheelchair or scooter). Three community forums (one in each city) were held to discuss the SWAN preliminary findings with participants and key stakeholders, such as urban planners and advocacy groups.
Complementarity of the approaches
The photovoice method and the SWAN audits complemented each other. They both focused on the assessment of the environmental barriers and facilitators; however, in photovoice, the participants captured that through photography of their daily lives, and in the SWAN audits, they conducted a structured assessment of specific sections of their neighbourhoods. The SWAN provided both objective and subjective quantitative data on the environmental features in the participants’ local neighbourhoods, while the photovoice pictures and interviews provided more contextual subjective qualitative information. Comparison of data from both sources helped to demonstrate complementarity and convergence of data (Farmer et al, 2006); sometimes the same barriers or facilitators were emphasized by both sources, while at other times, each shed light on different aspects of the environment. These data jointly provided an in-depth and nuanced information on salient social and physical environmental features that impact the mobility and inclusion of older MD users.
Findings and discussion
This chapter covers findings based on data collection with by 52 participants (20 men, 32 women) of which 11 completed both data collection methods, 20 did the photovoice only, and 21 did the environmental audits only. The average age of the participants was 61.8 years old. They all used some type of MD (powered and manual wheelchairs, scooters, walkers, or canes).
Combining the photovoice and the SWAN data, four overarching themes emerged that were central to understanding the experience of mobility and social participation of older MD users in their urban environments. These themes were: En route, Destination, Continuum of Accessibility, and Agency. Figure 2.1 presents examples that illustrate each theme from the three communities. Findings for each theme are presented and discussed in the following section.
Theme 1: En route
The first theme entitled ‘En route’ emerged from both data sources and covered the usability and safety aspects of the physical path leading to a destination. This theme included both barriers and facilitators in the pedestrian environment (or public right of way), such as sidewalks, crosswalks, curb cuts, traffic signals, and lighting. The aspect of maintenance, such as unrepaired cracks and bumps on the sidewalks were also covered in the ‘En route’ theme.
In the photovoice method, participants captured pictures of narrow sidewalks that did not allow two people to walk or wheel side by side and forced them to stop when someone wanted to cross. They also captured uneven or slippery sidewalk surfaces. The participants photographed curb cuts quite often to showcase both functional and safety issues such as steep slopes, misalignment with the crosswalks or absence of curb cuts. As one 85-year-old woman explained,
‘Some places […] the curbs are difficult to get over […] even though you use the cane you just don’t have the spring in your step anymore and trying to get from one side of the curb to the other side of the curb, especially if it’s grass or something uneven, it takes a little bit of, you know, mental determination to get through.’
Regarding traffic signals and street crossings, the most salient issue was the position of the pedestrian-activated buttons. Several photographs showed these buttons in hard-to-reach locations or putting the person in an unsafe position. This is particularly important in Vancouver, as most crossings are pedestrian-controlled unlike those in other large Canadian cities. The participants also identified positive characteristics in their communities that made their daily journeys easier and safer. They photographed wide sidewalks and curb cuts that were smooth and had a gradual slope. The pictures of these facilitators were mostly taken in Vancouver, and less so in the other two communities.
Figure 2.1: Examples of pictures from each community and for each theme
The theme of ‘En route’ was covered in the functionality domain in the SWAN tool, which includes features of the crosswalks and sidewalks including curb ramps/cuts, sidewalk obstructions and physical condition of both the street and sidewalk. One of the primary barriers observed in all three municipalities was related to the directionality of the curb cut not being aligned with the street crossing. The street crossings were equipped with visual or auditory pedestrian signals, however, less than half of them provided enough time to safely cross the street. Similar to the photovoice data, one of the main barriers noted on the sidewalks was the lack of maintenance, that is, the presence of bumpy and slippery material posing safety hazards. Additionally, permanent obstructions on the sidewalks and streets, such as trees, lamp posts, or fire hydrants, were noted as creating a break in the path, often needing excessive rerouting.
The safety domain of the SWAN also captured data on the ‘En route’ theme. It covered features including direction of traffic, the smoothness of street pavement, or buffer space between sidewalk and the street. Sharing the road with cyclists and drivers was noted as problematic, as it made the participants feel unsafe with traffic around them. The audits demonstrated that less than half of the drivers on the audited streets maintained speed limits and under 40% of the cyclists were perceived as adhering to street rules and paying attention to pedestrians. Only a few audited segments had designated bike lane, which could explain this conflicting situation. Participants also rated the overall maintenance and aesthetics of the street segments including appearance of buildings, maintenance of the paths and streets, open spaces, and street furniture. Only half of the segments had public open spaces and well-maintained greenery, presence of accessible street furniture and streetlights.
The environmental features discussed under this theme, such as curb cuts, crosswalks or traffic signals, were all identified as essential for mobility in a recent scoping review (Bigonnesse et al, 2018). Urban planners and decision makers should continue working on reducing those barriers to mobility in order to promote older adults’ social integration, which is critical for their health and quality of life (Courtin and Knapp, 2017). Literature has shown that older adults with greater mobility limitations are more likely to have lower levels of participation in activities that bolster social connectedness and identity than those with better mobility (Rosso et al, 2011). An important aspect reflected in this theme was that usability and safety were two central and intertwined urban design features that impact mobility of older adults. The participants wanted to move about in their community easily and safely. Falls and accidents resulted in reduced quality of life for older adults and severe injuries lead to high healthcare consumption and costs (Hartholt et al, 2011). Thus, proper maintenance of the sidewalk and crosswalk infrastructure needs to be carefully considered in urban design policies. Moreover, this issue was present across the three communities assessed by the participants highlighting the universality of this problem of upkeep of the quality of the pedestrian realm to ensure inclusion for older adults living with mobility challenges. The city planners and decision makers in city councils should consider maintenance as one of the priorities that needs to be an integral part of their annual budget to ensure usable and safe pedestrian infrastructure for all their citizens.
Theme 2: Destination
This theme was related to accessibility issues in public places, such as plazas and parks, as well as the transition spaces from outdoors to indoors in terms of public or private buildings. This theme was addressed differently in the photovoice and the SWAN audit.
During the photovoice interviews, the participants mostly talked about barriers they encountered in transition spaces of public buildings, shops, and services. For instance, they took pictures of parking areas that were not well connected to the public buildings or did not have ramps to get from the parking to main entrance. A few older adults also captured problems accessing main entrance because of stairs, lack of adequate wayfinding signage, or unsafe pathways in front of buildings such as public libraries or highly used tourist areas. As reported by one female MD user, using a powered wheelchair,
‘The design of [the convention centre] is horrible. They put the signs where you can’t read them! […] We had to walk a few blocks […] to find an elevator, but even the elevator pointed to different areas and didn’t have the right signage on it. Then for the elevator, we had to get accessed [through] a door that wasn’t accessible…’
Regarding stores and services, the presence of stairs and the absence of automatic or push-button doors were the main barriers that were photographed. The participants also took pictures of parks, most often to show paths with unusable surfaces (eg gravel, rocks, grass) limiting their ability to enjoy the entire space. However, some recently designed parks and recreation areas were chosen to illustrate examples of inclusive and accessible design. One participant explained about a new green urban space: ‘Beautiful view. It’s awesome. As far as that’s brand new, there’s no issues with gravel or ground surface or bumpiness.’
The environmental design features that fall under this theme were covered in the land use and supportive features as well as social aspects domains of the SWAN. On the one hand, the land use and supportive features domain contained items regarding the presence and accessibility of amenities and services such as benches and public toilets, as well as grocery shops, restaurants, and places of worship. Very limited numbers of amenities and services on the audited segments were noted as accessible. The objective scores in all three cities were low in this domain and across all categories, revealing lack of accessible entrances to shops, inaccessible transit stops, and inadequate outdoor furniture as predominant barriers. On the other hand, the social aspects domain included items about the availability of places to gather and support social connections and subjective data on the overall friendliness of people. Participants noted that there were positive social interactions on the streets, and people appeared friendly (eg smiled and/or talked to others). However, less than a third of the audited segments contained accessible spaces supporting opportunities for social connections.
The transition spaces were problematic because often they were not part of the public realm, that is, they were the responsibility of the building or store owner, or it was not always clear who had responsibility for those spaces. Moreover, despite the fact that these access areas were part of building codes, they often had minimal standards (Larkin et al, 2015). Parking access also came out as creating barriers and has been identified as an important environmental feature for mobility in previous studies (Evcil, 2009). As many older adults rely on cars (either as drivers or passengers) (Lord et al, 2011), it is important to continue to reinforce the need to make access to parking safe and usable. Parking accessibility could make a difference between an older adult going out to do their daily activities or becoming reliant on someone else, and consequently not going out at all. The SWAN data, and to a lesser extent the photovoice findings, demonstrated that accessible spaces for socialization are not sufficiently available for older adults. This is particularly alarming as study after study has shown that older adults, especially those with mobility limitations, experience higher levels of social isolation than other people (Courtin and Knapp, 2017) with severe consequences for their health and quality of life. Further, it is important to provide them access to outdoor accessible spaces such as parks and public places to facilitate contact with nature (Ryan et al, 2010) and foster connectedness to their community (Novek and Menec, 2014). Considering that social dimension of accessibility, urban stakeholders could for instance develop guidelines or information handouts for local businesses to inform them about why and how to assure access for older adults. Moreover, they should think about how the different public spaces in their city such as parks or plazas need to be connected to the pedestrian networks to allow older adults with mobility limitations to take advantage of them.
Theme 3: Continuum of accessibility
The theme ‘Continuum of accessibility’ focused on temporal fluctuations of accessibility with circadian and seasonal variations, as well as due to conflicting social practices or inappropriate usage of the public realm or streetscape. This theme was extensively addressed in photovoice for all three communities. The participants reported how visibility at night was essential for their mobility. Many took pictures of areas that were easy to navigate during the day but became inaccessible and unsafe at dark. As a male scooter user mentioned: ‘This is the public square […] Well, on a dark, rainy night […] If you came out [from the main door] on a wheelchair or a scooter, … and you could go right off that jump there… [and], if your vision is poor, you could be in trouble.’ Another issue was the leaves that cover sidewalks, crosswalks, or curb cuts in fall and winter, making the path slippery and often hiding the condition of the pathways – creating unsafe situations. Regarding conflicting social practices, the most-reported elements were construction (eg closed sidewalks) or ineffective positioning of signage, followed by placement of sandwich boards in the middle of sidewalks by shopkeepers. However, helpful actions of people were also identified as compensating sometimes for the lack of accessibility within the built environment. For instance, some storekeepers would make extra effort to accommodate their older clients using MD and the participants felt it created accessibility and inclusion in a different way. Finally, this theme also included pictures of environmental features that were originally well designed but became inaccessible because of improper usage. For instance, one female participant, using a manual wheelchair, explained about a path near her house:
‘So that picture has a very nice, wide sidewalk, one of the few where you can walk side-by-side two people in a wheelchair. The challenge with this one is there are often bicycles using it. There is paved bike lanes on the street that are wide [but] cyclists don’t often get off the pedestrian route onto the bike route, so they are infringing on pedestrian areas. So what could have been a friendly pedestrian barrier-free path it is now challenged with having to navigate bicycles.’
This conflict between users’ needs also happened with drivers.
The SWAN tool covered seasonal variations in the functionality and safety domains highlighting the upkeep of infrastructure during inclement weather conditions (eg snow and rain). The audits also captured information on safety of walking or wheeling at night, including issues of the adequacy of lighting. Participants’ objective audit scores showed that 50–70% felt safe to walk or wheel alone. Many participants also planned their day and routes in advance, so that they would avoid being out too late in dark areas. As was the case for photovoice, temporary obstacles (eg, garbage and recycling bins, parked vehicles, road construction) were noted in the audits. The participants explained how the lack of enforcement of regulations concerning temporary obstructions resulted in barriers that increased the time of travel or created disruption in their mobility network. In terms of social practices, there were also some issues noted, such as storeowners not only putting up sandwich boards for advertisements, but also littering and blocking off the sidewalks with their merchandise.
This theme highlighted how accessibility is not a fixed set of built environmental features, but it is rather a complex and fluctuant concept. This is why it is important to understand the embodied experience of older adults with mobility limitations in order to integrate those nuances into the design and planning of our communities (Imrie, 2013). This type of experience-based knowledge offers comprehensive insights about the qualities of the environment that go beyond the minimum codes and standards (Heylighen et al, 2017) and should be included in the planning process from the beginning (Boys, 2014). This theme also underlined that inclusive design for all has a large social dimension. People’s behaviour and attitudes can make an environment less accessible, or on the contrary compensate for the lack of physical accessibility (Hästbacka et al, 2016). This highlights the importance of raising awareness among the general public about norms and rules that lead to development of inclusive environments. The urban decision makers could also think about how their communications with the older adults are being managed, if the information is easily accessible, and if their staff are trained to interact with different types of population. For instance, in Vancouver, the staff at the 3-1-1 Contact Centre could be informed about the accessibility features and services of the city. Furthermore, central to this is the matter of educating both the general public and staff on how small changes in habits of all road users can go a long way to assure that everyone, especially those with age and mobility related challenges, has the opportunity to engage in meaningful activities within their communities.
Theme 4: Agency
This theme highlighted the agency of the older MD users in negotiating or changing their environment. It covered the modifications participants have requested from their city planners and the potential solutions they would like to see implemented. It also covered the changes in their own behaviour or habits in their daily lives.
‘Potential solution’ emerged frequently in the interview and focus group transcripts of the photovoice participants, resulting in the creation of this theme, which illustrated the older MD users’ expression of agency. The pictures showed environmental features similar to the other themes, but the reasons behind taking those pictures were different. These were taken by the participants to show what they did to make temporary or permanent changes in the environments of their daily paths, or how they changed their own actions to deal with problematic features. For instance, one powered wheelchair users indicated,
‘So this picture is actually a positive thing, and it sort of something I like to brag a little bit about. This is a ramp outside my bank and this yellow is a relatively new feature because… This ramp is the best way to get down into the bank for somebody in a wheelchair but there was a white line before and somebody would park right in front of the ramp so I was stuck. I went and talked to the bank and they did something, I guess it’s sort of named after me, haha.’
The other types of actions participants took were to complain to their city council, talk to service owners, discover new paths to reach their destination, or be assertive when there was obstruction in the path. Participants from the three communities shared pictures of the changes they asked for or would like to see happen.
In the SWAN, agency was not directly covered by any of the domains. However, disparities between the subjective rating and the objective score was found in all five domains and across all three communities, suggesting that the older MD users had modified (consciously or unconsciously) their perceptions of their environment to facilitate their daily lives. While the absence of several physical environmental features in the neighbourhood, such as curb cuts, well-maintained sidewalks, and adequate traffic signal timing led to a low objective score, this did not necessarily lead the participants to giving a lower subjective rating of their neighbourhood. For example, the average audit score for the Land Use and Support Features domain was 25%, compared to a subjective rating of 68%. Further analysis of qualitative secondary observations data and community forum transcripts revealed the ability of MD users to adapt to their challenging surroundings. The difference between the objective scores and subjective ratings raised important questions on the highly personal relationships older adults, especially those with mobility challenges, have with their neighbourhood environment, and the ways in which they adapted to these challenges.
This theme showed that older adults were not passive actors in terms of interaction with their environment. They actively tried to shape their environment to fit their needs, but also their needs and preferences affected and changed their perceptions of their environments. Gibson argued in his theory of affordances (1979) that users will assess how the environment will support or limit the behaviour or activities they want to accomplish in an environment at a specific time, and in turn, these assessments will influence the perception of the environment. Moreover, the findings demonstrated that subjective data often provide insights about the embodied and daily experiences of people in their environment, which is still not well understood and is often ignored (Jackson, 2003; Winter et al, 2016). For example, if older adults wanted to go to certain restaurants in their community, they might choose one that did not have accessible entryways, but as they had built relationships with the staff at those establishments, they felt supported and welcome in these spaces. They subjectively assessed these places as being supportive of the activities they wanted to accomplish. While making planning decisions, urban planners and municipal city staff should recognize this agency of older MD users and their needs and experiences (Lid, 2016; Winter et al, 2016). Indeed, it has been shown that public participation that emphasizes learning and sharing experiences lead to the design of better-quality urban spaces (Ismail and Said, 2015). All the cities involved in the project had advisory committees comprised of people with disabilities and older adults, which were regularly consulted. In addition, cities could develop platforms (online or in person) that would allow the public to regularly share their inputs to inform prioritization, accessibility, and inclusion in the cities.
Conclusion
A major strength of this study was the collection of both objective and subjective data, allowing participants to better communicate their mobility experiences. By combining two complementary approaches and tools, it allowed us to get a deeper understanding of the mobility and social participation barriers and facilitators in the physical and social neighbourhood environment. With population aging and the increasing longevity phenomenon we cannot keep overlooking these issues. Municipal officials and city planners should not just focus on piecemeal remedies of curb cuts and sidewalk extensions, but take a broader look at inclusion and participation by bringing a universal or inclusive design lens into the planning process (Imrie, 2012). These findings reinforce what other researchers (eg Stafford and Baldwin, 2018) have advocated for street and sidewalk gradient/slope, shelter, climate protection, crosswalk placement and curb design, pedestrian safety, places to meet and socialize, places to rest, to be incorporated in transportation and urban design standards and legislation. To be truly inclusive of people of different ages and abilities, it is not only the design of the urban built environment that needs adjustment, but also the scheduling and prioritization of maintenance and upkeep of these environments. This has to be accompanied by guidelines on how bylaws around accessibility are enforced. Additionally, there needs to be training and education to raise awareness of the private/business sector use public infrastructure, and how this may result in blocking and creating a burden on older adult pedestrians, especially those who use mobility devices (eg their use of sandwich boards for advertisement and seating on sidewalks obstruct the path of mobility).
A priority of this study was to include participants in the research process. In the SWAN, the older adults conducted the audits (as opposed to researchers), and they chose the audit segments themselves. In the photovoice process, the participants identified the pictures representing the themes they wished to highlight and also chose pictures that best represented their mobility experience. Similar types of participatory processes in recent research, especially where persons with higher vulnerability were part of the research process, have helped to highlight the ableist approach to planning and design of urban neighbourhoods and the built environment (Winter et al, 2014, 2016; King et al, 2016; Tuckett et al, 2018). Engaging participants as ‘citizen scientists’, that is, as contributors or co-creators in the research process, increases citizen engagement and advocacy, and potentially leads to removal of barriers to mobility in communities (King et al, 2016; Winter et al, 2016). This type of participatory research is a powerful method that enables older adults as citizen scientists to vocalize and advocate for pedestrian infrastructure that provides them choice and opportunity to move about safely and effortlessly in their city. This study demonstrates the pivotal need for and value of inclusion of diverse perspectives, especially those most affected by poor urban design, to better inform policy, planning, and design interventions that are spatially and socially just for all ages and abilities.
Funding and acknowledgement
The research presented here was supported by partnership grant by the Social Sciences and Humanities Research Council of Canada. Grant # 895-2013-1021. We would like to thank our co-researchers, the study participants for being involved in data collection, data analysis, and sharing of their experiences and knowledge of their daily mobility environments. We would also like to thank our community partners Better Environmentally Sound Transportation (BEST) and Seniors on the Move (SOTM) who helped us recruit our participants and helped to initiate, coordinate, and facilitate SWAN data collection and knowledge mobilization in different parts of Greater Vancouver. This project was successful because it was a team effort.
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