Journal of Architectural and Planning Research

20:1 (Spring, 2003) 29

ENVIRONMENTAL BARRIERS AND
DISABILITY
David B. Gray
Mary Gould
Jerome E. Bickenbach
People with disabilities perceive the Americans
with Disabilities Act (ADA) as legislation that
makes
building access a civil right. To others, the ADA
and associated guidelines are seen as unnecessary
regulations that are costly and limit creativity.
Conflicts resulting from attempts to comply with
minimal building codes in assuring access to
buildings stem, in part, from the building
professional's
lack of understanding of what people with
disabilities regard as barriers to their fidll
participation in
the built environment. This study explores the
views on barriers and facilitators to fill
participation in
major life activities for people with disabilities
using focus groups of people with mobility
impairments, their significant others, healthcare
professionals, and built environment professionals.

The results illustrate clear agreement that social

institutions and attitudes can be important
barriers.
The focus groups differ in their assessment of the
built environment as a facilitator and barrier to
participation. Designers, builders, building
owners, paying clients, and other intermediate
consumers
involved in construction mav learn from people
with disabilities. For example, end-users with
disabilities may be aware of alternative solutions
to ADA codes that allow building access without
rigid adherence to guidelines or codes. By
consulting people with disabilities, designers and
clients
may learn how to determine what is needed and
what works for access to and use of building
space.
Copyright 2003, Locke Science Publishing
Company, Inc.
Chicago, IL, USA All Rights Reserved
Journal of Architectural and Planning Research
20:1 (Spring, 2003) 30
INTRODUCTION
Access to the built environment for people with
disabilities is required as a civil right by the

Americans with Disabilities Act (ADA, 1990). As

with implementing other civil rights legislation,
although the principle of equal treatment is clear,
the regulations and standards intended to help
realize the ideal do not provide the details needed
to resolve problems in the built environment.
Practical applied solutions come from knowledge,
and shared knowledge of accessibility comes from
interactions among people with disabilities,
healthcare providers, designers and planners, and
other
building professionals. Representatives of these
different sectors of our society are beginning to
pool
their knowledge to invent built environments that
meet the legal regulations, best use the skills of
designers and the building industry, and provide
access for consumers with disabilities. Too often,
however, attempts to meet accessibility regulations
have resulted in a profound lack of fit between the
ideals of an accessible built environment and what
is actually built for use by persons with and
without disabilities. This article reports several
points of view about the relative importance of the
built environment compared to other
environmental factors as facilitators or barriers to
participation

in life activities of people who are mobility

limited.
The U.S. Census (McNeil, 1993) found that
approximately 50 million Americans are unable to
carry
out one or more major life activities such as
playing, attending school, working, and self-care.
The
National Health Interview Survey found 29.2% of
69.6 million families in the U.S. have one or more
members with a disabling condition (LaPlante, et
al., 1996). This article will focus on the 14.2
million
Americans who have physical impairments,
specifically those who use devices (i.e., canes,
walkers, scooters, and wheelchairs) to assist them
in moving about in their environments (LaPlante,
et
al., 1992).
BACKGROUND FOR CHANGE
The traditional notions of disability are being
challenged by recent developments in social
policy,
research findings, and even in some areas of
design (Fougeyrollas and Gray, 1998). People with

disabilities have formed an influential

sociopolitical group whose members consider
much of the built
environment to be a barrier to their participation in
activities. They have attacked these barriers to
inclusion as other disadvantaged groups in society
have challenged discrimination based on race or
gender. Disability advocates have been a major
force in having legislation passed that eliminates
these barriers (Hahn, 1985, 1988, 1994; Zola,
1985, 1989). The premise is that the effects of
many
disabling conditions can be alleviated primarily
through the adoption of public laws and policies
that
require all buildings to be made accessible (Mace,
et al., 1991).
A NEW PARADIGM
The concept that the environment can be a coequal factor contributing to disability has provided
the
impetus for broadening the scope of scientific
inquiries of disability. In this new paradigm,
disabilities
are considered to be the results of interactions
among personal, biomedical and functional
limitations,

and environmental barriers to participation

(Verbrugge and Jette, 1994). This assessment of
disability
requires that the traditional medical diagnosis be
combined with an ongoing evaluation of the social
and physical environmental factors that shape the
experience of living with a disability (Hahn, 1985,
1993a,b; Mace, et al., 1991; Law, et al., 1996;
Bickenbach, 1993; Ramey, et al., 1996). Enabling
America (IOM, 1997; Pope and Brandt, 1997)
presents a model that depicts the environment as a
three-dimensional matrix that supports or inhibits
participation in activities of people with
disabilities.
The concept that environmental factors constitute
an essential scientific component of disability has
led the World Health Organization (WHO) to
include environmental factors as part of its revised
classification instrument, the International
Classification of Imnpairments, Activities and
Participation:
A Manual of Dimensions of Disablement and
Healtl7 (ICIDH-2 Beta One, WHO, 1997). In this
docu- I
Journal of Architectural and Planning Research
20:1 (Spring, 2003) 31

ment, the environmental factors are considered as

either facilitators or barriers to participation for
persons with impairments or activity limitations.
The Americans with Disabilities Act provides a
basis for going beyond simple compliance with
minimal
building codes in assuring access to buildings by
allowing designers to provide for equivalent
facilitation of building access. But in order to
achieve equivalent facilitation, designers, builders,
building owners, and others involved in
construction of the built environment have had to
learn from
the people affected by building design. People
with and without disabilities may have differing
views
of what is needed for access to and use of building
space.
Fortunately, the general principles of how best to
structure the built environment for maximal use by
people with and without disabilities have evolved
as some architects and designers move from
barrierfree design to universal design (Bednar, 1977;
Ostroff and lacofano, 1982; Lifchez, 1987; Mace,

et al., 1991; Welch and Ostroff, 1995). This

broadened approach is based on the premise that a
very
significant part of the environment-person fit is
determined by the design of the built environment
(Steinfeld, et. al., 1979; Lawton, 1982). Designs
that do successfully embody these principles have
been described as having a universal design. To
know what works best for the greatest number of
people is the basis of universal design. Although
this general principle is clear, determining
guidelines
that apply to specific cases remains a challenge.
MOBILITY, DISABILITIES,
PARTICIPATION, AND ENVIRONMENT
PROJECT (MIDPEP)
The Mobility, Disabilities, Participation, and
Environment Project (MDPEP) at Washington
University
in St. Louis, Missouri (U.S.A.) is a three-year
research project funded by the Centers for Disease
Control and Prevention. This project is attempting
to discover common environmental barriers and
facilitators to participation for mobility-impaired
individuals. To accomplish this goal, a dynamic,

interactive measurement system is being

developed. The measurement system will consist
of three
assessment tools. The first will comprise existing
measures of functional capacities of people with
mobility limitations. A second tool, the
Participation Survey of Mobility Limited People,
has been
developed to allow assessment of participation in
daily activities. The third measure is a list of
environmental
barriers and facilitators, the Facilitators and
Barriers Survey for Mobility Limited People.
When the measurement system is completed,
changes in participation by people with mobility
impairments
may be detected either when their personal
capacity increases or after their environment is
made more accessible,
METHODOLOGY
The initial methodologies employed in the
development of the Participation Survey of
Mobility
Limited People and the Facilitators and Barriers
Survey for Mobility Limited People were
qualitative:

life history interviews, key informant interviews,

and focus groups. These methods relied on the
input
of people with mobility limitations, their
significant others, and professionals who serve
them, including
health care and built environment professionals. In
addition, several members of the research team
who conducted the interviews and focus groups
are mobility impaired. The combined experiences
of
these individuals contributed to making possible
the qualitative phase of the study.
SUBJECTS
To develop the measurement system, input was
sought from persons with mobility limitations,
people
whose lives are affected by persons with mobility
limitations (significant others), those who identify
mobility needs (physicians and therapists), and,
finally, those who play a major role in the creation
of
the built environment (architects and planners).
Seventeen focus groups were convened to discuss
the
concepts of participation and environmental
barriers and facilitators (see Table 1). All the focus

Journal of Architectural and Planning Research

20:1 (Spring, 2003) 32
TABLE 1. Description of focus-group participants.
Focus-Group Participants Male Female Black
White Total
Mobility Impaired (MI)
Spinal Cord Injury 6 0 1 5 6
Cerebral Palsy 3 3 0 6 6
Multiple Sclerosis 1 7 0 8 8
Stroke 4 4 4 4 8
Polio 3 9 0 12 12
Mobility Impaired Total 17 23 5 35 40
Significant Others (SO)
Spinal Cord Injury 0 5 0 5 5
Cerebral Palsy 0 6 0 6 6
Multiple Sclerosis 3 3 1 5 6
Stroke 1 4 2 3 5
Polio 4 6 1 9 10
Significant Others Total 8 24 4 28 32
Healthcare ProfessionalsParticipation (HCPP)
Spinal Cord Injury 2 7 0 9 9
Cerebral Palsy 2 6 0 8 8
Multiple Sclerosis 0 5 0 5 5
Stroke 2 6 1 7 8
Polio 4 2 0 6 6

Healthcare Professionals Total (HCPP) 10 26 1 35

36
Healthcare Professionals - Environment (HCPE) 1
5066
Built Environment Professionals (BEP) 8 0 0 8 8
Focus Group Participant Total 44 78 10 112 122
groups lasted one to two hours each and were
audiotaped. Each group concluded with a
summary by
the note-taker of major points covered in both the
participation and environment domains. Then, the
group was asked to add anything that was
overlooked in the discussion.
Fifteen focus groups were gathered to help
develop the concept of participation for mobilityimpaired
people. The participants were individuals with
mobility impairments: Spinal Cord Injury, Stroke,
Multiple Sclerosis, Cerebral Palsy, and Polio
Survivors. All five of these categories are referred
to as
the mobility-impaired (MI) participants. For each
of the five mobility-impaired groups, a focus
group
of significant others (SO) was formed, mainly
from people related to the persons with mobility
impairments

who participated in the mobility-impaired focus

groups. Five focus groups of healthcare
professionals were formed to match each mobility
impairment group. These five focus groups are
referred to as Healthcare Professionals
Participation (HCPP) since the questions
addressed in the
focus group sessions initially addressed
participation of their mobility-impaired patients or
clients.
(acronyms appear on Tables 2 and 3).
A second set of two focus groups was held to
examine environmental factors that are perceived
to be
barriers to or assist in participation by mobilityimpaired individuals, through the comments of
healthcare professionals representing various
disciplines working in healthcare environments
(HCPE)
and building environment professionals (BEP).
The healthcare professionals who commented on
environmental
barriers (HCPE) included a social worker,
occupational therapists, physical therapists,
nurses, and a recreational therapist. The
participants in the built environment professional
(BEP)

focus group included an interior designer, a

graphic designer, a contractor, a museum
supervisor and
builder, a director of design and construction, an
architect, a landscape architect, a durable
equipment
representative, and an elevator and lift designer.
Journal of Architectural and Planning Research
20:1 (Spring, 2003) 33
TABLE 2. Percentage of total comments on
participation by focus group.
Focus Group
Participation Category Ml SO HCPP HCPE BEP
Personal Independence 17 19 16 9 0
Mobility 14 21 22 22 14
Exchange of Information 2 1 1 9 43
Interpersonal Relationships 13 6 13 22 0
Occupation 49 50 45 13 43
Economic Life 0 3 0 22 0
Civic and Community 2 1 3 4 0
MI = Mobility Impairment
SO = Significant Other
HCPP = Healthcare Professional - Participants
HCPE = Healthcare Professional - Environment
BEP = Built Environment Professionals
FOCUS GROUP PROCEDURES

The same questions were asked of the first set of

15 focus groups -the mobility-impaired, significant
others, and healthcare professional participants
(MI, SO, and HCPP). These questions were
designed to elicit the group members' perceptions
of participation in major life activities by people
with mobility impairments. Each focus group had
a moderator, who was a member of the project
staff, and a note-taker. The following open-ended
questions were asked: What do you (significant
other, patient) do in a typical day? What would
you (significant other, patient) like to do that you
are
unable to do now? What in the environment keeps
you (significant other, patient) from doing what
you want to do? What in the environment would
help you (significant other, patient) do what you
want to do?
The second set of two focus groups was held to
examine environmental factors that are perceived
to
be barriers to or assist in participation by mobilityimpaired individuals, through the comments of
healthcare professionals representing various
disciplines (HCPE) and building professionals
(BEP).

The following open-ended questions were used for

the focus group of healthcare professionals asked
about environmental barriers (HCPE): What are
barriers to and supports for engaging in life once
they
are discharged? What are minimal supports? Are
they being met? Who is responsible for decreasing
these barriers? Who currently pays or should pay
to remove these barriers? How do these barriers
impact your client's quality of life? What would
your clients say? Questions asked of the builtenvironment
professionals (BEP) focus group included the
following: What are the supports and barriers
for people with disabilities in the home and in the
community? What would your clients say? Do you
know what clients need? What are barriers to
providing accessible design? Do you have specific
requests for design elements?
RESULTS
Focus group audiotapes were transcribed and each
was analyzed by at least two people. A coding
system was developed to count the number of
comments made during the focus groups that
referred

to areas of participation, environmental

facilitators, and environmental barriers. The
coding system
addressed frequency of items, uniqueness of items,
and themes; the themes that emerged during
coding are discussed below. The coded comments
were then compiled into categories for
participation
and environmental factors. The total number of
comments made by each group was calculated
and used as the denominator in determining the
percentage of comments made that fit each
category.
All focus groups agreed that participation by
individuals with mobility impairments occurred
most
frequently in the category of occupational pursuits
(leisure, work, education, and religion). For most
Journal of Architectural and Planning Research
20:1 (Spring, 2003) 34
TABLE 3. Percentage of environmental factors
referred to as barriers or facilitators by focus group
participants.
Focus Groups*
MI MI SO SO HCPP HCPP HCPE HCPE BEP
BEP
Environmental Factors B* F* B F B F B F B F

Products and Tools 10 38 6 43 5 26 11 11 1 24

Personal Support 13 26 12 22 16 36 14 44 3 0
Social Institutions 20 6 24 14 28 16 22 34 33 38
Sociocultural Norms 9 5 12 2. 14 3 19 0 25 0
Built Environment 29 10 24 9 14 10 15 1 1 28 38
Natural Environment 2 0 3 0 1 0 3 0 0 0
Personal Attitudes 8 6 6 8 10 3 0 0 0 0
Mental Health 2 0 4 0 2 1 0 0 0 0
Other 7 9 9 2 10 5 16 1 10 0
MI = Mobility Impairment
SO = Significant Other
HCPP = Healthcare Professional - Participation
HCPE = Healthcare Professional - Environment
BEP = Built Environment Professionals
*B = Barrier
*F = Facilitator
focus groups, mobility (moving within and outside
home) and personal independence (personal
hygiene, dressing, and eating) were mentioned as
frequent activities for people with mobility
impairments.
The built environment professionals commented
more on the importance of exchanging information
among the architects, planners, and contractors
than on the activities of the persons with
mobility impairments (see Table 2).
BARRIERS AND FACILITATION

In Table 3, the comments made during all 17 focus

groups regarding environmental factors are
compared
to illustrate the differences among the groups in
evaluating the nine factors considered to be
barriers, facilitators, or both by ICIDH-2 (WHO,
1997) (see Table 3). Each of the mobility-impaired
(MI), significant other (SO), and healthcare
professionals focus groups (including HCPP and
HCPE)
includes the comments made in the five diagnostic
categories of mobility impairments. The results of
the comparison of environmental factors as
barriers or facilitators show that built environment
professionals
(BEP) are the only group who ranked the built
environment more frequently as a facilitator
than a barrier. The mobility-impaired and
significant other groups found the built
environment to be
very significant barriers to participation. Products,
tools, and personal support were listed as
facilitators rather than barriers to participation by
most of the focus groups. Social institutions and
social cultural norms were considered
unanimously as significant barriers to
participation.

THEMYIES
Comments made during the focus groups were
reviewed for themes about barriers and facilitators
to
participation. For example, a theme that
characterized the groups with mobility limitations
was that
people with disabilities should be consulted on
how to adapt to the built environment. Private and
personal housing designs and transportation
systems emerged as important areas where input
from
individuals with mobility impairments could
provide valuable input when designers, architects,
and
city planners are considering retrofitting or new
construction.
The built environment professional focus groups
emphasized retrofitting existing physical
environments
as barriers to their profession and very costly
compared to new construction. The concept of
universal design was described in the groups of
built-environment professionals as not realistic and
Journal of Architectural and Planning Research
20:1 (Spring, 2003) 35

impossible to put into practice. For example, one

person said, "I don't know that there is always a
universal solution that is going to work for
everybody." This group found legislative
mandates, codes,
and guidelines to be restrictive and too often based
on one segment of the population - people who
use wheelchairs. A built-environment professional
stated, "I think the laws have become too focused
on wheelchair access." Some members of this
group expressed the opinion that codes and
guidelines
restrict their creativity and "take away the
challenges of the designer to come up with
intelligent