A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).
Community participation is central to one’s quality of life. People with mobility disabilities may experience barriers or challenges to community participation. These can include physical factors such as the severity of disability and environmental factors such as home accessibility. These barriers can lead to participation restriction or the inability to take part in community life activities. Prior research has shown that participation restriction in social activities is strongly associated with social isolation, depression, and a decrease in overall health status. Most of this research has focused on how physical factors like disease severity relate to participation restriction, but not much on environmental factors.
Previous research on home accessibility has shown that over half of people with mobility disabilities in the US live in homes that are not accessible, including homes that have steps to enter and exit, even after years of public policy attempting to improve housing accessibility for people with disabilities. Past research also demonstrated connections between activity participation inside the home and the environment within the home, where people with disabilities report difficulties with activities of daily living when their homes have at least one barrier. However, exploration of the connection between the home environment and activity participation outside of the home has been minimal. In a recent NIDILRR-funded study, the researchers wanted to see how the presence of entrance stairs affected participants’ exertion in leaving and entering home and if there was a relationship between the need to use such stairs and their participation in required and discretionary activities outside the home.
For this study, researchers at the Rehabilitation Research and Training Center on Disability in Rural Communities and the Rehabilitation Research and Training Center on Promoting Interventions for Community Living looked at survey data collected from 431 people, between 18 -94 years old, prior to their participation in 2 different intervention studies. The survey data included the demographic information; and information on the participants’ sensory, physical, or mental disabilities, including any serious difficulty walking or climbing stairs (mobility disabilities). The survey data also included the number and types of required and discretionary trips the participants made outside the home in the previous week. Required activities included going to appointments or stores, while discretionary activities included engaging in social or recreational activities. They also rated on a scale of 1 to 10 how exerting they thought it was to do things in their home, including exiting or entering their home. Finally, the participants provided information about the features of their home, including whether or not they could enter their home without using steps.
A total of 320 participants reported a mobility disability, while 103 reported no mobility disability. The researchers found the following results:
- More than half of participants with mobility disabilities reported that they had to use stairs to enter or exit the home by their most-used entrance, while more than 80% of participants without mobility disabilities reported having to do so.
- Participants with mobility disabilities reported 63% less exertion when not having to use stairs to enter/exit than when having to use stairs to enter/exit the homes.
- Participants with mobility disabilities who had to use the stairs to enter/exit the home participated in about 50% fewer discretionary activities than those who did not have to do so. Participants without mobility disabilities reported no such reduction in activities, regardless of entrance type.
- For required activities such as appointments or grocery shopping, there was no difference in level of participation between participants with mobility disabilities and those without mobility disabilities, regardless of whether they had a stepped entrance.
For many of the participants in this study, having to use the stairs to enter/exit their home presented a significant barrier to participating in social and recreational activities in their community. Not having to use stairs required significantly less effort to enter or leave. The level of effort required to use stairs to enter/exit the homes may lead those with mobility disabilities to save their energy for required tasks and forego those discretionary activities. This may increase the risk of social isolation and loneliness, which have been linked to poorer health outcomes.
The authors noted this study, along with previous research on home accessibility, suggest that roughly half of US citizens with mobility disabilities may have a decrease in social and recreational interactions due to having stairs at the entrance of their home. They suggested that investing in accessible housing may reduce medical costs by minimizing social isolation and related health risks. They also suggested that this medical cost reduction may offset the cost of investing in accessible housing. The authors acknowledged that future research may be needed to further investigate the quality of life and financial impact of investing in accessible housing. However, this study may provide initial supporting evidence toward adoption of accessible home entrances as an intervention to improve community participation for people with mobility disabilities.
To Learn More
The Home Usability Program, developed by the RRTC on Disability in Rural Communities, helps people with disabilities assess their homes to identify possible usability problems, set goals to address these problems, and identify community and personal resources to help reach those goals.
Centers for Independent Living are organizations run by and for people with disabilities that offer programs and services to support community participation. These can include information about home usability, assistive technology, transportation, and more.
To Learn More About this Study
C. Ravesloot, A. Myers, L. Greiman, et al. (2021) Is the presence of home entrance steps associated with community participation of people with mobility impairments? Disability and Health Journal. This article is available from the NARIC collection under Accession Number J87284.