Gloria Y. K. MA Diversity and Well-being Lab Department of Psychology The Chinese University of Hong Kong Effects of Burden of Environmental Inaccessibility and Perceived Stigma on Social Participation and Acceptance of Disability among Adults with Physical Disability 1

Aim of study To examine the mechanism of how environmental factors would affect social participation and psychological adjustment in people with physical disability (PWPD) in Hong Kong. Social Participation Community exposure (objective) Social enfranchisement (subjective) Environmental Barriers Burden of environmental inaccessibility Perceived stigma Psychological Adjustment Acceptance of disability an important indicator of adjustment to disability

3 9 Domains of Participation 1) learning and applying knowledge, 2) general tasks and demands, 3) communication, 4) mobility, 5) self-care, 6) domestic life, 7) interpersonal interactions and relationships, 8) major life areas, e.g. education and employment, 9) community, social and civic life. Qualifiers Performance Capacity ** the focus is frequency of “doing” and level of functioning (Cummins & Lau, 2003). Social Participation “Involvement in Life Situations” in ICF by WHO

Social Participation “Doing in life situation” is merely “community exposure” but not “full participation” (Cummins & Lau, 2003) It is the subjective feeling of sense of belonging to the community that really contributes to one’s participation and psychological wellbeing. Qualitative findings suggested that the core of social participation was the subjective appraisal of their social participation, the sense of being valued, and having autonomy and control in societal activities (Brown, 2010; Dijkers, 1998; Lysack et al., 2007). 4

Perceived stigma as a major attitudinal barrier 1.Visibility of the non-typical body movements, deformities, and/or use of assistive devices may elicit stereotypical signs of weakness and dependence; 2.Unfriendly gaze by the public on the street (Brown, 2010); 3.Public kindness, which is perceived by PWPD as an patronizing and embarrassing act (Cahill & Eggleston, 1988). Being devalued, unwelcomed by the society, and discriminated against in employment and recreational activities (Brown, 2010; Gray, Gould, & Bickenbach, 2003; Rimmer et al., 2004). Negatively associated with acceptance of disability (Li and Moore, 1998) 5

Influence both the objective community exposure and the subjective appraisal of social participation among PWD. (Meyers, Anderson, Miller, Shipp, & Hoenig, 2002; Nilay Evcil, 2009; Putnam et al., 2003; Rimmer et al., 2004; Schoell, 2009; Stark, Hollingsworth, Morgan, & Gray, 2007; Steinfeld and Danford, 1999) Physical environment sets the stage for social participation to occur, affecting the success and enjoyment of processes like wayfinding and navigation. 6 Environmental inaccessibility as physical barrier Environmental accessibility = Broadly defined as whether the natural or built environment and transportation system is physically accessible.

Burden of inaccessibility associated with stigma 7 Difficult to do actual audit or recall the number of barriers as required by many instruments; although they have their own advantages How they perceive the physical accessibility and thus anticipated burden may play important role Burden of environmental inaccessibility  may not be localized in particular geographical location,  nor whether he/she has carried out that activity before. Architectural buildings would create social experiences that express or reinforce certain social values and perceptions towards particular groups of people (Cahill & Eggleston, 1988; Conell & Sanford, 1999; Iwarsson & Stahl, 2003; Joines, 2009; Robinson & Thompson, 1999; Steinfeld & Danford 1999).

The Present Study

Sample 143 Chinese adults with physical disability from 10 NGOs serving people with disabilities in Hong Kong in % male; mean age = 37.4 years, SD = 15.2, range = years 48.1% congenital; 51.9% acquired disability 71.5% participants were single 26.2% attained secondary 4-5 education 9

Instruments 10 Self-report questionnaire with scales having reliability of.7 or above in Cronbach’s alpha.

Statistical Analysis Structural equation modeling (SEM) was conducted to examine the overall fit of the proposed model to the observed variance/covariance matrices of the data using the maximum likelihood method in EQS 6.1 for Windows. Goodness-of-fit was indicated by indices including CFI and NNFI greater than.95, SRMR of.08 or below, and RMSEA of.06 or below (Hu & Bentler, 1999) 11

Results 12

Results SEM showed satisfactory model fit of the proposed structural model to the data: χ 2 = 49.24, (df= 38, p =.10), χ 2 /df = 1.30, GFI =.92, CFI =.98, NNFI =.98, SRMR =.04, RMSEA = *-.27*.59* -.29* non-significant direct path -.46* Figure 2. Standardized path loadings. *p <.05.

Results The model explained 65% of variance in acceptance of disability. Significant direct association between environmental inaccessibility and perceived stigma. Significant indirect effect of environmental inaccessibility on acceptance of disability via perceived stigma and social participation (B = -.21, β = -.49, p <.05). Independent samples t-test showed that participants having congenital physical disability -- had significantly better social enfranchisement than having acquired physical disability; t (93) = 2.60, p <.05; and -- had significantly higher acceptance of disability than participants with acquired physical disability, t (92) = 2.56, p <.05.

Discussion 15

Promoting universal design The significant and direct association between the burden of environmental inaccessibility and perceived stigma. New perspective of stigma reduction through promoting universal design 16

Perspective of counselling service The significant and indirect effects of burden of environmental inaccessibility on acceptance of disability through perceived stigma and social participation Social experiences would influence the perceptions of self and one’s own disability (Li & Moore, 1998). Consistent with the notion of social model of disability. Counselling services should adopt macro perspectives to enhance disability adjustment. 17

Personalized counselling services Acquired physical disability (e.g. stroke) is generally a sudden and drastic challenge to one’s life, imposing intense stress and burden to the person. They may face great changes in daily life; and it may take considerable duration of time to gradually adapt to the social life. Counsellors should take into account of both their clients’ nature of disability and their social experiences when designing personalized counselling services. 18

Limitations Cross-sectional sample and small sample size; Findings may not be generalized to people with all types of physical disability (and other disabilities); No comparison on the effects of actual physical barriers and the burden of environmental barriers. 19

Future research directions association of environmental accessibility and stigmatization community exposure VS social enfranchisement 20 different dimensions of acceptance of disability effectiveness of different counselling therapeutic interventions

Acknowledgments The present study was funded by the I.CARE Programme Research and Studies , the Chinese University of Hong Kong (reference no.: R01-13). We would like to express our heartfelt thanks to the participating organizations and all participants. Research helpers and members of the Diversity & Well- being Laboratory in data collection, data analysis, and peer support. 21

22 Let’s build a truly barrier-free society together!

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