1. Assessment of Environmental Enablers and Barriers as Related to Leisure versus Need Anne Kramlinger, MSOT/S Julia Sanders, OTD/S Jaren Soelberg, MSOT/S Carolyn Slentz, MSOT/S Elizabeth Williams, MSOT/S

3. Problem and Purpose As of 2009 19,425,100 people in the United States reported having a disability affecting their mobility Maslow's Hierarchy of Needs shows us that physiological needs must be met before a person can move to higher levels of need, desire, and self-actualization Environment plays a major role in enabling or inhibiting accessibility and thus can affect one's ability to access and obtain food Purpose: This study utilizes the CHEC-M in hopes of gauging the accessibility of various grocery stores and restaurants in the St. Louis area. We theorized that buildings utilized for need would be more accessible than buildings utilized for leisure activities. It is hypothesized that restaurants in St. Louis will be found to be less accessible as measured by the CHEC-M than grocery stores in the same area.

4. Participants 52 establishments were selected o 25 grocery stores (need) o 27 restaurants (leisure) Inclusion o Anything under "grocery store" or "restaurant" in the phone book in the 2012 St. Louis metropolitan area Exclusion o Safety o Distance

5. Figure 1. Locations of Grocery Stores used in the study.

6. Figure 2. Locations of Restaurants used in the study.

7. Grocery StoresN=25% RestaurantsN=27% Chains1768 Sit-Down Restaurants830 Ethnic416Asian Takeout830 Convenience Markets312Café519 Farmers Market14Bar with Food311 Fast Food Chains311 Table 1 Type of Grocery Stores and Restaurants Assessed

8. Type of Grocery Stores Assessed

9. Type of Restaurants Assessed

10. Outcome Measure Community Health Environment Checklist - Mobility (CHEC-M) o 39-item survey that measures the accessibility of a building based on ADA guidelines and the relative importance to individuals with a disability

11. Data Collection – Inter-rater Reliability Inter-rater reliability was established prior to beginning the study: o 93% o 2 grocery stores and 2 restaurants o Included “CHECin’ out the Lou” After determining inter-rater reliability the CHEC-M was then used to assess the full sample of grocery stores and restaurants

12. Data Collection – The Sample A random sampling of 52 buildings were taken from the 2012 St. Louis phone book o 25 Grocery stores - every 6 th entry under the heading “grocery” o 27 Restaurants - every 50 th entry under the heading “restaurant” The grocery stores and restaurants chosen were then called to see if they were still in business. If they were no longer in business the building listed directly under it in the phone book was selected and included instead.

13. Data Collection Each rater assessed 10 buildings selected on a regional convenience basis The buildings were assessed during the time period of February-March 2012 Each assessment took an average of 10 minutes to perform

14. Test Design and Data Analysis Design o Cross-sectional between subjects design Statistical Analysis o Each item either met accessibility requirements (1), did not meet accessibility requirements (0), and not applicable (1) o 6 Independent t-tests performed o We compared total CHEC-M scores (out of 100), which represented the accessibility of each grocery store or restaurant

15. Results Table 2 CHEC-M Raw Scores and Total by Building Type and by Subdomain SubdomainBuilding TypeMean ± SDSignificance Entrance Grocery 34.91 ± 9.74 0.000* Restaurant24.12 ± 9.04 Using Building Grocery32.84 ± 6.20 0.465 Restaurant31.66 ± 5.29 Restrooms Grocery6.06 ± 2.36 0.360 Restaurant5.41 ± 2.70 Amenities Grocery2.73 ± 0.76 0.917 Restaurant2.75 ± 0.69 Usability/Rescue Grocery6.53 ± 2.57 0.666 Restaurant6.19 ± 3.06 Total Grocery83.06 ± 16.15 0.005* Restaurant70.13 ± 15.92 Note: * indicates a significance of p<0.05.

16. Mean CHEC-M Scores by Subdomain

17. Star Rating Entering Building Using BuildingRestrooms Amenities Usability Total Score 1 Star0-550-590-250-330-250-69 2 Star55-7160-7225-63-- 70-79 3 Star72-8272-8864-7534-6526-5080-89 4 Star82-9389-9476-8866-8050-7590-95 5 Star 96-10094-10089-10080-10075-10096-100 Table 3 Proposed Usability Ranking System for CHEC-M Subdomains (DACPRO) Results

18. Table 4 Frequency and Percentage of Restaurants and Grocery Stores Assessed Receiving Acceptable Accessibility Scores by Subdomain Entrance Using the BuildingRestroomsAmenitiesUsability Total Score Acceptable Score82-10089-10076-10066-10050-10090-100 Grocery Frequency181312212013 Percent72%52%48%84%80%52% Restaurant Frequency481021 1 Percent15%30%37%78% 4%

19. Discussion Statistical Insights o As expected, grocery stores are more accessible than restaurants in the St Louis metropolitan area o As a whole, bathrooms are the least accessible part of a grocery store or a restaurant Current literature identifies that the need for food is directly related to occupational performance which impacts quality of life

20. Similar Research Findings According to McClain, et. al. 1990 - Convenience stores (78%) are far less accessible than chain grocery stores (100%) According to McClain, et. al. 1993 - Getting in the door of an establishment was not an obstacle (66% accessible); handicapped parking was (53%)

21. Adding to Current Knowledge Grocery stores are significantly more accessible than restaurants (p =.005) as measured by the CHEC-M Grocery store entrances are more accessible than restaurant entrances

22. Clinical Implications In order to enhance accessibility, architectural modifications are needed Both grocery stores and restaurants had ‘inaccessible’ scores Leisure as food is not as accessible o Only 4% of restaurants had total usability in an acceptable range o Only 15% of restaurants had acceptable entrance scores Grocery stores had very high scores and can be used as a model of acceptable entrance

23. Limitations CHEC-M o Training o Rater reliability o One item’s reliability o May not be the most effective for comparing accessibility o ‘N/A’ is treated as a ‘yes’ during scoring Wide outliers

24. Limitations

25. Existing locations do not all match the phone book entries CHEC-M o Training o Rater reliability o One item’s reliability o May not be the most effective for comparing accessibility o ‘N/A’ is treated as a ‘yes’ during scoring Wide outliers in site selection

26. Limitations

27. Existing locations do not all match the phone book entries CHEC-M o Training o Rater reliability o One item’s reliability o May not be the most effective for comparing accessibility o ‘N/A’ is treated as a ‘yes’ during scoring Wide outliers in site selection

28. Limitations

29. Future Work Usability of restroom accessibility should be further researched More studies should be done o Rural environments o Different socioeconomic areas o Other cities The CHEC-HOH and CHEC-LV should be done

30. References Erickson, W., Lee, C., von Schrader, S. (2010, March 17). Disability Statistics from the 2008 American Community Survey (ACS). Ithaca, NY: Cornell University Rehabilitation Research and Training Center on Disability Demographics and Statistics (StatsRRTC). Retrieved Feb 07, 2012 from www.disabilitystatistics.org. Maslow, A. H. (1943). Conflict, frustration, and the theory of threat. Journal of Abnormal Psychology, 38, 81-86. McClain, L., Beringer, D., Kuhnert, H., Priest, J., Wilkes, E., Wilkinson, S., & Wyrick, L. (1993). Restaurant wheelchair accessibility. American Journal of Occupational Therapy, 47(7), 619-623. McClain, L., & Todd, C. (1990). Food store accessibility. American Journal of Occupational Therapy, 44(6), 487-491. Imrie, R. O. B., & Kumar, M. (1998). Focusing on disability and access in the built environment. Disability & Society, 13(3), 357-374. doi: 10.1080/09687599826687 Stark, S., Hollingsworth, H. H., Morgan, K. A., & Gray, D. B. (2007). Development of a measure of receptivity of the physical environment. Disability & Rehabilitation, 29(2), 123-137. Stark, S. & Sanford, J. (2005). Environmental enablers and their impact on occupational performance.. In C.H. Christiansen, C.M. Baum, & J. Bass-Haugen (Eds.), Occupational therapy: performance, participation, and well- being (pp. 298-331). Thorofare, NJ: SLACK Incorporated. Vincent, G. K., Victoria, V. A. (2010). The next four decades: The older population in the United States: 2010 to 2050. Retrieved Feb 07, 2012 from http://www.census.gov/prod/2010pubs/p25-1138.pdf. Wilcock, A. (1993). A theory of the human need for occupation. Occupational Science: Australia 1(1), 17-23.

31. Questions?

32. Expected Outcome By using an independent t-test analysis we expect that there will be a significant difference between the accessibility of grocery stores and the accessibility of restaurants in the St. Louis metropolitan area. We hypothesize that the buildings utilized for need (grocery stores) will be more accessible than the buildings utilized for leisure (restaurants).