Effects of Burden of Environmental Inaccessibility and

Perceived Stigma on Social Participation and

Acceptance of Disability among Adults with Physical
Disability

Gloria Y. K. MA
Diversity and Well-being Lab
Department of Psychology
The Chinese University of Hong
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.

Environmental Social Psychological

Barriers Participation Adjustment

Burden of Community Acceptance of

environmental exposure disability
inaccessibility (objective)

Perceived stigma Social

enfranchisement
(subjective) an important
indicator of
adjustment to
disability
 Social Participation
Involvement in Life Situations in ICF
by WHO
9 Domains of
Participation Qualifiers
1) learning and applying
knowledge, Performance
2) general tasks and
demands,
3) communication,
4) mobility,
Capacity
5) self-care,
6) domestic life, ** the focus is
7) interpersonal interactions frequency of
and relationships,
8) major life areas, e.g.
doing and level of
education and employment, functioning (Cummins
3

9) community, social and

 Social
Participatio
n
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
ones 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
4
societal activities (Brown, 2010; Dijkers, 1998;
1. Visibility of the non-typical
Perceived
body movements, deformities, stigma as a
and/or use of assistive
devices may elicit major
stereotypical signs of
weakness and dependence;
attitudinal
2. Unfriendly gaze by the public barrier
on the street (Brown, 2010);
3. Public kindness, which is
perceived by PWPD as an
patronizing and embarrassing
act (Cahill
Being devalued,
& Eggleston, unwelcomed
1988). 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 5

(Li and Moore, 1998)
 Environmen
Physical environment sets
the stage for social tal
participation to occur,
affecting the success and
inaccessibili
enjoyment of processes ty as
like wayfinding and
navigation. physical
Environmental accessibility
barrier
= Broadly defined as whether the natural or built
environment and transportation system is physically
accessible.

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, &
6
Gray, 2007; Steinfeld and Danford, 1999)
 Difficult to do actual audit or
Burden of
recall the number of barriers inaccessibil
as required by many
instruments; although they ity
have their own advantages associated
How they perceive the with stigma
physical accessibility and
thus anticipated burden
Burden of environmental inaccessibility
may play important role
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 of7
people
The Present
Study
 Sample
143 Chinese adults with physical disability from
10 NGOs serving people with disabilities in Hong
Kong in 2014.
56.0% male; mean age = 37.4 years, SD = 15.2,
range = 17-78 years
48.1% congenital; 51.9% acquired disability
71.5% participants were single
26.2% attained secondary 4-5 education

9
 Instruments
Self-report questionnaire with scales having reliability of .7 or
above in Cronbachs alpha.
Constructs Measures
1. Burden of -- Access Subscale of Physical Disability
Environmental Stress Scale (Furlong & Connor, 2007)
Inaccessibility -- 7 items from the Disabled Related Stress
Scale (Rhode et al., 2012)
-- 4 self-constructed items on transport
2. Perceived Stigma 7 items on perceptions of stigma (Brown, 2010)
3. Community Exposure 18 items adapted from the Participation
Objective, Participation Subjective (Brown et al.,
2004)
4. Social Enfranchisement Participation Enfranchisement Scale
(Heinemann et al., 2011)

5. Acceptance of Disability Acceptance of Disability Scale Revised

(Grommes & Linkowski, 2004; Linkowski, 1971) 10
 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: 2 = 49.24,
(df= 38, p = .10), 2/df = 1.30, GFI = .92, CFI = .
98, NNFI = .98, SRMR = .04, RMSEA = .06.
-.29*
-.46*

.51* -.27* .59*

non-significant direct
path
Figure 2. Standardized path loadings. *p < 13
.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, = -.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
Discussio
n

15
 The significant and direct
association between the
Promotin burden of environmental
inaccessibility and
g perceived stigma.
universal New perspective of
design stigma reduction through
promoting universal
design

16
 The significant and indirect
effects of burden of
environmental
inaccessibility on
Perspective acceptance of disability
through perceived stigma
of and social participation
counselling
Social experiences would
service influence the perceptions of
self and ones own disability
(Li & Moore, 1998).
Consistent with the notion of
social model of disability.
Counselling services should
adopt macro perspectives17to
 Acquired physical disability
(e.g. stroke) is generally a
sudden and drastic challenge
to ones life, imposing
Personaliz intense stress and burden to
the person. They may face
ed great changes in daily life;
and it may take considerable
counsellin duration of time to gradually
adapt to the social life.
g services
Counsellors should take into
account of both their clients
nature of disability and their
social experiences when
designing personalized
18
counselling services.
 Cross-sectional sample
and small sample size;

Findings may not be Limitatio

generalized to people with ns
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
association of
environmental research
accessibility and direction
stigmatization
s
community exposure VS
different dimensions of acceptance of disability
social enfranchisement

effectiveness of different counselling therapeutic

interventions

20
 Acknowledgments
The present study was funded by the I.CARE
Programme Research and Studies 2013-14,
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
 e-mail:
gykma@psy.cuhk.edu.hk

Lets build a truly barrier-

free society together!
22
 Brown, M., Dijkers, M. P., Gordon, W. A., Ashman, T.,
Charatz, H., & Cheng, Z. (2004). Participation
objective, participation subjective: a measure of
participation combining outsider and insider
perspectives. Journal of Head Trauma Rehabilitation,
19(6), 459-481.
Brown, R. L. (2010). Physical disability and quality of
life: The stress process and experience of stigma in
a chronically-strained population. Unpublished thesis.
Cahill, S. E., & Eggleston, R. (1988). Reconsidering
the stigma of physical disability: Wheelchair use and
Reference public kindness. The Journal of Interdisciplinary
History, 18(4), 591-613.
s Conell, B. R., & Sanford, J. A. Research implications of
universal design. In: E Steinfeld, GS Danford (eds).
Enabling Environments. Measuring the Impact of
Environment on Disability and Rehabilitation. New
York: Kluwer Academic/Plenum Publishers, 1999.
Cummins, R. A., & Lau, A., (2003). Community
integration or community exposure? A review and
discussion in relation to people with an intellectual
disability. Journal of Applied Research in Intellectual
Disabilities, 16, 145-157.

23
 Dijkers, M. (1998). Community integration: Conceptual
issues and measurement approaches in rehabilitation
research. Topics in Spinal Cord Injury Rehabilitation,
4(1), 1-15.
Furlong, M., & Connor, J. (2007). The measurement of
disability-related stress in wheelchair users. Archives
in Physical Medicine and Rehabilitation, 88(10), 1260-
1267.
Gray, D. B., Gould, M., & Bickenbach, J. E. (2003).
Environmental Barriers and Disability. Journal of
Architectural and Planning Research, 20(1), 29-37.
Reference Gray, D. B., Gould, M., & Bickenbach, J. E. (2003).
Environmental Barriers and Disability. Journal of
s Architectural and Planning Research, 20(1), 29-37.
Groomes, D. A. G., & Linkowski, D. C. (2007).
Examining the structure of the Revised Acceptance
Disability Scale. Journal of Rehabilitation, 73(3), 3-9.
Heinemann, A. W., Lai, J-S., Magasi, S., Hammel, J.,
Corrigan, J. D., Bogner, J. A., & Whiteneck, G. G.
(2011). Measuring participation enfranchisement.
Archives of Physical Medicine and Rehabilitation,
92(4), 564-571.
Hu, L. T., Bentler, P. M. (1999). Cutoff criteria for fit
indexes in covariance structure analysis: Conventional
criteria versus new alternatives. Structural Equation
24
Modeling: A Multidisciplinary Journal, 6(1), 1-55.
 Iwarsson, S., & Stahl, A. (2003). Accessibility, usability
and universal design---positioning and definition of
concepts describing person-environment relationships.
Disability and Rehabilitation, 25(2), 57-66.
Joines, S. (2009). Enhancing quality of life through
universal design. NeuroRehabilitation, 25, 313-326.
Li, L., & Moore, D. (1998). Acceptance of disability and
its correlates. The Journal of Social Psychology, 138(1),
13-25.
Linkowski, D.C. (1971). A scale to measure acceptance
to disability. Rehabilitation Counseling Bulletin, 14(4),
Reference 236-244.
Lysack, C., Komanecky, M., Kabel, A., Cross, K., &
s Neufeld, S. (2007) Environmental factors and their role
in community integration after spinal cord injury.
Canadian Journal of Occupational Therapy, 74, 243-254.
Meyers, A. R., Anderson, J. J., Miller, D. R., Shipp, K., &
Hoenig, H. (2002). Barriers, facilitators, and access for
wheelchair users: Substantive and methodologic
lessons from a pilot study of environmental effects.
Social Science & Medicine, 55, 1435-1446.
Nilay Evcil, A. (2009). Wheelchair accessibility to public
buildings in Istanbul.
Disability and Rehabilitation: Assistive Technology, 4(2),
76-85. 25
Putnam, M., Geenen, S., & Powers, L. (2003). Health and
 Rhode, P. C., Froehlich-Grobe, K., Hockemeyer, J. R.,
Carlson, J. A., & Lee, J. (2012). Accessing stress in
disability: Developing and piloting the Disability Related
Stress Scale. Disability and Health Journal, 5, 168-176.
Rimmer, J. H., Riley, B., Wang, E., Rauworth, A., &
Jurkowski, J. (2004). Physical activity participation among
persons with disabilities. American Journal of Preventive
Medicine, 26(5), 419-425.
Robinson, J. W., & Thompson, T. (1999). Stigma and
architecture. In Steinfeld, E., & Danford, G. S. (Eds.),
Enabling environments: Measuring the impact of
Reference environment on disability and rehabilitation (pp. 251-
270). Dordrecht, Netherlands: Kluwer Academic

s Publishers.
Schneidert, M., Hurst, R., Miller, J., & Ustun, B. (2003).
The role of environment in the International Classification
of Functioning, Disability and Health (ICF). Disbility and
Rehabilitation, 25(11-12), 588-595.
Schoell, D. M. (2009). Moving vertically: A research
method, grounded in the social sciences, about the built
environment's influence on social integration.
Unpublished Thesis. State University of New York at
Buffalo.
Stark, S., Hollingsworth, H. H., Morgan, K. A., & Gray, D.
B. (2007). Development of a measure of receptivity of the
physical environment. Disability and Rehabilitation, 26