Disability and Health Journal xxx (xxxx) xxx
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Original Article
Participation by design: Integrating a social ecological approach with universal design to increase participation and add value for consumers* John F. Butzer a, b, *, Roberta Virva a, b, Allan J. Kozlowski a, b, c, Rebecca Cistaro a, b, Michael L. Perry d a
John F. Butzer Center for Research and Innovation, Mary Free Bed Rehabilitation Hospital, 235 Wealthy St SE, Grand Rapids, MI, USA Division of Rehabilitation, Michigan State University College of Human Medicine, 235 Wealthy St SE, Grand Rapids, MI, USA Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, 235 Wealthy St SE, Grand Rapids, MI, USA d Universal Design Consulting, 1811 4, Mile Rd NE, Grand Rapids, MI, USA b c
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a b s t r a c t
Article history: Received 31 March 2020 Received in revised form 10 September 2020 Accepted 13 September 2020
Background: Physical activity is an essential component of a healthy lifestyle. Health clubs encourage sustained healthy lifestyles but are still largely not accessible to people with disabilities. Cost is a barrier for accessibility enhancements. Hypothesis: We postulate that: (A) universal design coupled with a social ecological approach improves measured accessibility compared with existing fitness facilities constructed since the adoption of the ADA; (B) increased accessibility coupled with an environment friendly to people with disabilities attracts more participants to a YMCA than predicted by traditional industry market research producing a recovery of the cost of increased accessibility; and (C) attitudes of facility members toward people with disabilities may improve if an accessible facility facilitates more personal interactions between people with and without disabilities. Methods: Accessibility is measured with the Accessibility Instruments Measuring Fitness and Recreation Environments (AIMFREE). Cost recovery is determined by comparing excess membership revenue to the cost of universal design elements beyond regulatory requirements, and attitudes toward people with disabilities are measured with the Attitudes Toward Disabled Persons Scale. Results: AIMFREE scores were significantly higher than comparison facilities in all areas except for equipment, parking, training, and programs. Excess revenue exceeded the extra cost of accessibility enhancements and attitudes toward people with disabilities did not change. Conclusions: Universal design coupled with a social ecological approach improves accessibility in fitness facilities and results in a reasonable payback time. Attitudes toward people with disabilities did not change in a YMCA designed to accommodate people with disabilities. © 2020 Elsevier Inc. All rights reserved.
Presented in part to the American Congress of Rehabilitation Medicine, November 2e4, 2016, Chicago, IL; the American Medical Rehabilitation Providers Association, October 23e25, 2017, Chicago, IL; and Environments for Aging, February 28-March 1, 2018, Las Vegas, NV. Keywords: Facility access Social ecology People with disabilities Cost benefit Value-based purchasing
Introduction Physical activity is an essential component of a healthy lifestyle and is known to protect against obesity, stroke, heart disease, type 2
* This research was supported in part by a grant from Progressive AE, Grand Rapids, MI USA. * Corresponding author. Mary Free Bed Rehabilitation Hospital and Michigan State University, John F. Butzer Center for Research and Innovation, 235 Wealthy St SE, Grand Rapids, MI, USA. E-mail address: john.butzer@maryfreebed.com (J.F. Butzer).
diabetes and depression.1 People are increasingly attending fitness facilities for exercise and in 2018 held over 62 million gym memberships in the United States, up 2.9% from 2017.2Health clubs encourage sustained healthy lifestyles by promoting physical activity, providing training and supervision, and by fostering social relationships. However, people with disabilities live with greater risk for health conditions,3 and face more barriers to access fitness facilities.4,5 Regular physical activity6 and age-friendly environments are two essential components of healthy aging.7 Initiating and sustaining a program of regular physical activity is challenging for all people and particularly challenging for people with
https://doi.org/10.1016/j.dhjo.2020.101006 1936-6574/© 2020 Elsevier Inc. All rights reserved.
Please cite this article as: J.F. Butzer, R. Virva, A.J. Kozlowski et al., Participation by design: Integrating a social ecological approach with universal design to increase participation and add value for consumers, Disability and Health Journal, https://doi.org/10.1016/j.dhjo.2020.101006