Community participation disparities among people with disabilities during the COVID-19 pandemic.

PURPOSE: To describe disparities in community participation during the COVID-19 pandemic among people with disabilities. METHODS: Respondents to Phase 3.3 of the COVID Household Pulse Survey (US Census Bureau) were classified by disability status. Risk ratios and risk differences were computed to compare the risk of poor outcomes on economic participation, community service use, and community activities by disability status - both overall (compared to the nondisabled reference) and by race/ethnicity (each subgroup compared to the White nondisabled reference). RESULTS: At least one type of disability was reported by 59.6% of respondents. People with disabilities were more likely to report in-person medical appointments but were at greater risk of poor outcomes across all other outcomes [risk ratio range = 1.01(1.01-1.02) to 1.91(1.80-2.01), risk difference range = 1.0(0.5-1.5) to 13.4(12.6-14.2)]. The disabled Black and disabled Hispanic/Latino groups experienced disproportionately high risk of poor outcomes across all indicators [risk ratio range = 1.0 (1.0-1.1) to 6.1 (5.0-7.1), risk difference range = 3.2 (1.9-4.4) to 33.1 (30.1-35.4)]. CONCLUSIONS: The high number of people reporting disability, along with the notable disparities in community participation outcomes among those reporting disability, suggest the need for expanded rehabilitation services and community supports to enhance participation.

People with disabilities experienced disparities in community participation outcomes during the pandemic, particularly in indicators of economic participation (paid employment, income, and education).Disabled people from racial and ethnic minority groups experienced the most severe disparities in outcomes.Stronger rehabilitation services are critical to address new disability or pandemic-related changes in the experience or severity of existing disability.Stronger community and social supports (employment supports, accessible assistive technology, and safe transportation options) may also reduce the disparities in community participation experienced by people with disabilities.

"They Just Love Me"-An Examination of Social Support Experiences and Values Among People With TBI.

OBJECTIVE: Social support is important for health and functional outcomes after traumatic brain injury (TBI), but many adults with TBI report inadequate social support. Little research has examined the social support priorities of adults with TBI or what an optimal social support network should include. The objective of this study was to describe the social support structures and experiences of adults with TBI. SETTING: Community-based rehabilitation program. PARTICIPANTS: Community-dwelling adults with TBI, predominantly from racial and ethnic minority groups. DESIGN: Cross-sectional collection of quantitative and qualitative data. MAIN MEASURES: Number of close social contacts and total social contacts, along with a report of the frequency of social support using the Medical Outcomes Study Social Support Survey. Qualitative interviews were used to examine the quality of social support and participant values and priorities. RESULTS: Participants had an average of 4.3 close contacts (median 3.5, range 1-10), an average of 8.5 total social contacts (median 7, range 2-28), and a low frequency of social support (mean 28.4, SD = 24.7). Interview themes fell under 2 grand themes: structure of social networks (social networks are made up of families; proximity influences the type of support) and quality of social support (commitment vs indifference; doing things with and for others adds meaning; and "they just love me"). CONCLUSION: Participants in this study had small social networks and a low frequency of social support. Findings suggest that people with TBI value committed support partners, social inclusion, bidirectional relationships, and emotional connection, yet experience lower support in these areas compared to tangible support. Future research should examine how to adapt existing models of social support to more closely align with participant values. Rehabilitation services may need to focus more heavily on individual and family training, addressing strategies to develop and maintain relationships, emotional connection, and communication to enhance relationship and social support quality.

Ongoing Challenges Related to the COVID-19 Pandemic Among People With Brain Injury.

The COVID-19 pandemic exacerbated social isolation among people with traumatic brain injury (TBI). Yet, little is known about how changes in personal factors, environmental factors, or the characteristics of activities affected social participation. We examined experiences with social isolation and barriers to social participation using the person-environment-occupation-performance model as a framework. Twelve adults with TBI participated in a series of three focus groups. Data were analyzed using thematic analysis. We identified two primary themes with sub-themes: (1) social isolation experiences: (1a) emotional impact and (1b) managing personal risk; and (2) greater barriers but a lack of strategies to address them: (2a) access and opportunities and (2b) social and societal factors. New environmental barriers and task demands affected occupational performance, and participants identified few successful strategies to overcome these barriers. Occupational therapy can develop new strategies to re-balance the person-environment fit and enhance social participation.

Ongoing Challenges Related to the COVID-19 Pandemic Among People With Brain InjuryPeople with traumatic brain injury (TBI) have experienced increased social isolation because of the COVID-19 pandemic. There has been limited research to describe how social isolation has been experienced beyond the initial pandemic lockdowns, what limits people from participating in more social activities, and how occupational therapy can help people overcome these new challenges. We interviewed 12 people with TBI to understand their experiences of social isolation using the person­environment­occupation­performance model as a framework. We found that people with TBI have continued to experience worse social isolation, which has affected their emotional well-being. They continue to worry about their risk of exposure and illness. We found that limited opportunities for social activities, inaccessibility of activities, and a lack of social support have contributed to social isolation. Occupational therapy practitioners can help people with TBI develop new strategies to overcome barriers to social participation so they may safely return to important social activities.

Participation and Its Association With Health Among Community-Dwelling Adults With Chronic Stroke.

IMPORTANCE: Little is known about the severity of participation restrictions among people living in the community with chronic stroke. Even less is known about the association between participation and health in this population. OBJECTIVE: To describe participation among people with chronic stroke and examine the association between participation and physical and mental health. DESIGN: Secondary analysis of baseline data from an intervention study. SETTING: The parent multisite intervention study was conducted in the community, and assessments were administered in participants' homes. PARTICIPANTS: Thirty-one community-dwelling adults with chronic stroke. OUTCOMES AND MEASURES: Participation was measured with the Activity Card Sort (percentage of prestroke activities retained) and the Enfranchisement Scale of the Community Participation Indicators. Health was measured with the PROMIS®-29 Physical Health and Mental Health subscales. We calculated descriptive statistics for participation measures and Spearman's ρ correlations between participation and health outcomes. RESULTS: Participation scores were poor on all measures of participation. Most striking, 94.9% of participants retained less than 80% of their prestroke activities. All measures of participation were modestly correlated with physical health (ρ = .28-.46) and were moderately correlated with mental health (ρ = .42-.63). CONCLUSIONS AND RELEVANCE: Participation restrictions are prevalent among adults with chronic stroke, with potential implications for mental health. Stronger community-based rehabilitation and support services to enhance participation of this high-risk population are warranted. What This Article Adds: This report highlights the severity of participation restrictions among people with chronic stroke. Moreover, this report shows that people with stroke feel a lack of inclusion in the community and that participation is associated with mental and physical health.

Stakeholders' Experiences Using Videoconferencing for a Group-Based Stroke Intervention During COVID-19: A Thematic Analysis.

IMPORTANCE: Guidance is limited for training protocols that support stakeholders who are new to participating in telerehabilitation interventions using videoconferencing software. OBJECTIVE: To explore stakeholders' experiences participating in a group-based intervention during the coronavirus disease 2019 (COVID-19) pandemic using a videoconferencing software (Zoom). DESIGN: Ad hoc exploratory thematic analysis. SETTING: Community-based telerehabilitation. PARTICIPANTS: Stakeholders included group members (n = 8) who were low-income adults with chronic stroke (≥3 mo) and mild to moderate disability (National Institutes of Health Stroke Scale ≤ 16), group leaders (n = 4), and study staff (n = 4). INTERVENTION: Group-based intervention, ENGAGE, delivered using videoconferencing technology. ENGAGE blends social learning and guided discovery to facilitate community and social participation. OUTCOMES AND MEASURES: Semistructured interviews. RESULTS: Stakeholders included group members (ages 26-81 yr), group leaders (ages 32-71 yr), and study staff (ages 23-55 yr). Group members characterized ENGAGE as learning, doing, and connecting with others who shared their experience. Stakeholders identified social advantages and disadvantages to the videoconferencing environment. Attitudes toward technology, past technology experiences, the amount of time allotted for training, group size, physical environments, navigation of technology disruptions, and design of the intervention workbook were facilitators for some and barriers for others. Social support facilitated technology access and intervention engagement. Stakeholders recommended training structure and content. CONCLUSIONS AND RELEVANCE: Tailored training protocols may support stakeholders who are participating in telerehabilitation interventions using new software or devices. Future studies that identify specific tailoring variables will advance the development of telerehabilitation training protocols. What This Article Adds: These findings provide stakeholder-identified barriers and facilitators, in addition to stakeholder-informed recommendations, for technology training protocols that may support uptake of telerehabilitation in occupational therapy.

Rest-Activity Rhythm Characteristics Associated With Depression Symptoms in Stroke Survivors.

OBJECTIVE: To examine which 24-hour rest-activity rhythm (RAR) characteristics are associated with depression symptoms in stroke survivors. DESIGN: Cross-sectional observational study examining associations of RAR characteristics with the presence of depression symptoms adjusting for age, sex, race, and medical comorbidity. SETTING: Community setting. PARTICIPANTS: Stroke survivors: (1) recruited locally (N women=35, N men=28) and (2) a nationally representative probability sample (the National Health and Nutrition Examination Survey [NHANES]; N women=156, N men=124). INTERVENTIONS: None. MEASUREMENTS: Objective RAR characteristics derived from accelerometer recordings including activity onset/offset times and non-parametric measures of RAR strength (relative amplitude), stability (interdaily stability), and fragmentation (intradaily variability). The presence of depression symptoms was categorized using Patient Health Questionnaire scores. RESULTS: In both samples, the only RAR characteristic associated with depression symptoms was intradaily variability (fragmentation): local sample, odds ratio=1.96 [95% confidence interval=1.05-3.63]; NHANES sample, odds ratio=1.34, [95% confidence interval=1.01-1.78]). In the NHANES sample, which included both mild and moderate/severe depression, the association between 24-hour sleep-wake fragmentation and depression symptoms was driven by moderate-to-severe cases. CONCLUSIONS: Stroke survivors with higher levels of RAR fragmentation were more likely to have depression symptoms in both samples. These findings have implications, given prior studies in general samples linking RAR fragmentation with future depression and dementia risk. Research is needed to establish the potential consequences, mechanisms, and modifiability of RAR fragmentation in stroke survivors.

Cut points and sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in adults with traumatic brain injury.

BACKGROUND: Community participation is an important outcome of rehabilitation following traumatic brain injury. Yet, few measures assess inclusion and belonging (enfranchisement) as a dimension of community participation. The Enfranchisement scale of the Community Participation Indicators addresses this need. However, research on its psychometric properties is lacking. OBJECTIVE: To examine cut points and sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in adults with traumatic brain injury. DESIGN: This was a repeated measures study with assessments administered twice (3 months apart). SETTING: Assessments were administered either over the phone, virtually (Zoom), or in person at the participant's home. PARTICIPANTS: A total of 44 participants from community settings who had either experienced a traumatic brain injury within the previous year or were receiving rehabilitation interventions were recruited. MAIN OUTCOME MEASURE: The Enfranchisement scale has two subscales: the Control subscale (range: 13-65) and the Importance subscale (range: 14-70). On both subscales, lower scores indicate better enfranchisement. METHODS: The software SAS PROC Logistic and the macro %ROCPlot were used to examine cut points at varying levels of sensitivity and specificity. The area under the receiver operating characteristics curve was calculated to determine overall classification accuracy. Minimum detectable change and minimal clinically important difference were also calculated. RESULTS: For the Control subscale, a cut point of 44 (area under the curve = .75), a minimum detectable change of 8, and a minimal clinically important difference of 5 were found. For the Importance subscale, a cut point of 39 (area under the curve = .81), a minimum detectable change of 8, and a minimal clinically important difference of 5 were found. CONCLUSIONS: The cut points resulted in good classification accuracy, providing support for their reliability. The results provided evidence that both subscales are sensitive to change in adults with brain injury.

Effect of interventions on activity and participation outcomes for adults with brain injury: a scoping review.

OBJECTIVE: To characterize the intervention elements associated with improvements in activity and participation outcomes for adults with brain injury. DATA SOURCES: PubMed and PsycINFO/Ovid. STUDY SELECTION: We included RCTs that examined interventions for adults with acquired brain injury with an activity or participation outcome measure. DATA EXTRACTION: We classified intervention elements and extracted effect sizes. We examined patterns of effect sizes associated with each intervention element based on time of follow-up and level of outcome (home versus community). DATA SYNTHESIS: Thirty-nine articles were included. Outcomes focused on the performance of home and community activities. There was wide variation in effect sizes across all intervention elements, as well as by time and by outcome level (home versus community). Metacognitive interventions and daily life skills interventions showed the greatest promise for improving performance of home and community activities. Additionally, cognitive training interventions may play a role in improving home activity performance and social skills training interventions may play a role in community activity performance. Physical activity interventions showed the least promise for improving home and community activity performance. CONCLUSION: This study highlights the importance of interventions that incorporate explicit strategies and task-specific training, rather than only addressing specific injury-related impairments.

Construct validity of the enfranchisement scale of the community participation indicators.

OBJECTIVE: This study examined the construct validity of the Enfranchisement scale of the Community Participation Indicators. DESIGN: We conducted a secondary analysis of data collected in a cross-sectional study of rehabilitation outcomes. SUBJECTS: The parent study included 604 community-dwelling adults with chronic traumatic brain injury, stroke, or spinal cord injury. The sample had a mean age of 64.1 years, was two-thirds male, and included a high proportion of racial minorities (n = 250, 41.4%). MAIN MEASURES: The Enfranchisement scale contains two subscales: the Control subscale and the Importance subscale. We examined correlations between each Enfranchisement subscale and measures of participation, environment, and impairments. The current analyses included cases with at least 80% of items completed on each subscale (Control subscale: n = 391; Importance subscale: n = 219). Missing values were imputed using multiple imputation. RESULTS: The sample demonstrated high scores, indicating poor enfranchisement (Control subscale: M = 51.7; Importance subscale: M = 43.0). Both subscales were most strongly associated with measures of participation (Control subscale: r = 0.56; Importance subscale: r = 0.52), and least strongly associated with measures of cognition (Control subscale: r = 0.03; Importance subscale: r = 0.03). The Importance subscale was closely associated with depression (r = 0.54), and systems, services, and policies (r = 0.50). Both subscales were associated with social attitudes (Control subscale: r = 0.44; Importance subscale: r = 0.44) and social support (Control subscale: r = 0.49; Importance subscale: r = 0.41). CONCLUSIONS: We found evidence of convergent validity between the Enfranchisement scale and measures of participation, and discriminant validity between the Enfranchisement scale and measures of disability-related impairments. The analyses also revealed the importance of the environment to enfranchisement outcomes.

Detecting change in community participation with the Enfranchisement scale of the community participation indicators.

OBJECTIVE: This study determined the sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in people with stroke. DATA SOURCES: We analyzed data from two studies of participants with stroke: an intervention study and an observational study. MAIN MEASURES: The Enfranchisement Scale contains two subscales: the Importance subscale (feeling valued by and contributing to the community; range: 14-70) and the Control subscale (choice and control: range: 13-64). DATA ANALYSIS: Assessments were administered 6 months apart. We calculated minimum detectable change and minimal clinically important difference. RESULTS: The Control subscale analysis included 121 participants with a mean age of 61.2 and mild-moderate disability (Functional Independence Measure, mean = 97.9, SD = 24.7). On the Control subscale, participants had a mean baseline score of 51.4 (SD = 10.4), and little mean change (1.3) but with large variation in change scores (SD = 11.5). We found a minimum detectable change of 9 and a minimum clinically important difference of 6. The Importance subscale analysis included 116 participants with a mean age of 60.7 and mild-moderate disability (Functional Independence Measure, mean = 98.9, SD = 24.5). On the Importance subscale, participants had a mean baseline score of 44.1 (SD = 12.7), and again demonstrated little mean change (1.08) but with large variation in change scores (SD = 12.6). We found a minimum detectable change of 11 and a minimum clinically important difference 7. CONCLUSIONS: The Control subscale required 9 points of change, and the Importance subscale required 11 points of change, to achieve statistically and clinically meaningful changes, suggesting adequate sensitivity to change.

Rasch Analysis of Social Attitude Barriers and Facilitators to Participation for Individuals with Disabilities.

OBJECTIVES: To develop item banks of social attitude barriers and facilitators to participation and validate them with established instruments. DESIGN: We used the Rasch model to identify misfitting items and rating scale problems, calibrate items, and develop KeyForms and short forms. Correlations between the Social Attitude Barriers and Facilitators item banks with the Patient-Reported Outcomes Measurement Information System (PROMIS) Social Health domain and National Institutes of Health Toolbox Emotional Battery Social Relationships domain were computed to evaluate convergent and divergent validity. SETTING: Community-dwelling individuals traveled to 3 academic medical centers for testing. PARTICIPANTS: Participants (N=558) who had a primary impairment of stroke, spinal cord injury, or traumatic brain injury (mean age, 47.0±16.0y) completed 31 social attitude facilitator and 51 barrier items using a 5-point rating scale. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Item banks to measure social attitude barriers and facilitators for individuals with disabilities. RESULTS: After combining the "never" and "rarely" rating scale categories, 30 Facilitator items fit the Rasch model and demonstrated person reliability of 0.93. After collapsing the "never" and "rarely" rating scale categories, 45 Barrier items fit the Rasch model and demonstrated person reliability of 0.95. Ceiling and floor effects were negligible for both item banks. Facilitators and Barriers item banks were negatively correlated, and these banks were moderately correlated with PROMIS and Toolbox measures, providing evidence of convergent and divergent validity. CONCLUSIONS: Findings support the reliability and validity of the Social Attitude Facilitators and Barriers item banks. These item banks allow investigators and clinicians to measure perceptions of social attitudes, providing information that can guide individual interventions to reduce barriers and promote facilitators. Moderate correlations between the Social Attitude banks and PROMIS and Toolbox variables provide support for the measurement and theory of environmental influences on social health and participation.

Sedentary behavior patterns over 6 weeks among ambulatory people with stroke.

Objective: To describe patterns of sedentary behavior over 6 weeks among ambulatory people with subacute and chronic stroke.Design: Observational longitudinal study with assessments at baseline (T0) and week 6 (T1).Methods: Community-dwelling people with stroke (n = 39) pooled from two studies who were ≥18 years of age were assessed for sedentary behavior at 2 timepoints (T0, T1). Sedentary behavior was measured with the activPAL micro3 following a 7-day wear protocol to obtain mean daily: total sitting time, sitting time accumulated in bouts ≥30 minutes, number of sit-to-stand transitions, and fragmentation index (sit-to-stand transitions/total sitting hours). Paired samples t-tests were used to calculate mean group differences in sedentary behavior metrics between T0 and T1 (α =.05). Cohen's d was calculated to describe the magnitude of within-person change between T0 and T1.Results: There were no statistically significant within-person differences between T0 and T1 on mean daily sitting time (Cohen's d= -0.21, p=.19), sitting time accumulated in bouts ≥30 minutes (d= -0.27, p=.11), number of sit-to-stand transitions (d= -0.02, p=.53), or the fragmentation index (d= -0.11, p=.92).Conclusions: Sedentary behavior metrics were stable for over 6 weeks. The number of sit-to-stand transitions per day and the fragmentation index appeared to be the most stable indicators over 6 weeks. Future research should confirm these findings and identify correlates of sedentary behavior among people with stroke.

"Starting to Live a Life": Understanding Full Participation for People With Disabilities After Institutionalization.

IMPORTANCE: A key objective of the Americans With Disabilities Act of 1990 (ADA) is community integration; yet, nearly 30 yr later, little is known about the participation of people with disabilities who transition from institutions to the community. OBJECTIVE: To understand how people with disabilities describe full participation after transitioning from an institution to the community and to identify environmental barriers and facilitators to participation during and after this transition. DESIGN: The ADA-Participatory Action Research Consortium (ADA-PARC), a collaboration among researchers, people with disabilities, and community organizations, is implementing a multimethod, participatory action research study of participation among people with disabilities posttransition. This article presents qualitative findings from semistructured interviews collected as part of the larger ADA-PARC project. SETTING: ADA-PARC community partners across the United States. PARTICIPANTS: One hundred fifty-three adults with disabilities. OUTCOMES AND MEASURES: We used a semistructured interview guide to ask participants about their experiences during and after transition to the community. RESULTS: We identified four themes: (1) the process of transition as ongoing rather than a single event, (2) access to everyday occupations as full participation and what fully represents "living a life," (3) environmental barriers to participation, and (4) social identity as participation as the transformative process of moving from the disempowering isolation of the institution to being integrated into the community. CONCLUSIONS AND RELEVANCE: As people with disabilities transition into community settings, they require ongoing supports to facilitate their full, long-term participation. WHAT THIS ARTICLE ADDS: People with disabilities reported that transitioning from institutions to the community was itself not enough to support their full community participation; rather, they viewed transition as an ongoing process, and they needed services and supports to fully participate. Occupational therapy practitioners working in institutional and community settings can partner with local disability advocacy communities to support their clients' sense of identity and self-confidence during and after transition to the community.

Community participation and public transportation barriers experienced by people with disabilities.

Background: Barriers to public transportation quickly impact the ability of people with disabilities to fully experience their community.Objective: A national survey of people with disabilities was conducted to understand the barriers and supports to accessing public transportation and the impact on community participation.Method: A total of 1748 respondents responded to a web-based survey investigating the accessibility of public transportation. Results present frequency of barriers to public transportation and group differences using Pearson's chi-square technique and Mann-Whitney U tests.Results: A majority of respondents experienced difficulties accessing public transportation, and community activities that do not occur on a regular schedule are more affected by problems with public transportation. Individuals with blindness or low vision, psychiatric disabilities, chronic health conditions, or multiple disabilities experienced more problems using public transportation for community participation, along with participants who were female, Hispanic, Latino/Latina, or Spanish origin.Limitations: Survey distribution was convenience-based, which may have affected participation of certain disability groups, cultural groups, and/or those without computer access, and interpretations cannot be made regarding predictive or casual relationships.Conclusions: Significant challenges face individuals with disabilities as they use public transportation, and certain disability groups are more severely impacted by these problems.Implications for RehabilitationCertain disability groups experience more severe problems with public transportation, as compared to other groups.Public policy advocacy and actions related to public transportation must prioritise individuals with disabilities who experience significantly more problems.Problems using public transportation for spontaneous activities pose increased problems for individuals with disabilities, and steps (i.e., extended hours or alternative transportation options) must be taken to overcome this barrier.

Understanding self-determination as a crucial component in promoting the distinct value of occupational therapy in post-secondary transition planning.

School-based occupational therapists are well-equipped to prepare adolescents to transition from the education system to work and live in their communities, but they report challenges in securing their place on post-secondary transition planning teams. We argue that occupational therapists' efforts to advocate for their role in post-secondary transition could be strengthened by a deeper engagement with what is considered 'best practice' in transition planning: improving students' ability and opportunity to exercise self-determination. In this commentary, we review the self-determination evidence-base; identify congruence between the underlying philosophies of self-determination and occupational therapy; and highlight gaps in existing self-determination models that occupational therapists are uniquely posed to fill by focusing on self-determination as they support transition age students.

Satisfaction, safety, and supports: Comparing people with disabilities' insider experiences about participation in institutional and community living.

BACKGROUND: Legislation and court decisions in the United States mandate the right to least restrictive community living and participation for people with disabilities, yet little research has examined differences in participation across institutional and community settings, or over time in the community post-transition. OBJECTIVE: As part of a multi-site participatory action research project examining participation, we examined the differences in quality of life in institutional and community living environments among people with disabilities. METHODS: We conducted surveys with adults with disabilities between 18 and 65 years-old that transitioned from institutions to the community in the United States within the last five years. This paper reports on findings for a diverse sample of 150 participants. RESULTS: We found significant differences between ratings of institutional and community experiences, with increased reports of satisfaction, personal safety, service access, and participation in community settings. We also found significant improvements in community integration and inclusion after transition to community living, although barriers to transportation and activity access often remained. CONCLUSIONS: This study of insider experiences of previously institutionalized people with disabilities illuminates important understandings of community participation, integration, and quality of life for the disability community in the United States.

What is and isn't working: Factors involved in sustaining community-based health and participation initiatives for people ageing with intellectual and developmental disabilities.

As people with intellectual and developmental disabilities (I/DD) age, it is important that I/DD agencies are prepared to support healthy ageing in homes and in communities. This study explored supports and barriers to sustaining community-based health and participation initiatives (CBHPI) for people ageing with I/DD living in group homes managed by agencies. The study utilized interviews and photovoice with 70 participants-35 individuals with I/DD and 35 management/direct support agency staff. Data were analysed through content analysis and triangulation of data where five themes emerged: Agency values and policies related to healthy ageing; resources and staff competencies; communication between management and staff; community/university partnerships; and peer relations. Findings show that I/DD agencies and people with I/DD value CBHPI, but they find them difficult to sustain due to limited resources and lack of training specific to ageing with I/DD. Conducting system-level research within I/DD agencies to include first-person accounts of people with I/DD, staff and management provides insight on how to effectively support the needs of people with I/DD to improve their health and community participation as they age.

Initial psychometric evaluation of the Community Participation Activation Scale.

BACKGROUND.: Current assessments do not capture the dynamic and complex process of managing different individual and environmental factors influencing community participation post-stroke. PURPOSE.: The purpose of this study was to examine the psychometric properties of the Community Participation Activation Scale (CPAS) in persons with stroke. METHOD.: Rating scale structure, unidimensionality, reliability and precision, construct validity, and differential item functioning of the CPAS were examined with 93 community-dwelling people with stroke. FINDINGS.: The CPAS consists of 15 action items and 10 attitude items. Person separation reliabilities of the action and attitude domains were .75 and .72, respectively, and internal consistency reliabilities were good (>.80). The CPAS showed low to moderate correlation with community integration and enfranchisement constructs. IMPLICATIONS.: The CPAS may be used as an assessment to better understand an individual's level of activation and to inform individually designed, participation-focused interventions, although it needs further improvement to be used as a clinical measure.

Using Photovoice as a participatory method to identify and strategize community participation with people with intellectual and developmental disabilities.

BACKGROUND: Adults with intellectual and developmental disabilities (I/DD) experience barriers to community participation, yet their insider experiences of environmental barriers and supports to participation are largely absent from the literature. AIM/OBJECTIVE: The aims of this research were to evaluate Photovoice as a participatory research method, examine environmental barriers and supports to community participation, and develop strategies to support self-determination and community participation for and with people with I/DD. MATERIAL AND METHOD: This study utilized a participatory action research (PAR) approach in which participants used Photovoice during interviews and audits of participation environments to identify high interest participation activities and document supports and barriers in these environments. Data analysis utilized an iterative, participatory approach in which researchers and participants teamed up to select, contextualize, and codify the data. Thematic analyses involved both inductive and realist approaches. RESULTS/FINDINGS: Participants included 146 community-dwelling adults with I/DD from three U.S. urban sites. We present a conceptual model of nine themes at microsystem, mesosystem, exosystem, macrosystem, and chronosystem environmental levels. CONCLUSIONS: Using Photovoice as a participatory method to strategize community participation can help ground systems change efforts in the voices of people with I/DD. SIGNIFICANCE: By including people with I/DD in conversations that concern them, researchers and practitioners can support this population in ways that they find meaningful.

Validation of the Participation Strategies Self-Efficacy Scale (PS-SES).

PURPOSE: To develop and examine the psychometric properties of a newly developed Participation Strategies Self-Efficacy Scale (PS-SES) designed to assess self-efficacy in using participation strategies following a stroke. METHOD: One hundred and sixty-six subjects with mild to moderate stroke were recruited and interviewed using the PS-SES. The principal axis factoring analysis was run to examine the factor structure, and internal consistency was assessed by computing Cronbach's alpha coefficient. RESULTS: The final measure is a 35-item scale with six subscales: (1) managing home participation, (2) staying organized, (3) planning and managing community participation, (4) managing work/productivity, (5) managing communication, and (6) advocating for resources. The instrument demonstrated high internal consistency. CONCLUSION: The PS-SES is a reliable measure offering unique information regarding self-efficacy in managing participation. Implications for Rehabilitation Post-stroke participation requires complex management of resources, information, and strategies. There is a gap in instruments that can assess self-efficacy in managing participation following a stroke. The PS-SES is a valid tool measuring self-efficacy in using participation strategies in home, work, and community contexts.