Ecology of Rural Participation-Longitudinal Survey

May 2016
Andrew Myers and Craig Ravesloot

Background

Personal factors (e.g., mobility impairment, health) can have large effects on a person’s choices and opportunities for participating in their community (Rimmer, Riley, Wang, Rauworth & Jurkowski, 2004). Further, environmental factors (e.g., built structures, social attitudes) may interact with personal factors to facilitate participation or function as barriers to participation. In rural areas, environmental factors can be particularly challenging.

Approximately 56 million Americans live in rural areas (Economic Research Service, 2012). They account for 16% of the total population but represent a higher share of people who live in poverty (Economic Research Service, 2012), are unemployed (Economic Research Service, 2012; Rojewski, 1992), have disability (Rural Policy Research Institute, 2009), and are elderly (Albrecht, 2012; Rural Policy Research Institute, 2009). While rural America is their home, living there can place them at a disadvantage. There is a need to increase understanding of the challenges people with disabilities in rural areas face and explore the relationships between personal and environmental factors that influence community participation.

The ecological model describes disability as a dynamic interaction between a person and their environment (NIDRR 2013; WHO 2001). However, scientific understanding of this interaction, specifically the role of environmental factors, is still lacking (Magasi et al. 2015). The science of person-environment (P-E) fit seeks to understand how personal characteristics interact with environmental features to influence outcomes (Edwards, Cable, Williamson, et al. 2006). For example, when people perceive a good “fit” between themselves and an environment, they are more likely to stay in that environment and engage it more fully (Beasely, Jason, & Miller, 2012). Individuals perceive they fit well in their environment when they believe their goals and values are similar to others, they can meet their needs, and can make a contribution.

We developed a longitudinal survey to measure personal factors (e.g., impairment) and environmental factors (e.g., social support) to examine how these interact with each other to shape community participation in rural communities across the United States. Outcomes from this research will further increase the knowledge for practitioners and policy makers about improving rural community living for people with disabilities.  We plan to collect data annually for four years.

Sample

We selected 12 rural communities stratified by population size and demographically representative of the four U.S. census regions (West, Midwest, South, Northeast). Surveys were collected from 285 people in separate households across these communities.

Community Population Disability Rate
Havre, MT 9,568 13.4%
Sparta, WI 9,302 13.4%
Ellsworth, ME 7,595 18.7%
Cameron, TX 5,242 22.2%
Russell, KS 4,398 17.1%
Franklin, NC 3,877 22.5%
Soda Springs, ID 2,917 13.3%
Coudersport, PA 2,378 19.9%
Galeton, PA 1,238 17.2%
Highlands, NC 1,082 10.8%
Grace, ID 914 19.4%
Lucas, KS 510 12.4%

 

Basic Demographics

Average age was 58 (range 23-91)

52% female

89% White; 5% American Indian/Alaska Native; 5% Black/African American; 1% Asian; 2% Other; 2% Hispanic/Latino

63% Not Employed; 11% Employed Part-Time; 24% Employed Full-Time

54% Mobility; 24% Self-Care; 31% IL; 27% Cognitive; 20% Deaf; 10% Blind.

Disability

We used six questions from the American Community Survey (ACS) to identify individuals who may experience some form of disability. Each of these questions evaluates functional impairment. While disability is much more than just functionality, it is difficult to measure directly because it is a dynamic interaction. These questions are frequently used by government organizations and researchers as an indicator of disability.

  1. Deaf: Are you deaf, or do you have serious difficulty hearing?
  2. Blind: Are you blind, or do you have serious difficulty seeing even when wearing glasses?
  3. Cognitive: Because of a physical, mental, or emotional problem, do you have serious difficulty remembering, concentrating, or making decisions?
  4. Mobility: Do you have serious difficulty walking or climbing stairs?
  5. Self-Care: Do you have difficulty bathing or dressing?
  6. Independent Living: Because of a physical, mental, or emotional problem, do you have difficulty doing errands alone such as visiting a doctor’s office or shopping?

Measures

Demographics

  • Age
  • Sex
  • Race
  • Relationship status
  • Education
  • Employment
  • Income
  • Housing status
  • Health insurance and coverage
  • Health conditions
  • Equipment use
  • Transportation access

Brief Community Engagement Questionnaire

The Brief Community Engagement Questionnaire was developed using items from the Survey of Participation and Receptivity in Communities (Gray, Morgan, Dashner, Garrett, & Hollingsworth, 2012) and the Participation Survey/General (Gray et al., 2006). Based on Gray and colleagues’ research, the 16 items with the greatest frequency of endorsement were used in this questionnaire. Participants specified the frequency of each item over the past 7 days as well as how usual their activity was relative to a typical week from “less,” “same,” and “more” than usual.

Trips – Number of visits in the past 7 days

  • Grocery Store
  • Doctors or other healthcare providers
  • Pharmacies
  • Restaurants
  • Large box stores such as Walmart or Home Depot
  • Pubic parks or recreation areas
  • Exercise facilities
  • Shopping malls

Activities – number of times in the past 7 days

  • Active Recreation such as exercise, sports or fishing
  • Socializing outside the home
  • Religious activities such as church services
  • Community activities such as voting, meetings
  • Entertainment such as movies or sporting events

Major Activities – number of hours in the past 7 days

  • Employment
  • School or Education
  • Volunteering

Secondary Condition Surveillance Instrument – (Seekins, Smith, McCleary, Clay, & Walsh, 1990)

Thirteen limiting conditions and their descriptions were presented.  Participants were asked to rate how each condition affected their activity and independence in the past 30 days using a 4-point scale from 0 (not experienced during the past month/insignificant problem) to 3 (significant/chronic problem).

  • Problems with mobility
  • Fatigue
  • Chronic pain
  • Physical fitness/conditioning problems
  • Sleep disturbance
  • Eating or weight problems
  • Depression
  • Anxiety
  • Joint & muscle pain
  • Anger
  • Isolation
  • Access problems
  • Arthritis

Positive and Negative Affect Schedule (PANAS) – (Watson, Clark, & Tellegen, 1988)

Participants indicated how they were feeling at the moment of the survey for each item on a 6-point scale: “not at all,” “very slightly,” “a little,” “moderately,” “quite a bit,” “extremely.”

  • Interested
  • Distressed
  • Excited
  • Upset
  • Strong
  • Guilty
  • Scared
  • Hostile
  • Enthusiastic
  • Proud
  • Irritable
  • Alert
  • Ashamed
  • Inspired
  • Nervous
  • Determined
  • Attentive
  • Jittery
  • Active
  • Afraid

The Hope Scale – (Synder et al. 1991)

Respondents indicate on a 4-point scale how false or true each statement applies to them: “definitely false,” “mostly false,” “mostly true,” or “definitely true.”

  • I can think of many ways to get out of a jam.
  • I energetically pursue my goals.
  • I feel tired most of the time.
  • There are lots of ways around any problem.
  • I am easily downed in an argument.
  • I can think of many ways to get the things in life that are most important to me.
  • I worry about my health.
  • Even when others get discouraged, I know I can find a way to solve the problem.
  • My past experiences have prepared me well for my future.
  • I’ve been pretty successful in life.
  • I usually find myself worrying about something.
  • I meet the goals that I set for myself.

Abbreviated Duke Social Support Index – (Parkerson et al. 1989)

This is an 11-item version of the Duke Social Support Index which examines family and non-family social support. Respondents indicate how supportive the specified individual is by marking “no such person,” “none,” “some,” or “a lot.”

Family Members:

  • wife, husband or significant other
  • children or grandchildren;
  • parents or grandparents;
  • brothers or sisters;
  • other blood relatives;
  • relatives by marriage (in-laws, ex-wife, ex-husband)

Non-family members:

  • Neighbors
  • co-workers
  • church members
  • other friends.

Social Activity Log – Syrjala et al. 2010

Respondents indicate how many days in the last week they participated in voluntary social activities such as sports, eating out, and religious events among others. They then indicate whether this was a normal week: yes, no more than usual, no fewer than usual.

Respondents also indicate their activity over the last month for a given activity from: 0, 1, 2, 3, 4, 5, 6+

  • Went shopping with friends or family you do not live with.
  • Had friends or family come to visit.
  • Talked on the telephone with friends or family you do not live with.
  • Went to a movie, concert, theater, or other cultural or entertainment musical event.
  • Went to a sports game to watch.
  • Participated in sports with other people you do not live with.
  • Got emails, letters, cards, or notes from people you know, but do not live with.
  • Went to the museums, art exhibits, or similar activities.
  • Had coffee, tea, or other drinks with friends or family you do not live with.
  • Sent emails, letters, cards, or notes to people you know but do not live with.
  • Played cards or games with people you do not live with.
  • Went to other social events (parties, meals, or other happenings) where you talked with people you do not live with.
  • Did other social activities with people you do not live with.

Person-Environment Fit

P-E fit was measured using an adapted version of the General Environment Fit scale (Beasley, Jason, & Miller 2012). Respondents rated on a scale from Strongly Disagree (1) to Strongly Agree (4) for each item.

  • “The things that I value in life are very similar to the things that other people in my community value.”
  • “The community that I currently live in gives me just about everything I could ever need from a town.”
  • “My abilities and personal experience are a poor fit with the requirements of the community.”
  • “My personal values match those of people in my community.”
  • “My personal abilities and education are a good match for the demands that my community places on me.”
  • “The other residents in my community are similar to me.”
  • “I do not add anything unique to my community.”
  • “My needs are met by the community I live in.”
  • “My values prevent me from fitting in with my community.”
  • “I have the ability to meet the demands of my community.”
  • “The other residents of my community are different from me.”
  • “My community fulfills my needs.”
  • “There is a poor fit between what my community offers me and what I need in a town.”
  • “I don’t fit in with my community because I am different than other residents.”
  • “The values of my community do not reflect my own values.”
  • “My unique differences add to the success of my community.”
  • “The community that I live in does not have the attributes that I need in a town.”
  • “I am different than the other residents in my community.”
  • “The match is very good between the demands of my community and my personal skills.”
  • “I am not able to meet the demands of my community.”
  • “Nothing unique about me adds to the success of my community.”
  • “I am similar to other residents of my community.”
  • “I make unique contributions to my community.”
  • “My personal values are similar to those of my community.”
  • “The values of my community are a good fit with my values.”
  • “I fill an important role in my community that others in the community don’t fill.”

Disability and Health Perceived Barriers

Barriers to getting out were measured using an adapted version of the Disability and Health Perceived Barriers scale (Murphy-Southwick & Seekins 2000). Respondents rated on a scale from Never (1) to Routinely (4) how often they encountered barriers in the community in the past seven days.

  • It was easy to get in and out of my house.
  • My community had too few curb cuts.
  • I felt safe when leaving my home.
  • Poor air quality or other pollutants bothered me.
  • The weather was too bad to get out.
  • Buildings were accessible to me.
  • I didn’t have transportation.
  • I had the assistive equipment I needed.
  • My health was limiting me too much.
  • I had a hard time thinking and concentrating.
  • I was too busy to do everything I needed to do.
  • People’s attitudes toward me were positive.
  • My daily self-care needs took too much energy.
  • I had the help I needed.
  • I was too tired.

Procedures

We recruited participants to complete a paper and pencil longitudinal survey from 12 rural communities throughout the United States. Communities were chosen to be socio-demographically representative of their region, and were selected based on population. Four communities have populations from 5,000-10,000 (Group A), four communities have populations from 1,000 – 5,000 (Group B) and four communities have populations less than 1,000 (Group C). The Tailored Design Method was then utilized for participant recruitment (Dillman, 2007). We mailed a total of 13,600 recruitment letters to randomly selected households in each community, a total of 2,000 randomly selected households in Group A, 1,000 randomly selected households in Group B, and 400 randomly selected households in Group C. Pre-coded recruitment letters and pre-coded anonymous postage paid post-cards were sent to each household twice approximately two months apart requesting that individuals mail back the post card if they were between the ages of 18 and 65 years of age and they could answer “yes” to at least one of the impairment questions listed above. Interested participants who returned the post card were sent a survey using Tailored Design procedures for materials development and follow-up (Dillman, 2007).

These results are part of the Ecology of Rural Disability Project.

Additional information is available on our Ecology of Participation Website