Healthy and inclusive communities

The stories of lived experience provide important nuanced details that are rarely picked up in survey questionnaires or comparing one group with another. One way to capture lived experience is by using “photovoice” – a method of visually recording experiences. This method reveals detailed ways of creating healthy and inclusive communities for all.

Five Canadian researchers used the photovoice method to discover the everyday barriers and facilitators mobility device users face. Participants not only provided photographic evidence, they related what it meant for them as an outcome. Unsurprisingly, footpaths, road crossings and road maintenance and construction featured strongly in their findings.

Photos of environmental barriers provide important information for urban planners. They can see more clearly how the small details matter. This image shows an uneven footpath and no clear access to the bus stop.

A narrow footpath and a nature strip with a bus stop. The bus stop has no seat and there is no pathway or concrete apron for the bus stop. Passengers have to cross the grass to get to the bus. Healthy and inclusive communities.

Participants in the study captured physical characteristics that both helped and hindered their ability to navigate the environment. Objective assessments such as access audits, do not reveal the complex interaction of social participation and health. Lived experience and the everyday stories, on the other hand, provide this valuable information.

This image shows a woman with a walking aid and a man with a baby stroller need to pass on a narrow path encroached by gravel and mulch.

Image by John Evernden

A woman with a wheelie walker and a man with a baby stroller meet from opposite directions on the footpath. In order to pass, one of them will have to walk and wheel on the gravel which is encroaching on the footpath.

Key points and themes

Five key themes emerged from the study.

En Route: the usability and safety of the physical path to reach a destination, road crossings and traffic signals. Included in this theme are footpath width, maintenance and surface materials.

Thresholds: Accessibility issues in the transition spaces from outdoors to indoors at a destination. Difficulty getting into shops and other public places limited access to goods and services.

Temporal Rhythms: Fluctuations of accessibility with circadian and seasonal variations as well as urban practices. Differences between day and night where it is easy during the day but not at night. Temporary closures to footpaths due to maintenance meant going back home or trying to find another route.

The Paradox of Accessibility: Fluctuation of accessibility due to inappropriate usage or of conflicting user needs. Participants also found examples of poor attempts at accessibility such as a ramp leading to sand or gravel, or a ramp with a steep grade. The conflict of cyclists using the wider footpaths was also an issue.

Making Change Happen: Actions and solutions to improve the accessibility. Participants were not passive in accepting the status quo. They showed pictures where they had successfully lobbied for changes to a business or a community building. Participants also showed the converse – places where their lobbying had not yet brought about change.

Installing kerb ramps, footpaths and pedestrian crossings are essential physical improvements. However, changing social and urban practices have a role to play as well. The participation of people using mobility devices needs to go beyond tokenism. That means involving users in decision making process – a universal design concept.

The title of the article is, Creating inclusive and healthy communities for all: A photovoice approach with adults with mobility limitations.

From the abstract

This study used photovoice to document the lived experience of 30 people with mobility limitations to see how their interactions with the urban environment affected their mobility, participation and health.

Five themes emerged: 1) En Route, 2) Thresholds, 3) Seasonal variations, 4) The Paradox of Accessibility, and 5) Making Change Happen.

Accessibility exists along a continuum, which acknowledges people with mobility limitations to cope with environmental barriers and maintain their health. This requires an understanding of accessibility that integrates physical, psychological and social dimensions.

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