Access to Care

Project helps those with spinal cord injury identify community and environmental barriers

Individuals with spinal cord injuries who use wheelchairs encounter a variety of social and environmental barriers in their everyday lives. While rehabilitation professionals try to help them overcome these obstacles, providers do not always know the full extent of these barriers in the community. A new study has found that giving people with spinal cord injury a chance to document existing barriers with a camera helps professionals find solutions to these problems.

Photovoice is a participatory research method that equips individuals with digital cameras to photograph what they experience out in the community. Ten people with spinal cord injury and a center for independent living participated as research partners in the project. All participants received training sessions dealing with camera use, the Photovoice method, and assignments. For each assignment, participants were asked to take at least 10 photos and provide notes for each one. Assignments included taking photos that explained community barriers and facilitators they encountered, as well as creating a photo documentary of a day out in the community.

Interviews with the participants, along with the photos, revealed nearly equal numbers of barriers and facilitators in the community. Most barriers were land-development related, including parking lots, sidewalks, ramps, and curb cuts. Numerous problems existed with accessible parking opportunities. The second most frequent source of barriers was building design and construction. Participants also reported barriers in medical care, such as inaccessible exam tables. However, participants also indicated support from most health care professionals, peers, colleagues, family, and friends.

The group identified problems with accessible parking as a priority issue. The participants used their photos to supplement written testimony presented to South Carolina Senate and House committees in support of a bill to strengthen accessible parking laws in the State. The bill was subsequently signed into law, which went into effect this year. The study was supported in part by the Agency for Healthcare Research and Quality (HS16941).

See "Evidence-based advocacy: Using Photovoice to identify barriers and facilitators to community participation after spinal cord injury," by Susan D. Newman, Ph.D., R.N., C.R.R.N. and SCI Photovoice Participants, in the March/April 2010 Rehabilitation Nursing 35(2), pp. 47-59.

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