OBJECTIVE: The Craig Hospital Inventory of Environmental Factors (CHIEF) is a tool designed to assess and quantify the impact of environmental factors on an individual\'s functioning and social participation. In this study, we aim to culturally adapt the CHIEF from its original English version into the Malay language (M-CHIEF) and examine its validity and reliability among older adults in Malaysia.
METHODS: The original CHIEF was cross-culturally adapted into the Malay language following the published guidelines on cross-cultural adaptation of health questionnaires. Its content and convergent validity were assessed using the content validity index and correlation with participants\' gait speed, respectively. The reliability of M-CHIEF was assessed for its internal consistency using Cronbach\'s coefficient alpha and Cohen\'s kappa and its test-retest reliability was assessed using intraclass correlation coefficients (ICCs).
RESULTS: The M-CHIEF was rated with excellent content validity with a scale-level content validity index (S-CVI) of 0.86. Its internal consistency was demonstrated to be high with Cronbach\'s alpha of 0.84. The test-retest reliability at a two-week interval showed a stable score of the M-CHIEF and its subscales with an ICC value of 0.89.
CONCLUSIONS: The M-CHIEF is deemed relevant for use among Malay speakers. It can function as an instrument to quantify the environmental barriers of an individual while considering broad environmental factors including policy, physical/ structural, work/school, attitude/support, and services/assistance.

In the UK people living in disadvantaged communities are less likely than those with higher socio-economic status to have a healthy diet. To address this inequality, it is crucial scientists, practitioners and policy makers understand the factors that hinder and assist healthy food choice in these individuals. In this scoping review, we aimed to identify barriers and facilitators to healthy eating among disadvantaged individuals living in the UK. Additionally, we used the Theoretical Domains Framework (TDF) to synthesise results and provide a guide for the development of theory-informed behaviour change interventions. Five databases were searched, (CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science) for articles assessing healthy dietary intake of disadvantaged adults living in the UK. A total of 50 papers (34 quantitative; 16 qualitative) were included in this review. Across all studies we identified 78 barriers and 49 facilitators found to either impede and/or encourage healthy eating. Both barriers and facilitators were more commonly classified under the Environmental, Context and Resources TDF domain, with 74% of studies assessing at least one factor pertaining to this domain. Results thus indicate that context related factors such as high cost and accessibility of healthy food, rather than personal factors, such as lack of efficiency in healthy lifestyle drive unhealthy eating in disadvantaged individuals in the UK. We discuss how such factors are largely overlooked in current interventions and propose that more effort should be directed towards implementing interventions that specifically target infrastructures rather than individuals.

UNASSIGNED: Autistic adults engage in lower levels of physical activity (PA) than their nonautistic peers, and over 60% do not meet national guidelines for PA. In addition, autistic adults face myriad barriers to PA participation that can make accessing activities challenging. To support the inclusion of autistic adults in PA, this study sought to explore first-hand recommendations for PA participation from autistic adults\' perspective.
UNASSIGNED: We interviewed 23 autistic adults aged 18 to 75 years about their PA experiences across their lifespan, including querying the participants\' recommendations for supporting autistic adults in PA. A qualitative descriptive design with a constructivist lens guided the thematic analysis.
UNASSIGNED: The analysis resulted in two overarching themes: (1) It\'s helpful to have someone there to support; and (2) It\'s that sensory thing, it always is. Each theme includes participant-provided recommendations to guide professionals in the field of PA.
UNASSIGNED: The autistic adult voice, long absent from conversations about PA, is a valuable and needed addition to understand how to improve PA experiences for this population. Recommendations from this study include (1) listening to the perspectives and insight of autistic adults, (2) consideration of sensory stimulus when planning for PA participation, and (3) encouraging and providing social supports for PA participation.
UNASSIGNED: Why was this study done?: Autistic adults have many health concerns such as anxiety, depression, and obesity. Physical activity can improve these health concerns. Yet, professionals lack knowledge about how to provide optimal physical activity experiences for autistic individuals. Very little research has engaged autistic adults to directly ask their recommendations about their own physical activity needs.What was the purpose of this study?: This study wanted recommendations from autistic adults on how to make physical activity more accessible and enjoyable. By doing this, the authors hope to increase the voices of autistic adults in physical activity research.What did the researchers do?: The researchers asked 23 autistic adults for their recommendations on how to improve physical activity experiences.What were the results of the study?: Participants\' responses were grouped into two categories: (1) It\'s helpful to have someone there to support and (2) It\'s that sensory thing, it always is. The first theme highlights the social supports that many autistic adults feel they need to be successful. Supports include individuals within the close social circles of the autistic adults, such as parents, friends, and other close people. They can also include professionals, such as teachers or exercise trainers. The second theme highlights the need to address the sensory sensitivities of the individual before activity can take place; if an environment or activity is not \"sensory friendly\" or is not accommodating, then autistic adults are less likely to engage.What do these findings add to what was already known?: Autistic adults face many barriers to physical activity participation. These findings offer first-hand accounts by autistic adults about how to improve their physical activity experiences. These results also offer ideas on how to increase physical activity engagement for autistic individuals. Other research has focused on improving physical activity in those who are autistic, but this research is rarely from the perspective of the autistic individual. This study is one of a very small number of studies that has done this and is the first to ask autistic adults to give recommendations for physical activity participation.What are potential weaknesses in the study?: This study only interviewed autistic adults who prefer to communicate verbally, and so the study sample is not representative of all autistic adults. Many participants in the sample were from the United States, and autistic adults in other countries may have different opinions about physical activity participation. Finally, the researchers may have recruited individuals with an interest in physical activity-autistic adults who are not interested or dislike physical activity may have different recommendations.How will these findings help autistic adults now or in the future?: This study will help professionals provide more appropriate physical activity experiences to autistic adults. Also, this research could help practitioners and researcher make physical activity spaces more welcoming and enjoyable for autistic adults.

(1) to describe environmental barriers and participation restrictions experienced by people with spinal cord injury (SCI) from China, (2) to examine associations between lesion characteristics and participation restrictions, considering a mediating role of environmental barriers, (3) to identify those environmental barriers that have the largest influence on participation.
Cross-sectional study. This study is part of the International Spinal Cord Injury Survey (InSCI).
Community, Jiangsu and Sichuan Province, China.
1355 persons with SCI.
Not applicable.
Participation restrictions were measured with items from the Model Disability Survey, Environmental Barriers were measured with the Nottwil Environmental Factors Inventory-Short Form.
Participants experienced a median of five (IQR 1-9) environmental barriers and five (IQR 0-9) participation restrictions. Environmental barriers were mainly reported in relation to climate, insufficient resources and accessibility, and participation restrictions mainly occurred in using public transportation, taking care of others, and getting to places. In an adjusted zero-inflated Poisson model, people with more severe injuries reported a greater number of environmental barriers (complete injury: IRR = 1.31, 95%CI = [1.24,1.38]) and participation restrictions (tetraplegia: IRR = 1.15, 95%CI = [1.10,1.21]; complete injury: IRR = 1.25, 95%CI = [1.18,1.31]). Moreover, environmental barriers (IRR = 1.07, 95%CI = [1.06,1.08]) were a significant predictor of participation restrictions and partially mediated the association of lesion completeness with participation restrictions. Barriers related to accessibility of public places (IRR = 1.47, 95%CI = [1.33,1.62]), accessing homes (IRR = 1.32, 95%CI = [1.21,1.44]), long distance transportation (IRR = 1.11, 95%CI = [1.04,1.20]), communication devices (IRR = 1.07, 95%CI = [1.01,1.15]) and state services (IRR = 1.10, 95%CI = [1.02,1.19]) had the greatest negative impact on participation.
Social participation of people with SCI is seriously restricted in China. Removing environmental barriers will be an important element of programs to address this problem.

OBJECTIVE: The German Spinal Cord Injury Survey is part of the International Spinal Cord Injury Survey, which aims to collect data about the life experience of persons with spinal cord injury worldwide. This paper reports on the perceived environmental barriers of the German study population and their associations with quality of life.
METHODS: Cross-sectional explorative observational study using survey data.
METHODS: A total of 1,479 persons with spinal cord injury aged 18 years and older.
METHODS: After descriptive analyses, exploratory factor analysis was used to build groups of environmental barriers. Logistic regressions were performed to assess correlates of perceived environmental barriers. Spearman\'s correlations were used to analyse the association between perceived barriers and quality of life.
RESULTS: Barriers regarding infrastructure had a relatively large impact. Barriers in relation to people\'s attitudes towards spinal cord injury and the equipment of people with spinal cord injury had a relatively small impact on the lives of people with spinal cord injury. Several subpopulations showed a higher risk in experiencing barriers. Quality of life decreased with increasing experience of barriers.
CONCLUSIONS: The most life-hardening barriers were identified related to infrastructure, a category in which most barriers are modifiable, for example, buildings or transportation.

Purpose: To help enhance participation, the study aims to identify and document a comprehensive list of environmental barriers for people with SCI in the broad travel setting.Methods: Semi-structured interviews were conducted among four stakeholder groups: people with SCI (n= 39), caregivers and family members of people with SCI (n= 24), therapists who work with people with SCI (n= 9), and travel professionals specializing in accessible travel (n= 11).Results: Five major categories of travel barrier emerged from the interviews: Partial Accessibility, Systemic Ignorance, Travel Hassles, Poor Service Performance, and Lack of Support. Detailed barriers in each category are described. The analysis of multi-stakeholder perspectives indicates while respondents with SCI offered the most specific information about the barriers, family members/caregivers were most concerned about the impact of systemic ignorance on their loved ones. Therapists focused on offering their clients tools to overcome barriers, and travel agents emphasized their limitations of serving customers with disabilities.Conclusion: Results of the study should help not only health and travel professionals better assist individuals to reintegrate into society after SCI, but also travel and hospitality businesses to better meet the accessibility needs of people with SCI.Implications for rehabilitationTravel is important to full participation in society for people after SCI.The study has identified five categories of barriers to travel participation after SCI: partial accessibility, systemic ignorance, travel hassles, poor service performance and lack of support.While traveling is important for participation in society for people with SCI, rehabilitation professionals should work together with policy makers, travel and hospitality businesses and agencies to lower the found barriers.

Concerning psychosocial aproaches to disability, Romania is characterized by significant discrepancies between the Disability Rights legislation and reality, while the input of people with disabilities regarding the matter is largely overlooked. This study aims to explore perceptions regarding Romania\'s built and sociocultural environment, as they are expressed by bloggers with disabilities and users of disability-specific forums.
Data were collected from four personal blogs and three discussion forums on the topic of physical disabilities. Thematic analysis was performed.
Four major themes emerged from the analysis: the disabling built environment; the isolating sociocultural environment; blaming others and the past; self-empowerment and the movement towards independent living.
The resistance of disabled people to negative perceptions of disability and their calls to action in this regard may foster positive changes in social attitudes towards disability.Implications for RehabilitationRomanians with physical disabilities perceive that the adaptation and implementation of inclusion and accessibility regulations are superficial.They promote a proactive defence of their rights, independence, and dignity, to resist against discrimination and stigma resulting from the medicalization of disability.Education regarding disability, its evaluation, and the development of inclusion policies should stop focusing on \"incapacity\" as an individual attribute and focus more on the disabling roles of environmental factors.Responsible authorities should understand and enforce the implementation of inclusion and accessibility regulations accordingly.

Background: On the basis of the Social-Ecological Model, there are assumed to be three sources of motivation - intrapersonal, interpersonal, and community motivation - that prompt older adults to participate in physical activity (PA). These three motivational sources can lead to PA behavior adherence. Little empirical research exists that investigates which motivational source is more influential in older adults\' adherence to PA, thus creating an area of interest for this research. Methods: A cross-sectional study was used to investigate the relationship between levels of PA and different sources of motivation. The convenience sample of 140 community-dwelling older adults, aged 60 and greater, living in Shiraz, Iran agreed to complete self-reported questionnaires,to measure motivation and PA. Five statistical tests were used: Independent-samples t test, one way ANOVA, Pearson correlation coefficient, chi-square, and ordinal regression. Results: Ordinal regression indicated that gender (P = 0.001, CI: 0.523-2.115) and intrapersonal motivation (P < 0.001, CI: 0.038-0.126) were useful predictors of variations in the levels of PA. Compared to males, females engaged in PA with less frequency (P = 0.006). Community motivation decreased with age (r = - 0.213, P < 0.05). There were no significant relationships between age, educational level, health status, and PA (P > 0.05). Conclusion: Interpersonal and community motivation were insignificant factors for PA participation, perhaps due to non-facilitating environment. Future research should be conducted to investigate the environmental issues that hinder PA participation in older adults.

Earthquake survivors whose physical injuries result in disability may be at increased risk for prolonged and severe post-traumatic stress disorder. We estimated the prevalence of post-traumatic stress disorder, functional limitations, and environmental barriers in 289 survivors with disabilities induced by the 2008 Wenchuan earthquake eight years after the disaster. We also investigated the relationship of post-traumatic stress disorder symptom severity with function, considering a mediating role of environmental barriers.
Post-traumatic stress disorder was measured with post-traumatic stress disorder checklist-civilian version. Physical and mental functioning was assessed with Medical Outcomes Short Form-36 and perceived environmental barriers were evaluated with Nottwil Environmental Factors Inventory-Short Form. Path analysis was employed to examine the relationship of exposures, post-traumatic stress disorder symptom severity, environmental barriers, and physical and mental function.
Prevalence of probable post-traumatic stress disorder was 18.68% (95% CI: 14.19-23.18%). Earthquake survivors with lower physical and mental functioning perceived more environmental barriers, and those who perceived more barriers demonstrated more severe post-traumatic stress disorder symptoms, confirming a mediating role of environmental barriers.
Long-term community-based health services for earthquake survivors with disabilities should combine both mental and physical rehabilitation and focus on creating disability-inclusive environments.Implications for rehabilitationEarthquake survivors whose physical injuries result in permanent disability may experience two different types of psychological trauma. The first originates from the initial psychological impact of the disaster and their injuries and the second arises from the added difficulty of coping with environmental barriers given the limitations imposed by their impairments.Even years after the disaster, prevalence of post-traumatic stress disorder is likely high in earthquake survivors with acquired musculoskeletal or neurological impairments and needs to be considered in the rehabilitation process.Physical and mental functioning, as well as environmental barriers, are important intervention targets to reduce post-traumatic stress disorder symptoms.Long-term community-based health services for earthquake survivors with disabilities are needed that combine both mental health and physical rehabilitation components with advocating for disability-inclusive environments.

Young adults with cerebral palsy (CP) are reported to be less active than their typically developing peers, have higher rates of sedentary behaviors, engage in slower tempo activities, and overall participate in a smaller variety of physical activities (PA). Functional motor level and environmental barriers have been purported to impact the ability of young adult with CP to participate in physical activity and recreational activities.
To examine the role functional motor level and environmental barriers have on participation in PA and recreation in young adults with CP.
A survey assessing functional motor level (Gross Motor Function Classification Scale), participation in physical activity (The Physical Activity Scale for Individuals with Physical Disabilities) and recreation (The Assessment of Life Habits), and environmental barriers (The Craig Hospital Inventory of Environmental Factors) was mailed to 442 young adults with CP, between the ages of 18-30 years.
97 surveys were returned. No differences in PA were found between GMFCS level; however, young adults in GMFCS levels I and II participated more in recreational activities than GMFCS levels III-V. Greater environmental barriers were experienced by young adults in GMFCS II-V.
This study showed that GMFCS level and physical/structural, policy and attitudinal barriers significantly impacted participation in recreational activities for young adults with CP. Strategies for addressing these barriers from both an individualized therapeutic and advocacy perspective are needed in order to facilitate engagement in physical activity and recreation for young adults with CP at all GMFCS levels.