Jennifer Adler (Graduate Center, City University of New York)

Abstract

This piece provides a brief overview of a multi-phase study designed to explore the relationship between adaptive design and implementation processes with user outcomes. Results suggest significant relationships between environmental adaptation satisfaction and participatory engagement with design and implementation processes, as well as with a user’s perception of receptivity of the adaptation team to their input. Using a classically ecological approach, the concept of environmental press (EP) is reconceptualized to apply to a broader non-institutionalized population. Environmental efficacy is also proposed as a critical mediator to environmental engagement and as a tool for evaluating perceived capacity in particular domains.

Keywords

Adaptations, Agency, Disability, Environmental Press, Environmental Efficacy, Participatory Design

Introduction

Though conceived to evaluate and assess geriatric environments, Lawton’s environmental press (Nahemow & Lawton, 1973) has broad applicability for the assessment of modern dwellings. Particularly in the wake of technological advances minimizing the action and agency of all dwellers, press (and its adjacent theoretical constructs) critically considers the importance of environmental engagement and personal agency in the ways we interact with our environments. Designed to examine space and the older dweller, press is also supremely suited to examine the ways those with disabilities interact with physical space and for the analysis of all types of restorative environments (and environments of degradation). It would seem it is not just environments themselves that mediate positive and healthy experiences. The nature of our interactions with such places is just as important.

Environmental adaptations of all types are used to bridge the gap between individual functional ability and desired behaviors in a given environment. As such, they often modulate the very factors featured in the model, personal competence and environmental demand characteristics. Typically,these objects directly contribute to improved performance potential through improvements in dexterity, mobility and/or the diminishment of discomfort. They may amelioratetheimpact of psychosocial stressors when users are able to express themselves through design and feel comfortable being seen using these objects.

Rather than focusing on institutionalized senior citizens as Lawton did, this project recruited a diverse pool of individuals with disabilities who use adaptations to assist their daily environmental functioning. As disability tends to be a dynamic rather than static state, many participants regularly varied in their degree of need for environmental assistance. Research here explored the ways in which press may be modulated by the nature of the adaptation acquisition process itself. One’s interpretation of particular capacity in a given space is at once both subjective and objective. Classic affordance theory (Gibson 1977, 1986) allows for an examination of the potential of all environments. It provides the theoretical framework for us to consider an infinite number of behavioral possibilities. However, one’s physical and mental capacities as well as an individual’s aptitude coalesce to create finite environmental options and individual object manipulations. This study aspires to explore how the processes by which adaptations tend to be prescribed, acquired and implemented might influence user outcomes.

Methods

The data here represent one part of a larger multi-phase study consisting ofa comprehensiveadaptive device/assistive technology online survey and additional qualitative methods. Survey participants were recruited via direct email and disability-focused social media outreach. Project notices were also posted at a number of regional disability-focused organizations, public libraries and local universities (including New York University and campuses in the public City University of New York system). Digital solicitations were also shared by a number of major New York metropolitan area and national disability advocacy groups primarily via online forums or social media platforms.

Results

Comprehensive data on a total of 124 unique adaptations (N=124) were provided by 60 unique study participants. Age of included respondents varied from 18-74 years of age. Of these adaptations, 23 (~19%) were utilized by self-identified males. The majority of survey participants were female adaptation users. Respondents tended to be from the United States but study recruiting also captured participating adaptation users currently residing in Canada, the Netherlands, Philippines, Slovenia, Spain, and the UK. Internationally designed and/or implemented adaptations made up 10% (N = 13) of the total equipment total. Overall study participation consisted both of individuals with congenital disorders and/or those living with acquired disabilities.

The majority of adaptations described were prescribed for mobility support and assistance. These included lower limb braces, canes, crutches, rollators/walkers, wheelchairs, and lower limb prostheses. Other described devices included structural implants, upper limb prostheses, upper limb bracing devices, wheelchair/walker/rollator accessories, ramps, pressure devices, tools for hearing and vision impairment, automobile alterations to assist with driving, and devices to assist with general self-care (including food preparation, bathroom practices etc.). For the purposes of analysis, adaptations were categorized as “mobility” oriented, “vehicle” specific (including van and customized automobile adaptations), equipment designed to assist with “vision/hearing” challenges (hearing aids, interpreters, specialty software, magnification devices etc.), items used specifically to assist with activities of daily living (ADL) in the home, and “comfort.” Items deemed appropriate for the “comfort” category included anything designed to mitigate discomfort and/or pain including pressure devices for anxiety, pain management devices/supports designed to minimize physical pain, emotional support animals, and “fidgets” for attention challenges. It is important to note that adaptations not specifically designed to assist with mobility (such as those used for communication, pain mitigation, vision/hearing support and others) are additionally likely to facilitate one’s ability to interact with the physical environment. Incomplete responses were excluded from data analysis and subsequent discussion here.

Table 1.

Measures of Central Tendency, Variability, for the Four Statements of Adaptation Use for the Participants of Study

Note.M = Mean; SD = Standard Deviation; Mdn = Median.

Possible range of all scale scores is 1 to 5.

Table 2.

Spearman’s Rank Order Correlations for Bi-Variate Relationships of the Four Statements of Adaptation Use for the Participants of Study

* p < .05

** p < .01

Both 1-tailed and 2-tailed tests were completed in order to assess any correlational relationships between survey values. Preliminary statistical analysis explored the interrelations between survey items including a) overall adaptation satisfaction with degree of perceived design involvement, b) degree of overall satisfaction with perceived receptivity of those involved in the process of procuring the device/adaptation in question, c) degree of perceived receptivity of those involved in the process of procuring the device/adaptation in question with self-reported feelings of efficaciousness, d) involvement and perceived receptivity of the team, and e) perceived receptivity of those involved in the process of procuring the device/adaptation in question with self-reported feelings of efficaciousness. Each one of these values was addressed with a specific question asking for degree of agreement on a Likert-type scale.

Because of the ordinal nature of this data, Spearman’s rank order correlations were used to evaluate relationships between variables with Likert-scaled values.Study participants had the option to choose “Does Not Apply” for specific parts of the survey, measurable N values varied between correlations. Statistical significance was set to the 95% level (p < .05) All correlations evaluated were positive and statistically significant.

Overall satisfaction with adaptation was positively and moderately correlated with self-reported feelings of post-intervention efficaciousness (r = .487, p < .0005; N = 117), and with degree of perceived design involvement (r = .471, p < .0005; N = 101). Interestingly, data here suggests that while perception of having been included in some way in the design and/or acquisition process was associated with a greater degree of satisfaction, the relationship between perceived receptivity of the team (not actual involvement itself) and satisfaction shows an even stronger correlation (r = .570, p < .0005; N = 110).

Satisfactionshowed a strong positive correlation with perceived receptivity of those involved in the process of procuring the device/adaptation in question (r = .570, p < .0005; N = 110) suggesting the belief that one’s provider team would listen and be responsive to their needs was an even more powerful indicator of adaptation satisfaction than even active involvement in the process.

Perceived post-intervention efficaciousness had a positive and weak correlation with degree of involvement in adaptation acquisition process (r = .203, p = .037; N = 106), and a positive and moderate correlation with perceived receptivity of those involved in the process of procuring the device/adaptation in question (r = .399, p < .0005; N = 112). Understandably, perceived receptivity of those involved in the process of procuring the device/adaptation in question did positively correlate with actual involvement in the process of procuring the device/adaptation in question (r = .573, p < 0005; N = 99).

Discussion

In addition to the relationships suggested by the quantitative data summarized above, results of this project illuminated a number of themes important to adaptation users. These included a) a desire to be listened to by a system responsive to their physical, psychological and social needs, b) the opportunity to express themselves and demonstrate their unique interests though environmental adaptations and c) an understanding of the ways adaptive devices and environments often mediate one’s sense of overall efficaciousness in particular spaces (referred to here as environmental efficacy).

This study supplements previous participatory design literature in that it suggests the process by which adaptations are designed is at least as important as the designs themselves. Gathered data here suggests design processes may mediate functional outcomes for those who utilize adaptations of all types. The benefit of end-user participation is multifactorial. Users may derive measurable benefits from completed designs as well as from the ways their perceived value in the process may contribute to feelings of agency. Data generated by this study additionally suggests professional stakeholders (architects, interior designers, occupational and physical therapists, orthopedists, orthotists, prosthetists, etc.) should reassess the ways client input is solicited and utilized in design and implementation decisions. There is profound behavioral, emotional and clinical value in the adoption of a comprehensively transactional and participatory approach to assistive device and adaptation processes. It appears one’s belief in their ability to succeed may be a significant mediator. Efficacy here could encompass both individual agency and resilience to domain specific functional struggles. While some face challenges and assume these are indicators of inherentglobal inability, others may assume these same challenges are event/environment specific and not representative of their overall functionalaptitude.

Feeling a part of, agentive, and/or efficacious in a particular space relates not just to individual psychology but also to the forces placed upon us by the dwellings themselves. As Bandura (2006) pointed out, “To be an agent is to influence intentionally one's functioning and life circumstances.” Thus, it is prudent to consider this aspect of the interaction between person and space when conceptualizing and designing restorative environments of all types. This is where an environmentally specific notion of efficacy could have significant value to the analysis of person-environment (PE) fit. Fit here is more than simply an accommodation for the physical self. It is instead a holistic consideration of the entirety of a person’s being including the ability to achieve desired behavioral outcomes and psychosocial goals. Ideally suited spaces are not just appropriately matched to physical ability but rather flexible enough to account for vast individual differences. This research calls instead for dynamically supportive spaces. An ecological approach suggests “success” is not necessarily an outcome, but rather a deeply contextual process. Among other measures, study participants were asked to gauge how efficacious they interpreted themselves to be before and after given adaptive interventions.

Considered with environmental press, the docility hypothesis and adjacent ecological models of human-environment interactions, this newly proposed measure of perceived environmental efficacy is a byproduct of and a contributor to undesirable affect and other effects. As a measure of efficaciousness within a particular physical environmental domain, this evaluative concept relates not just to activities afforded by specific objects. It integrates individual assessment of capacity (physical, cognitive and emotional) with and without the use of assistance, and balances the potential risks and rewards associated with particular environmental engagements. Thus, a truly holistic approach to environmental well-being needs to consider disability itself as a byproduct of specific person-environment mismatches as well as with individual psychology and cognitive evaluative processes. Context is a critical factor here. Any congenital or acquired physical and/or mental challenge proves to be uniquely challenging only in concert with static and unyielding environmental characteristics.

Relationship to Press

Figure 1. Environmental Press. Adapted from “Graphic representation of an ecological theory of adaptation and aging” by Nahemow & Lawton, 1973 p. 27.

Environmental press is akin to other Goldilocks type effects in that it suggests optimal user function occurs within a narrow band of press. That is, the press exerted on a person by the physical environment is not too strong or too weak to allow the dweller to achieve his/her particular goals. Challenging to designers, EP value varies among those with differing abilities, as press itself can be subjective. Without the input of end users, it can be difficult to anticipate the needs and desires of users. This is especially important when considering the diversity of a population with some degree of disability in a given space. It is reasonable to expect that involving people in the design of their own adaptations has the potential to increase individual competencies and thus achieve a fitting degree of environmental press. Though the term “environmental press” is not formally used in much of this literature, a number of pieces discussing participatory adaptations describe design scenarios in which environmental press functions as a positive force for creativity and optimal functioning. Allsop, Holt, Levesley, and Bhakta (2010), Peterson (2008),and Werner’s classic Nothing About Us Without Us: Developing Innovative Technologies For, by and With Disabled Persons(1998) are just a few.

A consideration of the degree of press/stimulation imposed on a person in a given environment is important to the determination both of optimal physical functioning and healthy affective balance. This consideration is applicable to far more than struggling institutionalized or home-based seniors. It applies to all of us who strive to fit and achieve particular active goals in an environment. If we are to assume people become more susceptible to their social and physical environment as competence in a given context decreases, we must centrally position participatory approaches to design for those who are especially vulnerable to these domains.

The experience of deficient press varies by scenario and person, but it seems likely the phenomenon dovetails with other conceptions of maladaptive behaviors relating to insufficient stimulation.The term “covert capacity” has been used to illustrate diminished functioning in otherwise capable seniors. Essentially, a functional capacity exists in a person but remains unexpressed because an individual is deprived of a suitable situation and/or the required physical and/or emotional support to demonstrate the novel skill. Consider an environment allowing senior residents little opportunity to engage in independent and/or autonomously initiated and experienced activities. In these cases, institutionally dwelling seniors may effectively become impaired as a result of a dearth of opportunities to demonstrate specific abilities and/or more nuanced expressions of environmental mastery. It would seem environmental press in many ways acts bidirectionally in terms of individual agency. Compare the scenario above to one where residents are given just enough environmental support to explore novel pursuits and develop task-related skill sets.

When considering person-environment fit in the context of environmental press, we must factor in the many elements contributing to competence and mastery. Physical capacity is central. However, one’s perception of their own capacity for competence figures prominently as well. Lawton himself referred to competence as the “theoretical limit of capacity in the individual to function in the areas of biological health, sensation-perception, motor behavior, and cognition” (Lawton, 1982, p. 38).Diminished competence here correlates with greater susceptibility to potentially maladaptive influence of environmental factors. While foundational work by Murray (1938) suggested the importance of both environmental demand characteristics and those which are simply perceived, neither Murray nor Lawton expanded their work to include anexamination of psychological mediators influencing perception of functional capacity.

Iecovich (2014) points out a number of theoretical objections to traditional conceptions of the environmental press model. Many of these concerns can be effectively addressed by expanding upon Lawton’s work, the development of adjunctive theoretical concepts (such as environmental efficacy proposed here), and further exploration of the nuances of the relationship between environmental fit and individual differences. Lawton no doubt recognized the nuanced relationship between a person and their environments. Environmental press addresses a variety of capacities in our spaces and places. Designers should consider the need for functional flexibility in all built environments. Even so, properly implemented adaptations are important tools for assuring maximal positive person-environment interactions. Though zones of “maximal performance potential” and “comfort” vary among individuals, these remain important factors to well-being. Matching environmental press appropriately to capacity would seem to be an emotional and physical health promoting tactic in built real (and theoretically virtual) environments. When environments and systems within a given institution provide a minimum of physical discomfort and discourage unintentional docility, they respect the entirety of the individual. Though theoretically important, Lawton’s focus on a particular population constrained the many ways theorists conceived of press. The mismatched application of press could function on a number of levels. For example, a sick building may cause respiratory problems as a result of poor air quality. Thus, it would be reasonable to consider impaired performance as a result of yet identified toxic environments to be a sort of press on the individual.

Conclusion

While adaptations themselves are designed to mediate our physical relationships with the world around us, they no doubt also exist in the liminal social space between the self and the outside world. They have the potential to alter the ways others see us and the ways we see ourselves. Physical adaptations of all types may serve to mediate our identities and contribute to degree of self-confidence. Study participants spoke fondly of effective adaptations designed in accordance with their own aesthetic identities. They also spoke of their social affiliations independent of their “disabled” identities. Strong support networks and role models (fictional and/or real) as well as feelings of control during the adaptation acquisition processes all were reported to contribute to overall satisfaction measured. Not surprisingly, evidence gathered during this project suggests feeling active or having the potential for such activity (rather than feeling passive and objectified) and able to adapt to a myriad of types of environmental stimuli are important factors to maximizing function.

While the study described herefocused on those living with disability, the themes suggested are more globally applicable. Participatory design practices have the potential to themselves maximize user well-being and restorative outcomes. While thoughtfully designed technological innovations can preserve independence and autonomy, poorly conceived top-down solutions can contribute to increasing user impairment. In ever more integrated and technologically mediated environments it is important to remember the centrality of the person­— their uniqueness, the dynamic nature of their environmental engagement, their sense of agency, and their profound value in fundamentally humane and inclusive spaces.

References

Allsop, M., Holt, R., Levesley, M., & Bhakta, B. (2010). The engagement of children with disabilities in health-related technology design processes: Identifying methodology. Disability & Rehabilitation: Assistive Technology, 5(1), 1–13. https://doi.org/10.3109/17483100903323267

Bandura, A. (1982). Self-Efficacy Mechanism in Human Agency. American Psychologist, 37(2), 122–147.

Gibson, J. J. (1977). The theory of affordances. In R. Shaw & J. Bransford (Eds.), Perceiving, acting and knowing. Hillsdale, NJ: Lawrence Erlbaum Associates.

Iecovich, E. (2014). Aging in place: From theory to practice. Anthropological Notebooks, 20, 21–32.

J. J. Gibson. (1986). The ecological approach to visual perception (New edition). Lawrence Erlbaum.

Lawton, M. P. (1990). An Environmental Psychologist Ages. In I. Altman & K. Christensen (Eds.), Environment and Behavior Studies (pp. 339–363). https://doi.org/10.1007/978-1-4684-7944-7_14

Murray, H. A. (1938). Explorations in personality. New York: Oxford University Press.

Nahemow, L., & Lawton, M. P. (1973). Toward an Ecological Theory of Adaptation and Aging.1, 24–32. Retrieved from http://www.edra.org/content/toward-ecological-theory-adaptation-and-aging

Peterson, W. (2008). Role of Persons with a Disability in the Design Process. Topics in Stroke Rehabilitation, 15(2), 87–96. https://doi.org/10.1310/tsr1502-87

Werner, D. (1998). Nothing about us without us: Developing innovative technologies for, by, and with disabled persons (1st ed.). HealthWrights.