The Relationship Between Community Integration and Environmental Barriers in People With Spinal Cord Injuries in Tehran, 2018-19

Community integration is one of the goals of rehabilitation programs that include home integration, social integration, and integration into productive activities. Various factors affect the degree of community integration among different people. Theoretically, environmental adjustment is one of the factors that can affect the community integration and adaptation of people with disabilities in society. The environmental adjustment refers to the development and construction of a suitable and unobstructed environment for all members of society (with different physical, mental and psychological capacities). However, economic status, history, social culture, population density, and even types of disabilities are different in various societies, and these factors affect the degree of community integration. So, the achievements of one society cannot be generalized to other societies. This study aims to determine the relationship between environmental barriers and the degree of community integration of people with disabilities with spinal cord injuries in Tehran City, Iran.

This cross–sectional observational study was conducted with a correlational design. The statistical population included people with spinal cord injuries living in Tehran City, Iran, in 2018–19. Using G–power software, with an effect size of 0.21, alpha of 0.55, and the test power of 0.80, a sample size of 170 was obtained. The samples were recruited by the available purposeful sampling method from the Spinal Cord Injury Center of Tehran. Finally, 152 people answered our study questionnaires. The inclusion criteria were as follows: having a spinal cord injury at least one year before the study, having the minimum functional abilities to sit and move, being between 15 and 60 years old, having a spinal lesion (complete or incomplete amputation of the spinal cord) from the C4 vertebra down, being Persian literate. The exclusion criteria were as follows: having a history of congenital paralysis of the lower or upper limbs, suffering from disorders such as visual or auditory impairment, and not answering two (or more) questions from the questionnaire. To collect study data, we used a demographic questionnaire, the Community Integration Questionnaire (CIQ) (Willer et al., 1993), and the Craig Hospital Inventory of Environmental Factors Questionnaire (CHIEF) (2001). The demographic questionnaire examines patients' demographic characteristics, including age, gender, marital status, education level, employment status, and characteristics of the injury. Statistical analysis of the obtained data was performed in SPSS software. Descriptive statistics indices included mean and standard deviation. Because of the non–normal distribution of data, we used the Spearman correlation coefficient to examine the relationship between study variables. The significance level was considered 0.05.

Findings showed inverse and significant relationships between the frequency of environmental barriers with home integration (r=–0.311, p<0.001), social integration (r=–0.401, p<0.001), integration into productive activities (r=–0.483, p<0.001) and total community integration (r=–0.444, p<0.001). Also, there were inverse and significant relationships between the frequency in size of environmental barriers with home integration (r=–0.315, p<0.001), social integration (r =–0.421, p<0.001), integration into productive activities (r=–0.514, p<0.001) and the total score of community integration (r=–0.545, p<0.001). These relationships, although weak to moderate, were significant. The highest correlation was observed between the total score of community integration and the score of frequency in the size of environmental barriers (r=– 0.545, p<0.001). Among the components of community integration, the highest correlation with frequency in the size of environmental barriers was obtained in the component of integration into productive activities (r=– 0.514, p<0.001). Also, the frequency in the size of environmental barriers had a correlation coefficient of –0.421 (p<0.001) with the social integration. This result shows the average relationship between low community integration and integration into productive activities with increased environmental barriers.

The present study showed that environmental factors have an inverse and moderate relationship with integration into productive activities for people with spinal cord injuries living in Tehran. Therefore, authorities in the field of disability should take comprehensive action to reduce environmental barriers for increasing employment and integration into productive activities of disabled people.