Interpersonal Barriers

Specific barriers identified through various methods of primary and secondary research were classified into the following categories; internal, interpersonal and external environmental. Internal barriers involved physical and mental health issues. Physical health concerns were related to respiratory health, autonomic dysreflexia, preserving skin integrity, bowel and bladder, spasticity and pain. Mental barriers were concepts such as anger, depression, hopelessness, and self-pity. The most psychical challenges faced by participants with regards to enhancing health were related to bowel and bladder routines (urinary tract infections and constipation) and mental health issues such as the ability to cope with the new situation and finding inner

strength to move forward.
Communication and relationships were identified as the main interpersonal barriers faced by respondents in the secondary research.

These two concepts are closely related, and can also serve as facilitators to the client when executed appropriately. Data revealed the quality of the therapeutic relationship and communication between clients and attended is directly related to the levels of satisfaction clients report with their attendant’s services. All clients at GTIL have to direct attendants in order to completing ADLs. Barriers to effective relationships and communication included, attitudes of attendant’s, differences in perception and viewpoint, expectations and prejudices may lead to false assumptions or stereotyping, and cultural differences.(Arnold & Boggs, 2011). Primary research offered some supported for the findings in the secondary research. Participants reported feelings of frustration and anger with their attendants when their care wishes were not respected, and when care tasks where not performed to their preference.
The most significant challenges to community integration were reported to be navigation, and environmental barriers. External environmental barriers are categorized as architectural, transportation, and

weather.
Architectural: Participants reported relative ease in accessing most destinations they frequented; both primary and secondary research indicated that friends and families homes were the most difficult destination to visit as they were not physically accessible. Architectural barriers were reported to be encountered occasionally by 67% of participants and daily by 33%. Leading architectural barriers were reported to be stairs, doors, and ramps that were too steep. Grocery store accessibility was another barrier discovered through conversation with Gage OTs. Blue signs on the outside of stores indicate that the store is considered “accessible”, but that doesn’t also hold true 100% of the time. The major issue with the “accessible” label is that it appears to only apply to those who have use of their upper extremities. Clients of the GTIL program often face functional challenges once inside the store related to selecting items, navigating confided areas with large wheelchairs, and payment at the check out.
Transportation: Access to wheelchair accessible private transportation was the most common barrier in this category. Participants preferred using Wheeltrans over the subway or bus. Major challenges faced when using Wheeltrans, had to do with scheduling, quality of service and attitudes of Wheeltrans staff. Wheeltrans services have to be booked in advance, which results in the inability to do anything spontaneously. One participant relayed a particular example of a frustrating issue related to having to depend on Wheeltrans. The client needed to be picked up at 3:30pm after doctors appointment, the Wheeltrans service, scheduled his pickup time at 5:30pm; therefore he had to wait around the doctor’s office for two hours. Concerns with TTC focused around safety and reliability. The gap between train and platform doesn’t allow the power chairs to role properly on to and off the train. The subway doors do not stay open long enough and the elevators that are required to access the platform cannot be relied upon to always be functional.
Weather was cited as another barrier to community participation; all participants reported frequently having to cancel plans due to incremental weather.

I personally experienced this while working with clients at GTIL; visits to the bank were cancelled and delayed for up to 2 days because of rainy weather. Snow and ice are another concern for those clients at GTIL. City policies regarding snow removal and sidewalk shovelling impact the ability of the clients to navigate around their neighbours, a number of clients at GTIL report, “trying not to go out very often in the winter.” Since they don’t feel safe in their neighbourhood, participants that “just stay in” are at risk for experiencing social isolation during the winter

months.
Facilitators
Participant attitude is the number one internal facilitator to health and community participation. Programs such as GTIL facilitate empowerment and self-efficacy within clients which lead towards health promotion. Block, Vanner, Keys, Rimmer, and Skeels (2010) defined self-efficacy as an aspect to developing empowerment, it’s “how people perceive their abilities to handle challenges and accomplish goals, it influences self-perception, feelings as motivation. Empowerment is defined as the process of gaining control over events, outcomes, and resources, emphasizing the role of control as the central characteristic of power” (Block, Vanner, Keys, Rimmer & Skeels, 2010, pp. 742) Secondary research indicated that successful empowerment programs like GTIL utilized peer support strategies and promoted independence by modifying the environment of the individual. This is accomplished through assistive technology, promoting self-advocacy to meet needs, and encouraging participation in community life. (Block, Vanner, Keys, Rimmer & Skeels, 2010)
Major facilitators to interpersonal relationship were reported to revolve around combination and relationships. Positive relationships with attendants and strong family support system were identified as resources that facilitated participation. One participant reported working with a therapist in order to build anger management capacities; he stated that is working on anger management strategies in order to stop telling his attendants to just “fuck off”, when he is unhappy with care services.
Assistive technology, social programs, and services were identified as the greatest environmental facilitators. Mobility devises such as motorized wheelchairs with joystick environmental controls allowed participants in the project to navigate freely. Modifications to the home like the instillation of ramps, Hoyer lift; lowered counters; switches and nobs all facilitate easier navigation around the home environment. Ann Johnston health station is a community health centre that provides a wide range of services and programs for those with physical disabilities. The centre has been specially designed to be “barrier free” and provided services such as peer support programs, health promotion workshops, sexual health workshops, and fitness programs such as chair yoga. (Block, Vanner, Keys, Rimmer & Skeels, 2010)