Martha Banda-Chalwe^a*, Jennifer C. Nitz^a, Desleigh de Jonge^b

^a* Lecturer, University of Zambia, Department of Physiotherapy

^aSenior Lecturer, Department of Physiotherapy, ^bAssociate Lecturer, Department of Occupational Therapy, The University of Queensland, St Lucia, Qld 4072, Australia

^a* Corresponding author and presenter: Dr Martha Banda-Chalwe

University of Zambia, School of Medicine, Department of Physiotherapy, P. O. Box 50110, Lusaka, Zambia.

Purpose: Accessibility of the built environment can either facilitate or hinder full participation of people with disabilities. Non-communicable diseases such as cardiovascular diseases, diabetes, trauma and cancer requiring ambulatory devices contribute to the high prevalence of disabilities globally increasing the need for the built environment to be accessible. Firstly, this paper described the preliminary development of a potential measure for accessing the built environment in Zambia. Further, it examined the test-retest reliability of the Participation-Based Environment Accessibility Assessment Tool (P-BEAAT) checklist. The purpose was to identify the environmental features that present as barriers to participation for people with mobility limitations (PWML) using mobility devices such as wheelchairs or crutches. Evidence to be used to initiate a process of accessibility standards and rehabilitation policy development in Zambia.

Method: A cross sectional study with the P-BEAAT being developed through focus group discussions and personal interviews with 88 PWML from five out of nine provinces in Zambia regarding accessibility of the built environment. The content validity of the P-BEAAT checklist was accomplished through the three phases of development with data gathered from 11 focus groups and 9 personal interviews. The participants described accessibility barriers, which affect their participation in daily life. Twenty buildings considered important in daily life participation were identified by PWML who relied on wheelchairs or crutches for ambulation. The researcher, two research assistants, three local purposively recruited PWML audited the buildings.

Results: Information from the focus groups and personal interviews generated the P-BEAAT with 66 items describing eight environmental features with potential for identifying environmental barriers. The P-BEAAT has shown homogeneity with Cronbach’s alpha of 0.91. Using the non-weighted multiple rater kappa examined intra and inter-rater agreement between the two assessments undertaken within two weeks apart. Intra-rater reliability achieved substantial agreement at ≥0.88. Inter-rater reliability achieved almost perfect agreement at 0.89.

Conclusion: The P-BEAAT was constructed grounded in the reality of people’s experiences in Zambia for use in assessing environmental features important in the daily life of PWML pertinent to developing countries. The P-BEAAT was shown to be a reliable tool for evaluating building access and special training in its use was not necessary.

Key word: P-BEAAT, built environment, mobility limitation, accessibility barriers, barriers to participation, Zambia