Meredith Perry, School of Physiotherapy: Improving access to parks for persons with a disability

Child with mother, and Dr Meredith Perry.

Participants interviewed for the case study

Principal investigator

Dr Meredith Perry
Senior Lecturer, School of Physiotherapy, the University of Otago Wellington

Researcher

Professor Vicky Cameron
Group Leader, The Omics Laboratory, Christchurch Heart Institute
Deputy Dean, University of Otago Christchurch

Stakeholders

Olivia Dovey
Parks Manager, Porirua City Council

Adrienne Murray
Assistant Governor for District 9940 of Rotary Member of Plimmerton Rotary Club and Plimmerton Inner Wheel

Christine Quested
Health Promotion Advisor, Public Health South, Southern District Health Board

Mary O'Brien
Moving Around Communities Co-ordinator, CCS Disability Action Southern Region

Janice Burton
Professional Leader Health Promotion, Public Health South, Southern District Health Board

Raewyn Hailes
Access and Community Development Manager, CCS Disability Action

Summary of the impact

Disability should not be a barrier for access to parks, which are important for physical health and social wellbeing. The Parks for Activity and Recreation in the Community (PARCs) study led by Dr Meredith Perry, a Senior Lecturer, researcher and physiotherapist in the School of Physiotherapy at the University of Otago Wellington, looks at access to parks for persons with a disability. Social ecological barriers can limit persons with disabilities' journey to, entry into, and full use of a park and its facilities.

Through the PARCs research, Meredith created a tool which is used to evaluate park infrastructure against national and international minimum standards or legislative rights for disability access.

Meredith's research aims to change policy around park design, in order to promote equity in access and usability of parks for persons with a disability. She has worked with multiple community organisations and city councils to achieve impact.

The PARCs tool has been widely used to evaluate park access, and findings used in advocacy and lobbying to support council policy change.

Underpinning research

Parks, which are a component of greenspace, help to improve physical activity levels, and thus the health and wellbeing of the population¹. Increasingly, parks are being recognised as supporting social cohesion and building community resilience^{2, 3}. Dr Meredith Perry became interested in equity of access to parks for persons with a disability (including long-term health conditions) in 2016.

In New Zealand, 25 per cent of people self-report a disability, with this rising to over 64 per cent in adults >65 years old⁴. Access to parks may be limited by the routes to and within the park, including parking and pathways, and also by the facilities and amenities, such as play areas, rest areas, toilets and drinking fountains. Equity in park access is important, particularly as community members with a long-term condition or disability are more at risk of developing health comorbidities related to physical inactivity⁵.

A systematic review undertaken by Meredith and colleagues on park-based physical activity interventions for persons with disabilities identified health outcomes from health outcomes from park-based interventions ^5p19 (Figure 1).

Meredith developed an evaluation tool called the PARCs tool to determine whether a park meets disability access requirements. The 50-item tool comprises of questions divided into sections covering many aspects of accessibility^{6 Appendix A: supplementary data}.

This tool has been used in an evaluation of 21 parks in three metropolitan areas of New Zealand⁶. No parks met the national standards and/or international guidelines for park and playground design, and the study identified areas for improvement. Figure 2 outlines the results of the audit.

This tool is now being used by multiple councils around New Zealand to evaluate their parks. Meredith has been working with organisations (such as Public Health South, Rotary and Inner Wheel, CCS Disability Action and the Blind Foundation), and councils across New Zealand to implement the use of the tool. City councils are able to use the PARCs tool to assess park access against international human rights laws and the United Nations Convention on the Rights of Persons with Disabilities (which New Zealand has signed).

In a further study (unpublished), Meredith conducted a survey of 1000 older adults and found private vehicle use to (OR 3.99 (1.48, 10.8)), and mobility within (OR 9.55 (1.95, 46.8)) the park significantly influenced park use in older adults with disability. Significantly more older adults with a disability had not visited an urban park in the last month than older adults without a disability. Older adults with disability enjoy visiting parks because this allows them to risk-take, feel socially connected, and it was perceived to improve health and well-being. However, qualitative interviews found the effort of negotiating inaccessible areas, the reliance on family members to support them moving freely through the park and no or limited accessible amenities (i.e. toilets) was off-putting.

Meredith has also interviewed 17 children and their whānau about their experiences of park use (unpublished). This research revealed only one child could visit their local neighbourhood park. The 16 others had to travel considerable distances to be able to participate in any park related activities. Whānau and the children appreciated going to the park as they challenged the children's capabilities and independence, offered a multi-sensory environment that benefited physical, psychological and social wellbeing and provided a place for the family to be together. The inaccessibility of their local parks made children with disability and their whānau feel excluded.

“This research is about creating the places and spaces that give the best benefit to the population that it serves.”

Dr Meredith Perry – School of Physiotherapy, the University of Otago Wellington

Funding

• University of Otago Research grant
• Porirua City Council
• Collaboration of Ageing Research Excellence Summer Student Grant

Research snapshot

• There are two research publications from this work^{5, 6}.
• Meredith's research is highlighted on the Activity & Nutrition Aotearoa⁷, Office for Disability Issues⁸, Plimmerton Rotary⁹ and Porirua City¹⁰ websites.

Details of the impact

PARCs tool used in evaluation

• Since Meredith's initial study, the PARCs tool has been used nationally and internationally to evaluate park access. The Playable Porirua audit was undertaken on all 41 parks in the Porirua Area, supported by Plimmerton Rotary and Porirua Rotary, and the Inner Wheel Club of Plimmerton, with the research team led by Meredith providing training and support⁹. The findings were used to make submissions to Porirua City Council regarding changes that could be made.

“Having that audit tool to be able to say 'this is the state of the playground that you're talking about', and 'this is what's required to bring it up to scratch', and 'these are the costs that are involved in doing that', is very, very valuable”

Adrienne Murray – Assistant Governor for District 9940 of Rotary Member of Plimmerton Rotary Club and Plimmerton Inner Wheel

• Dr Pauline Boland, Lecturer at the University of Limerick (Ireland) teaches in a graduate entry programme for Occupational Therapy students. She uses part of the PARCs tool in her lecture on inclusive design. Students then use the tool to audit their campus to gain awareness of what may be challenging for those with a disability. She also illustrates how the PARCs tool can be used for lobbying authorities, and supporting clients to make statements about public spaces not accessible to them. Pauline had two Occupational Therapy Masters students in 2017 who, between them, audited about 50 parks in Limerick and Kerry. The findings of this study have been submitted to two county councils who gave consent for the audits to occur for their consideration in updating current parks and designing future ones.
• University of Otago Master of Dietetics students on placements with Public Health South (PHS; the public health unit at the Southern District Health Board) have developed a questionnaire focusing on the water fountain section of the PARCs tool. Drinking fountains were chosen to support PHS work in promoting water as the drink of choice. The students evaluated seven fountains in Dunedin and four in Invercargill and presented their results to PHS and CCS Disability Action staff. A report was also prepared which was subsequently used to advocate for improved drinking fountains with the Invercargill City Council's Parks and Reserves departments.
• Community groups are able to use the PARCs tool to evaluate parks, and the results can then be used for advocacy purposes. Raewyn Hailes, Access and Community Development Manager at CCS Disability Action, has completed park audits for multiple councils in the Wellington area. The Rotary Club are trying to get training in the use of the PARCs tool so they can incorporate it into their District Plan in Plimmerton, and also into the national plan, led by Adrienne Murray (Assistant Governor District 9940 of Rotary).
• Waitaki District Council have been using the PARCs tool in an accessibility study in Oamaru. The West Coast Regional Council have begun an audit using the PARCs tool.
• Discussions are underway with the Dunedin City Council to evaluate their parks. Training on the PARCs tool for Dunedin Council Staff was completed in March 2019.

Environmental change

• Submissions and discussions from the use of the PARCs tool by the Master of Dietetics students helped to inform the choice of a drinking fountain for the Bluff Community.
• Dunedin City Council have installed a wheelchair-accessible fountain in Caversham Reserve using the PARCs tool in August 2019. The council are now investigating putting similar fountains in the proposed George St upgrade.

Policy change

• A draft policy change at Porirua City Council called Playable Porirua is a 10-year planning document informed by the Playable Porirua audit⁸. This provides guidance for playgrounds and will come up for review in 2022. The council will then go through the formal policy process, including community consultation, and they will take the document specific to playgrounds and integrate it into the Reserves Management Plan. At the moment Playable Porirua is classified as a 'working policy' – it is being implemented without yet being formalised.
• PHS staff have developed a guidelines document for choosing drinking fountains, and this is recommended by CCS Disability Action.

Pathway to impact

Collaboration

• A key feature of Meredith's research has been her close relationship with community organisations such as Rotary, Inner Wheel and CCS Disability Action, as well as local councils.
• Members of community organisations and councils value collaborating with Meredith and her colleagues at the University of Otago, saying their reputation meant the research was taken seriously. This is important in a challenging funding environment where councils operate on three-year cycles and have multiple potential projects to fund.

“Having the reputation of Otago University and the Physiotherapy School in behind what we're doing, having that name attached to the Playable Porirua work has just been valuable to getting councillors on board, getting the community on board and telling people that we are serious about accessible playgrounds and parks.”

Olivia Dovey – Parks Manager, Porirua City Council

Dissemination

• Meredith spoke at multiple national and international conferences to disseminate this work, enhancing the uptake of the research by organisations and councils. She presented her research at:
  – The New Zealand Recreation Association conference in 2017 to parks and green space policy directors¹¹.
  – The International Society for Physical Activity and Health (ISPAH) in London in 2018, the biggest international physical activity conference in the world¹².
  – The Active Living and Environment International Symposium at the University of Otago in 2017¹³.
  – The Physiotherapy New Zealand conference in 2018¹⁴.
• Meredith, Olivia Dovey (Parks Manager, Porirua City Council), Christine Jacobson (Senior Policy Analyst Porirua City) and Adrienne Murray (Assistant Governor for District 9940 of Rotary) were invited to attend the IMPACT Conference hosted by the University of Otago in 2017¹⁵ where they led a workshop about the project. Considerable interest was expressed by the audience comprising social research staff, health policy advisors and council members from around the country.

What next?

• Meredith would like to publish the PARCs tool in a free format that councils or other organisations can use.
• Meredith has two project ideas for the future; to formally evaluate a park before and after the PARCs tool intervention, and to create a park in conjunction with council from the bottom up – an inclusive park design. This would be best achieved via co-creation with the disability community.
• Meredith's ultimate goal is to make every park in New Zealand fully accessible.

References

1. Mytton OT, Townsend N, Rutter H, Foster C. Green space and physical activity: an observational study using Health Survey for England data. Health Place. 2012;18(5):1034-41.
2. Federal Emergency Management Agency. How parks and open spaces can strengthen resilience. 2014.
   https://www.fema.gov/disaster/4085/updates/how-parks-and-open-spaces-can-strengthen-resilience
3. Jennings V, Bamkole O. The relationship between social cohesion and urban green space: an avenue for health promotion. Int J Environ Res Public Health. 2019;16(3):452.
4. Office for Disability Issues. Key facts about disability in New Zealand. 2016.
   https://www.odi.govt.nz/home/about-disability/key-facts-about-disability-in-new-zealand/
5. Saitta M, Devan H, Boland P, Perry MA. Park-based physical activity interventions for persons with disabilities: a mixed-methods systematic review. Disability and Health Journal. 2019;12(1):11-23.
6. Perry MA, Devan H, Fitzgerald H, Han K, Liu L-T, Rouse J. Accessibility and usability of parks and playgrounds. Disability and Health Journal. 2018;11(2):221-9.
7. Activity & Nutrition Aotearoa. Development of an evaluation tool to measure accessibility and usability of parks and playgrounds. 2020.
   https://ana.org.nz/resource/development-of-an-evaluation-tool-to-measure-accessibility-and-usability-of-parks-and-playgrounds/
8. Office for Disability Issues. Outcome 5 in action - accessibility - Playable Porirua. 2017.
   https://www.odi.govt.nz/nz-disability-strategy/strategy-action-stories/outcome5-in-action-playable-porirua/
9. Murray A. Co-creating playable spaces. 2017.
   https://plimmertonrotary.org.nz/co-creating%20playable%20spaces
10. Porirua City. Making Porirua play-able. 2017.
    https://ana.org.nz/resource/development-of-an-evaluation-tool-to-measure-accessibility-and-usability-of-parks-and-playgrounds/
11. Perry M, Jacobson C, Sullivan J, Devan H.. Accessibility and usability of parks by older adults. New Zealand Recreation Conference; 2017; TSB Place, New Plymouth (invited speaker).
12. Human Kinetics. 7th International Society for Physical Activity and Health Congress. Journal of Physical Activity and Health [Internet]. 2018.
    https://journals.humankinetics.com/view/journals/jpah/15/s1/article-pS1.xml?rskey=XLX85G&result=3&tab=pdf
13. University of Otago. Active living and environment: towards a healthier and more sustainable future. International symposium.2017.
    https://www.otago.ac.nz/active-living-2019/otago694082.pdf
14. Perry M, Devan H, Sullivan J, Ergler C, Boland P, editors. Accessibility and usability of parks by older adults with disability. Physiotherapy New Zealand Conference; 2018; Dunedin (platform).
15. Perry M, Murray A, Dovey O, Jacobson C, Devan H, editors. Co-creating parks for all people. IMPACT conference: Realising the potential by Ageing Well National Science Challenge, Collaboration for Ageing Research Excellence and Centre for Health Activity and Rehabilitation Research. 2017. Dunedin Art Gallery (invited speaker).