Explaining activity-related travel behaviour in persons with disabilities by means of health condition and contextual factors

Mobility, or the making of (physical) trips from one place to another, is one of the basic conditions to participate in professional, social and economic life. Individuals have a personal need to perform various activities, and for this reason they have to travel to the destination where this specific activity takes place. Persons with disabilities (PWD) may experience multiple functional disorders, which can have an influence on their functioning and by which their participation in society can be limited, leading to a decline in independence and autonomy; as well as to societal and economic consequences for the wider society. According to the International Classification of Functioning, Disability and Health (ICF) of the World Health Organization, disability is described as the interaction between features of the person (functioning), and the overall context in which the person lives (contextual factors). Hence, participation restrictions are not inferred from disease-related dysfunctions alone, but are a dynamic interaction between the health condition of an individual, and contextual (personal and environmental) factors: a person may become disabled or enabled within a particular mobility context, rather than focusing on specific impairments in isolation. The distinction between an urban or rural environment, the support of a social network, the supply of (adapted) transport, the distance to provisions or the availability of mobility devices, among others, may play an important role in the activity-related travel behaviour of an individual, and his/her participation in society. In order to enable PWD to fully participate in society, disabling situations (e.g. in the living space of individuals, or in the mobility system) should be limited as much as possible. Because of budget constraints, it is important to establish which investments, e.g. in attributes of the mobility system, would have the greatest impact for the participation enhancement and quality of life of PWD. While there is growing attention to the out-of-home mobility of elderly and PWD, knowledge about underlying disabling mechanisms or determinants causing changes (or decreases) in activity-related travel behaviour is sparse. However, knowledge about key factors influencing changes in activity-related travel behaviour is necessary in rehabilitation, in order to define guidelines for interventions to optimize their travel possibilities, with social participation enhancement of PWD in daily life as ultimate goal. This doctoral thesis aims to provide more insights into the activity-related travel behaviour of PWD. In a first track, we aim to document on a detailed level the activity-related travel behaviour in PWD with different disability level (Mapping mobility). In a second track, we investigate the impact of both health condition, measured on different levels of the ICF framework, and contextual personal and environmental factors, on this activity-related travel behaviour (Explaining mobility). In a third track, we determine which policy decisions regarding adapted transport services can be made to make the mobility system more inclusive, while guaranteeing its financial sustainability (Supporting mobility). Part of the work in this doctoral thesis, i.e. the first 2 tracks about mapping and explaining mobility, is specifically performed in persons with Multiple Sclerosis (PwMS). Choosing a well-defined patient group as research population enables us to investigate their behaviour in depth (e.g. by looking at the impact of specific symptoms), as it would be too heterogeneous to include all persons with all kinds of different impairments in these tracks. Multiple sclerosis (MS) is a progressive inflammatory and neurodegenerative chronic disease of the central nervous system, with a life-long progression of the disease which can be very unpredictable and various between and within PwMS. The patient group MS is chosen because of the occurrence of multi-dimensional symptoms of various severities, involving both young and older persons (as MS occurs during the complete life span), and (work) active and less active persons. In the track of supporting mobility, the results will be generalized to the larger population of all PWD, with different types and disability severities. While the travel patterns and/or experienced problems may be different between different patient groups (and are thus investigated in detail only in MS as research population), supporting measures to optimize their travel behaviour should be developed for the full population of PWD, as the majority of supporting measures are beneficial for different groups of PWD, leading to a higher cost-efficiency because of economies of scale.

Jaar van publicatie:2015

Toegankelijkheid:Open