Developing a Barriers Scale in the Context of Travel: TRIP.

OBJECTIVE: To develop an environmental-barriers scale, Travel Restrictions Influencing Participation (TRIP), in the context of travel for people living with spinal cord injury (SCI). DESIGN: A mixed-method approach where, in the qualitative phase, items were developed and written based on results of interviewers with different stakeholder groups and, in the quantitative phase, survey data were collected to examine the psychometric properties of the scale. SETTING: Home, work, and community settings. PARTICIPANTS: People living with SCI, caregivers/family members, therapists, and travel professionals (N=333). INTERVENTIONS: None. MAIN OUTCOME MEASURES: A 19-item TRIP scale that measures the travel barriers encountered by people with SCI. RESULTS: Results from 83 semi-structured in-depth interviews with 4 stakeholder groups guided the writing of items in the TRIP scale. Seven cognitive interviews and an expert panel conducted reviews for content validity of the scale, and 19 items were included in the quantitative assessment of the scale. A total of 250 patients enrolled in the Rocky Mountain Regional Spinal Injury System was systematically selected to report their experience with each travel barrier. Item-response theory-based Rasch analysis revealed that TRIP has acceptable psychometric properties. CONCLUSIONS: The 19-item TRIP scale demonstrates promising psychometric properties for the scale to be used in clinical settings to quickly identify environmental barriers individuals with SCI encounter when traveling. It has the potential to assist with developing interventions that will improve the travel experience of individuals with SCI or to assist with strategies to overcome travel barriers.

Exploring the Relationship of Leisure Travel with Loneliness, Depression, and Cognitive Function in Older Adults.

Loneliness, depression, and cognitive decline are pressing concerns among older adults. This study examines the association between leisure travel participation and these health outcomes in older adults, aiming to provide further evidence of the benefits of leisure travel. Using nationally representative historical data from the 2006 household survey of the Health and Retirement Study, this study conducted a series of regression analyses to investigate the relationship between traveling and the three health outcomes, adjusting for age, sex, race, marital status, education, total wealth, annual income, and difficulty with daily activities. The results reveal that travel patterns in terms of distance are significantly associated with loneliness, depression, and cognitive function. Long-distance travel is positively related to higher cognitive function and a reduction in depressive symptoms, along with lower levels of loneliness, reinforcing the notion that leisure travel can potentially act as a catalyst for improved cognitive and mental health by offering opportunities for enhancing social connections and forming new relationships. The findings on the relationships between participation in leisure travel and mental and cognitive health contribute to the body of evidence supporting the therapeutic value of leisure travel in promoting healthy aging and enhancing the overall well-being in older adults.

Travel and Social Isolation of People With Spinal Cord Injury.

Background: People with spinal cord injury (SCI) are at high risk for social isolation because they face barriers to social participation owing to limitations in physical functioning, secondary health conditions, and environmental barriers. Research has shown that social isolation, an objective lack of contact with others, can lead to loneliness, mental health issues, and low life satisfaction. Leisure travel, which involves interactions with others, may have the potential to reduce social isolation. Objectives: To explore the association of travel participation with social isolation among people with SCI. Methods: A total of 11,091 cases from 2016-2021 in the SCI Model Systems database were included in the study. Participants were categorized into low and high social isolation groups. A hierarchical logistic regression was performed with social isolation as the dependent variable and travel groups as the independent variable, while controlling for age, family income, and health conditions. Results: Travel participation is negatively associated with social isolation. People with SCI who traveled for one to two nights (odd ratio [OR] 0.52, 95% CI 0.40-0.67), three to four nights (OR 0.56, 95% CI 0.43-0.72), or more than five nights (OR 0.41, 95% CI 0.35-0.49) in the past 12 months are less likely to be socially isolated compared to those who have not traveled in the past 12 months. Conclusion: Travel participation may help reduce the social isolation of individuals with SCI. Therapists and rehabilitation professionals should design effective travel training programs that encourage patients with SCI to travel more often.

Leisure, Recreation, and Life Satisfaction: A Longitudinal Study for People With Spinal Cord Injury.

Background: Leisure and recreation (LR) are positively associated with social integration and life satisfaction in people with spinal cord injury (SCI). However, few studies have longitudinally observed long-term changes in LR participation among people with SCI and discussed the association of these activities with social integration and life satisfaction. Objectives: This study aims to determine for people with SCI, within a 45-year period, the association between mobility and LR participation; the associations between LR participation and social integration and life satisfaction, respectively; and whether the association between LR participation and life satisfaction is mediated by social integration. Methods: Growth modeling and linear mixed modeling were employed as the primary data analysis tools to explore longitudinal changes in LR participation, social integration, and life satisfaction. A mediation test was conducted to examine the potential mediation effect of social integration on the relationship between LR participation and life satisfaction. Results: The mobility level, LR participation hours, and social integration of people with SCI decreased gradually during the 45-year period, whereas life satisfaction increased as they lived longer with the injury. LR participation was consistently and positively associated with social integration and life satisfaction of people with SCI. A mediation effect by social integration was observed between LR and life satisfaction. Conclusion: A decline in mobility level was associated with a decrease in LR participation over time for people with SCI. Engaging in LR activities regularly and maintaining a certain level of social interaction are consistently and positively associated with long-term life satisfaction.

Is Spending Nights Away From Home Associated With Participation and Life Satisfaction After Spinal Cord Injury? A Longitudinal Perspective.

Background: Community reintegration after SCI rehabilitation consists of readjustment not only to the home setting but also to the social and occupational spheres, which often require people to spend nights away from home. Because community reintegration contributes to life satisfaction after SCI, it is necessary to investigate how travel participation is related to occupational and social participation and life satisfaction. Additionally, better management of the long-term effects of SCI requires better understanding of the changes in participation and life satisfaction over time. Objectives: To examine how participation and life satisfaction change over time following SCI, and to investigate whether spending nights away from home is associated with occupational and social participation and life satisfaction over time. Methods: This is a longitudinal analysis of data extracted from the publicly available database of Spinal Cord Model Systems from 1996 to 2016. A generalized linear mixed model was developed to examine the changes of outcome variables over time while controlling demographic variables. Results: Travel and social participation declined while life satisfaction increased as people lived longer with SCI, controlling for confounders. No significant change was identified in occupational participation. Spending nights away from home was significantly and positively associated with social and occupational participation and life satisfaction over time. Although travel participation of people with SCI declined over time, its association with social participation strengthened as the number of postinjury years increased. Conclusion: Travel participation plays an important role in successful community reintegration. Rehabilitation services and travel services should provide training and resources on travel after SCI for improved participation and life satisfaction.

Influence of Psychological Factors on Participation and Life Satisfaction in the Context of Travel and Tourism after Spinal Cord Injury.

Spinal cord injury (SCI) can significantly compromise people's participation in travel and tourism activities, which is considered an important and meaningful way to engage in one's chosen lifestyle and wellness pursuits. Yet, travel often presents challenges for people with spinal cord injury (PwSCI), as it requires overcoming a wide range of potential psycho-physical challenges or barriers during trips. There is a lack of theory-based research that can help us understand and address the psychological factors and processes influencing participation and life satisfaction following SCI. Drawing on self-determination theory (SDT), this study examines the effects of psychological needs satisfaction on participation in the travel setting, and their subsequent impact on perceived life satisfaction. This study uses a mixed-methods approach with 39 in-depth telephone interviews conducted that focus on developing needs satisfaction measures for PwSCI in the travel setting, and an online survey among 258 PwSCI examining the relations between needs satisfaction and outcome variables. This study finds that the psychological needs satisfaction of autonomy and relatedness significantly contribute to self-determined participation in travel and tourism activities for PwSCI. This self-determined participation outcome thus represents an individual's improved ability to exert choice and control, which exhibits their level of regained mobility and further improves their life satisfaction.

How environmental and psychological factors interact with travel participation after spinal cord injury.

PURPOSE/OBJECTIVE: Spinal cord injury (SCI) usually causes neurological impairment, which can make traveling to places challenging. The ability to travel is nevertheless essential for societal participation, and full participation of persons in society after SCI is a key indicator of successful rehabilitation. Research has widely documented lowered level of participation of people living with SCI. To offer insights for effective intervention, the study aims to examine how psychological and environmental factors influence participation in travel related activities after SCI. Based on the self-determination theory (SDT) and the literature in participation research, the study proposed a model depicting the interrelationships among travel barriers, travel need satisfaction, travel motivation and participation of people with SCI in travel-related activities. RESEARCH METHOD/DESIGN: Cross-sectional quantitative data were collected from 250 individuals enrolled in a SCI model system. RESULTS: Path analysis reveals significant negative effect of travel barriers on respondents' need satisfaction for autonomy, which in turn affects controlled motivation (introjected and external) and amotivation. Only external motivation leads to participation in travel while amotivation negatively influences travel participation. Travel barriers were found to indirectly influence travel participation through need satisfaction for autonomy, external motivation and amotivation. CONCLUSIONS/IMPLICATIONS: Although people have high intrinsic motivation for travel, they do not travel for fun as much as for external motivations after SCI. Travel barriers can lower people's need satisfaction for autonomy, which results more travel for external motivation. The study provides preliminary evidence supporting an SDT-based travel participation model after SCI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Multi-stakeholder perspectives of environmental barriers to participation in travel-related activities after spinal cord injury.

PURPOSE: To help enhance participation, the study aims to identify and document a comprehensive list of environmental barriers for people with SCI in the broad travel setting. METHODS: Semi-structured interviews were conducted among four stakeholder groups: people with SCI (n= 39), caregivers and family members of people with SCI (n= 24), therapists who work with people with SCI (n= 9), and travel professionals specializing in accessible travel (n= 11). RESULTS: Five major categories of travel barrier emerged from the interviews: Partial Accessibility, Systemic Ignorance, Travel Hassles, Poor Service Performance, and Lack of Support. Detailed barriers in each category are described. The analysis of multi-stakeholder perspectives indicates while respondents with SCI offered the most specific information about the barriers, family members/caregivers were most concerned about the impact of systemic ignorance on their loved ones. Therapists focused on offering their clients tools to overcome barriers, and travel agents emphasized their limitations of serving customers with disabilities. CONCLUSION: Results of the study should help not only health and travel professionals better assist individuals to reintegrate into society after SCI, but also travel and hospitality businesses to better meet the accessibility needs of people with SCI.Implications for rehabilitationTravel is important to full participation in society for people after SCI.The study has identified five categories of barriers to travel participation after SCI: partial accessibility, systemic ignorance, travel hassles, poor service performance and lack of support.While traveling is important for participation in society for people with SCI, rehabilitation professionals should work together with policy makers, travel and hospitality businesses and agencies to lower the found barriers.

Contribution of travel participation to social integration and life satisfaction after spinal cord injury.

BACKGROUND: Research has found that participation in travel declines for people after spinal cord injury (SCI) because the traumatic injury usually results in impaired physical mobility and sensation, and barriers in the environment make travel more challenging. While travel participation can offer numerous physical, psychological, and emotional benefits, empirical evidence on positive outcomes of travel for people after SCI is scarce in the literature. OBJECTIVE: To empirically examine the effects of travel participation on social integration and life satisfaction for people with SCI, along with other personal characteristics including income, self-perceived health status, levels of physical independence, occupational activities, and travel barriers. METHODS: Cross sectional data are collected from 250 patients enrolled in a SCI Model System. Hierarchical regression analyses, followed by mediation analyses, are conducted to assess the effects of travel participation on social integration and life satisfaction. RESULTS: Travel participation along with occupational activities is shown to significantly impact social integration, with participation in occupational activities partially mediating the relation from travel participation to social integration. The significant effect of travel participation on life satisfaction is fully mediated by social integration. Income and self-perceived health status both significantly contribute to social integration and life satisfaction. CONCLUSIONS: Travel participation should be considered as an independent domain that directly impacts the social integration of people with SCI, which in turn enhances their life satisfaction. Systematic interventions with standard protocols for travel-related skill training and assessments procedures are needed for people after SCI.

Developing a Facilitators Scale in the Context of Travel: ReTRIP.

OBJECTIVE: To develop a scale for measuring factors that facilitate participation of people with spinal cord injury (SCI) in travel-related activities: Removing Travel Restrictions Influencing Participation (ReTRIP). DESIGN: A mixed-method approach where in the qualitative phase, items were developed and written based on results of interviewers with different stakeholder groups and in the quantitative phase, survey data were collected to examine the psychometric properties of the scale. SETTING: Home, work, and community settings. PARTICIPANTS: People living with SCI, caregivers or family members, therapists, travel professionals (N=333). INTERVENTIONS: None. MAIN OUTCOME MEASURES: An 11-item ReTRIP scale that measures the facilitators that enhance the travel participation of people with SCI. RESULTS: In the qualitative phase of the study, 5 categories of travel facilitators were identified based on semistructured in-depth interviews with 83 respondents from 4 stakeholder groups. Initial items of the ReTRIP scale were written based on the travel facilitators identified. Items in the scale were then revised based on results of cognitive interviews and an expert panel review. In the quantitative phase, a total of 250 patients enrolled in a Spinal Cord Injury Model System were systematically selected to report their experience with each travel facilitator. Item-response theory-based Rasch analysis revealed that the 11-item ReTRIP has acceptable psychometric properties, containing 2 main dimensions: industry-oriented facilitators (6 items) and self-oriented facilitators (5 items). CONCLUSIONS: The 11-item ReTRIP scale demonstrates promising psychometric properties, allowing researchers and clinicians to potentially use self-reported environmental factors that are beneficial for people's participation in travel after SCI to properly design client-centered interventions. Future studies using a larger sample are needed to validate the scale.