Participation by design: Integrating a social ecological approach with universal design to increase participation and add value for consumers.

BACKGROUND: Physical activity is an essential component of a healthy lifestyle. Health clubs encourage sustained healthy lifestyles but are still largely not accessible to people with disabilities. Cost is a barrier for accessibility enhancements. HYPOTHESIS: We postulate that: (A) universal design coupled with a social ecological approach improves measured accessibility compared with existing fitness facilities constructed since the adoption of the ADA; (B) increased accessibility coupled with an environment friendly to people with disabilities attracts more participants to a YMCA than predicted by traditional industry market research producing a recovery of the cost of increased accessibility; and (C) attitudes of facility members toward people with disabilities may improve if an accessible facility facilitates more personal interactions between people with and without disabilities. METHODS: Accessibility is measured with the Accessibility Instruments Measuring Fitness and Recreation Environments (AIMFREE). Cost recovery is determined by comparing excess membership revenue to the cost of universal design elements beyond regulatory requirements, and attitudes toward people with disabilities are measured with the Attitudes Toward Disabled Persons Scale. RESULTS: AIMFREE scores were significantly higher than comparison facilities in all areas except for equipment, parking, training, and programs. Excess revenue exceeded the extra cost of accessibility enhancements and attitudes toward people with disabilities did not change. CONCLUSIONS: Universal design coupled with a social ecological approach improves accessibility in fitness facilities and results in a reasonable payback time. Attitudes toward people with disabilities did not change in a YMCA designed to accommodate people with disabilities.