Age-Friendly Buses: Development, Evaluation and Occupational Therapy Theory

Kieran Broome (2010). Age-Friendly Buses: Development, Evaluation and Occupational Therapy Theory PhD Thesis, School of Health & Rehabilitation Sciences, The University of Queensland.

       
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Author Kieran Broome
Thesis Title Age-Friendly Buses: Development, Evaluation and Occupational Therapy Theory
School, Centre or Institute School of Health & Rehabilitation Sciences
Institution The University of Queensland
Publication date 2010-10
Thesis type PhD Thesis
Supervisor Professor Linda Worrall
Associate Professor Jennifer Fleming
Total pages 229
Total colour pages 8
Total black and white pages 221
Subjects 11 Medical and Health Sciences
Abstract/Summary The ability of older people to successfully participate in life situations can be either facilitated or hindered by the physical, social, cultural and institutional environment. The enablement of older people via environmental intervention at a societal level is a core concern of occupational therapy, and exemplifies macro practice. This example of macro practice is captured by the concept of age-friendliness, used by the World Health Organization. The aim of this thesis is to develop, and evaluate the effectiveness of, age-friendly guidelines using the case study of public buses. The thesis includes two literature reviews and eight original research studies. A review of the literature (chapter 2) regarding older people and bus use identified that older people experience significant transport disadvantage that restricts bus use, useability and participation. Using the Person-Environment-Occupation Model as a conceptual framework, a wide variety of barriers and facilitators to bus use were identified from previous literature. Physical, social, institutional and cultural factors were implicated. In the first stage of the thesis, a series of studies were conducted to develop age-friendly guidelines for public buses (chapters 3, 4, 6, 7 and 8). Multiple methods, both qualitative and quantitative, were used to establish the need for age-friendly guidelines, prioritise the barriers and facilitators to be addressed in age-friendly guidelines, clarify criteria for achieving age-friendliness and review potential interventions to achieve the priorities. The nominal group technique and participant observations with stimulated recall interviews were used to provide complementary data regarding actual and perceived bus useability. The nominal group technique was used to establish that older adults aged 60 and over have specific priorities that differ from those of younger adults (chapter 3). Subsequently, both the nominal group technique (n=227 older adults) and participant observation with stimulated recall interview (n=40 older adults) were used to identify barriers and facilitators to bus use for older people and quantify their relative impact on the useability of the bus system (chapter 4). The seven highest priorities for an age-friendly bus system were concerned with, in order, (1) vehicular accessibility, (2) bus driver friendliness and helpfulness, (3) scheduling, (4) bus stop locations, (5) pedestrian infrastructure, (6) information and training, and (7) routes and destinations. Older people’s priorities for an age-friendly bus system formed the basis for an appraisal of the literature (chapter 5). Multiple interventions that could achieve outcomes in these priority areas have been suggested in the literature, with varying degrees of evidence. The literature review showed that evidence was particularly focussed around interventions to achieve better vehicular and pedestrian accessibility, with limited attention paid to the other priorities. There was a lack of evidence regarding the specific behaviours associated with bus driver friendliness and helpfulness, and specific requirements relating to information, scheduling, routes and bus stop locations. A qualitative analysis of the stimulated recall interviews (n=40 older people) illuminated the behaviours required of age-friendly bus drivers and the characteristics associated with age-friendly information (chapters 6 and 7). It revealed that older people relied on a wide variety of information sources, including printed timetables, bus stop timetables, word-of-mouth, bus drivers, telephone and the internet. The level of information complexity required varied between participants. Age-friendly bus drivers exhibited a range of general and specific behaviours that were considered to be helpful. Age-friendly behaviours included allowing older people to feel safe, being courteous, friendly and helpful, being aware of disabilities that they could not see, giving older people sufficient time, pulling in close to the curb and being an effective communicator of information. A survey of older people (n=100) provided criteria for age-friendly scheduling, routes and bus stop locations (chapter 8). The majority of older people preferred 30 minutes bus headways, a distance to the bus stop of 200m or less and routes that provided cross-suburban travel, access to leisure destinations, shops, the Central Business District (CBD), medical services and other nearby towns. In the second stage of the thesis, age-friendly guidelines were implemented and evaluated in Hervey Bay, Queensland, Australia (chapters 9, 10 and 11). Focussed studies around flexible route transport and age-awareness training for bus drivers were conducted to enhance the evidence underlying these interventions. A pilot study evaluated age-awareness training for bus drivers (chapter 9). The training session resulted in subjective improvements in observed bus driver friendliness and helpfulness, with some improvements in the frequency of objective observed behaviours. Underlying attitudes and knowledge did not change. The replacement of a fixed route bus service with a flexible route bus service was evaluated using a pre-post test design (chapter 10). Ticket sale data were collected over a seven month period. On-board satisfaction surveys were conducted before and after the intervention. The introduction of the flexible route service was associated with an almost two-fold increase in patronage, alongside significant improvements in satisfaction with the bus system. Flexible route transport was identified as a valuable model of service delivery that meets a number of the priorities for an age-friendly bus system. To culminate the second stage of the thesis, an overall evaluation of the implementation of age-friendly guidelines in Hervey Bay was conducted (chapter 11). North Brisbane, Queensland, Australia, where age-friendly guidelines were not explicitly implemented, acted as a comparison site. A pre-post test design was adopted using two methodologies. A repeated measures cohort study (n=100 older people) and an on-board satisfaction survey (n=335 older people) were conducted. Participants in Hervey Bay identified an improvement in the bus system, yet experienced no change in bus frequency of use, useability or social participation over the 3 year intervention period. In comparison, participants in Brisbane experienced a decrease in satisfaction with the bus system, decreased ease of bus use and decreased social participation over the intervention period. Results from this study suggest that the implementation of age-friendly guidelines enhances older peoples’ ability to maintain bus use and social activity despite ageing. Reflections on this case study show that the development of age-friendly guidelines benefits from a systematic approach, requiring multiple methods, both quantitative and qualitative, as well as subjective and objective. Improving age-friendliness is one example of macro practice for occupational therapists. Undertaking macro-, rather than micro- or meso-, occupational therapy practice requires further considerations concerning occupational therapy theory and practice skills. The learnings from this case study provide further guidance for how occupational therapists can continue to expand their role in macro practice.
Keyword age-friendly
Buses
Older people
elderly
seniors
Occupational Therapy
macro practice
Additional Notes Pages for printing in colour: 30, 36, 46, 110, 126, 142, 143, 164 Pages for printing in landscape: 50, 51, 62, 63, 135, 211, 228, 229

 
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Created: Thu, 10 Mar 2011, 06:56:33 EST by Mr Kieran Broome on behalf of Library - Information Access Service