Understanding the longer-term experience of community inclusion for wheelchair users following the 2010/2011 Canterbury earthquakes: A mixed methods study
Thesis DisciplineHealth Sciences
Degree GrantorUniversity of Canterbury
Degree NameDoctor of Philosophy
Background The 2010/2011 Canterbury earthquakes and aftershocks in New Zealand caused unprecedented destruction to the physical, social, economic, and community fabric of Christchurch city. The recovery phase in Christchurch is on going, six years following the initial earthquake. Research exploring how disabled populations experience community inclusion in the longer-term recovery following natural disasters is scant. Yet such information is vital to ensure that recovering communities are inclusive for all members of the affected population. This thesis specifically examined how people who use wheelchairs experienced community inclusion four years following the 2010/2011 Canterbury earthquakes.
Aims The primary research aim was to understand how one section of the disability community – people who use wheelchairs – experienced community inclusion over the four years following the 2010/2011 Canterbury earthquakes and aftershocks. A secondary aim was to test a novel sampling approach, Respondent Driven Sampling, which had the potential to enable unbiased population-based estimates. This was motivated by the lack of an available sampling frame for the target population, which would inhibit recruitment of a representative sample.
Methodology and methods An exploratory sequential mixed methods design was used, beginning with a qualitative phase (Phase One), which informed a second quantitative phase (Phase Two). The qualitative phase had two stages. First, a small sample of people who use wheelchairs participated in an individual, semi-structured interview. In the second stage, these participants were then invited to a group interview to clarify and prioritise themes identified in the individual interviews.
The quantitative phase was a cross-sectional survey developed from the findings from Phase One. Initially, Respondent Driven Sampling was employed to conduct a national, electronic cross-sectional survey that aimed to recruit a sample that may provide unbiased population-based estimates. Following the unsuccessful application of Respondent Driven Sampling, a region-specific convenience sampling approach was used. The datasets from the qualitative and quantitative phases were integrated to address the primary aim of the research.
Results In Phase One 13 participants completed the individual interviews, and five of them contributed to the group interview. Thematic analysis of individual and group interview data suggested that participants felt the 2010/11 earthquakes magnified many pre-existing barriers to community inclusion, and also created an exciting opportunity for change. This finding was encapsulated in five themes: 1) earthquakes magnified barriers, 2) community inclusion requires energy, 3) social connections are important, 4) an opportunity lost, and 5) an opportunity found. The findings from Phase One informed the development of a survey instrument to investigate how these findings generalised to a larger sample of individuals who use wheelchairs.
In Phase Two, the Respondent Driven Sampling approach failed to recruit enough participants to satisfy the statistical requirements needed to reach equilibrium, thereby enabling the calculation of unbiased population estimates. The subsequent convenience sampling approach recruited 49 participants who, combined with the 15 participants from the Respondent Driven Sampling approach that remained eligible for the region-specific sample, resulted in the total of 64 individuals who used wheelchairs and were residents of Christchurch.
Participants reported their level of community inclusion at three time periods: the six months prior to the first earthquake in September 2010 (time one), the six months following the first earthquake in September 2010 (time two), and the six months prior to survey completion (between October 2015 and March 2016, (time three)). Survey data provided some precision regarding the timing in which the magnified barriers developed. Difficulty with community inclusion rose significantly between time one and time two, and while reducing slightly, was still present during time three, and had not returned to the time one baseline. The integrated findings from Phase One and Phase Two suggested that magnified barriers to community inclusion had been sustained four years post-earthquake, and community access had not returned to pre-earthquake levels, let alone improved beyond pre-earthquake levels.
Conclusion Findings from this mixed methods study suggest that four years following the initial earthquake, participants were still experiencing multiple magnified barriers, which contributed to physical and social exclusion, as well as fatigue, as participants relied on individual agency to negotiate such barriers. Participants also highlighted the exciting opportunity to create an accessible city. However because they were still experiencing barriers four years following the initial event, and were concerned that this opportunity might be lost if the recovery proceeds without commitment and awareness from the numerous stakeholders involved in guiding the recovery. To truly realise the opportunity to create an accessible city following a disaster, the transition from the response phase to a sustainable longer-term recovery must adopt a new model of community engagement where decision-makers partner with people living with disability to co-produce a vision and strategy for creating an inclusive community. Furthermore, despite the unsuccessful use of Respondent Driven Sampling in this study, future research exploring the application of RDS with wheelchair users is recommended before discounting this sampling approach in this population.