8 Application of Time Use Research to the Study of Life with a Disability Wendy E. Pentland and Mary Ann McColl
INTRODUCTION More and more persons with long-term disabilities and chronic illnesses are living in the community. Chronic illness or severe disability can interfere not only with an individual’s ability to perform specific tasks, but can also impair his or her ability to carry out normal life roles associated with self-care, family, productivity, and leisure. Despite the recognition of activity limitation as a measure of disability (World Health Organization, 1998), very little is known about how persons with severe physical disabilities spend their time, and what the relationship is between their activity patterns (time use) and health and well-being. Successful reintegration of both persons with disabilities and those with chronic illness constitutes a social change, and it has been advocated that time use patterns in a society may ultimately be the only way of assessing social change (Gutenschwager, 1973). One of the benefits of studying time use is that it gives us a way of understanding activity patterns. Activity patterns of subgroups within the population, when compared Wendy E. Pentland and Mary Ann McColl • Division of Occupational Therapy, School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario K7L 3N6 Time Use Research in the Social Sciences, edited by Wendy E. Pentland, Andrew S. Harvey, M. Powell Lawton, and Mary Ann McColl. Kluwer Academic/Plenum Publishers, New York, 1999. 169
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with those of the population as a whole, can suggest areas where activity is limited or constrained in special populations, such as people with disabilities. Understanding these constraints then helps in fashioning policy and social institutions that support fair and equitable access of all people to a broad and satisfymg range of activities. The few studies of time use in this population are restricted to very small samples. They suggest that there are substantial differences in the use of time or activity patterns between individuals with a disability and those with no disability. These differences include persons with a disability spending less time in productivity-related tasks, more time on personal care activities, and having more free time (Brown & Gordon, 1987; Kielhofner, 1977; McColl & Skinner, 1990–1991; McColl, Rosenthal, & McNair, 1991–1992; McDonald, Nielson, & Cameron, 1987; Pentland & White, 1992; Yerxa & Baum, 1990). Results of recent work examining the time use of men with spinal cord injury (n = 165) showed mean hours allocated to four primary activity categories to be sleep, 8.4 hours; self-care, 4.0 hours; leisure, 5.5 hours; and productivity, 4.4 hours (Pentland, Harvey, Smith, & Walker, 1998). This is in distinct contrast to the mean hours allocated to the same categories by able-bodied Canadians (n = 9,946); sleep, 8.2 hours; self-care, 2.8 hours; leisure, 5.5 hours; and productivity, 7.5 hours (Harvey, Marshall, & Frederick, 1991). In order to better understand the experience of disability, we need more specific information as to how persons with disabilities organize their daily lives and how this differs from the able-bodied population, what constitutes temporal balance and imbalance for those with disabilities, and what factors are associated with the healthy use of time in these persons whose balance in time use is threatened. Activity pattern/time use studies are able to give us a window on actual lifestyles. This can include information about a group's underlying activity preferences, dispositions, and priorities. From these normative measures, we can begin to see where and what types of healthy and unhealthy behaviors occur, which in turn will suggest necessary interventions and intervention strategies.
WHAT IS MEANT BY TIME USE? The purpose of this chapter is to present a model for the study of time use in persons with disabilities and offer methodological considerations for application of the model. The literature does not contain a clear, empirically established conceptualization of humans' use of time. However, it is acknowledged that any true understanding of a group’s use of time can only begin to be achieved if both objective (such as amount of time spent in
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various activities) and subjective (such as degree of liking of the activity) factors are considered. Three aspects of time use that are important to examine are time allocation, balance of time use, and satisfaction with time use. Human's allocation of time to daily activities has been documented for numerous populations, frequently using a form of time diary (Belloni, 1990; Grimler & Roy, 1987; Hanslow, 1988; Harvey et al., 1991; Niemi & Paakkonen, 1990; Ujimoto, 1985; Yerxa & Baum, 1986). This has been the most commonly studied aspect of time use, presumably because of its apparent objectivity (Robinson, 1985). Nonetheless, it has been acknowledged that in order to fully understand the nature of humans' use of time, it is necessary to capture factors in addition to time allocation. These factors include subject’s satisfaction with or enjoyment of the activities (Banks, 1983; Csikszentmihalyi, 1975; Juster, 1985a; Kielhofner, 1992; Lawton, 1983; Lewinsohn & Graf, 1973; Luckmann, 1991; Taylor, 1991; Yerxa & Baum, 1986) and whether the individual’s distribution of types of activities is balanced or varied (Banks, 1983; Canadian Association of Occupational Therapists, 1991; Law, 1991; Lawton, 1993; Meyer, 1922; Reed & Sanderson, 1983).
THE RELATIONSHIPS AMONG TIME USE, HEALTH, AND WELL-BEING The investigation of humans' time use patterns dates back as far as 1924 (Andorka, 1987). As long ago as 1922, it was recognized that balanced, varied, and purposeful use of time is both health maintaining and health regenerating (Meyer, 1922). However, only recently have the relationships between time use, activity patterns, health, and well-being begun to be recognized (Brown, 1983; Brown & Gordon, 1987; Hasselkus, 1989; Lawton, Moss, & Fulcomer, 1987; Michales, 1980; Ross, 1990; Yerxa & Baum, 1990). It has been shown that active involvement and participation in a variety of activities and roles positively affect health and well-being (Kielhofner, 1992; Law, 1991; Lewinsohn & Graf, 1973). Szalai (1980) pointed out that the use of time can be an indicator of an individual’s quality of life (Andorka, 1987). The ability to engage in activity has been regarded as a biological necessity for the mind and body (Selye, 1975), and as "enabling the development and integration of the sensory, motor, cognitive, and psychological systems; serving as a socializing agent, and verifying one's efficacy as a competent, contributing member of one's society" (Fidler & Fidler, 1978, p. 305). A purposeful daily routine exerts an organizing force and generates
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an image of external reality (Kielhofner, 1977). Presumably, if active involvement and participation in a variety of activities and roles have been shown positively to affect health and well-being, it follows that imbalance in activities and roles may precipitate or aggravate problems with health and quality of life. To date, the vast majority of research examining relationships between time utilization and health and well-being is based on the general population (Andorka, 1987; Chapin, 1974; Harvey et al., 1991; Sorokin & Berger, 1939; Szalai, 1972). Research exists describing the habitual time use patterns of national populations (Belloni, 1990; Grimler & Roy, 1987; Hanslow, 1988; Harvey et al., 1991; Justera, 1985; Nakanishi & Suzuki, 1986; Niemi & Paakkonen, 1990), as well as for some specific groups such as the elderly (Baltes, Wahl, & Schmid-Furstoss, 1990; Gourlay, Pentland, & McColl, 1992–1993; Harvey & Singleton, 1986; Quinn & Reznikoff, 1985; Smith, Kielhofner, & Watts, 1986; Ujimoto, 1985), parents (Dyck, 1992; Hermann, 1990), shift workers (Rosenthal & Howe, 1984), and to a very limited extent, persons with disabilities (Larson, 1990; Pentland & White, 1992; Yerxa & Baum, 1986,1990). The relationships between time use and humans' health and wellbeing are receiving increased attention in the literature. Particularly striking is the range of disciplines that have acknowledged the importance of activity participation or "doing" to humans' health and well-being. These include economics (Juster, 1985b; Keynes, 1931), theology (Banks, 1983), psychology (Csikszentmihalyi, 1975; Maslow, 1968), occupational therapy (Kielhofner, 1992; Reed & Sanderson, 1983), medicine (Meyer, 1922; Sigerist, 1955), sociology (Andorka, 1987), and philosophy (Taylor, 1991). Although there has been very little empirical work in the area, humans' engagement in activity is seen to influence biological health (musculoskeletal, cardiorespiratory, cognitive, and motor development) (Kielhofner, 1992; McArdle, 1991; Meyer, 1922; Salter, 1989; Smith & Raab, 1984) and psychological health (discovery, creativity, mastery, control, organization of one's day, confidence, self-worth, socialization, stress release, and giving life-meaning) (Csikszentmihalyi, 1975; Fidler & Fidler, 1978; Jahoda, 1982; Juster, 1985b; Keynes, 1931; Maslow, 1968; Selye, 1975; Sigerist, 1955; Szalai, 1972). In terms of the mechanism of this effect, a number of hypotheses have been advanced: that personal control over time use is influential on health and well-being (Michelson, 1988); that the match between an individual’s skill and the challenges inherent in the activity are consistent with health (Csikszentmihalyi, 1975); that balance and variety of activities are necessary for health (Kielhofner, 1992; Law, 1991; Reed & Sanderson, 1983); and that meaningfulness of the activity is associated with health (Iso-Ahola, 1990; Fidler & Fidler, 1978).
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Results of two studies of the able-bodied elderly have suggested that time use, specifically whether individuals liked their daily activities, was positively related to personal adjustment (Lawton et al., 1987) and selfrated happiness (McKinnon, 1992).
WHAT IS KNOWN ABOUT TIME USE AND VARIABLES RELEVANT TO PERSONS WITH DISABILITIES? There has been only limited examination of the nature, obstacles, and facilitators of activity patterns of persons with disabilities. However, it will be of use to the reader to understand for what purposes, and how, time use methods have been applied in this population, and with what types of disabilities. We have employed time use methodology to examine relationships between aspects of disabled persons’ lifestyles and their health and well-being (Pentland, Harvey, Smith, & Walker, 1998). A model we are currently examining is shown in Figure 8-1. Existing literature related to time use and disability is discussed with this model as a format.
RELATIONSHIPS BETWEEN DISABILITY AND USE OF TIME As mentioned previously, there is a large body of literature on the use of time by the able-bodied population (Belloni, 1990; Grimler & Roy, 1987; Hanslow, 1988; Nakanishi & Suzuki, 1986; Niemi & Paakkonen, 1990) but very few published works have focused on time use in the disabled, and the relationship between severity of disability and time use is not clear. The existing research suggests that disability has a negative impact on time use in terms of decreased frequency of activities (Brown, 1983; Brown & Gordon, 1987; McDonald et al., 1987; Trieschmann, 1988), higher unemployment (Danek & Lawrence, 1985; Niemi, 1993; Yerxa & Baum, 1986), and altered time allocation compared to the general population (Baltes et al., 1990; Brown, 1983; Dowler & Jordan-Simpson, 1990; Lawton et al., 1987; Morgan & Jongbloed, 1990; Niemi, 1993; Trieschmann, 1988). Persons with disabilities have also been shown to experience less satisfaction with their performance of activities than able-bodied individuals (Dowler & JordanSimpson, 1990; Yerxa & Baum, 1986,1990). Parker (1992) examined the impact of serious parasitic disease by comparing the time use patterns of infected and noninfected women laborers in Sudan. The women’s productivity was lower and they engaged
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Figure 8.1. Conceptual model of time use by persons with a physical disability.
in fewer personal-care behaviors than their noninfected peers. The study was the basis for important recommendations for local public health policy. Time use methodology also formed the basis for an examination of the impact of the environment on children with disabilities (Law, 1993). Based on the work, Law and Dunn (1993) proposed a sociopolitical planning model designed to improve the community participation of children with disabilities. Time use methodology has been used to help understand the impact of disability at the level of caregivers. The effectiveness of a 10-day respite program for mothers caring for young children with severe disabilities was examined by Botuck and Winsburg (1991) using time use methodology. With time spent on caregiving removed, these women showed increases of well-being and reduced depression. A number of studies have attempted to understand the impact of disease, disability, or illness by comparing specific characteristics of activity performance before and after onset or rehabilitation (such as functional level, satisfaction) (Kinney & Coyle, 1992). When this information is combined with the actual activity patterns or time use (activities engaged in
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and duration/ frequency), a very comprehensive picture of life with a disability can be obtained. Some studies have attempted to go beyond the description of time use patterns in persons with disability to try to discern what aspects of disability seem to precipitate changes in a person's time use or are the source of differences in time use between persons who have disabilities and those who do not. These factors may be classified according to the World Health Organization Classification of Impairments, Disabilities and Handicaps (World Health Organization, 1980), which defines " impairment" as losses or abnormalities at the level of the organ. " Handicap" is defined as those sociopolitical aspects of the environment that impact (usually seen to impede) the individual’s performance of activities and roles, and "disability" is the restriction of an ability to perform in a normal way and is seen to result from the interaction of the individual’s impairment and handicaps. Time use methodology provides one of the few convenient and objective global measures of disability and, as such, is a valuable tool to identify and examine the extent and impact of various impairments and handicaps. While the impact of these specific aspects of disability on time use is not clear, time use methodology has revealed a variety of impairment factors that influence daily activity patterns of persons with disabilities. These include reduced muscle strength and endurance (Cheng & Rogers, 1989; Noreau, Shepard, Simard, Pare, & Pomerlau, 1993), general fatigue and poor sleep patterns (Parker, 1992); altered cognitive/emotional sensorimotor function (e.g., postacquired brain injury) (Soderback & Ekholm, 1992; Soderback, Ekholm, & Caneman, 1991); and major depression (Astrom, Asplund, & Astrom, 1992). Similarly, studies of time use in persons with disability have revealed valuable information about the restricting aspects of particular handicapping factors. These include environmental constraints (physical, social, institutional, economic, cultural factors) (Law, 1993; Schalock & Genung, 1993); impaired social network (Astrom et al., 1992; Morgan & Jongbloed, 1990); and income (Osberg, McGinnis, DeJong, & Seward, 1987).
Relationships between Social Support and Time Use There is limited published work on the effect of social support on time use, particularly for persons with disabilities. Morgan and Jongbloed (1990) reported that the quality of an individual's relationships with family and friends was often the most influential factor in determining social and leisure activities following stroke. Kemp and Vash (197l) found that persons with quadriplegia who had less interpersonal support were significantly less productive. The Canadian 1986–1987 Health and Activity Lim-
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itations Survey Statistics Canada, (1987) revealed that for people with disabilities, the lack of assistance was as much of a barrier to their participation in cultural and leisure activities as lack of transportation (Dowler & Jordan-Simpson, 1990). In a study of elderly disabled persons, Osberg and colleagues (1987) found being married had a significant positive effect on activity level. The support of friends for persons with disabilities has been acknowledged as crucial to their continued independence (Armstrong, 1991; Trieschumann, 1987).
Relationships between Time Use and Outcomes There has been very little examination of the relationships between time use and outcomes in persons with disabilities. What exists is characterized by small, often heterogeneous samples, and uses loosely defined constructs and instruments with unclear reliability and validity (Brown, 1982; Larson, 1990; Yerxa & Baum, 1990). In our model, we look specifically at three outcomes: life satisfaction, perceived health and adjustment to disability (Pentland et al., 1998). Osberg and colleagues (1987) found activity to be the best (positive) predictor of quality of life in disabled elderly persons. In persons who were depressed, Larson (1990) found a positive correlation between increased stress and greater time spent in the home rather than in the community. Based on their work with depressed persons with spinal cord injury, McDonald and colleagues (1987) pointed to the relationship between time use and depression in spinal cord injury, finding that mild depression reduced the work and activity levels of persons with paraplegia, such that they were similar to those of individuals with much more severe disability (quadriplegia). In a study of 15 persons with spinal cord injury, Yerxa and Baum (1986) reported a significant relationship between activity performance and overall life satisfaction. In a study of persons with spinal cord injury, Gordon (1982) found a significant positive correlation between depression and time spent inactive and watching television, and a significant negative correlation between depression and traveling, socializing, and leaving the home. In a longitudinal study of long-term adjustment in 256 persons with spinal cord injury, Kraus and Crewe (1987) found that even survival was affected by being more socially and vocationally active.
The Impact of Demographic Variables on Time Use When examining time use of persons with disabilities, it is important to consider the potential effects of demographic variables. These include age, gender, and socioeconomic status.
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Research on the effect of age on human time use has tended to focus on time allocation without capturing information on subjects' perceptions of their time use, specifically its quality, meaningfulness, or satisfaction (McKinnon, 1992; Ujimoto, 1985). For an in-depth discussion of time use in later life, the reader is directed to the chapters in this volume by Lawton (Chapter 5) and Ujimoto (Chapter 11). It is generally accepted that age affects time allocation throughout the life span (Tindale, Chapter 7, this volume; Lawton et al., 1987; McKinnon, 1992; Zuzaneck & Box, 1988), but the nature of the relationship is not well understood. Morgan and Jongbloed (1990) found that age affects the types of activities that people find meaningful. Lawton et al. (1987), in a large study of older adults, found that although age was associated with a somewhat slower pace of activities, the more pleasurable activities consumed more of the individual’s day. This led the investigators to conclude than older people do what they like doing. In a study of aging in persons with spinal cord injury, Pentland, McColl, and Rosenthal(1994) found that increased age was associated with decreased activity level. While the effect of age on time use in persons with disabilities is not well understood, the available information suggests that persons with disabilities slow their activity level and tend to engage in more personally satisfying activities as they grow older. It is well established that gender influences time allocation in the ablebodied population, due to a complex set of factors influencing roles adopted with the family unit related to raising children and housework, and paid and unpaid participation in the workforce (Eichardus & Glorieux, 1994; Harvey et al., 1991; Shaw, 1985). But less attention has been paid to the relationship between gender and the broader definition of time use (satisfaction, balance, meaningfulness, etc.) We were unable to locate any published work comparing time use between women and men with a disability. However, the literature suggests that the time use of disabled women is rated more poorly, secondary to factors mentioned such as their lack of access to rehabilitation, education, employment, financial assistance, lower marriage rates, and higher likelihood of being stigmatized than disabled men (Altman, 1985; Danek & Lawrence, 1985; Evers, 1981; Fine & Asch, 1981; Lesh & Marshall, 1984; Wallston, DeVellis, & Wallston, 1983). In the able-bodied population, examinations of socioeconomic status (SES) and time use have shown that higher income and more education affect time allocation to more satisfying activities (Lawton et al., 1987) and return to work (Dyck, 1992). Employment status has been shown to be a major factor affecting both activity participation and time allocation to activities (Harvey, Elliot, & Procos, 1977). In persons with disability, SES affects whether they need and have the skills to be employed or the resources to engage in some activities (Danek & Lawrence, 1985). In the
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1986–1987 Health and Activity Limitation Survey (Statistics Canada, 1987), "cost" was cited by disabled persons as being a major barrier to participating in leisure and cultural activities (Dowler & Jordan-Simpson, 1990). In their study of disabled elderly adults, Osberg and colleagues (1987) found income to be positively related to activity, in that those with higher incomes had higher activity levels. Larson (1990) found time allocation was altered in depressed persons as their income changed. Clearly, SES can be expected to be an influential factor in daily activity patterns of persons who have a disability.
METHODOLOGICAL CONSIDERATIONS WHEN EXAMINING USE OF TIME IN THIS POPULATION A variety of methodologies are available to examine time use of persons with disabilities. As with any population, the primary issues in the choice of a time use methodology are accuracy of the data, invasion of subject privacy, and cost of the research ouster, 1985a; Robinson, 1985). Qualitative methods, including ethnography, random spot visits, and participatory action research, provide rich time use data but are costly and can suffer from lack of scientific validity ouster, 1985a; Moss & Lawton, 1982; Robinson, 1985). Direct observation is arguably the most accurate; however, it is extremely expensive, and subjects' behavior may be altered by an observer's intrusion into the home (Robinson, 1985). Similarly, this method can be prone to a high, nonrandom refusal rate by subjects not comfortable with being observed. Another method of measuring time use involves frequency and duration of activity surveys, such as the Activity Pattern Indicators (Belcher, Clowers, Cabanayan, & Fordyce, 1982; Brown & Gordon, 1987; McDonald et al., 1987). These are "stylized" lists of activities for which subjects provide frequency and duration of participation information. They have been used in the rehabilitation literature to examine the time use of persons with disabilities, but have been shown to have poor reliability (Robinson, 1985). In order to be accurate and interpreted consistently by all subjects, the activities must be very narrowly defined. This results in lists of more than several hundred activities, the tedium of which can result in poor subject compliance. Attempts to shorten the list by broadening the activity categories will reduce the reliability of the time estimate (Robinson, 1985). A third method of collecting time use data is the time budget or time diary (Harvey & Singleton, 1986; Harvey et al., 1991; Robinson, 1985; Sorokin & Berger, 1939; Szalai, 1972). This is a systematic recording of time use, normally over a 24-hour period, and consists of a diary in which the
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subject records sequentially, including time of start and end of each activity, all of the activities that were engaged in during the reporting period. The advantage of time diaries is that they are comprehensive for the time period, and subjects can use their own terminology, which can then be coded according to uniform classification criteria (Robinson, 1985). Time budgets can be administered either as " leave behind diaries" (Harvey & Singleton, 1985), where the subject completes the diary on his or her own as the day progresses, or as "recall diaries," where the subject is asked to recall his or her activities for the previous day (Harvey et al., 1991; Robinson, 1985). Design issues for time-budget methodology that require consideration are sampling and data collection (Justera, 1985; Kalton, 1985; Robinson, 1985). Sample selection issues in time-budget research are similar to those for any survey research: specifically, sample selection must be accomplished so that inferences drawn from the sample may accurately be applied to the population of interest. In studying people with disabilities, sampling is a particular challenge for several reasons. First and foremost, the definition of disability is an issue about which there is little consensus. Some surveys use self-reported activity limitation (Statistics Canada, 1993), while others adopt a more biomedically rigorous definition, such as the presence of particular disabling diagnoses. At the root of this issue is the question as to whether disability is an experienced or an observed phenomenon. Some surveys use only those disabled individuals living in the community, while others include institutionalized individuals, with notably different results, due to the inclusion of those with more severe disabilities in the latter samples. The choice of an appropriate sampling frame is also an issue for time use surveys of people with disabilities. In most countries, there is no central registry of people with disabilities. Thus, researchers are obliged to use sampling frames such as hospital statistics, membership lists of voluntary organizations, lists of disability pension recipients, or some combination of sources. Each of these sources of survey participants has associated with it bias that causes results either to overestimate or underestimate certain parameters within the population. Finally, because of the specialized nature of this population, sample size is also an issue. Surveys of time use among people with disabilities are inevitably smaller than those based on census or other general population surveys. Thus, the estimates produced are usually less precise; that is, they have larger standard errors, making statistical analyses less rigorous. Generally, multiple days of data collection have been found to be more efficient and valid than conducting a single wave of data collection on a larger sample (Kalton, 1985; Pas, 1984). This is an important factor in
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that larger samples of persons with disabilities can be difficult to obtain, since subject identification (though not necessarily recruitment) is always more complicated than in the general population. Thus, we find that 2 days of data collection (separated by 1 day) on a smaller sample to be the most efficient. We do stratify for days of the week and seasons of the year.
Time Use Instrument The Time Use Questionnaire that we have developed for our work with persons with disabilities is shown in Figure 8.2. This time-diary instrument was adapted form the Occupational Questionnaire, which has been used to measure daily activity patterns and life satisfaction in the elderly (Smith et al., 1986), from Section D of the 1986 Canadian General Social Survey (GSS; Harvey et al., 1991), and the 1992 General Social Survey (GSS) Time Use Survey (Statistics Canada, 1993). Reliability and validity of the Occupational Questionnaire has been shown to be good (Smith et al., 1986). The instrument was modified to its present form following pilottesting on 27 adult subjects with severe physical disability (Pentland & White, 1992). Activities of 5 minutes or more duration are recorded to the nearest 5 minutes. This is the same strategy used in the time use component of the Canadian General Social Surveys (Statistics Canada, 1987). We believe it to be more accurate than confining activities to half-hour intervals, and it enables comparison of data for persons with disabilities with data for those who are not disabled (e.g., 1992 Canadian Time Use Survey). One item was included to determine the degree of control that the individual perceives he/she has over his/her use of time (Figure 2, Column h) (Ujimoto, 1985). In addition, to measure participants’ subjective perceptions of their use of time, we ask them to respond to two Likert statements about their satisfaction while doing each activity (Figure 2, Column g) and perceived balance of the activities in which they engage.
Procedures for Collecting Time Use Data from Persons with Disabilities In our experience, time use data from persons with disabilities is best collected by telephone interview. We have used personal interviews to collect time use information on the assumption that personal contact would improve compliance, and that some subjects with disabilities might need physical assistance to complete the forms (Pentland & White, 1992). However, our experience was that the face-to-face aspect in fact compromised the accuracy of the information due to subject embarrassment
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regarding some personal activities and discomfort in admitting when there had been lulls of inactivity during the day. Furthermore, Robinson (1985) pointed out that the use of personal interviews to collect time use data has been shown to be substantially more expensive than telephone interviews, with estimated cost differences ranging from 39% to 172%. In a pilot study, we also tried autochronography (Andorka, 1987) or " leave behind diaries" (Robinson, 1985) with this population. The disabled subjects seemed more comfortable with the increased anonymity of this method, but the quality of the data from the " leave behind diaries" was noticeably poorer than that from the " recall diaries" completed by personal interview, or by telephone interview. In our studies we generally need to administer a variety of instruments in addition to the time use questionnaire. We have found that compliance, reliability /validity, and budget considerations all seem best addressed by a data collection protocol that combines telephone interview and mailed, self-administered methods, with the time use data collected by telephone. The validity and reliability of time use diaries are directly affected by subject motivation, belief in the importance of the data, and sense of involvement in the study (Grinder & Roy, 1987). The study is carefully explained to subjects, and a small honorarium is paid upon completion of the interviews and receipt of their questionnaires. The approach and manner of the interviewers in critical in this regard. We select interviewers carefully, and they are specially trained to interview persons with disabilities. Each interviewer is assigned subjects for whose data collection they are responsible. Since the interviewers' manner, motivation, and skills are critical to ensure a good response rate and quality data, we provide interviewers with a 1-day workshop in interviewer technique and time use data collection, specifically tailored for working with people with disabilities. Topics in the workshop include the purpose and nature of the study, the measurement instruments, the importance of consistency and standardization, and basic understanding of the particular disability or disabilities. During training, the interviewers practice collecting time use data in pairs under supervision and receive feedback. In conclusion, a fuller understanding of time use has implications for theory, practice, and research among people with disabilities. The field of disability studies and rehabilitation is a relatively new one, with only the most rudimentary body of theory associated uniquely with it. In the past, theory from other disciplines, such as anatomy, physiology, neurosciences, and medical sciences has informed our understanding of disability and rehabilitation. Conspicuously absent from the theory base is theory applying specifically to an understanding of disability and the many parameters
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Figure 8.2. Time use questionnaire.
that affect life with a disability. Theory on time use has endless potential to contribute to our understanding of disability and the factors that affect activity patterns and lifestyles of those with disabilities. In the research area, time use approaches offer an objective means of addressing issues, such as those just mentioned, which are largely phenomenological or subjective in nature. Furthermore, it offers a means of increasing our understanding of issues associated with activity patterns, through quantitative approaches to understanding the relationship between time use and other measurable variables, such as age, duration of disability, and financial security, to name a few. Finally, as regards practice and rehabilitation, the consideration of time use by rehabilitation professionals offers a means of ensuring a more holistic and person-centered view of the role of the professional. If therapists and others working with disabled people were to routinely measure time use as part of their battery of assessments, it is unlikely that they could then focus exclusively on a wrist or a back, or a behavior. This failure to treat disability issues in the context of the whole person and his or her life is one of the most commonly leveled complaints of disabled consumers about their therapists. Perhaps by understanding time use, activity patterns, and lifestyle requirements, a more balanced program could be offered by therapists, thus leading to increased understanding and greater satisfaction in the client–therapist relationship.
REFERENCES Altman, B. (1985). Disabled women in the social culture. In S. E. Brown, D. Connors, & N. Stem (Eds.), With the power ofeach breath: A disabled women's anthology (pp. 69–76). San Francisco: Cleis Press. Andorka, R. (1987). Time budgets and their uses. Annals of Reviews in Sociology, 13,149–164. Armstrong, M. J. (1991). Friends as a source of informal support for women with disabilities. Journal of Women and Aging, 3, 63–83. Astrom, M., Asplund, K., & Astrom, T. (1992). Psychosocial function and life satisfaction after stroke. Stroke, 23(4), 527–531. Baltes, M., Wahl, H., & Schmid-Furstoss, U. (1990). The daily life of elderly Germans: Activity patterns, personal control, and functional health. Journal of Geron tology, 45(4), 173–179. Banks, R. (1983). The tyranny of time. Downers Grove, IL: InterVarsity Press. Belcher, S., Clowers, M., Cabanayan, A., & Fordyce, W. (1982). Activity patterns of married and single individuals after stroke. Archives of Physical Medicine and Rehabilitation, 63, 308–312.
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