Providing Accessible ReCreation Outdoors: User-driven Research on Standards (PARCOURS) – Research protocol (Preprint)

BACKGROUND Canada’s national parks are world-renowned. However, despite recent attempts to improve access, many are not accessible to people with disabilities. With the advent of provincial and federal legislation, standards are being developed to assist with the design and management of parks. OBJECTIVE The overarching objective of this study is to inform accessibility standards for federal parks that meet the needs of all park visitors, regardless of ability. The specific objectives of this study are to: 1. Identify park accessibility standards that exist internationally; 2. Identify the accessibility challenges that people with disabilities face in park environments; 3. Prioritize and recommend accessibility standards for national parks. METHODS A three-phase approach will be used to achieve study objectives. In the first phase, a scoping review of the existing accessibility standards will be conducted. The second phase will include an objective audits of trails and features in six parks, three in western Canada and three in eastern Canada, as well as mobile interviews with 24 diverse participants in each region regarding their experiences of and recommendations for improving the park’s accessibility. In the final phase, a Delphi participatory consensus-development process will be used, based on the data gathered in the first two phases, to prioritize recommendations for standards. RESULTS We expect to find gaps in existing standards that do not account for the diverse range of accessibility requirements that people with disabilities have for visiting parks. We also expect to find that existing standards, on their own, may not be enough to ensure equitable access to all the experiences and amenities that parks have to offer. Development of subsequent guidelines and best practices may be necessary to address complex scenarios for which standards may not be the best approach to ensuring accessibility. CONCLUSIONS The participatory and mixed-methods approaches used in this study will provide rich insights for developing accessible park standards that consider the diverse needs of people with disabilities. The findings will also support the development or enhancement of park standards at all levels of government.

Communicating Electronic Adherence Data to Physicians—Consensus-Based Development of a Compact Reporting Form

Information on medication adherence is missing in patient files, although it might be helpful to optimize treatment. An adherence report that presents data from electronic adherence monitoring and provides recommendations regarding pharmacological treatment could close this gap. We aimed to develop an adherence reporting form that combines suitable calculations and graphical representations to facilitate the physicians’ interpretation of (non-)adherence. Two consensus development panels were conducted. First, pharmacists with expertise in adherence monitoring debated the items needed to calculate and illustrate electronic adherence data. Second, physicians discussed the items they would need for an adherence report and were encouraged to propose new items. Preference was indicated by raising a green or red card. Voting was repeated until consensus was obtained. Third, first drafts of the adherence reporting form were created by two pharmacists. Seven pharmacists agreed on four metrics to express medication adherence and three graphical representations. Five physicians approved the four metrics and rated the dot chart as the most useful illustration for judging the patient’s adherence patterns. Additionally, they required a clinical–pharmaceutical evaluation of the adherence estimates considering drug-related properties. We developed an adherence reporting form for the first time in a compact format and based on the recommendations of experts. In addition, we considered the preferences of physicians, who appreciated the clarity of the reporting form.