Tuesday, January 7, 2014

Ask the Expert: Rebecca H. Hunter, M.Ed., Research Associate, University of North Carolina Center for Health Promotion and Disease Prevention

What is your background?

Rebecca H. Hunter
I’ve been privileged to follow many different paths over the years. Trained as a counselor, I spent the first 15 years of my career in mental health. During those years, while traveling throughout North Carolina, I saw firsthand the impact of communities on the health and well-being of their residents. During my subsequent years at the University of North Carolina at Chapel Hill,  I embraced a community-oriented public heath perspective while working in health professions education, teaching rural health, and conducting aging research in partnership with communities. Today I am proud to be affiliated with UNC’s Center for Health Promotion and Disease Prevention, one of CDC’s Prevention Research Centers, and a member of the CDC-Healthy Aging Research Network (CDC-HAN) (www.prc-han.org).  My work on community wayfinding is though the CDC-HAN, a network of several academic centers across the county, including local and national partners. I also work on pedestrian safety and walkability, and brain health issues.
How are health and wayfinding connected?
When thinking about wayfinding—the process of finding our way from place to place—it’s useful to consider that we are all “wayfarers” and have been so since the beginning of time. Knowing that we can find our way is pretty basic to our sense of self. In fact, many of us take pride in pinpointing where we are and knowing which way to go to find key landmarks or places of interest or importance. We feel especially good when we succeed in finding our destination in an unfamiliar or challenging place. At the same time, if wayfinding is problematic for us, then we may be insecure in venturing out. We may be less willing to explore new places whether traveling on foot or by cycling, driving or using public transit. 
So we can think of wayfinding as something that is crucial to our mobility, whether we are walking or using other means of transport. It is a vital link to a variety of activities that are important to our well-being, such as physical activity, shopping, visiting family and friends, working or volunteering, and enjoying community cultural or sporting events. All of these are activities known to be important to personal health.
Poor wayfinding may also increase health and safety risks. For example, a jumbled group of signs may confuse freeway drivers who then create a safety hazard for themselves or others. Pedestrians may lose their way, walking further than intended and increasing risk of fatigue and exposure to the elements. Such a situation can be especially dangerous for frail older adults or people with chronic health conditions that affect their stamina.
As these examples suggest, poor wayfinding can be result from the individual’s status, for example, problems with vision, or from a community environment that lacks good design features and aids that support wayfinding. Since changing individuals is not always feasible or even desirable, it is important that our community environments are well designed for wayfinding and have a variety of wayfinding aids, such as well-organized and maintained signage and information systems, that help people navigate regardless of their abilities and regardless of their mode of travel (see Pathways to Better Community Wayfinding). While rare at present, integrated pedestrian, motor vehicle, bicycle and transit wayfinding systems can contribute significantly to more livable communities for all. They also support community health through economic and commercial vitality and increased walking and cycling with reduced pedestrian and motor vehicle injuries and fatalities. Air quality benefits when drivers are efficient in wayfinding and when more people find it easy to walk, cycle or use public transit, rather than driving. All in all, good wayfinding is a win-win for individual and community health.
What work has the CDC-Healthy Aging Research Network done around wayfinding, including for people with disabilities?
Our focus on community wayfinding grew out of our work on community environments that support healthy aging. It began with a simple question: Why isn’t ease of wayfinding routinely considered in work to build healthy communities? After all, we all have to find our way from place to place! Moreover, we know that wayfinding can be more challenging for older adults and for anyone with functional limitations. Demographic projections make it clear that our population is aging and that there will also be an increase in the numbers of people with disabilities.  From a public health perspective, we want to enable people to be active and engaged in the lives of their communities for as long as possible. Good wayfinding environments can make a big difference!
Now it has been almost three years since we began work on wayfinding. First, we created a series of items to assess wayfinding and added them to the CDC-HAN Environmental Audit Tool for use in comprehensive community assessments of neighborhood walking conditions. Secondly, we were delighted to assist in creating the Easter Seals Project ACTION Neighborhood Wayfinding Assessment Pocket Guide a brief, user-friendly tool for evaluating how well neighborhood infrastructure helps people find their way.
We next conducted an extensive review of published literature across numerous disciplines. We drew upon findings to develop a conceptual framework for community wayfinding to promote understanding across sectors and to focus attention on relevant public health outcomes. We are preparing a manuscript detailing that work. Concurrently, with the leadership of David X. Marquez at the University of Illinois, Chicago, we conducted an exploratory study of older adult wayfinding in the neighborhood of South Chicago. Participants in that study included several people with mobility or cognitive limitations. We are wrapping up a manuscript on that project. Currently, we are completing a review of the literature on technologies to support community wayfinding ranging from individual user tools to complex wayfinding systems.
We also prepared a compendium of practice and policy resources which is available on the CDC-HAN website (http://www.prc-han.org/docs/CWF_practice_policy_grey_lit_15nov13.pdf). In addition, we convened an expert panel of representatives from the fields of planning, engineering, architecture, transportation, public health and universal design to share their perceptions of wayfinding barriers, best practices and sector-specific and cross-sector recommendations. The panel came together for a “cross-fertilization” meeting to define key themes and recommendations for Pathways to Better Community Wayfinding. Now our goal is to broadly disseminate Pathways and to promote action to improve wayfinding in all of our communities.

I should mention that wayfinding is one of those areas where there is a lot of research and observation of the particular challenges faced by people with disabilities, especially people with visual or cognitive challenges.  There is also a lot of product development going on, both for personal products, like smartphone apps, and environmental products, like improved audible beacons at pedestrian crossings.  What is exciting about much of this work is that innovations stand to benefit all users. Audible beacons, for example, will not only help the walker with low vision, but perhaps also serve to prompt the teenager distracted by texting or the harried young mother with toddlers in tow.
What health results have you seen first-hand in local communities, including regarding people with disabilities?
Truth be told, we are a very long way from where we need to be in the areas of wayfinding practice and policy. That makes this question a difficult one to answer, as many communities have yet to tap into a vision of wayfinding that includes public health goals. The good news is that communities, whether large cities or small towns, already allocate resources to wayfinding; the bad news is that communities tend to focus those resources narrowly. Some will emphasize branding; others, economic goals such as getting people to commercial areas or other community attractions. Traditionally, there has not been a great deal of attention to pedestrian wayfinding and even less to bicycle wayfinding. And unfortunately, there is little integration across transportation modes, jurisdictions and even neighborhoods within a single community.
This situation is largely the result of a lack of guidelines and widely known best practices.  As such, the process of implementing best practices in local communities and assessing results is just beginning to take off, so there is not a great deal to report yet. At the same time, we are seeing exciting new approaches to wayfinding that offer direction to other communities. London (U.K.) is one shining example. Through the Legible London initiative, the city has made great strides to transform London from a confusing and intimidating city for pedestrians to an inviting, inclusive, walk-friendly city. Legible London has an explicit public health agenda to increase walking for health as well as to foster economic and environmental benefits. Increased walking In the U.S., New York City has a similar initiative that is yielding results such as reducing the numbers of visitors and residents getting lost in the city. Nashville (TN) is using wayfinding aids to link community residents to physical activity opportunities. These and other examples are highlighted in Pathways.
The big challenge is always how to effectively get wayfinding and related issues in front of planners and decision makers, so that change can happen and results ensue. In the Walk Wise, Drive Smart project, community members, including people with disabilities, taught us that accessibility, safety and ease of wayfinding go hand in hand. By participating in neighborhood walking assessments with planners, public works and transportation officials, they also helped these influential decision makers understand problems in the pedestrian environment from a very immediate and compelling human perspective. It is one thing to observe a problem sans people and quite another matter, for example, to see an older person with a walker stranded in the roadway when the light changes or to see a person in a wheelchair resort to riding on a busy street because of sidewalk obstructions.
Focused efforts like these involving community residents and planners and decision-makers and implementers (e.g. residential and commercial developers) can have a big impact. We see that happening all over the country in initiatives to improve community walkability, promote safe routes, implement complete streets and achieve healthy communities. However, the issue of wayfinding is not always an integral part of these initiatives, and we need to change that.

How can communities use Pathways to Better Community Wayfinding to improve current conditions?
We hope Pathways will be a catalyst for community wayfinding practice and policy improvement. Pathways looks at what we know about wayfinding, how communities currently approach wayfinding, and what needs to be done to create better wayfinding for all people, regardless of age or ability. Planners and policy makers can use it to assess community practices and wayfinding-relevant policies across all transportation modes and in development and redevelopment. The content and recommended action steps in Pathways can also serve as a starting point for dialogue among citizens and professionals of differing backgrounds toward the goal of improved wayfinding for people of all ages and abilities.
If wayfinding is to be easy, seamless and enjoyable, then the community vision of wayfinding must be expanded well beyond tourism, city image and commercial goals. Indeed, good wayfinding is basic to vital and livable communities and supports public health and safety of all motorists, walkers, cyclists and transit users. A broad vision of wayfinding makes for the best possible use of community resources.

Final thoughts?
Wayfinding can be a tough topic. Many people have never thought about it beyond their immediate experiences, and the different professionals who work in this area do not always collaborate. We hope you will share Pathways with others in your community, region or state and join us in working to get this issue the attention it needs. Together we can find the way!

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