Abstract

Although participation in organized religion provides many health and psychological benefits, fewer people with disabilities attend religious services than people without disabilities. Some models of disability suggest that one possible cause for this disparity may be the influence of environmental barriers in religious buildings. A random sample of 22 religious buildings in the St. Louis, Mo., metropolitan area was evaluated using the Community Health Environment Checklist to determine what environmental barriers a worshiper with mobility limitations might encounter when attending a worship service and using the restroom. The overall receptivity of participating congregations ranged from 46.7 to 92.1 out of 100, with lower scores indicating less receptivity than higher scores. The age of the building is positively correlated with the receptivity score (p < 0.05), indicating that older buildings are less likely to be receptive to people with mobility impairments. Over half of restrooms evaluated received scores indicating no receptivity. The results indicate that environmental barriers may be a significant barrier to religious participation by people with mobility impairments in some religious congregations. The findings of this study suggest that further examination of the impact of the environment on religious participation by people with disabilities is warranted.

Keywords: Access to religious buildings, Community Health Environment Checklist, environmental barriers and religious services, religious participation by people with mobility impairments

Introduction

Religion is a key aspect of community participation for most Americans. More than 80% of American adults claim to belong to a specific religion (Kosmin & Mayer, 2001; Harris Interactive, Inc., 2000). Religion has been attributed with providing a sense of purpose and meaning, hope, optimism, social support, and a coping mechanism (Koenig, McCullough & Larson, 2001; Idler, Kasl & Hays, 2001; Idler & Kasl, 1997a). People with religious beliefs tend to have a high internal locus of control and high self-esteem (Koenig, McCullough & Larson, 2001).

A positive link between religion and good health has been supported by literature published over the past century. In the most recent meta-analysis, religious beliefs and involvement in religious activities have been shown to correlate significantly with reduced rates of depression, suicide, alcohol and drug use, anxiety, hypertension, and in some cases, cancer (Koenig et al., 2001). Idler (1994) suggests several possible explanations for this phenomenon: Religious beliefs promote good health practices and discourage poor health practices, religious communities provide a social network and support system, and religion provides an overarching set of beliefs for interpreting events of life and death. Because of a statistical predominance of Christianity and Judaism, the vast majority of health and religion studies conducted in the United States are rooted in these belief systems (Koenig et al., 2001). Consequently, little is known about the impact of other religious belief systems on health.

Despite the abundance of modern academic literature connecting religion and health, most publications examining religion, health, and disability focus on subjective religious feelings and coping patterns used by people with disabilities (Decker & Schulz, 1986; King, Speck & Thomas, 1999). Few published works discuss actual participation in organized religious settings by people with disabilities (Idler & Kasl, 1997a; Idler & Kasl, 1997b; Idler, Kasl & Hays, 2001; Benjamins, 2004).

Religion may provide great comfort to people with disabilities, but a lack of willingness on the part of clergy or congregational members to acknowledge the theological implications of disability or to integrate a person with a disability into a religious organization may prevent a person with a disability from participating to the extent that they desire (Treloar, 2002). Clergy members indicate that while they feel compassion for people with developmental disabilities, they do not know how to provide pastoral care and integrate those people into congregations (Rose, 1997). Furthermore, some of the existing literature and attitudes toward disability within modern religious organizations romanticizes the experience of disability (Selway & Ashman, 1998; Rose, 1997). These findings suggest that the attitudes present in the social environment of religious organizations impact the participation experience of people with disabilities. Limited knowledge and unrealistic understanding of the needs of people with disabilities may influence how people with disabilities are integrated into a religious organization and may increase the likelihood of barriers to religious participation.

An increasing amount of literature in recent years has described the degree to which physical and social environments influence occupational performance. Interactions between a person and the environment are complex and multilayered (Schneidert, Hurst, Miller, & Üstün, 2003). Some theories suggest that physical or mental impairments only become disabilities when in the context of an unsupportive environment (Verbrugge & Jette, 1994). Lawton and Nahemow (1973) proposed that a fit between the person and the environment is critical to functional, adaptive behavior. According to their Ecological theory, the competence of the person and the amount of challenge offered by the environment–also called environmental press–determine the degree to which the person is able to perform functional tasks. As the competence of the person increases, performance improves. Likewise, as the environmental press decreases, performance improves. The lower the competence of the person, the more dramatically a change in environmental press can impact their performance.

The contribution of the environment to the disablement process has been further explicated in a model presented by World Health Organization (WHO) in the International Classification of Functioning, Disability, and Health (ICF). The model posits a relationship between the function of the person and contextual factors contributing to the overall health of the individual. Function includes the anatomical structures and physiological functions of the body as well as the activities performed and participation life activities. The Environmental Factors emphasize the role that the environment plays in enhancing human functioning. This ICF category clearly justifies including environmental factors in an analysis of social participation. The ICF stresses the importance of assessing and intervening with environmental influences on functioning, as well as the need to document the extent to which the environment influences functional outcomes. To better describe the aspects of the physical, social, and societal environment that can impact functioning, the ICF allows for classification regarding products and technology, the natural environment and human made changes to that environment, support and relationships, attitudes, and services, systems, and policies (WHO, 2001, p.40). By using this framework, disability becomes something that occurs when health condition, personal factors, and environmental factors do not interact in such a way as to support a person' s ability to fully function (Schneidert et al., 2003).

Despite legislation designed to decrease environmental barriers to participation in public places, barriers still exist that prevent some of these places from being accessible and useable (Thapar et al., 2004; Hoenig, Landerman, Shipp & George, 2003). Common barriers encountered by wheelchair users in the community are rudeness, narrow aisles, lack of ramps, bad weather, poorly designed door handles or heavy doors, lack of curb cuts and poor pedestrian crossings, inaccessible bathrooms, lack of parking, uneven surfaces, and good and services placed higher than a reaching range (Meyers, Anderson, Miller, Shipp & Hoenig, 2002; Fänge, Iwarsson & Persson, 2002). Thapar et al. (2004) found that, contrary to their hypothesis, mobility-impaired participants found structural components of buildings to be the largest barrier to task completion in a sample of buildings challenged. Additional results from this study indicate that while structural barriers may not always prevent task completion, they may make task completion much more difficult for a person with a mobility impairment than for other people (Thapar et al., 2004). One possible explanation for the continued presence of barriers in public spaces is that significant variations between people within a population make it difficult to have optimal accessibility for all people (Iwarsson & Stahl, 2003). These literature findings suggest that the environment does play an important role in the ability of people with mobility impairments to participate in community life outside of their home. Objective evaluations performed on 108 buildings in urban and rural settings build upon this idea by indicating that while some buildings in both settings have features that create excellent receptivity for people with mobility impairments, many buildings have features that are barriers to people with mobility impairments (Stark, Hollingsworth, Morgan, & Gray, in press).

Most research about religion and disability has centered on the subjective spiritual feelings and beliefs experienced by people with disabilities, but little information focuses on the actual participation of people with disabilities in organized religious settings (Idler & Kasl, 1997a). After analyzing epidemiological data collected from a large sample of older adults with functional deficits, Idler and Kasl (1997a) determined that those older adults who engaged in active religious participation had many more benefits–such as optimism, positive affect, and stronger social networks–than older adults in the same sample who only expressed subjective religious feelings. Despite these findings, only 49% of people with disabilities attend religious services at least once per month, whereas 57% of people without disabilities attend religious services at least once per month. Furthermore, 56% of people with minor disabilities attend worship regularly, while only 44% of people with severe disabilities attend regularly (Harris Interactive, Inc., 2004). However, 65% of people with severe disabilities claim that their faith is very important to them, which indicates that something is preventing some people with disabilities from attending worship services in religious buildings. Physical and attitudinal barriers present in places of worship may be one possible explanation of lowered attendance rates among people with disabilities (Harris Interactive, Inc., 2004). Meyers et al.(2002) discovered that of 28 participants who used wheelchairs, 44 % successfully accessed religious buildings, while 12% were not able to access religious buildings because of barriers in the environment or because of personal factors.

Changes to the physical and social environment can greatly increase the functional abilities of a person and increase their ability to participate in activities and experiences (Lawton & Nahemow, 1973; WHO, 2001). Multiple studies have been conducted that identify environmental barriers that hinder participation in commonly-visited settings that are regulated by the Americans with Disabilities Act (Meyers, et al., 2002; Thapar, et al., 2004). However, no published study has specifically examined the physical accessibility of religious buildings. An unpublished survey of 100 religious buildings in Chicago using the Illinois Accessibility Code found that none of the buildings met the code, and that half of the buildings provided no accessibility. Common barriers to access included transportation problems, parking problems, the rise of a building, particularly involving stairs, the restrooms, hearing systems and lighting, and the aesthetic qualities of the buildings. None of the restrooms surveyed met the Illinois code. While the Chicago study provides some perspective on the accessibility of religious buildings, the measure used is based on Illinois building code and may not be applicable in other states or countries (Vogel, 2000).

Although religious buildings and organizations are only regulated by the Americans with Disabilities Act when those organizations employ 15 or more people (Thornburgh, 1996), the doctrinal and moral beliefs of many religious organizations suggest that all people should be able to attend communal worship, rather than just able-bodied people. Religion has been shown to be of great comfort and assistance to people with disabilities (Treloar, 2002; Idler & Kasl, 1997a). Attending organized religious services and activities, in addition to just having subjective religious beliefs, may provide even more benefits to people with disabilities (Idler & Kasl, 1997a). Possible explanations for this phenomenon include social opportunities and the opportunity to transcend to a positive state of being through the means of prayer, the sacraments, aesthetic beauty, and communal worship (Idler & Kasl, 1997b). However, if people with mobility impairments are physically unable to get into a religious building, they may not experience the benefits of participation in religious activities. Although professionals speculate that the inaccessibility of a religious building may hinder people with mobility impairments from attending religious activities (Davie & Thornburgh, 2000; Patterson & Vogel, 2003), only a small amount of research has been conducted to determine the actual accessibility of religious buildings and the barriers to religious participation among people with mobility impairments.

Little research has been conducted to determine whether the environment of religious buildings is actually a barrier to religious participation. The purpose of this study was to determine the receptivity of religious buildings to people with mobility impairments. The hypothesis guiding the study is that religious buildings will have some physical features that enhance religious participation, but will have more physical features that hinder religious participation.

Method

Site of Study

One hundred ten churches and synagogues were randomly selected in November, 2004, from 1,617 listed in the St. Louis, Mo., yellow pages and invited to participate in the study. To be included in the study, religious buildings needed to be listed in the yellow pages and located in St. Louis City or St. Louis County. The religious organization occupying the building also needed to identify itself as either Christian or Jewish. Buildings and religious organizations that did not meet these criteria were not included in the study.

St. Louis is a diverse city with a population of 332,223 in 2003 with a median household income of $27,156 and 24.6% of the population living below poverty (U.S. Census Bureau, 2005a) at the time of this study. St. Louis County had a population of 1,009,235 in 2004 with a median household income of $50,532 and 6.9% of the population living below poverty (US Census Bureau, 2005b).

Design

This exploratory, naturalistic, mixed method pilot study measured whether features were present in religious buildings that might hinder or enhance participation by people with mobility impairments. The protocol for the research was exempted by the Human Subjects Committee at the Washington University in St. Louis School of Medicine.

Measures

The Community Health Environment Checklist (CHEC) was used to determine the physical receptivity of the participating religious buildings. Many instruments that are available to measure the environment utilize self-report or standards and codes as the method of evaluation. While self-report provides insight into one person' s subjective experience of the environment, it does not provide an objective measure of what aspects of the environment impact many people. Standards and codes provide an objective measure of the environment, but they are not always written to reflect optimal accessibility or features that are important to people with mobility impairments (Stark et al., in press). The CHEC is a recently developed instrument that assigns quantitative measurements to various aspects of the environment based on whether or not they are present. The weight of the measurement is based on the perceived importance of that feature as rated by people with mobility impairments. Sixty-five specific features are assessed in entrance, building, restroom, and amenities sections. Sample questions include: "Are the distances between personal transportation drop off areas and the building as short as possible," "Are there accessible places to sit that are integrated into the regular seating spaces," and "Can the faucet be reached from a seated position and operated with one closed fist?" Each section is scored, and the scores from all four sections are summed to produce a final CHEC score that indicates the building' s receptivity level. A glossary and rule book accompany the CHEC, which promotes interrater reliability. The CHEC has an internal consistency reliability of 0.95 as measured by Cronbach' s alpha. The CHEC also has excellent face and content validity (Stark et al., in press). Further reliability and consistency testing is currently in progress.

Data collectors were trained in the CHEC by authors of the measure and practiced administration at multiple non-religious community locations prior to collecting data for this study. Once data collection commenced, the interviewer collected CHEC measurements and a copy of a recent bulletin or newsletter (publicly available documents) from each religious organization. These documents were subjected to a qualitative analysis to determine whether the organization advertises any accessible features and to determine what services and resources may currently be available within that organization.

Procedures

Potential participating congregations received a letter inviting them to participate in the study, which involved a single site visit to audit physical and social features of religious buildings. If a congregational representative wanted to participate, they could respond by phone, email, or a response card that was included with the invitation letter. Evaluation appointments were scheduled within two days of contact by responding congregations. Researchers attempted to contact each congregation that did not respond within two weeks via phone. A contact person or religious organization representative was required to be available during the evaluation due to building security, scheduling concerns, and information required during the evaluation.

Upon arrival at the participating religious organization' s building, a member of the research team met with a representative of the organization. The representative answered questions related to the building and congregation and provided the researcher with a recent service bulletin or newsletter produced by the congregation. While the representative gave the evaluator a tour of the parking lot, entry area, worship space, and restrooms, the researcher administered the CHEC.

Results

Twenty-two participants were recruited from a variety of denominational backgrounds See Table 1.

Participating congregations were located throughout St. Louis city and St. Louis County. However, the edges of the county and the suburbs immediately northwest of the city were not well represented. For each participant, descriptive information was gathered about the worship space size, average weekly attendance, and the age of the building. There was a great deal of variability in all of these factors. See Table 2. The staff at one facility did not know when the building was constructed, and no cornerstone was visible at that building. Evaluations lasted from 15 to 45 minutes.

The remaining 88 congregations did not participate for a variety of reasons: 11 congregations declined to participate, seven were no longer located at the address or phone number listed in the yellow pages, and 66 congregations did not return phone messages or were unable to be reached despite up to three attempts to call them at various times throughout the week. We were unable to ascertain specifically why these congregations refused participation. An additional four congregations were located outside of St. Louis city or county, and were excluded from the study. Of the 84 non-participants located in St. Louis city or county, 29 were located throughout St. Louis City and 55 were located throughout St. Louis County. Non-participating congregations were affiliated with a variety of denominational categories. See Table 3.

Scores were calculated for each section of the CHEC. See Table 4. The scores for each section varied widely, and participating congregations received overall scores ranging from 46.7 to 92.1 out of a possible 100. Within the restroom section, 54.5% of participants received scores of 0.0. In the amenities section, which included information about drinking fountains, public phones, rescue assistance, and feature usability, 40.9% of participants received a perfect score.

Two-tailed Pearson' s correlation tests were calculated to determine whether the overall CHEC score correlated with the worship space size, average weekly attendance, or age of the building. The age of the building was significant at r = -0.529 (p < 0.05), indicating that the older the building, the lower the CHEC score is likely to be.

Responses to interview questions yielded important information about the role of congregation members during services. Typical lay worshiper roles included usher, intercessor, acolyte, communion server, musician, and reader. Two congregations also allowed laity to preach. Common movement patterns during services included movement within the pew, such as standing, sitting, and kneeling, moving around the room to greet one another, moving to the front or to stations to receive Communion or respond to an altar call. Seven congregations mentioned that the pastor is willing to bring Communion to a member in the pew if that member is unable to come to the front, and seven congregations have moved their altar rails or serving stations so that these areas can be accessed without steps. Two congregations provided access up to the front platform or altar area: one congregation had a built-in ramp, while another used a removable wooden ramp.

Throughout the evaluations, 19 congregational representatives volunteered information about members with disabilities, and 17 representatives asked to learn information about evaluation results. Six congregations voluntarily described plans to improve building receptivity, and three reported remodeling projects that had been finished within the previous year. Lack of funding was commonly cited as a reason for congregations to not improve their receptivity.

Qualitative analysis was performed on 19 recent service bulletins and 8 newsletters that congregations provided to determine the extent to which the congregations published information related to receptivity for people with disabilities. Several congregations offered large print worship materials and hearing devices, and some bulletins asked members to "stand if able" during some parts of the worship service. Some congregations had a parish nurse or health and wellness-related programming. Three congregations printed a mission statement that stated that people of all abilities were valued in the church. Announcement pages were a place to advertise new accessible building features or availability of medical equipment. Programs specifically for people with disabilities were also announced on these pages.

Discussion

The results of this pilot study reveal interesting information about religious building receptivity. CHEC results indicated that religious buildings in the St. Louis area vary widely in their receptivity to people with mobility impairments, though restrooms were not receptive in more than half of the buildings evaluated. The older the religious building is, the less likely it is to be receptive for people with mobility impairments. Many opportunities exist for people with disabilities to participate in religious services, but the extent to which they actually participate is unknown. Printed materials are commonly used in congregations to welcome, include, and inform members and visitors with disabilities. Most of the congregational participants described members with disabilities, and wanted to know how to improve receptivity.

Whether or not a person comes to and participates in a worship service is dependent on many factors. Physical receptivity may be one of those factors. Mean CHEC scores indicate that congregations have some physical receptivity, but still have areas in which they can improve, which supports our hypothesis. Congregational representatives from six congregations volunteered information about plans to improve receptivity, and three indicated that they had recently carried out plans. The remaining 13 congregations that did not share information about receptivity planning may not have a plan due to limited funding or limited knowledge about the needs of people with disabilities. Congregations may have little desire to improve receptivity, or conversely, congregations that already have high receptivity may not need to plan for further receptivity.

The results were mostly consistent with previous CHEC studies, although the minimum score in this study was much higher than previous CHEC studies. Over half of congregations received a score of zero in the restroom, which is consistent with the results of the survey of religious buildings in Chicago (Vogel, 2000). The findings of this study support community participation literature by indicating that features in a building may be a barrier to participation by people with disabilities (Thapar et al., 2004; Hoenig, et al., 2003; Meyers et al., 2002; Fänge, Iwarsson & Persson, 2002). The results of this study support environmental press as a possible explanation for decreased rates of attendance at religious services by people with disabilities. This in turn supports the interplay between the environment and participation suggested by the ICF. The use of a scientific evaluation method to determine religious building receptivity contributes to the body of knowledge about religion and disability in a way that no other study has ever done. Information shared during conversations and printed in congregational publications may provide a starting point for future religious participation research.

Poor receptivity of religious organizations may deprive people with disabilities of the benefits of religious involvement. People with disabilities and qualified professionals could play a valuable role in helping congregations to develop and implement a receptivity plan, particularly in older buildings and in restrooms. Published materials, such as service bulletins and newsletters, can be an excellent way to advertise a congregation' s receptivity to people with disabilities, and can also be used to include them in and inform them about opportunities for congregational participation. While the CHEC is a very useful tool to help determine building receptivity for people with mobility impairments, situations only experienced in religious settings, such as communion, are not easily accounted for by the CHEC. Future evaluations of religious buildings should ask additional questions about ceremonial happenings during worship services to learn whether people with disabilities are able to participate in all aspects of worship services.

Limitations of the study include a small sample size, the use of a convenience sample, and the sample bias. Some of the congregations may have hesitated to participate in the study because they received invitations during the holidays, which tends to be an especially busy time of year for religious organizations. Many areas of St. Louis city and county were not well represented in the study, which reduces the extent to which the results can be generalized. Because the participants were all located in urban and suburban areas, information was not collected about religious building receptivity in small cities and rural areas. The CHEC only evaluates building receptivity for people with mobility impairments, and neglects evaluating for acoustics and lighting, among other aspects of receptivity. Evaluations were not conducted during busy times, which may not have allowed accurate assessment of CHEC items related to lighting and crowding. Information was not collected about the entire facility, which reduces the ability to generalize these findings to other CHEC studies. Many topics, such as experiences of members with disabilities or proposed building modifications, were discussed during evaluations. These conversations provided valuable information about congregational participation by people with disabilities, but were not standardized. Time constraints prevented the use of more thorough methods to determine attitudinal receptivity. Despite these limitations, this exploratory pilot study provides important, new information about the existing receptivity of some religious congregations as well as valuable information about the use of a new assessment tool within a religious setting. Although the sample used in the study is somewhat small, the results may be generalized to religious congregations with characteristics similar to those that participated in the study and do suggest that further study of physical environments is warranted.

Because so little has been studied about religious participation and disability, many opportunities are available for future research. Some topics that would benefit from research include studying all aspects of physical receptivity in religious buildings, such as acoustics and lighting, attitudinal receptivity, and the actual religious participation by people with disabilities. Future receptivity studies should be conducted using a larger and more diverse sample, and all aspects of the building should be evaluated. Receptivity evaluation tools for use in religious organizations should be developed or modified to reflect this information.

This pilot study provides important insights into the receptivity of religious buildings and supplies information about possibilities for religious participation by people with disabilities. However, this study is only the beginning of scientific inquiry in this area. Further research will greatly enhance understanding of religious building receptivity and religious participation. Greater understanding of these topics will provide more information for those who study religious participation by people with disabilities and may help to open opportunities to all people for religious participation.

References

Davie, A.R., & Thornburgh, G. (2000). That All May Worship: An Interfaith Welcome to People with Disabilities. Washington, D.C.: National Organization on Disability.

Decker, S.D, & Schulz, R. (1985). Correlates of life satisfaction and depression in middle-aged and elderly spinal cord-injured persons. American Journal of Occupational Therapy. 39 (11): 740-745.

Fänge, A., Iwarsson, S., & Persson, A. (2002). Accessibility to the public environment as perceived by teenagers with functional limitations in a south Swedish town centre. Disability and Rehabilitation, 24, 318-326.

Harris Interactive, Inc. (2004). Access to Religious Services. N.O.D./Harris 2004 Survey of Americans with Disabilities.

Hoenig, H.; Landerman, L.R.; Shipp, K.M. & George, L. (2003). Activity Restriction Among Wheelchair Users. Journal of the American Geriatrics Society. 51: 1244-1251.

Idler, E.L. (1994). Cohesiveness and Coherence: Religion and the Health of the Elderly. New York: Garland.

Idler, E.L, & Kasl, S.V. (1997a). Religion among disabled and nondisabled persons I: cross-sectional patterns in health practices, social activities, and well-being. Journal of Gerontology: Social Sciences, 52B, S294-S305.

Idler, E.L, & Kasl, S.V. (1997b). Religion among disabled and nondisabled persons II: attendance at religious services as a predictor of the course of disability. Journal of Gerontology: Social Sciences, 52B, S306-S316.

Idler, E.L.; Kasl, S.V. & Hays, J.C. (2001). Patterns of religious practice and belief in the last year of life. Journal of Gerontology: Social Sciences, 56B, S326-S334.

Iwarsson, S. & Ståhl, A. (2003). Accessibility, usability and universal design–positioning and definition of concepts describing person-environment relationships. Disability and Rehabilitation, 25, 57-66.

King, M., Speck, P. & Thomas, A. (1999). The effect of spiritual beliefs on outcome from illness. Social Science & Medicine. 48: 1291-1299.

Koenig, H.G, McCullough, M.E., & Larson, D.B. (2001). Handbook of Religion and Health. New York: Oxford University Press.

Kosmin, B.A.& Mayer, E. (2001). American Religious Identification Survey. New York: City University of New York. Retrieved June 10, 2004 from http://www.gc.cuny.edu/studies/aris_index.htm.

Lawton, M.P. & Nahemow, L. (1973). Ecology and the aging process. In C.L. Eisdorfer, M.P. (Ed.). Psychology of Adult Development and Aging (pp. 619-674). Washington, D.C.: American Psychological Association.

Meyers, A.R., Anderson, J.A., Miller, D.R., Shipp, K., Hoenig, H. (2002). Barriers, facilitators, and access for wheelchair users: substantive and methodologic lessons from a pilot study of environmental effects. Social Science & Medicine, 55, 1435-1446.

Patterson, E.A., & Vogel, N.A. (2003). Accessible Faith: A Technical Guide for Accessibility in Houses of Worship. Chicago: The Retirement Research Foundation.

Rose, A. (1997). 'Who Causes the Blind to See' : disability and the quality of religious life. Disability and Society, 12, 395-405.

Schneidert, M., Hurst, R., Miller, J., & Üstün, B. (2003). The role of Environment in the International Classification of Functioning, Disability and Health (ICF). Disability and Rehabilitation, 25, 588-595.

Selway, D. & Ashman, A.F. (1998). Disability, Religion and Health: a literature review in search of the spiritual dimensions of disability. Disability & Society, 13, 429-439.

Stark, S.; Hollingsworth, H.; Morgan, K.; & Gray, D. (in press). Development of a measure of community receptivity. Disability and Rehabilitation.

Thapar, N., Warner, G., Drainoni, M., Williams, S.R., Ditchfield, H., Wierbicky, J., et al. (2004). A pilot study of functional access to public buildings and facilities for persons with impairments. Disability and Rehabilitation, 26, 280-289.

Thornburgh, G. (Ed.). (1996). Loving Justice: The ADA and the Religious Community. Washington, D.C.: National Organization on Disability.

Treloar, L.L. (2002). Disability, spiritual beliefs, and the church: the experiences of adults with disabilities and family members. Journal of Advanced Nursing, 40, 594-603.

United States Census Bureau. (2005). St. Louis (city), Missouri QuickFacts. Retrieved November 28, 2005 from http://quickfacts.census.gov/qfd/states/29/2965000.html.

United States Census Bureau. (2005). St. Louis County, Missouri QuickFacts. Retrieved November 28, 2005 from http://quickfacts.census.gov/qfd/states/29/29189.html.

Verbrugge, L. & Jette, A. (1994). The disablement process. Social Science & Medicine, 38(1), 1-14.

Vogel, N.A. (2000, November 15). Accessible Faith: Serving the Needs of the Elderly. (Available from the Retirement Research Foundation, 8765 West Higgins Road, Suite 430, Chicago, IL 60631-4170).

World Health Organization. (2001). International Classification of Functioning, Disability, and Health. Geneva, Switzerland: Author.

Table 1. Participant Denominational Affiliation