Expectations and Planning for Future Transportation-Related Mobility in Adults 55-84 by Annie C

250 Pages·2016·12.19 MB·English

Expectations and Planning for Future
Transportation-Related Mobility in Adults 55-84

by

Annie C. Harmon

A dissertation submitted in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
(Health Behavior and Health Education)
in the University of Michigan
2016

Doctoral Committee:

Associate Professor Brian J. Zikmund-Fisher, Chair
Professor Cathleen M Connell
Professor Ruth E. Dunkle
Associate Professor Thomas M. Meuser, University of Missouri-St. Louis
DEDICATION

This dissertation is dedicated to two Amazons who knew I would make it, even though
they are not here to see it.
To my mother: I would trade all of my tomorrows for a single yesterday. Thank
you for bringing me into such an incredible and enthusiastic family. You taught me how
to survive without you and always believed I would be a good adult. I’m trying, Mom. I
love you like a mother.
To my Ga: who showed me how to be strong, told me what to eat, and
hypocritically tried to get me to be patient with myself and others. I’m trying, Stara Ga.

I love you both. I miss you both. Loku noć.

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ACKNOWLEDGEMENTS

First and foremost, sincere thanks to Dr. Brian Zikmund-Fisher, who generously
funded the data collection using his University of Michigan research incentive funds;
the University of Michigan Claude E. Pepper Center and the Center for Healthier Black
Elders (HBEC) for access to their volunteer registries; and to my participants. None of
this would be possible without you.

To my sisters, Emily and Kelsey: None of us would be complete without the
other two. I wouldn't pick anyone else to go through this life with, especially the rocky
patches, because we make that shit fun.
To Aunt Sam and Auntie: Thank you for your eternal support. You are a credit
to your mother and especially gifted at mothering others. If Mom could not be here, I'm
so lucky that you two watch over me.
To Charae and Carissa: Cousins, you bring joy and laughter and wisdom and
understanding to my life every day. Thank you for being you.
To MMJ, Liz, and Reba: By our combined wisdom and strength I believe we can
do anything. Thank you for inspiring me, providing therapy, and always being there to
normalize and mitigate the snowballs thrown at us.
To my committee: Thank you for everything you taught me. I will take these
lessons with me always.
To BZF: You shared this experience, promising to finish this journey with me,
and you did. Just wow. Thank you for believing in me and being an incredible role
model and mentor. You are an extraordinary human being and a limitless improv artist.
You. Are. Awesome!!!!!
To all the other amazing professionals, researchers, scholars, and friends
who supported me: My cohort (Katrina Ellis, Michelle Johns, Alana Lebron, Massy
Mutumba, Jonathon Vivoda and Emily Youatt), Lindsey Robinson, Marla Berg-Weger,
Jen Gates, Netflix, Kirsten Herold, Linda Chatters, Robert Taylor, Gary Harper, Jenny
Crawford, Jackie Cormany, Kelso Hope, Meg Bakewell, Laura Schram, Alisa & Emmy
(Pantanakasame) Young, Amelia Mary Mary and Martha, and Dan Stewart: We did it!
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TABLE OF CONTENTS

DEDICATION ii
ACKNOWLEDGMENTS iii
LIST OF TABLES viii
LIST OF FIGURES x
LIST OF APPENDICES xi
ABSTRACT xii
CHAPTER
1. The Importance of Mobility 1
Driving Dependence Among Older Adults 1
Few People Prepare for Driving Retirement 3
Challenges to Addressing Driving Retirement 4
Building a Better Approach to Driving Retirement 6
Specific Aims 7
2. Encouraging Safe Mobility Across the Lifespan 10
The Increasingly Diverse Experience of Aging in the United States 10
Discrepancies in Driving Retirement Patterns 11
The Importance of Context to Maintaining Community Mobility in 15
Later Life
Safe Driving at Any Age 20
Age-Related Changes that Threaten Driving Safety 23
Current Strategies to Maintain and Improve Abilities Required for 23
Safe Driving
The Challenges of Driving Retirement 26
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Impacts of Driving Retirement 30
Detroit, MI: A Case Study 31
Preparing for Driving Retirement 33
Gaps in Knowledge About Driving Retirement 36
3. Mobility Planning as Intervention 37
Goals of Planning for Community Mobility 38
Conceptual Model of Community Mobility Planning 39
Barriers to Mobility Planning 41
Lessons from Other Types of Planning 45
Making Better Plans for Driving Retirement 48
4. Using Mental Models to Explore Meanings of Mobility and 50
Driving Retirement
A Mental Models Approach 51
Design and Impact of Dissertation Research 53
5. Pilot Interviews: Informing Quantitative Survey Using 57
Stakeholders’ Mental Models of Driving Retirement
Development of Interview Protocol Using a Mental Models 58
Framework
Pilot Qualitative Data Phase Overview 61
Qualitative Analysis Approach 63
Overview of Interview Sample 64
Thematic Results 67
Summary 81

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6. Methodology for Quantitative Mobility Planning Survey 83
Quantitative Survey Development 84
Quantitative Survey Sample 99
Data Management 103
Ethical Considerations 105
7. Dissertation Measures and Analysis Plans 106
Analytical Measures 106
Describing and Predicting Mobility Planning: Analytic Approaches 115
8. Descriptive Results from the Mobility Planning Survey 119
Dissertation Sample Demographic Results 119
Current Transportation Context Results 125
Theoretical Construct Results 130
Mobility Planning Results 131
9. Mobility Planning Regression Results 139
Primary Regression Variables Results 140
Missing Data 140
Regression Model Test Results 144
10. New Understanding of Mobility Planning and Suggestions for 162
the Future
Deeper Insights into the Challenges of Mobility Planning 162
Key Findings 163
Limitations 172
Next Steps: Research and Practice Implications for Public Health 177
Conclusion 182

vi
APPENDICES
Appendix A. Expert Stakeholder Interview Guide 184
Appendix B. Older Adult Stakeholder Interview Guide 189
Appendix C. Mobility Planning Survey 196
REFERENCES 214

vii
LIST OF TABLES
TABLE
1. Characteristics of Expert Interviewees and Interviews 66
2. Characteristics of Older Adult Interviewees and Interviews 67
3. Quantitative Survey Structure 99
4. Age of Dissertation Sample by Gender and Race 121
5. Demographic Characteristics of Dissertation Sample 122
6. Relationship Status by Gender and Race 125
7. Current Transportation Use 128
8. Current Transportation by Age Group 129
9. Information Seeking by Gender and Race 132
10. Information Seeking by Age Group 133
11. Concrete Plans by Gender and Race 135
12. Intention to Plan More by Gender and Race 136
13. Statistics of Primary Regression Outcomes 141
14. Correlation Table of Regression Variables 142
15. Model 1 Baseline Regression Results 144
16. Model 2 Experiential Regression Results 148
17. Model 2a Regression Results by Race 149
18. Model 2b Regression Results by Race 151
19. Model 3 ARMT Regression Results 153
20. Model 3a Regression Results by Race 154
21. Model 4 Theoretical Regression Results 157
22. Model 4a Regression Results by Race 158
viii
23. Model 4b Regression Results by Race 161

ix
LIST OF FIGURES
FIGURE
1. Ecological Model of Driving Decisions 35
2. Behavioral Model of Nondriving Mobility Planning 39
3. Recruitment Flowchart for Quantitative Survey 102
4. Eligibility Criteria for Dissertation Analyses 106
5. Dissertation Sample Eligibility 120

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