Section 1. Overview of Tactics for Modifying Access, Barriers, and Opportunities

• What do we mean by modifying access, barriers, and opportunities?
• What constitutes access to community services?
• What are the barriers to access to community services?
• What do we mean by opportunities for access to services... and by opportunities to reduce exposure to harmful products, practices, or conditions?
• What tactics might be useful in modifying access, barriers, and opportunities?

When you begin an initiative or intervention, you usually have particular participants or communities in mind. They may be connected by geography, language, identity, shared interests, economic circumstances, experiences, or priorities, or your initiative may be intended for the community as a whole. In either case, your effort is unlikely to succeed if the people it is intended to benefit cannot or do not participate.

In other words, people need meaningful access to what you're offering. Access is more than being able to enter a building. It can include physical accessibility, affordability, transportation, language and communication access, information, technology, scheduling, trust, cultural responsiveness, eligibility requirements, and whether people see the service as relevant and useful to them.

Improving access means understanding and reducing the barriers people experience while creating conditions that make participation realistic and welcoming. It also means involving community members in identifying what access looks like from their perspective rather than assuming that providers already know what people need.

Chapter 23 is about ways to improve access -- for particular communities or for everyone -- to resources and opportunities that contribute to quality of life. These may include services, products, healthy practices, libraries and parks, information, educational opportunities, employment, and public institutions. In this section, we'll discuss these ideas broadly; the following sections will examine several strategies for improving access in greater detail.

The following video illustrates how community conditions and access to resources can shape health behaviors and outcomes:

 

What do we mean by modifying access, barriers, and opportunities?

Access to what? Barriers to what? Opportunities for what? What exactly are we talking about here?

Access

In general terms, this chapter is about making sure people can benefit from the full range of community resources and opportunities -- health care, education, human services, recreation, the arts, transportation, employment, civic participation, and others.

Access also includes the conditions that contribute to a good quality of life: safe and stable housing, meaningful employment, a healthy environment, opportunities to participate in community decisions, reliable information, and responsive institutions.

Meaningful access is not achieved simply because a service or resource technically exists. People must be able to find it, reach it, afford it, understand it, use it, and feel that they will be treated with dignity and respect when they do.

Barriers

Barriers are conditions, policies, practices, systems, or attitudes that make it harder for people to use or benefit from services, resources, opportunities, products, or information. Barriers may be physical, economic, informational, technological, social, cultural, organizational, or related to public policy.

Barriers should not automatically be understood as problems within individuals. What may appear to be a person's difficulty accessing a service may actually reflect transportation gaps, cost, inaccessible communication, discrimination, inflexible schedules, complicated procedures, lack of childcare, or other conditions that organizations and communities can address.

Opportunities

"Opportunities" is not simply another word for "access." Increasing access and reducing barriers can create more realistic opportunities for people to use community resources or pursue their goals.

An opportunity means that a meaningful option is available. People still decide for themselves whether and how to use it. Communities can create opportunities for education, employment, healthy activities, civic participation, homeownership, or other goals, but those opportunities should respect people's choices, priorities, and circumstances.

Modifying access, barriers, and opportunities

To modify something is to change some aspect of it. In most of this chapter, we'll be talking about increasing access and opportunity while reducing barriers.

In some situations, however, communities may also seek to reduce access to products or circumstances associated with significant health or safety risks. Examples might include limiting young people's access to tobacco and nicotine products or alcohol, improving safe storage of firearms and medications, or changing environments in ways that reduce opportunities for violence or injury.

A community health initiative might also work with stores, schools, workplaces, or other organizations to make nutritious food and beverage options easier to find and afford rather than focusing primarily on restricting individual choices.

Similarly, a community violence prevention initiative might improve street lighting, create safe and welcoming public spaces, expand transportation options, support youth activities, or strengthen neighborhood relationships. The goal is to change the conditions that influence safety rather than placing responsibility only on individuals.

In all of these cases, the goal is to shape environments and systems in ways that support health, safety, participation, and quality of life.

In this section, we'll look at access, barriers, and opportunities and then discuss how communities can modify them in ways that are responsive to local strengths, priorities, and circumstances.

What constitutes access to community services?

There are several different ways to look at access, all of them relevant here.

• Availability of services, amenities, or products. If a needed service doesn't exist, people cannot use it. The same is true when capacity is too limited, hours do not fit people's schedules, eligibility rules exclude people who could benefit, or information about the service never reaches the community. Availability also includes whether people can obtain useful community resources such as recreation, cultural programs, libraries, nutritious food, clean water, transportation, and reliable information.
• Physical, transportation, and communication access. A service or facility should be designed so people with disabilities can enter, move through, communicate, and participate. Access can include ramps, elevators, accessible restrooms, seating, signage, captioning, interpretation, assistive technology, accessible websites and documents, and other accommodations. Transportation also matters: a resource may technically exist but still be inaccessible if people cannot reasonably get there.
• Access to information. Information should be understandable, accessible, available in relevant languages and formats, and shared through channels community members actually use. Written materials alone may not reach everyone, so organizations might also use audio, video, plain-language materials, visual communication, community educators, accessible digital formats, or other approaches.
• Quality and effectiveness. Access also involves whether a service is useful, respectful, evidence-informed when appropriate, and responsive to the people it is intended to serve. A service that exists but consistently fails to meet participants' needs may not provide meaningful access.
• Affordability. Fees, transportation costs, lost work time, childcare expenses, technology costs, and other financial demands may prevent people from participating even when a service is otherwise available.
• Trust and experience. People may be less willing to use a service if they have experienced discrimination, disrespect, poor treatment, breaches of confidentiality, or exclusion from the institution providing it. Building access may therefore require rebuilding trust and accountability as well as changing logistics.

What are the barriers to access to services, amenities, practices, products, and information?

Barriers to access take many forms. They may arise from broader social and economic conditions, institutional practices, public policies, community circumstances, or the way services are designed and delivered.

Structural and societal barriers

These are barriers produced by broader systems, policies, patterns of investment, and longstanding social conditions. They can affect different communities in different ways.

• Education. Unequal access to well-resourced schools, experienced educators, technology, advanced coursework, disability supports, safe learning environments, and other educational opportunities can shape people's options later in life. Students and families facing economic barriers and people from underrepresented racial and ethnic groups may be disproportionately affected by these inequities.
• Employment. Access to employment can be affected by discrimination, transportation, childcare, education and training opportunities, professional networks, disability access, criminal-record policies, geographic location, and the availability of jobs that provide adequate wages and working conditions.
• Stereotyping, prejudice, and discrimination. People may experience unequal treatment because of race, ethnicity, disability, gender, age, religion, sexual orientation, gender identity, immigration experience, language, socioeconomic circumstances, or other characteristics.
• Limited recognition of community needs and priorities. Services may be unavailable or underfunded when decision-makers do not understand community conditions, do not have adequate information, or do not meaningfully involve the people most affected.
• Public policy and investment decisions. Decisions about transportation, housing, education, health care, public space, social services, infrastructure, and other community resources can expand opportunities for some people while creating or reinforcing barriers for others.

Institutional and organizational barriers

Schools, colleges, health systems, government agencies, workplaces, businesses, nonprofits, and other institutions may intentionally or unintentionally create barriers through their policies, practices, facilities, schedules, communication, or organizational culture.

• Location and transportation. Organizations may assume that everyone can reach their facilities. Transportation costs, limited public transit, long travel distances, unsafe routes, or unreliable transportation may make participation difficult, particularly in rural communities and areas with limited transportation options.
• Physical and communication accessibility. People with permanent, temporary, visible, or non-visible disabilities may encounter barriers if buildings, services, websites, communications, or activities are not designed accessibly or do not provide appropriate accommodations.
• Administrative barriers. Long forms, complicated eligibility requirements, repeated documentation requests, long waits, difficult phone or online systems, limited office hours, and confusing procedures can make services unnecessarily difficult to use. These barriers may be especially challenging for people balancing work, caregiving, disability, transportation, language, technology, or other responsibilities.
• Communication barriers. Organizations may use technical or bureaucratic language, fail to provide interpretation or translation, rely on inaccessible digital systems, or communicate in ways that make people feel unwelcome or disrespected. Plain language, multiple communication formats, and responsive staff can improve access.
• Lack of cultural humility and responsiveness. Organizations may unintentionally design services around the experiences and expectations of only some groups. Cultural humility involves recognizing those assumptions, listening to community members, adapting practices when appropriate, and avoiding the expectation that everyone should communicate, participate, or seek help in the same way.

Individual and household circumstances that can affect access

People may also experience circumstances in their daily lives that make participation difficult. These should not automatically be understood as personal shortcomings; many are closely connected to broader economic, social, and institutional conditions.

• Stigma, fear, or concerns about privacy. People may hesitate to seek services related to sexual health, substance use, mental health, literacy, housing, legal concerns, or other sensitive issues if they fear judgment, discrimination, loss of privacy, or negative consequences.
• Economic instability and competing demands. Families facing economic barriers may also be managing unpredictable work schedules, transportation challenges, housing instability, caregiving responsibilities, health expenses, limited internet access, or other demands. These conditions can make participation difficult even when people value the service.
• Cultural, religious, or community considerations. Beliefs, traditions, family expectations, or community practices may shape how people view particular services or activities. Avoid making broad assumptions about any cultural or religious group. Instead, ask community members what matters to them and look for respectful ways to respond.
• Family and caregiving responsibilities. Childcare, elder care, household responsibilities, family schedules, or concerns about how participation will affect family routines can influence whether someone can use a service. Flexible schedules, childcare, transportation, and family-inclusive approaches may help.
• Language, literacy, numeracy, or digital-access barriers. People may have difficulty using services when information depends on advanced reading, writing, math, technology, or proficiency in a particular language. Plain language, interpretation, accessible formats, and staff assistance can reduce these barriers.
• Limited access to training, professional networks, or employment opportunities. People may have valuable skills and experience but lack access to credentials, training, transportation, technology, professional networks, or other resources that employers expect. Programs can help address these gaps without defining participants by what they lack.

What do we mean by opportunities for access to services…and for reducing exposure to harmful products, practices, or conditions?

Communities, organizations, and individuals can modify services, amenities, products, information, and environments to create more meaningful opportunities for participation. They can also unintentionally create conditions that make harmful products, practices, or situations easier to encounter.

Increasing opportunities for access may involve affordability, availability, effectiveness, transportation, accessibility, language, or trust. Sometimes relatively small changes -- clearer information, different hours, a more accessible location, interpretation, or a different outreach strategy -- can make a significant difference.

Reducing exposure to harmful products, practices, or conditions also requires careful analysis. Consider what is contributing to the concern, which factors can realistically be changed, and whether the proposed response addresses underlying conditions rather than simply placing responsibility on individuals.

What tactics might be useful in modifying access, barriers, and opportunities?

This chapter examines five broad tactics for modifying access, barriers, and opportunities:

1. Reducing access or exposure to products, practices, and conditions associated with health or safety risks
2. Enhancing access to services, healthy practices and products, community resources, and information
3. Expanding access and opportunity for people and families facing economic barriers
4. Increasing accessibility and inclusion for people with disabilities
5. Using outreach to increase awareness, connection, and access

Each of these tactics will be treated in detail in its own section in this chapter. We'll introduce them briefly here and discuss how each can be part of a larger strategy for long-term change.

1. Reducing access or exposure to harmful products, practices, and conditions

Communities can sometimes improve health and safety by changing environments, policies, or systems so that harmful products or situations are less accessible while healthier and safer options become easier to choose.

Examples may include:

• Improving street lighting and the design of public spaces to support visibility and safety
• Creating smoke-free and tobacco-free public environments
• Using appropriate laws, policies, storage practices, and safety measures to reduce access to dangerous weapons
• Enforcing age requirements for alcohol, tobacco, nicotine, and other regulated products
• Working with food vendors, schools, employers, and other organizations to make nutritious and affordable options more available
• Rehabilitating vacant or neglected properties for housing, community use, or other purposes identified by residents
• Using pricing, incentives, or other policy tools to influence access to products associated with significant health or environmental risks

A broader health strategy may combine these approaches with education, accessible services, community engagement, and efforts to make healthier options affordable and realistic for people to use.

2. Enhancing access to services, amenities, healthy practices and products, and information

This usually means addressing one or more of the issues described earlier as elements of access.

Some ways to increase access include:

• Adjusting schedules, locations, eligibility requirements, and service structures based on the needs and preferences of the people the program is intended to serve
• Expanding transportation options
• Providing physical, digital, communication, and language access for people with disabilities and people who use languages other than English
• Using cultural humility and community knowledge to make services more relevant, respectful, and responsive
• Offering peer support, navigation, coaching, or other forms of assistance for people pursuing health or behavior changes
• Working with community members to identify what products, services, environments, or resources would make healthy choices easier and more realistic

These approaches can stand alone or be combined with other strategies as part of a larger effort to improve access.

3. Expanding access and opportunity for people and families facing economic barriers

Many of the same strategies used to improve access generally are also important for people and families facing economic barriers. Additional approaches may include:

• Programs and services that use income-based eligibility or sliding-scale costs to make education, health care, childcare, housing, transportation, workforce development, and other resources more affordable
• Community and economic development strategies that invest in neighborhoods with limited economic resources and support employment, locally owned businesses, housing, transportation, and other community priorities
• Policies and organizational practices designed to address documented patterns of exclusion and expand opportunity for groups that have been historically underrepresented
• Entrepreneurship, cooperative development, financial education, grants, low-cost lending, and other strategies that expand people's access to capital and opportunities to build economic security

These strategies can be especially effective when people affected by economic barriers have meaningful roles in deciding which investments, services, and opportunities will be most useful in their communities.

4. Increasing accessibility and inclusion for people with disabilities

Accessibility involves much more than installing a ramp. It means designing facilities, communication, technology, programs, and organizational practices so that people with disabilities can participate fully and equitably.

Important areas include:

• Respect and inclusion. People with disabilities should be treated as full participants, community members, employees, leaders, customers, students, and partners. Avoid defining people primarily by disability or making assumptions about what someone can or cannot do.
• Communication access. Depending on individual needs, access may include sign-language interpretation, captioning, assistive listening systems, screen-reader-compatible digital content, Braille, large print, accessible electronic documents, plain language, augmentative and alternative communication, or other supports.
• Physical access. Accessible environments may require appropriate entrances, doors, elevators, restrooms, pathways, parking, seating, counters, emergency exits, signage, and room layouts. Accessibility should be considered throughout a facility rather than limited to one entrance or feature.
• Program and digital accessibility. Websites, registration systems, virtual meetings, events, activities, policies, and communication practices should also be designed to allow people with disabilities to participate meaningfully.

Accessibility requirements vary by setting and jurisdiction. Organizations should follow applicable disability-rights laws and current accessibility standards and, whenever possible, include people with disabilities directly in planning and evaluating accessibility.

5. Using outreach to increase access

The term "outreach" covers many different activities. It can include sharing information through community networks, providing services in neighborhood locations, using mobile programs, working with trusted community members, conducting home visits when appropriate, or taking services directly to people who face barriers to reaching traditional sites.

Effective outreach begins by listening. Organizations should understand how community members prefer to receive information, which people and organizations they trust, what barriers they experience, and what would make services more useful and accessible.

• Outreach to increase awareness. People cannot use services they don't know about. Community media, public events, neighborhood organizations, schools, faith communities, social media, home visits, and trusted community messengers can all help share information. Community members who have relevant relationships and lived experience can be especially valuable partners in designing and carrying out outreach.
• Outreach to strengthen relevance and trust. If people are reluctant to use a service, find out why. Concerns may involve location, privacy, past experiences, cultural fit, language, eligibility rules, cost, or how the service is presented. Work with community members to address these concerns rather than assuming that reluctance is simply resistance.
• Outreach to reduce barriers. Services can sometimes be offered through mobile units, neighborhood-based sites, schools, community centers, shelters, libraries, homes, or other locations people can reach more easily. Outreach may be especially useful for people experiencing homelessness, young people disconnected from traditional services, people affected by substance use, people with limited transportation, or others who face barriers to conventional service settings.

In Summary

For an intervention or initiative to have an impact, people must be able to participate in it. The same is true for community resources such as libraries, parks, cultural facilities, transportation, information, educational opportunities, and public institutions.

Access depends on more than whether something exists. It is shaped by affordability, physical and digital accessibility, transportation, language, communication, organizational practices, cultural responsiveness, trust, public policy, and many other conditions.

Improving access therefore requires more than encouraging individuals to make different choices. It requires communities and organizations to examine the systems and environments that shape people's options, remove unnecessary barriers, build on community strengths, and involve the people most affected in designing solutions.

By improving access, reducing barriers, expanding meaningful opportunities, and addressing conditions associated with health and safety risks, communities can create environments in which more people are able to participate, contribute, and thrive.