Emerging Technologies, Data, and Information

Transportation Research Record

2019, Vol. 2673(7) 12–24
Ó National Academy of Sciences:
‘‘You Are Really at Their Mercy’’: Transportation Research Board 2019
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DOI: 10.1177/0361198119839969

Transportation Disadvantage and Social journals.sagepub.com/home/trr

Exclusion among Older Adults through

the Use of Innovative Technology

Noelle Fields1, Courtney Cronley1, Stephen P. Mattingly2,

Erin R. Murphy1, and Vivian J. Miller1

Abstract
This study investigates transportation disadvantage (TD) and its impact on social exclusion among lower-income older adults
(n = 10) through the use of a custom-designed daily transportation diary app, MyAmble. The study utilized an ecological
momentary assessment design using the Travel Buddy, which was the qualitative feature of MyAmble. The Travel Buddy
allowed study participants to share their transportation experiences as they relate to the following domains of social exclu-
sion: quality of life, participation, and resources. Conventional content analysis revealed five primary themes related to TD
and social exclusion: constrained autononmy and flexibility, safety concerns, dimished emotional well-being, barriers to com-
munity engagement, and burdensome. The Travel Buddy produced qualitative data that contextualize lost opportunities and
how characteristics of economic justice exacerbate the risk of TD, as well as how individuals manage within these intersec-
tions of disadvantage. Study findings provide insight for expanded conversations about how to transform transportation plan-
ning from mobility to equity. Finally, the use of ecological momentary assessment through digital platforms such as the Travel
Buddy offer an innovative way to collect holistic data related to TD that will lead to better opportunities for transportation
planners, engineers, and social service providers to work together to address the needs of environmental justice populations,
including lower-income older adults.

In the United States, more than 20% of residents are pro-
jected to be age 65 or older by the year 2030 (1). Most
older adults report preferring to remain in their home as
they age; however, with growing numbers of older adults
seeking home and community-based supports to age in
place, communities around the United States often
encounter complex challenges in meeting the long-term
needs of this population (2, 3). Environmental obstacles
to aging in place are especially salient in low-density
urban and suburban cities characterized by sprawl (4).
Older adults who are lower-income, have a disability, or
both are often considered transportation disadvantaged
([TD]: please note, TD refers both to transportation dis-
advantage and the disadvantaged in this paper) (5), in
that they are unable to drive owing to disability or a med-
ical illness, are unable to afford a vehicle, or lack access
to transit services, and also have limited access to other
transportation options. In the context of urban sprawl,
TD is compounded (6), as they face further obstacles that
impede access to healthcare services, healthy food, social
connectivity, and community engagement (7, 8). TD is
characterized by difficulties both accessing and maintain-
ing adequate transportation (9–11). Research demon-
strates that TD can have detrimental implications on
individuals’ overall quality of life (12) and life opportuni-
ties, including employment (13–16), education (15–17),
healthcare (16, 18–20), social activities (10, 15, 16, 21),
and nutrition (16). TD may also be a contributing factor
in the social exclusion (SE) of some populations (22–26).
1
School of Social Work, The University of Texas at Arlington, Arlington,
TX
2
Civil Engineering Department, The University of Texas at Arlington,
Arlington, TX
Corresponding Author:
Address correspondence to Noelle Fields: noellefields@uta.edu
Fields et al
Social Exclusion
SE, broadly used in the social policy literature, refers to a
‘‘group of people living on the margins of society and, in
particular, without access to the system of social insur-
ance’’ (e.g., government assistance) (27). Although scho-
lars note that there are differing operationalizations of
the concepts associated with SE, the term has generally
come to be accepted as the process by which margina-
lized individuals’, groups’, and communities’ abilities to
obtain resources, goods, and services are impeded upon
(27–33). One of the critiques of the extant literature on
SE is the lack of standardized, validated measures to cap-
ture the complex concept (34, 35).
Although difficult to measure, scholars have found
that SE is a multi-dimensional process that can occur
across one or a combination of the following arenas:
a) economic; b) social; c) cultural, and; d) political
(27, 32, 33). Exclusion in one arena can lead to exclu-
sion in another, simultaneously or across the life-span,
and this cumulative disadvantage can perpetuate a
cycle that is difficult to overcome (29). Therefore,
some advocates propose strategies and solutions to
prevent social exclusion altogether, rather than strate-
gies to combat or mitigate the symptoms associated
with SE (29, 31). Acceptable access to affordable, suit-
able, and adequate public transportation may be
a preventive solution as public transport involves
traveling with others and provides opportunities for
social engagement while traveling to obtain goods and
services (29, 36).
Transport-Related Social Exclusion
Transportation, or lack thereof, is an important fac-
tor to consider when analyzing SE. Transport-related
SE limits individuals’ abilities to participate and
engage in desired activities (21, 22, 37, 38).
Individuals experiencing TD and transport-related
SE often report high costs, limited available routes,
safety concerns, long wait times, length of time spent
traveling, and inconvenient stops and transfers (21,
37–39). Research demonstrates that transport-related
SE significantly negatively affects social outcomes
including employment, health, education, and social
inclusion (21, 38). Church and colleagues identified
seven transport-related SE types: 1) physical exclu-
sion, 2) geographical exclusion, 3) exclusion from
facilities, 4) economic exclusion, 5) time-based exclu-
sion, 6) fear-based exclusion, and 7) space exclusion
(38). Later, Greico collapsed these seven types
into three core components: 1) place-based measures,
2) social-based measures, and 3) person-based
measures (40).
13
Transportation Disadvantage and Social Exclusion
Research demonstrates that some groups are particularly
vulnerable to either TD or SE but there are also groups
at increased risk of both TD and SE (41). Many of these
particularly vulnerable groups are considered environ-
mental justice populations, including individuals living in
low-density urban environments (7, 16), older adults (11,
42–46), racial and ethnic minorities (16, 47), and house-
holds below the poverty line (39, 48–50). Although large
cities and metropolitan areas tend to have public trans-
portation systems, infrastructure is lacking in low-density
urban environments and rural areas (7, 51, 52).
Therefore, individuals living in these areas are dependent
on personal vehicles, and individuals who are unable to
afford a vehicle or are unable to drive because of a physi-
cal or mental disability experience high rates of TD (7).
For these individuals, research indicates that they spend
little time outside of their homes and rarely engage
socially with unpaid visitors (34, 53).
Households below the Poverty Line. Household income is
associated with the primary type of transportation utilized,
car ownership, and SE. In fact, researchers found that
‘‘social exclusion is intricately related to poverty and depri-
vation, and it is difficult to separate the two at both a the-
oretical and a practical level’’ (34). In the United States,
over three-quarters of public transportation users have
annual household incomes of less than $50,000, with
nearly one-third of users earning less than $15,000 (15).
Not only do low-income households have to rely on public
transportation, but they also have to spend a more sub-
stantial proportion of their annual incomes on transporta-
tion. Households in the lowest income quintile spend
about 36% of their annual budget on transportation com-
pared with 14% for those in the highest quintile (15).
The proportion of annual household income that low-
income families spend on transportation is projected to
increase in the coming decades (54, 55). The majority of
households living below the poverty line do not have
access to reliable personal vehicles and fares are dispro-
portionately expensive for public transportation, when it
is accessible and suitable (15, 21, 56, 57). Consequently,
many people with low incomes become isolated, unable
to travel to desired activities outside of their immediate
neighborhoods (56, 57).
Older Adults. Research suggests that lower-income older
adults are at high risk of SE in part on account of TD
(58). A study of 20,275 home-dwelling older adults across
80 municipalities found that more than 60% of partici-
pants experienced SE in two or more of the SE arenas
(35). The most commonly reported exclusion arenas were
14 Transportation Research Record 2673(7)

political and social, with older adults describing the Table 1. Comparison of Transportation Data Collection
desire to vote and participate civically and limited inter- Strategies
actions with friends as well as high rates of self-reported
Paper/website Smartphone My
loneliness (35). Findings indicate that access to adequate
Features/data travel diary travel diary app Amble
transportation may play a critical role in successful aging
in place (59–61). Driving cessation causes older adults to Observed trips
become more dependent on public transportation or to *Mode X X X
rely on family and friends for rides to goods and services *Purpose X X X
*Departure time X X X
(12, 44). In the United States, studies estimate that more *Origin/destination X X X
than 600,000 older adults will stop driving every year *Trip importance X X
because of changes in physical and cognitive health status *Trip success X X
(44, 62). Without adequate transportation, these individ- *Trip challenges X
*Impact on mood X X
uals are at high risk of becoming excluded, particularly
*Interact X X
politically and socially (12, 35, 44). w/ friends/family
SE means more than social isolation. It is a process in Unserved/failed
which structural factors within the community impede trips
individuals’ opportunities for upward mobility and deny *Purpose X
*Trip importance X
them basic needs and rights. Structural factors may *Impact on mood X
include discriminatory allocation of public services and *Reason for no trip X
infrastructure, such as transportation. Unsurprisingly, *Consequences X
the individuals at high risk of SE tend to be the same GPS identifies trips X
individuals who are at high risk of TD—low-income GPS verification X X
of destination
older adults, minority populations, and individuals who Social exclusion X
are on lower incomes (41). TD may even cause SE; at the and transportation
very least, adequate access to transportation is a funda- Travel history X
mental component of social inclusion (24, 26, 63, 64). Visual record X X
of challenges

Current Study the lived experience of TD individuals using a digital plat-

In summary, a paucity of published research using the SE
framework to explore TD among older adults within the
United States currently exists. Existing studies examining
the relationships between older adults and transportation
mobility often focus on individual level factors (e.g.,
sociodemographics, health-related variables) with scant
attention to the contextual factors behind older adults’
experiences with transportation. Furthermore, research on
transportation mobility and aging is hampered by metho-
dological difficulties and the limited scope of discovery
inherent in the use of traditional travel surveys and travel
diaries to capture the lived experience of transport struc-
ture (64, 65). Thus, the current study fills an important gap
in the literature by investigating TD and its impact on SE
among a highly vulnerable population of older adults that
are often overlooked by transportation researchers. The
research team custom-designed a daily transportation diary
app, MyAmble, which included a feature for older adults
to qualitatively share their transportation experiences as
they relate to the following domains of SE: resources, par-
ticipation, and quality of life (66). This qualitative feature
was named Travel Buddy in reference to the text-messaging
that occurred between two ‘‘buddies’’ (i.e., participant–
researcher dyad). The use of Travel Buddy extends the typ-
ical travel diary to capture more qualitative detail about
form for data collection. The researchers also collected
quantitative data related to participants’ daily activities
using MyAmble; however, these results are presented in
detail elsewhere (67) as the focus of the current study is on
the Travel Buddy feature of the app.
The overall purpose of creating MyAmble and the
Travel Buddy was to address the need for data collection
strategies and techniques that capture the unserved travel
demands of TD individuals. Unlike other transportation
data collection strategies, MyAmble provides the advan-
tage of holistically capturing the consequences of unrea-
lized but desired travel experiences (see Table 1).
MyAmble includes four features: 1) daily trip planner, 2)
travel history, 3) challenge logger, and 4) Travel Buddy
(66). The daily trip planner allows participants to record
their daily experiences with transportation mobility and
includes prompts to capture unserved travel demand.
The travel history prompted participants to share their
previous experiences with transportation mobility with
the aim of capturing the contextual factors related to
TD. The challenge logger enabled participants to utilize
videos, photos, or both to document real-time transpor-
tation barriers in the environment. Finally, the Travel
Buddy enabled the research team to collect data related
to SE and TD.
Fields et al
Methods
Design
A large and diverse team comprised of faculty and gradu-
ate students in social work, civil engineering, and computer
science undertook this project. The team utilized an inten-
tional inter-disciplinary approach in that the members
actively integrated the expertise of the three disciplines into
the conceptualization, planning, and implementation of the
app (68). Table 1 illustrates a comparison of transportation
data collection strategies including MyAmble. Android
tablets were used as the digital platform for this study, in
part given their dominant market share (60%). Each parti-
cipant was lent a Samsung Galaxy tablet (10 in.) and a
Verizon Wi-Fi hotspot for the duration of the study. The
participants returned the tablets to the university at the
conclusion of the study.
The study utilized an ecological momentary assessment
design (69, 70) using Travel Buddy, which was the qualita-
tive feature of MyAmble. An ecological momementary
assessment design provided the advantage of real-time,
qualitative data collection in a naturalistic setting (e.g.,
home/community) with minimal recall bias (69). Travel
Buddy was designed to be a dynamic feature that captures
more in-depth, perceptual data related to TD versus tradi-
tional static data collection methods such as surveys or in-
person interviews that do not take place on a daily basis.
The Travel Buddy provided a digital platform for the use
of ecological momentary assessment whereby more in-
depth, ongoing conversations related to the lived experi-
ence of TD could take place. Each study participant was
partnered one-to-one with a virtual ‘‘Travel Buddy’’
(researcher); the researcher text messaged six standardized
questions related to TD and social exlusion four to five
times per week over the 14-day study period. Travel
Buddy questions elicit information across the three
domains of the theoretical framework of SE: quality of
life, participation, and resources (see Figure 1). Probing
questions were also used to keep the lines of communica-
tion open between researcher and participant, and to
encourage conversation related to the domains of SE.
Participants could respond to Travel Buddy questions
using the tablet’s keyboard or through a voice-to-text
microphone embedded in MyAmble. To notify partici-
pants of when they received a message, the tablet device
played a musical alert and presented a pop-up notification.
When the participant pushed ‘‘OK’’ on the notification, it
led them directly into the Travel Buddy chat where he or
she could respond via text message to the question/s.
Setting
The study occurred in two cities in Tarrant County,
TX—Fort Worth and Arlington. Tarrant County is the
15
Figure 1. Domains of social exclusion.
third largest county in Texas and borders Dallas County
in north central Texas. Data from the 2015 American
Community Survey (ACS) (71) reveal that the region
includes some of the fastest-growing communities in the
United States, and Tarrant County’s population is pro-
jected to grow to more than 2 million people by 2020.
Fort Worth is the largest city in Tarrant County, and
Arlington is the second largest. Arlington is also the larg-
est municipality in the United States to lack a public
transit system. The ACS found that the average regional
travel time to work in 2015 was 26 min, compared with a
national average of 25 min. The poverty rate in 2015 was
13.1%, and persons 65 years and older represented
10.5% of the total population (71).
Sample
Building upon previous pilot data related to aging issues
in Tarrant County (8), the research team utilized an
already established community partnership with Meals
On Wheels of Tarrant County for sample recruitment. A
purposive sample of 20 low-income TD older adults were
drawn from the client database at the agency. Inclusion
criteria for sample selection included adults aged 62 and
older; English-speaking; able to read and write in func-
tional English; and ability to provide informed voluntary
consent. The final sample included 10 older adults.
Attrition was because of health concerns of the partici-
pants (e.g., prolonged hospitalization) and challenges
with technology (e.g., weak Wi-Fi signal).
The mean age of participants was 69.56 years
(SD = 3.75, median = 70). The majority of participants
were female (n = 7, 70%) and retired (n = 6, 60%). Half
of the participants were White and the other half were
African American. Most participants were living alone
(n = 7, 70%) in a senior housing complex (n = 6, 60%)
and had lived in their place of residence for longer than 5
years (n = 6, 60%). The majority of participants
reported that they did not currently drive (n = 9, 90%),
did not own a car (n = 9, 90%), and did not have a valid
driver’s license (n = 8, 80%). Most individuals (n = 8,
16 Transportation Research Record 2673(7)

Table 2. Demographics Table 3. Participant Experience with Technology

mean (SD), Variable n (%)

Variable n (%) median
Owns phone 8 (88.9%)
Age 69.56 years Owns computer/laptop 1 (11.1%)
(3.75), 70 Length of time using phones
U.S. citizen 10 (100%) Six months to one year 1 (10%)
Gender One to three years 2 (20%)
Female 7 (70%) Three to six years 3 (30%)
Male 3 (30%) Seven years or more 4 (40%)
Race Length of time using computers
African American 5 (50%) Never used 3 (37.5%)
Caucasian 5 (50%) Less than six months 1 (12.5%)
Marital status Seven years or more 4 (50%)
Single, never married 2 (20%) Length of time using tablets
Living with a partner, not married 1 (10%) Never used 3 (33.3%)
Married 1 (10%) Less than six months 3 (33.3%)
Separated 1 (10%) Three to six years 1 (11.1%)
Divorced 3 (30%) Seven years or more 2 (22.2%)
Widowed 2 (20%) Length of time using the Internet
Employment status Never used 2 (20%)
Retired 6 (60%) Less than six months 1 (10%)
Unable to work 3 (30%) One to three years 2 (20%)
Out of work and 1 (10%) Four to six years 1 (10%)
looking for work Seven years or more 4 (10%)
Highest level of education Frequency of accessing web from home
Some high school 3 (30%) Never 4 (44.4%)
High school or equivalent 2 (20%) Daily 5 (55.6%)
Vocational/technical school 3 (30%) Frequency of accessing web
Some college 1 (10%) from public spaces including libraries
College graduate 1 (10%) Never 4 (66.7%)
Residence Less than once a month 1 (16.7%)
Senior housing 6 (60%) Monthly 1 (16.7%)
complex/apartment
Own home 4 (40%) Note: Not every participant answered every item on the survey.
Living arrangements
Lives alone 7 (70%)
80%) reported using paratransit services (e.g., Mobility-
Lives with spouse 1 (10%)
Lives with non-family 1 (10%) Impaired Transportation Service (MITS) and Handitran)
caregiver or a public bus (n = 5, 50%) as their primary forms of
Lives with others 1 (10%) transportation. For more details on the study popula-
Length of time living in 21.35 years tion’s demographics, see Table 2.
city of residence (26.16), 7.5
Car ownership Most participants in this sample owned a phone
No 9 (90%) (n = 8, 88.9%). Prior to this study, three of the partici-
Yes 1 (10%) pants (33.3%) had never used a tablet device. Some
Valid driver’s license individuals were able to access the Internet from their
No 8 (80%) homes (n = 5, 55.6%) and others occasionally accessed
Yes 2 (20%)
Currently drive the Internet from public spaces. Two participants (20%)
No 9 (90%) had never accessed the Internet, prior to this study. See
Yes 1 (10%) Table 3 for more details about participants’ experience
Current modes of with technology.
transportation
Paratransit services including 8 (80%)
MITS and Handitran
Public bus 5 (50%) Data Collection
Catholic Charities 3 (30%)
Prior to any data collection, the study was approved by
Family members with cars 1 (10%)
Medicaid and Medicare 1 (10%) the University of Texas at Arlington Institutional Review
ride service Board. Four graduate research assistants (GRAs) and
Personal car 1 (10%) two faculty worked individually with the 10 participants.
To train the participants to use the tablet and Travel
Note: MITS = Mobility-Impaired Transportation Service.
Buddy, the GRAs and faculty arranged a time to meet
Fields et al
Figure 2. Travel Buddy Conversation.
with each participant individually in a location convenient
for the participant (e.g., home, coffee shop). Part of the
training included a step by step user guide that included
instructions on how to use the tablet and Wi-Fi as well as
included screen shots on how to use the Travel Buddy fea-
ture of MyAmble. The GRAs and faculty met with the parti-
cipants twice prior to Travel Buddy data collection to
provide training as well as to complete the demographic sur-
vey. The participants then used Travel Buddy via the tablet
for 14 days. The Travel Buddy was Wi-Fi dependent and all
data were stored in a cloud-based interface and extracted
into a custom-built MyAmble database.
Data Analysis
The Travel Buddy database organized text messages
between the researcher and participant first by partici-
pant identifier, researcher, date, and the domains of SE.
Results were exported into Excel and then copied into
Microsoft Word for analysis. The researchers used
17
Figure 3. Five themes related to TD and social exclusion.
conventional content analysis (72) and iterative coding
(73) to identify and move from codes to summary themes.
Coding was conducted line by line and categories evolved
into themes as three members of the research team (two
faculty and one GRA) independently read and re-read
the Travel Buddy conversations. The team convened to
discuss the themes and this iterative process continued
until consensus was reached. Although the Travel Buddy
questions were theoretically informed, the analysis was
inductive and focused on answering the primary research
question: how does TD relate to the domains of SE?
Findings
During the 14-day study period, researchers sent a total
of 449 text messages to the 10 participants (M = 44.8;
SD = 40.34). The participants responded to these text
prompts by sending 213 total text message responses, or
a text message response rate of 47.4%. The text responses
of participants ranged in length from one-word answers,
such as ‘‘okay’’ or ‘‘good,’’ to one 381-word answer. The
mean text message response length was 23.60 words, with
a standard deviation of 40.45. (The median text message
response length was nine words.) See Figure 2 for a sam-
ple illustration of a Travel Buddy conversation.
Within the context of the lived experience of lower-
income older adults, the themes related to TD and SE
(74) were examined. Content analysis revealed five pri-
mary themes related to TD and SE: constrained autono-
nmy and flexibility, safety concerns, dimished emotional
well-being, barriers to community engagement, and bur-
densome (see Figure 3).
Constrained Autonomy and Flexibility
Constrained autonomy and decreased flexibility was a
theme that emerged from questions across the domains
of both quality of life and participation. One Travel
Buddy conversation emphasized the participant’s
18
reliance on others to get out of the house to see family
and friends and to complete errands, such as taking a
trip to the pharmacy. For example, one participant
explained that owing to a lack of transportation, her
friends and family had to ‘‘come see me or pick me up to
go places.’’ She further shared that to access the services
that she might need at short notice (i.e., pharmacy) that
‘‘[I] have to wait for a ride from my sister.’’ Similarly,
another participant shared that if her prescription medi-
cations were not ready by the end of the day on a day
that she had a ride arranged, it would take several more
days to secure transportation and travel to the pharmacy
to get her prescription.
Participants shared that access to transportation
meant having the ability to freely participate in life out-
side of their homes. One participant reported that having
transportation means ‘‘basically my getting out of the
house to be able to breathe and feel the freedom of what
is needed. I rely on the transportation for being there so
that I can do what I need to do.’’ Another participant
stated, ‘‘I always feel better if I am able to get out some
time during the day. I don’t feel like a shut-in. I think it
is important for seniors to be able to go out.’’ Other par-
ticipants shared about the lack of freedom that TD and
SE may bring. For example, one participant stated ‘‘You
ask about my day-to-day life, which is pretty boring
since I’m house-bound and in a wheelchair.’’ Another
participant stated: ‘‘I don’t always have a chance to go
[anywhere]. most days we don’t get out at all.’’
Several participants shared that flexibility with trans-
portation affected their quality of life. One participant
stated:
Lack of flexibility is a major issue . there haven’t been any
times when MITS forgot a planned trip. They just have a
huge time window that can be difficult. Today we were fin-
ished with our shopping but had to wait over an hour for
our scheduled pick up time.
Another participant explained that planning trips ahead
of time using her limited transportation options hindered
her day-to-day flexibility:
The lack of [transportation] access affects me. If there were
easier ways to get around it would be nice. One problem I
have is since I have to schedule a day ahead of a planned trip
I have no ‘‘wiggle room.’’ If I wake up the day of a sched-
uled trip and don’t feel well I still have to go, even if I would
rather go back to bed. There just isn’t an easy way to make
adjustments and there have been times I didn’t think about
planning a trip because I didn’t feel well but the next day I
felt great by comparison and it wasn’t possible to schedule a
trip. I really need a working crystal ball to be able to accu-
rately predict trips.
Transportation Research Record 2673(7)
One participant who often called her son to take her
places shared that ‘‘it’s hard when you have to depend
on people or transportation because you have to be there
on time and not late.’’ Similarly, another participant
reported that transit schedules limited her flexibility:
I also find it hard when I miss the bus because I have to wait
a whole hour afterwards for the next one to come. One of
the problems I have is that if I’m changing buses one bus
gets me there late and the other one leaves early makes it
hard to get from point A to point B.
Safety Concerns
Participants shared that a concern for personal safety
while traveling affected their quality of life. One partici-
pant felt particularly unsafe traveling alone because of
her disabilities: ‘‘I only feel unsafe when I travel by
myself. People in wheelchairs seem to have a bulls-eye
target on them and I get scared sometimes when I get
too many people around me that I don’t know.’’ Several
participants shared fears related to evening traveling.
For example, one participant shared ‘‘I feel safe traveling
around my neighborhood during the day but not at
night. Our neighborhood has people who seem to find
their way in drinking and visions of drugs too.’’ Another
participant commented that although she felt safe in her
immediate community, a lack of environmental safety
features such as lighting hindered her evening travel. She
commented that she felt,
very, very safe in my home and in the community. But the
only thing is afraid of that where we say there are no lights
no street lights lit up where I stay easy to get raped or a beat
up or robbed.
Two participants shared that they limit their travel
because of safety concerns. One shared, ‘‘we usually
don’t go far, just JPS [hospital], Walmart and the dollar
store down the street,’’ whereas the other reported ‘‘I
generally don’t go places where I might feel unsafe.’’
Diminished Emotional Well-being
When asked questions within the domain of participa-
tion, several participants shared that lacking reliable
transportation negatively affected their emotional well-
being. For example, one participant mentioned, ‘‘it gets
very depressing when you don’t have transportation to
get to some of the places that you would like to go and
spend time there.’’ This participant also shared that her
son had recently been hospitalized and that not having
transportation was ‘‘very hard and also depressing
Fields et al
because you always want to be there for your children
no matter what.’’
Social isolation also emerged as a negative outcome
of TD related to emotional well-being. One participant
shared:
Due to our health issues most of our so-called friends have
disappeared. One of the few left has a house I cannot get in
with a wheelchair. As for family, [her partner] has no family
left. I have my 84-year-old mother who lives in Keller, but
MITS won’t go there.
Barriers to Community Engagement
Within the domain of participation, several participants
shared that TD created barriers to engaging in the greater
community. Transportation prevented one participant
from being engaged in volunteer activities. As a resident
of a subsidized, senior living housing complex, she tried
to find ways to volunteer for her neighbors, however, she
wanted to volunteer in other ways. She shared: ‘‘I do
volunteer work in the building . every third Saturday .
we give out bags of groceries to the tenants in this build-
ing . it’s a blessing and I love doing it’’ but, ‘‘I would
love to volunteer at nursing homes, hospitals . I love
meeting new people . transportation is the biggest prob-
lem that I have.’’ When asked by the researcher what type
of transportation would allow her to volunteer in the
community she explained that she could possibly take
MITS but that it goes too many other places to pick up
other passengers for doctor’s appointments and phar-
macy trips. She further shared ‘‘With your MITS or
logisticare [non-emergency medical transportation] you
are really at their Mercy . so there’s nothing you can do
but just go for the ride.’’
Another participant explained that although she is
able to see her friends because of their proximity to her
home, she was unable to engage in activities in the larger
community. She shared:
my friends basically live where I live. but I still want to travel
where my son works and watch him as he does his tattoo
work. I’d like to take time to go to the zoo or two [sic] the
Will Rogers Stadium or even to the main area Fort Worth
just to wander around and look at the scenery.
Burdensome
Within the domain of resources, public transportation
was found to be a financial- and time burden on many
participants. One participant shared that using the city
bus can be an all-day ordeal and took away from his
already limited finances. This was especially true in sev-
eral situations for this participant such as when the bus
was not on time as scheduled, when he had to transfer
19
buses, and when he had more than one doctor’s appoint-
ment scheduled in a day. This participant stated that he
would rely on an alternative mode of public transit,
MITS, however, he shared that
the cost for senior citizens and disability people is $4.50 one
way so therefore the total cost is $9 for the doctor’s appoint-
ment travel. If you have more than one doctor’s visit per
month let’s say 5 appointments, it will cost the senior citizen
$45 in transportation fee. This therefore takes away from
there medicine and food allowance.
Similarly, another participant shared that the costs of
MITS could be a financial challenge for those on a fixed
income:
‘‘with MITS you have to pay 325 [$3.25] . but you have to
pay every time you ride it . either way it goes it gets pretty
hard to get around if you don’t want [to] have someone take
you or your own transportation . with MITS you have to
pay going and coming back . you have to pay twice.’’
Many participants noted time burdens related to trans-
portation. One participant shared, ‘‘we have (to) wait (a)
long time for pickup.’’ Another participant recalled
another instance in which time waiting for MITS was a
burden, sharing, ‘‘one lady who walked to the store
offered to go home and get her car to give me a ride
home so I wouldn’t have to sit there for another hour
waiting for MITS.’’ Similary, participants expressed that
once they were riding on the transportation system, time
burden increasingly became a challenge. For example,
one participant reported, ‘‘it’s hard on MITS because it
goes too many other places and makes too many stops.’’
Conclusion
Within the framework of SE, our findings begin to reveal
the extent to which transportation may prevent lower-
income older adults from participating in the broader
society, primarily by constraining their independence.
Consistent with previous research (75, 76), participants
in our study reported that they often depended on
friends or family for transportation, however, this depen-
dence often led to feelings of dimished autonomy.
Furthermore, our participants reported that they had
trouble creating and maintaining social relationships or
that they could not engage in civic activities (e.g., volun-
teering) because they lacked independent transportation
to get out of the house. They reported that relying on
public transportation meant that a doctor’s appointment
could require spending an entire day waiting and travel-
ing, thereby preventing them from taking care of
20
household chores, spending time with family and friends,
engaging in leisure activities, or relaxing. The Travel
Buddy findings suggest that a lack of flexibility with
transportation greatly hindered their quality of life and
ability to participate in the larger community.
The framework of SE suggests that the key aspects of
quality of life are health and well-being (74). Although
the link between TD, SE, and poor quality of life out-
comes have been well-established in previous research
(11, 77–79), the Travel Buddy allowed the research team
to examine these issues within the context of the lived
experiences of lower-income older adults in the United
States. In particular, the Travel Buddy data suggested
that TD negatively affected participants’ emotional well-
being and contributed to social isolation. These findings
are important given that social isolation has been linked
to increased mortality and functional decline among
older adults (80, 81). Furthemore, the benefit of utilizing
an ecological momentary assessment design with Travel
Buddy is that the research team was able to examine the
findings within the context of the participants’ daily lives,
which are impacted by intersecting social forces such as
poverty, age-related disabilities, discrimination, and the
built environment.
SE also involves the lack or denial of resources avail-
able to the majority of individuals in a society (74).
Research suggests that in the United States, older adults
consider transportation services inconvenient, expensive,
and mismatched with their travel needs (82). Moreover,
the SE of older adults is often reinforced by inadequate
transit systems (83). Many participants in our study
shared that MITS and the bus system were burdensome
both in relation to time and financial costs. These bur-
dens ultimately affected their ability to engage in the typ-
ical relationships and activities that are afforded to many
in the United States. Ultimately, the Travel Buddy find-
ings suggest that lower-income older adults feel disen-
franchised and undervalued by broader society.
In general, the results suggest that to participate in
society at a basic level, individuals require transporta-
tion. The impact of the lack of reliable, independent
transportation on participants’ lives underscores the
need to conceptualize transportation within a basic rights
paradigm in the United States rather than as an individ-
ual responsibility. Thus, the study holds several implica-
tions for public planning and policy making. In the same
way that food is a basic need, and thus, individuals in
the United States can receive food subsidies through the
supplemental nutrition assistance program, the govern-
ment could offer transportation subsidies in recognition
that transportation is also a basic need. Subsidies could
come in the form of transportation vouchers, which
would reduce the economic burden. Moreover, allowing
participants to apply vouchers toward transportation
Transportation Research Record 2673(7)
innovations like ride-sharing services would also increase
rider autonomy. Regarding the latter, public planners
ought to consider expanding ride-sharing services for
older adults. In our study, the predominant form of
transportation was paratransit, which has several limita-
tions including being time-intensive and requiring
advanced scheduling. Although paratransit may be
amendable to activities that are scheduled in advance,
such as regular doctor’s appointments, it is less effective
for day-to-day activities such as grocery shopping or
social engagements, and unexpected events. It may be
possible to design a ride-sharing service that recognizes
the unique needs of lower-income older adult riders and
that requires drivers to offer more disability accommoda-
tions. In addition, city planners could create a Travel
Buddy program for older adults to help them transition
to new services, many of which require using app tech-
nologies. Travel buddies could assist older adults in
downloading the ride-sharing app onto their phones and
could accompany them on the first several rides from
ordering the ride, to traveling to the destination, to
requesting the return ride, and returning home.
Limitations
Results from the current pilot study represent a first step
in understanding the lived experience of TD and SE
among older adults. However, the study findings should
be interpreted cautiously as several limitations exist. The
research team encountered technical challenges with the
Wi-Fi hotspots as they periodically failed causing the
Travel Buddy to lose data, so some participants may
have answered more questions than reported by the app.
Furthermore, the sample was small and limited to a par-
ticular geographical area, thus findings are not generaliz-
able. Additionally, the participants in this study
volunteered to participate, and thus, selection bias may
have influenced the data. Finally, our participants were
lower-income older adults with significant health chal-
lenges. Older adults who are healthier with more
resources may experience TD and SE differently.
Future Research
Travel Buddy is an innovative tool for data collection
that can be used for other environmental justice popula-
tions including persons with disabilities and residents of
lower-income neighborhoods. By utilizing the SE frame-
work, the team was able to examine the opportunity costs
related to civic engagement, social relationships, and
community belonging. Second, results from this study
have produced qualitative data that contextualize lost
opportunities and how characteristics of economic justice
Fields et al
exacerbate risk for TD, as well as how individuals man-
age within these intersections of disadvantage.
These data will lead directly into expanded conversa-
tions about how to transform transportation planning
from mobility to equity. Current methods to ensure that
all individuals have access to transportation fail to con-
sider that not all individuals have the same resources in
society to utilize the transportation that may be available,
for example, mass transit that operates on limited sche-
dules and with limited routes. Infrastructure transforma-
tions may include more creative solutions for reducing
the last-mile gap, and leveraging new technologies such
as Lyft, Uber, and app-facilitated ride-sharing to offer
door-to-door and on-demand transportation to those for
whom mass transit is not realistic, for instance, disabled
and older adults. The Travel Buddy data may also have
practical implications for social service agencies in rela-
tion to highlighting the role that TD and SE play in indi-
vidual general well-being. Case managers and social
service providers may want to assess individuals for TD
and develop action plans and referral services to respond
to transportation needs. Finally, the use of ecological
momentary assessment through digital platforms such as
the Travel Buddy may offer new ways to collect holistic
data related to TD that will lead to better opporutnities
for transportation planners, engineers, and social service
providers to work together to address the needs of envi-
ronmental justice populations.
Author Contributions
The authors confirm contribution to the paper as follows: study
conception and design: NF, CC, SM; data collection: NF, CC,
EM, VM; analysis and interpretation of results: NF, CC, VM;
draft manuscript preparation: NF, CC, SM, EM, VM. All
authors reviewed the results and approved the final version of
the manuscript.
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BMC Public Health, Vol. 15, 2015, pp. 503.
The Standing Committee on Environmental Justice in
Transportation (ADD50) peer-reviewed this paper (19-04734).