Understanding How a Public Transportation Network Training Program Can Improve the Self-Efficacy, Satisfaction and Experience of Community Mobility Among People with Disabilities: A Mixed Methods Research

Abstract

The Réseau de transport de la Capitale (RTC), Quebec City’s public transportation provider, has launched a training program to enhance skills and self-efficacy for using the bus, including training for people with disabilities: “Service d’accompagnement en mobilité intégrée (SAMI)”. This pre-post study with a convergent mixed approach aimed to evaluate the influence of the SAMI program (P-SAMI) on transportation self-efficacy, mobility and satisfaction with the bus use among people with disabilities. The study also explored people with disabilities’ experiences and perceptions with the P-SAMI and bus use. The P-SAMI was delivered, and questionnaires and semi-structured interviews were completed before and after P-SAMI. Paired t-tests, Wilcoxon tests, and deductive thematic analyses were performed. Thirty-three participants (53.7 ± 14.9 years-of-age) showed statistically significant gains in transportation self-efficacy (p < 0.01) and satisfaction with bus use (p < 0.01), with no statistically significant differences in mobility (p > 0.05). Qualitative findings confirmed enhanced transportation self-efficacy and satisfaction with bus use, with participants reporting using buses to carry out some daily activities. The P-SAMI shows promise for improving transportation self-efficacy and satisfaction with using the bus, with the potential to enhance participation in daily activities. Controlled trials should be conducted in the future to test the effectiveness of transportation training for people with disabilities.

1. Introduction

Public transportation, such as buses, trains, and tramways, is commonly used to achieve community mobility [1,2]. Transportation is essential to accomplish social roles, including education, socialization, employment, and medical appointments [3]. In turn, transportation can facilitate social relationships and support social participation for many people who are unable to use personal vehicles due to lack of resources or disability [4,5]. For the purposes of this work, as suggested by the World Health Organization, disability was considered as the interaction between health conditions (e.g., stroke) with environmental (e.g., transportation network) and personal (e.g., reduced mobility) factors [6].

Public transportation is a viable and ecological mode of transport, which typically implies various transportation tasks, such as walking from home (or another benchmark) to the bus stop or station, selecting the appropriate service or route, boarding the bus or train, finding a seat, deciding where to get off, managing interchanges as necessary, and completing the journey to the final destination [7]. These transportation tasks represent links in the travel chain, such as the distance between a benchmark and a stop or station and vice versa, at a stop, inside of the public transportation vehicle, and route to the final destination [8]. These links are commonly associated with barriers, particularly for people with disabilities. Thus, many people with disabilities experience barriers when attempting to use public transportation. These barriers may include long walking distance, lack of ramps or inoperable ramps, stairs or steps, difficulty reading information on a bus, difficulty hearing audio announcements on the bus, paying the fare and problems related to orientation and navigation [3,8,9,10,11,12].

Barriers may also arise from lack of awareness of existing services or not knowing how to use them [13]. Furthermore, operating staff who are unhelpful or unfriendly may exacerbate the existing obstacles [9]. Encountering multiple barriers when using public transportation (i.e., a negative public transportation experience) can generate negative emotions that can affect willingness or motivation to use it in the future [14], further impacting mobility, feelings of satisfaction and self-efficacy [8,15,16]. Likewise, people with disabilities with low self-efficacy for using public transportation may be reluctant to do so, fearing difficulties throughout the experience [17,18]. This may in turn contribute to limited mobility and reinforced low self-efficacy (i.e., belief in ability to accomplish a specific task [19,20,21]), suggesting a bidirectional relationship between transportation self-efficacy and public transportation accessibility.

Social Cognitive Theory posits that self-efficacy is both the cornerstone of human achievement and predictor of future behavior [20,21]. Self-efficacy is developed in four main ways, including mastery experience, social modeling or vicarious experience, social persuasion (e.g., positive feedback) and reinterpretation of emotional and physiological reactions (e.g., hedonic emotion or sense of well-being) [19,22]. In transportation research, self-efficacy is often used to describe the experiences of passengers [23] and to measure the effectiveness of travel training programs (i.e., travel behavior change) [24,25]. Transportation self-efficacy refers to a person’s belief in their ability to get where they want to go or to perform transportation-related tasks (e.g., from trip planning to destination) [26]. Consequently, transportation self-efficacy is considered to be one of the most important predictors of travel behavior change [27].

Satisfaction is described as an intrinsic positive consequence of behavior that meets an individual’s expectations [28]. A satisfactory journey using public transportation will typically involve: an acceptable walk to the bus stop; well maintained and well-lit pathways; a short, sheltered and secure wait for a service which arrives reliably, as expected from a readable timetable; a safe and comfortable journey that takes the traveler to a point for disembarking conveniently near the final destination; and a timely return service [7]. In transportation research, satisfaction is also used to measure passengers’ experiences and travel behavior [29]. Satisfying experiences have been shown to increase intrinsic motivation, which in turn increases the likelihood of continuing or changing behavior [27]. Indeed, experiencing a sense of satisfaction with one’s performance in relation to an environment, particularly public transportation, or during an intervention program (e.g., a travel training program), has the potential to continue or modify travel behavior [27]. Research focusing on behavior change assessment underlines that satisfaction is also an important determinant of travel behavior change [27].

To address the above-mentioned issue of mobility and unequal access to public transportation services for people with disabilities, as well as the resulting feelings of dissatisfaction and reduced transportation self-efficacy, laws and regulations have been enacted, leading public transportation providers to develop paratransit that offers door-to-door service. Even though this service is highly valued by people with disabilities, it does come with some drawbacks. First, reservations can be required at least 24 h in advance [16,30], limiting spontaneous travel. Moreover, limited financial and human resources reduce the ability of public transportation providers to sustainably guarantee paratransit services for all eligible people with disabilities users. From this standpoint, public transportation could be an alternative option for facilitating the transportation and the associated social participation of people with disabilities, provided it is accessible.

To enhance public transportation experiences, many public transportation providers, in collaboration with researchers, groups of people with disabilities and health professionals, have developed public transportation training programs. Travel training is often conceptualized as customized instructional programs in travel skills tailored to specific needs, such people with disabilities [31,32]. According to scientific literature, travel training programs originated in the United States in the 1970s [33] and became widespread with the adoption of the American’s with Disability Act in 1990 [34]. As interventions, they are based on the fundamental principle that education and training can change behavior through enhanced information and skills and have associated benefits such as increased transportation opportunities [31]. The programs address intrinsic psychological factors associated with transportation use (e.g., self-efficacy, satisfaction) to improve community mobility [35]. Thus, are recognized as catalysts for fostering self-efficacy for public transportation use [13,18,24,25,36].

Studies on travel training programs are scarce. Those that are available have used either quantitative [13,24,25,37,38,39,40,41,42] or qualitative [36] methods, or both [18,43] without integrating findings to improve understanding of how such programs can enhance the constructs under study, and people with disabilities’ experiences with public transportation use. Furthermore, their formats, content, dosages and examined constructs varied from one study to another.

In line with the 2018–2027 strategic plan, the Réseau de transport de la Capitale (RTC), the public transportation provider in Quebec City (Canada), has developed a public transportation training program for Quebec City residents, including people with disabilities, to help them overcome their lack of confidence in using RTC buses, improve their satisfaction with its services and potentially increase the use of RTC among them. This training program is known as the “Service accompaniments en mobilité intégrée (SAMI)”, where “Mobilité intégrée” suggests combining different modes of transport (active and passive), taking into account the realities and multiple needs of potential customers [44]. Thus, the overall aim of this study was to investigate the impact of P-SAMI on transportation self-efficacy and satisfaction with using the bus among people with disabilities. Specifically, the objectives were to (1) evaluate the influence of P-SAMI on transportation self-efficacy, mobility and satisfaction with using RTC buses, and (2) explore experiences and perceptions with the P-SAMI and bus use among people with disabilities after participating in the travel training program.

This study was conducted within the framework of a partnership research team, which brings together researchers, community organizations, municipal partners, and people with disabilities to co-develop and evaluate inclusive mobility solutions. Within this collaborative environment, the evaluation of P-SAMI was conceived as a participatory initiative aimed at documenting both changes resulting from P-SAMI and the lived experiences of people with disabilities using public transportation.

2. Hypothesis

We assumed that, under consistent conditions, P-SAMI improves transport self-efficacy, mobility, and satisfaction with using RTC buses to fulfill daily activities and social roles.

3. Materials and Methods

3.1. Design and Setting

This pre-post design with the convergent mixed approach (quantitative and qualitative) was conducted in partnership with the RTC between 2021 and 2024. We used this approach to explore in-depth the complexity of understanding improvements in transportation self-efficacy, mobility and satisfaction, as well as public transportation experience among people with disabilities after participating in P-SAMI. The present study was reported in accordance with the Standards for Mixed Methods Reporting in Rehabilitation Health Sciences Research [45].

3.2. Participants

The study involves a convenience and snowball sample for both quantitative and qualitative methods. The participants were recruited with the support of the RTC, the community organization Adaptavie, and the Centré intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN). The sample size was computed using G*Power (3.1.1.9 version) based on the statistical power (β = 0.90), significance level (α = 0.05), and effect size (ES) of confidence in using public transportation (the main variable of interest in this study) stemming from a previous study (ES = 0.347) [24]. A sample size of 31 was then obtained and an estimated attrition rate of 25% was applied to the calculated value. This resulted in a total sample size of 40. To be included, participants had to meet the following eligibility criteria: be a person with disabilities aged 18 years or older, live in the Quebec City area (RTC service territory), be able to use RTC services with or without assistance, be able to understand the study and the nature of the participation, be able to understand and speak French, having physical, visual or language disability and not have not previously completed the P-SAMI. Since the project was launched during the COVID-19 pandemic, participants presenting with symptoms of the virus or having had contact with a person displaying such symptoms within the previous two weeks (verified by telephone when consent was obtained) were excluded from the study.

3.3. Intervention

The intervention is described using Template for Intervention Description and Replication (TiDier) [46]. The P-SAMI was a 1 h customized training course based on didactic theoretical teaching followed by a simulation in a bus and bus stop mock-up, delivered in single session at the RTC’s facilities by its agents, who had previously received training in this field. Since the RTC is committed to the ecological management of material resources, only participants who expressed a need for a cheat sheet were given one. However, all participants had the possibility of calling or returning to the RTC facilities to ask questions about the use of bus transportation. The P-SAMI integrated information such as planning the trip using planning tools (the Nomade application, RTC website and telephone), how to buy transportation ticket, how to get to the nearest stop, how to sit or lean in a bus shelter while waiting for the bus, how identify the vehicle’s road number and associate it with the destination, how to ensure the safety near the boarding or disembarking point and while traveling, how to get on and off the bus, how to use the access ramp and request the bus to kneel, how to validate a ticket, how to hold on tight or get to the wheelchair space before the bus starts, how to sit down, how to find the way around the bus, etc.

3.4. Conceptual Framework

The Human Development Model—Disability Creation Process (HDM-DCP) conceptual framework [47], which describes how disabilities can be created from interaction between personal and environmental factors, was used to guide selection of outcomes, and to collect, analyze and interpret finings. It comprises domains of personal factors (e.g., confidence in one’s abilities), environmental factors (e.g., access to a travel training) and life habits (e.g., use of public transportation to go about one’s daily activities). This conceptual model deals with disability situations that arise when personal and environmental factors restrict life habits, thus reducing social participation. The HDM-DCP considers disability to be a situational problem and, therefore, not necessarily permanent, which can be resolved or diminished by creating or making the physical or social environment accessible.

3.5. Data Collection Procedures

The data was collected by the first author (C.R.M.) in person at the Centre for interdisciplinary research in rehabilitation and social integration (Cirris), a research center within the CIUSSS-CN, at the participants’ homes, or online via Teams software depending on participant preference. The data collection process encompassed a range of data types, including sociodemographic information, variables of interest (transportation self-efficacy, mobility, and satisfaction), and qualitative data. Sociodemographic data were collected within 14 days prior to the P-SAMI, while data on variables of interest were collected within a 14-day window before and after the intervention program. Qualitative data were collected only within 14 days after P-SAMI.

3.6. Sociodemographic Variables

Sociodemographic data (age, sex or gender, gender, disability status: physical, visual, intellectual or cognitive disability, hearing or language impairment, deaf, autism spectrum disorder, type of mobility aid used, and self-reported annual net income) were collected using a study-specific data collection form.

3.7. Variables of Interest

The variables of interest measured included transportation self-efficacy, mobility, and satisfaction with using RTC buses. As the main dependent variable, transportation self-efficacy was measured using a single visual analog scale (VAS, 100-point; score of 0, indicating no sense of transportation self-efficacy and 100, a strong sense of transportation self-efficacy) [24]. For this purpose, we asked participants the following question: Indicate how confident you are to use public transportation (bus) [24]. The extant scientific literature indicates that the single-item VAS for measuring self-efficacy regarding the use of public transportation is a measurement tool with excellent test–retest reliability (r = 0.96) among individuals with physical disability [24].

Mobility was assessed with the Life Space Assessment (LSA, 120-point) [48]. The LSA is a tool for assessing the frequency of independent mobility on five levels of living space over the past four weeks: (1) from the interior of the bedroom to the rest of the rooms in the house or apartment, (2) the distance from the front door to the edge of the garden or shared corridor, (3) mobility in the neighborhood, (4) in the city and (5) out of town [48]. The LSA demonstrates a very good test–retest reliability (intra-class correlation coefficient [ICC] = 0.87) and an excellent content validity for power mobility device users [48].

Satisfaction with public transportation goals was assessed using the Canadian Occupational Performance Measure (COPM) [49]. With the COPM, participants were asked to identify their goals for activities of daily living and social roles that they could achieve by RTC buses. They were then asked to rate their importance on a scale from 1 (not important) to 10 (extremely important). After this step, they were asked to rate their performance and satisfaction for each objective on a scale from 1 to 10, with higher values indicating better performance and greater satisfaction [49]. However, for the purpose of this study, only satisfaction scores were reported. The score was standardized by taking the average of the scores based on the total number of goals set. The COPM shows a very good test–retest reliability among stroke survivors with performance estimated at 0.89, and satisfaction at 0.87 with Spearman’s rho correlation coefficient [50].

3.8. Post-P-SAMI Interviews

To conduct interviews, a semi-structured interview guide was developed in French (Appendix A) in collaboration with researchers and RTC representatives (N.B. and D.H.). The interview guide covered all three domains (personal factors, environmental factors, and life habits) of the HDM-CDP, in such a way that questions about participants’ experiences and perceptions of SAMI and public transportation use were designed to highlight their feelings with the P-SAMI and public transportation use (personal factors), potential physical and social barriers and facilitators (unfavorable or favorable environmental factors), and daily activities for which they use public transportation (life habits). It was piloted with people with physical disabilities (n = 2) and people without disabilities (n = 6), lasting approximately 45 min. The interviews were audio-recorded and automatically transcribed using SharePoint, through Microsoft Stream. Then the first author immersed himself in the verbatims produced for manual revision, listening to the recordings again for accuracy.

3.9. Data Analysis

3.9.1. Sociodemographic Data

Sociodemographic data were summarized (means, SD, frequencies, percentages).

3.9.2. Quantitative Data

The assumptions for parametric analyses were verified. A one-sided paired t-test was conducted to identify improvements in COPM and LSA scores. As the post-P-SAMI self-efficacy scores (VAS) were not normally distributed, a one-sided Wilcoxon test was applied. A p-value < 0.05 was considered statistically significant. The guidelines for interpreting ES in rehabilitation research were used (ES = 0.08–0.15: small effects; ES = 0.19–0.36: medium effects; and ES = 0.41–0.67: large effects) [51]. The ES was reported as Cohen’s d for the paired t-test and the matched rank biserial correlation for the Wilcoxon test. Data were analyzed with JASP software, a user-friendly and flexible open-source statistical analysis software with structural support from the University of Amsterdam and others (JASP Team, 2025; JASP Version 0.19.1.0.).

3.9.3. Qualitative Data

The qualitative data were analyzed in accordance with the following reflexive analysis process recommended by Byrne [52].

Familiarization with the Data and Generation of Initial Codes

The first author familiarized himself with the data by listening to each interview recording once before transcribing it and noting down his initial observations. This first playback of each interview recording required ‘active listening’ and, as such, was an important step in the process. This active listening allowed him to develop an understanding of the primary areas addressed in each interview prior to transcription. The initial coding of the data was then performed. Thematic analysis was conducted deductively, based on the HDM-DCP conceptual framework [47], using Nvivo 14 (Lumivero, 2023 NVivo Version 14; www.lumivero.com, accessed on 10 December 2025). Nvivo is software for organizing, analyzing, and visualizing qualitative data, in such a way that within each theme and corresponding sub-theme there is one or more excerpts or references that underpin it.

Generating, Reviewing, Defining and Naming Themes

At this phase, a tree structure of themes and sub-themes was developed and analyzed to determine whether it would enable the second objective of the present study to be met. Meaningful references were extracted from verbatim transcripts and inserted into each theme and sub-theme so that the results of the analyses were supported by excerpts during the writing process, where excerpts were translated in English. To enhance trustworthiness, a two-stage review of the themes and sub-themes was conducted to ascertain whether they fitted within the HDM-DCP conceptual framework. The initial review involved the first author and T.A.A.T., while the second involved the first author, K.B., and F.R. After the thorough analysis, a thematic framework has finally been developed.

To identify commonality between the two types of findings and gain a more robust understanding of what both types of data mean together by drawing conclusions or meta inferences based on combined findings, we create a single table known as a joint display diagram [53,54]. The joint display showcased the variables of interest and the corresponding quantitative and qualitative findings, as well as the related meta-inferences that included convergent and divergent (or discordant) insights [53,54].

4. Results

4.1. Characteristics of Participants

A total of 35 participants were recruited for this study, two of whom stopped responding to our phone calls after completing the pre-intervention questionnaires. Of these participants, 29 were involved in data collection at Cirris, 4 at home, and 2 online. Thirty-three participants completed all stages of the research process. The age of these participants ranged from 20 to 89 years, with a mean (SD) age of 53.7 (±14.9) years (

Table 1. Characteristics of participants.

Sociodemographic Variables	Total (n = 33)	%
Age (years), mean ± SD	53.7 ± 14.9
˃80	1	3.0
80–71	3	9.1
70–61	7	21.2
60–51	8	24.2
50–41	8	24.2
40–31	4	12.1
30–21	2	6.1
Sex or gender, n (%)
Male	16	48.5
Female	17	51.5
Disability status, n (%)
Physical disability	29	87.9
Visual disability	3	9.1
Physical and language disability (mild aphasia post-stroke)	1	3.0
Mobility aids
Scooter	2	6.1
Manual wheelchair	13	39.4
Power wheelchair	1	3.0
Walker	2	6.1
Waking stick	10	30.3
Crutches	1	3.0
Without mobility aid	4	12.1
Self-reported annual net income (Canadian dollar), n (%)
˃75,000 $	3	9.1
60,000 $–74,999 $	1	3.0
45,000 $–59,999 $	1	3.0
30,000 $–44,999 $	2	6.1
15,000 $–29,999 $	14	42.4
<14,999 $	11	33.3
I prefer not to answer	1	3.0

SD = Standard Deviation.

). Most participants used manual wheelchairs (n = 13, 39.4%) and walking sticks (n = 10, 30.3%) for mobility. Twenty-nine (87.9%) participants had physical disabilities, three (9.1%) had visual disabilities and one (3%) participant had both physical and language disabilities (mild aphasia post-stroke) (Table 1).

4.2. Quantitative Findings

There was statistically significant increase in transportation self-efficacy (VAS scores) and satisfaction with using the bus (COPMs scores) before and after P-SAMI (

Table 2. Quantitative findings.

Outcome	Before-P-SAMI Score Mean (Range)	After-P-SAMI Score Mean (Range)	p Value	Effect Size
VAS	56.6 ± 30.0 (0–100)	65.6 ± 23.5 (10–100)	0.004 **	−0.686
LSA	44.8 ± 18.6 (8–112.5)	44.5 ± 17.4 (8–90)	0.529	0.013
COPMs	6.6 ± 2.3 (1.5–10)	7.3 ± 1.4 (3.2–9.6)	0.006 **	−0.460

VAS: Visual Analog Scale; LSA: Life Space Assessment; COPMs: Canadian Occupational Performance Measure on satisfaction slope; **: p < 0.01; SAMI: Service d’accompagnement en mobilité intégrée.

). However, there were no statistically significant differences in mobility (LSA scores) (p ˃ 0.05) (Table 2).

4.3. Qualitative Findings

Four overarching themes and respective sub-themes emerged from the interviews (Figure 1): P-SAMI fosters intrinsic factors related to bus use (improved self-efficacy and transportation-related skills, and satisfaction with the P-SAMI and use of RTC services), P-SAMI supports life habits, arising of barriers (physical and social barriers), and suggestions from participants (suggestions for P-SAMI and RTC services).

4.3.1. Theme 1: P-SAMI Fosters Intrinsic Factors Related to Bus Use

The P-SAMI seems to enhance intrinsic or personal factors specific to public transportation use and those related to participation in this program. These include self-efficacy and satisfaction with transportation and training program.

Self-Efficacy and Skills for Using the Bus

Participants reported that P-SAMI helped them maintain or improve their self-efficacy in taking the bus. For example, one man with visual disability (57-year-old) using a walking stick said, “I feel confident. I also feel confident that we can take public transportation in the city, rather than waiting at home for STAC [Paratransit Service of Canada]. In that sense, my confidence has improved.” Another woman with physical disability (32-year-old) using a manual wheelchair added, “There is more confidence. Now, as I was saying, I have more tools to know what to do. If I am in a bad situation, I can see that it is feasible. I have seen to what extent it is suitable too. It has increased my confidence.” Other participants described how P-SAMI helped them improve skills required for taking the bus, as one woman with a physical disability (35-year-old) using a manual wheelchair pointed out, “… he had explained to you everything you had to do to take the bus, how to prepare your route, in fact, also, to say that, Well, today, I’m going to go to such and such a place. Well, I have to leave at such-and-such a time to catch the bus at such-and-such a time, at such-and-such a stop, that’s going to take me to another stop, to get to where I want to go. So, they told me to prepare my route too, to look on the internet at the Nomade application, the route too, the bus times, the route, then if I had any questions, I could always call the RTC, they could help me with the route, if I ever had any questions.”

Satisfaction with the P-SAMI and Use of RTC Services

Beyond personal factors related to the prerequisites for optimal use of public transportation, participants also expressed satisfaction with the P-SAMI and use of RTC services. For example, one woman with a physical disability (35-year-old) using a manual wheelchair expressed her satisfaction with P-SAMI in this way, “I’m very pleased to have been able to take this training from someone who works at the RTC directly, so yes, I’m very satisfied.” However, another woman with a physical disability (43-year-old) using a manual wheelchair, was very nuanced in her impressions with P-SAMI, saying, “Yes. I found the trainer’s explanations very clear. I felt very welcome at this course. The explanations were clear. When I left, I was, as you said, quite enthusiastic about using the RTC, and it seemed to be an enriching experience… but it was when I returned home, then as the days went by […] that I said to myself, ‘Maybe there is the little side, yes, I’ve had the theory, it was very good, but the practical side of doing it, that is missing, being accompanied in the process or doing it on my own, putting myself into action, then doing it myself and really seeing where the experience can take me”. One man with visual disability (58-year-old) using a walking stick expressed his satisfaction with the use of RTC buses by stating, “I’m very satisfied. It’s going well overall. And I can find my seat pretty easily. And my trip is going pretty well. The drivers are willing to help me, the passengers are also willing to help me, whether it’s to change buses, to transfer, or sometimes to find the stop if I’m not quite at the stop. I ask to find out how long it will be before the bus arrives. And especially the new app, it makes it much easier for me to use. The voice that announces the stops [inside the bus] and also the announcement that Ben, the voice [at the bus station] that announces which bus has arrived, which is there.”

4.3.2. Theme 2: Arising Barriers When Using the Bus

The emergence of physical and social barriers in various links of travel chain was reported by participants.

To and from Bus Stop or Station

Participants reported encountering physical barriers on their way to and from the bus stop. The barriers included long walking distance, holes, snow, irregular sidewalk surfaces, etc. For example, one woman with a physical disability (35-year-old) said, “… But it’s more the road that’s not going well. There are sidewalks that aren’t very nice all the time… Then the distance, sometimes, to get to the stop, I mean. Maybe that could be an issue.” Another participant with a physical disability (20-year-old) who used a manual wheelchair added, “Sometimes the sidewalks are poorly made and there are holes, so there’s a risk of falling or the sidewalks aren’t even. So, it’s hard to get up small slopes or it’s not easy to use the sidewalk when you’re in a wheelchair.” The emergence of physical barriers on sidewalks can particularly compromise the mobility of visually impaired people, especially with the snow on the sidewalks. For example, one woman with visual disability (42-year-old) using a walking stick stated, “When there is snow, the sidewalks are all hidden by snow. For us, it is with the walking sticks, it is not easy in the snow to know whether you’re on the sidewalk or not.” A man with a visual impairment (57-year-old) using a walking stick also commented, “… With the walking sticks, you have to be careful. Sometimes in winter, [the sidewalks] are not too well cleared, it can happen where you’re on the snow.” Participants also reported experimented social barriers in this point of travel chain. For example, one man with physical disability (63-year-old) using a walker said, “… All related to the same thing, the class of society. They [people] don’t move out of the way [on the sidewalks]. They walk 2–3 people wide, but they don’t move out of the way. That’s another problem.”

At the Bus Stops or Stations

Participants also indicated having experienced physical barriers at bus stops that included the lack of accessible bus stops at some locations. One man with physical disability (48-year-old) using a manual wheelchair made the following observation while using the bus, “in the summer, the RTC services are provide satisfactorily, although there aren’t enough accessible stops yet.” On this link of travel chain, participants also encountered social barriers. For example, one woman using a manual wheelchair said, “I was ignored [by a bus driver] at the stop. Yes, I told you that at the beginning, but that was once… I was ignored, even if I held out my hand to say I wanted to board. Finally, the same time, I took another bus after that.” Another woman with low vision (74-year-old) stated, “Another problem, but this one’s quite important, is that bus shelters often change place temporarily. It’s frequent, mainly because of all the work that needs to be done. But it can also be because there’s a special event, the street is occupied for a demonstration or, I don’t know, a bike race. There are always reasons to temporarily move bus stops. So, that’s dramatic for me, when I get to a bus stop that has a big sign saying the stop has been moved, I’m able to see the message that the stop has been moved, but my difficulty is finding where the stop is.”

During Boarding

Participants also mentioned that they had encountered physical and social challenges when boarding. For example, a woman with physical disability (43-year-old) using a manual wheelchair had difficulty using an access ramp when boarding and indicated, “I found the ramp to get on the bus steep.” Another woman with physical and language disabilities post-stroke (50-year-old) who did not use a mobility aid had problems with the presence of snow when boarding and said, “In winter, it’s difficult, because there’s a lot of snow, a lot of snowbanks, and it’s hard to get on and off the bus. You must be really careful.”

Participants also mentioned having encountered social barriers during boarding. These barriers particularly concerned the lack of courtesy from passengers without disabilities and bus drivers. A manual wheelchair user said, “Sometimes people who are not very courteous and try to board before us, because normally we are supposed to board first and people after, but there are some who hurry to board.” A woman with a physical disability (58-year-old) who uses walking sticks said, “When they (bus drivers) did not kneel the bus for me, it is much more complicated, it was much more difficult… because I had a harder time getting on the bus. It is much harder for me to get on at that moment.”

Inside the Bus

Physical barriers were also experienced by participants, even on public transportation, and included the low volume of audible announcements, invisibility of the next stop display for wheelchair users due to their installation back to the information screens in the bus, and insufficient space reserved for people with disabilities on the metrobus. For example, a woman with low vision (74-year-old) who relies heavily on her hearing to interact with her environment expressed her difficulties on public transportation in these terms, “There is a question of volume to hear it. You know, if the bus is crowded, then that, then there is chatter, the audible warning needs to be loud enough to be heard. But there are also times when I wonder if it is that, maybe the driver was tired of hearing it, then he turned the volume down.” Another participant who also used a manual wheelchair user (48-year-old) stated, “As I was saying, inside the bus, the only problem is that you cannot see the bus screen, that’s the only problem I have.” Another woman with physical disability who used a power wheelchair added, “getting into the space reserved for people with reduced mobility on the bus is difficult because it is really not wide. They’ve left the minimum space for an electric wheelchair there, but you know, there are [grab] bars on each side, there is like a few hundred centimeters on each side. So that is also a challenge because I have to do it quickly, but I do not have much space. So, this is something that is difficult.”

Beyond physical barriers, participants also encountered social challenges within the public transportation system, that included sudden acceleration, and braking, seats reserved people with disabilities occupied by passengers without disabilities, and high cost of fares. The woman with post-stroke physical and language disabilities (50-year-old) reported, “… So I fell. They [bus drivers] go fast. I do not have time to hang on.” One man with physical disability (74-year-old) who used walking sticks added, “Then, sometimes, the drivers, there are some who go fast, sometimes there are some who almost fall into the bus, because there are drivers who go too fast you know. So, when there is a lot of people around, when the driver puts on the brake too hard, some of them fly off the bus.” A woman with physical disability (58-year-old) who also used walking sticks pointed out negative attitudes of other passengers describing, “The other thing was when the seats at the beginning [reserved for people with reduced mobility] were taken [by other passengers without disabilities], and then people would not give up their seats. I had to go and sit far away. That’s harder too.” One man with physical disability (60-year-old) using a wheelchair commented on the cost of fares, saying “I think the RTC still has wars to fight: lowering transportation fares. I earn less than $22,000 CAD a year. And then, it is a matter of pennies, of transportation costs.”

Of all these barriers, the one most pointed out by participants was winter. This barrier was the “common denominator” for all participants, often preventing them from getting around their community by bus.

4.3.3. Theme 3: P-SAMI Supports Life Habits

Participants reported maintaining or improving participation in daily activities and social roles, including going out for visits, work, leisure, grocery shopping, appointments, work, etc. For example, one man with physical disability (62-year-old) using a wheelchair said, “… I took the RTC [bus] to go to the restaurant, I went not far from our home to the Galeries de Charlesbourg with the [bus] 801. I went to see my mother, who was in a private RPA [residence for older adults] across from Patro Roc-Amadour [Quebec City Community Center]. I took the 801 and it worked out well. I went to visit my mother, who is in a private residence. I also went to rue Saint-Jean, once, I went up to René Lévesque. Once, yes, for leisure.”

4.3.4. Theme 4: Suggestions

Suggestions related to P-SAMI and RTC services emerged from verbatims.

Suggestions for P-SAMI

The most important suggestion for the P-SAMI was to practice or be accompanied in a real-world environment in order to be able to use the public transportation more confidently. For example, a man with physical disability (48-year-old) using a manual wheelchair said, “It could be something that could be done to go and do some training in a real context. That could be good. Because, yes, as I say, over there it is easy; there is no one, there is nothing, everything is quiet. On the ground, it is more hectic than that, I mean, there are people embarking, there are people disembarking, you have to weave your way through the people embarking and disembarking. This can not be really explained in training.”

Suggestions for RTC Services

Participants also made suggestions regarding RTC services, which included raising awareness among drivers of the needs of people with disabilities in using public transportation services, adding an additional wheelchair space and a screen to display upcoming stops in the view of wheelchair users, and provision of more accessible bus stops. For example, a woman with physical disability (30-year-old) using a power wheelchair said, “I think the RTC has to make drivers aware of the reality of people with reduced mobility that we are on wheels. So, we need to be given time to settle in before setting off again. You have [also] to let us get off first before letting people in [other passengers], … Otherwise, it does not work, because I take up all the space in the aisle [laughs].” Another manual wheelchair (59-year-old) user suggested this, “To add a seat or two to the buses…” One man with physical disability (48-year-old) using a manual wheelchair also reported, “We want to see the board [the screen] on the bus that tells us what stop we’re at and everything… That’s it. Our backs are to the board at the entrance. So, we cannot see it. It might help to have another board [the screen] further back.” Another one added (57-year-old), “there should be more bus stops, then the most accessible bus.”

4.4. Mixed Findings

Mixed findings are presented through a joint display diagram (

Table 3. Joint display of quantitative and qualitative finding within 14-day before and after P-SAMI.

Dependent Variables	Quantitative Findings	Qualitative Findings	Meta-Inferences
Self-efficacy	VAS scores before versus after P-SAMI showed statistically significant difference (p < 0.01).	“I feel confident. I also feel confident that we can take public transit in the city, rather than waiting at home for STAC [Paratransit Service of Canada] in that sense. My confidence has improved.” (A man with visual disability; 57-year-old) “There is more confidence. Now, as I was saying, I have more tools to know what to do, if I am in a bad situation, I can see that it is feasible. I have seen to what extent it is suitable too. It is increased my confidence.” (A woman wheelchair user; 32-year-old)	Convergence: The results of two methods indicated an improvement in the self-efficacy of people with disabilities following their participation in the P-SAMI
Life-space mobility	LSA scores before versus after p-SAMI demonstrated no statistically significant difference (p ˃ 0.05)	“I was more motivated by public transit, I was less afraid, the RTC, yes. I took the RTC [bus] to go to the restaurant, I went not far from our home to the Galeries de Charlesbourg with the [bus] 801. I went to see my mother, who was in a private RPA [residence for older adults] across from Patro Roc-Amadour [Quebec City Community Center]. I took the 801 and it worked out well. I went to visit my mother, who is in a private residence. I also went to rue Saint-Jean, once, I went up to René Lévesque. Once, yes, for leisure.” (A man with physical disability; 62-year-old)	Divergence: Only qualitative showed a gain in mobility, especially in the bus use after P-SAMI
Satisfaction	COPM scores (mean ± SD) before versus after P-SAMI indicated statistically significant difference (p < 0.01)	“I’m Um, I’m very satisfied. It’s going well overall. And I can find my seat pretty easily. And my trip is going pretty well. I have, I have, um, as much as the drivers are willing to help me, the passengers are also willing to help me, whether it’s to change buses, to transfer, or sometimes to find the stop if I’m not quite at the stop. I ask to find out how long it will be before the bus arrives. And especially the new app, it makes it much easier for me to use. The voice that announces the stops is also there.” (A man with visual disability; 58-year-old)	Convergence: Both results demonstrated improvements or a high level of satisfaction with bus use among people with disabilities after P-SAMI.

). Both quantitative and qualitative findings show a gain in transportation self-efficacy after P-SAMI. These findings also converged on the dependent variable of satisfaction with bus use. However, while quantitative findings did not demonstrate statistically significant difference in life-space mobility (p > 0.05), qualitative findings indicate that some participants used buses to fulfill their life habits.

5. Discussion

The objectives of this study were to evaluate the influence of P-SAMI on transportation self-efficacy, mobility and satisfaction with bus use, and understand the experience and perceptions towards P-SAMI and the use of this mode of transport among people with disabilities. The results from quantitative data, supported by theme 1 from qualitative data (Figure 1), suggested that the P-SAMI induces psychological improvements in transportation self-efficacy and satisfaction with the use of buses when implemented in a non-realistic setting. These findings represent novel and valuable insights from this study and are consistent with previous research on the main dependent variable, namely transportation self-efficacy [13,24,25,36]. Moreover, these results align with the fundamental principle that intervention programs can affect social cognitive processes, such as self-efficacy [55]. As mentioned earlier, self-efficacy is the basis of the performance and the strong predictor of future behaviors [19,21]. That is, people need to have confidence in their ability to initiate new behavior [56] and to have positive initial experiences of behavior change [57]. Consequently, participants who reported or observed improvements in their transportation self-efficacy used or are likely to use buses to accomplish activities of daily living and social roles. Even though participants believed they are capable of using buses for fulfilling daily life activities, some of them reduced or did not engage in any life-space mobility, particularly regarding interurban trips, within 14-day following the P-SAMI, as shown by the post-intervention LSA scores (Table 2). This may be explained by the fact that they did not feel like doing so.

Although participants improved transportation self-efficacy and satisfaction with using the bus after P-SAMI, as shown in theme 2 (Figure 1), they reported encountering physical and social barriers during their public transportation experience. This seems to confirm what Mwaka et al. [8] highlighted in their scoping review aimed at identifying barriers and facilitators to the use of public transportation by people with disabilities. Indeed, they point out that these barriers persist despite the adoption of the Convention on the Rights of Persons with Disabilities (CRPD). Hence the importance of continuing to work on improving accessibility of this mode of transport, through physical and technological amenities, travel training programs for people with disabilities, training for drivers on the needs of people with disabilities, and raising awareness among drivers and other passengers without disabilities, as working on accessibility is a continuous and holistic process, involving engineers, policymakers, researchers, etc., where current conditions are always being improved and made more accessible [58].

The results of this study also indicate that some participants were satisfied with P-SAMI. However, others found their satisfaction dampened by the lack of experience in a real-life environment, as the practical component of P-SAMI consisted of simulation. Since, it has been established that the delivery and structure of an intervention can influence adherence and outcomes [59], training programs aimed at improving public transportation use should be based not only on didactic teaching and simulation, but also and above all on practical experience in a real-life environment. It is vital that people with disabilities are accompanied in such an environment to facilitate public transportation use more independently and confidentially.

As it is also recognized that self-efficacy is influenced by successful experience, social modeling, social persuasion and emotional and physiological reactions [19,21,22,60], a transportation training program for people with disabilities that draws on these four sources of information may enable them to improve not only their sense of personal efficacy but also their performance on transportation tasks.

Our results suggest that public transportation may support people with disabilities in the realization of participation in meaningful life habits. This is even more relevant if one acts not only on physical and social barriers, but also on personal factors such as lack of confidence in one’s ability to use public transportation, by providing people with disabilities with travel training programs.

6. Strengths and Limitations

The strength of this study lies in its mixed methods approach, collaborative and reflexive approach to qualitative data analysis, and triangulation of researchers used to achieve its objectives. The mixed approach provided a better understanding of participants’ perceptions of P-SAMI and public transportation use, beyond assessments performed. In addition to coding and collaborative and reflexive approach to qualitative data analysis, the triangulation of researchers significantly contributed to reducing the risk of errors and thereby reinforce the reliability of this study. However, the present study has seven major limitations. The first limitation concerned the use of a pre-post design for measuring an intervention, while only randomized trials are robust and gold standard methods designed to measure the effectiveness of interventions [61]. Although promising, results on this non-controlled trial should be interpreted with caution as definitive conclusions about the effect of P-SAMI cannot be made. The second limitation pertained to the partner’s role in participants recruitment. Indeed, having a partner assist with recruiting participants can introduce selection bias into the study population because the individuals they bring in are unlikely to represent the full range of people in the target population. Instead, these participants may share characteristics with the recruiter—such as similar backgrounds, interests, or personality traits or they may simply be more willing to participate because of their personal relationship with the recruiter. This creates a form of sampling bias or self-selection bias. As a result, the study sample may differ systematically from those who were eligible but not recruited. For example, participants may be more cooperative, more motivated to help, or more positively disposed toward the study, which can influence both who enters the sample and how they respond once enrolled. These kinds of systematic differences reduce the representativeness of the sample and threaten the study’s external validity, limiting how well the findings can be generalized to the broader population. Another source of selection bias is that the inclusion criteria for this study did not require participants to be able to travel to the RTC facility for training. As the intervention was provided at this location and the population under study may have travel difficulties, requiring participants to travel to the RTC may have introduced selection bias into the sample. The fourth limitation concerns data collection with the LSA. Because the LSA captures the prior 4 weeks, our post-assessment (within 14-day window) likely included pre-intervention activity, potentially biasing effects. Therefore, the LSA results should be interpreted with some caution. Another limitation concerned the underrepresentation of groups in the sample. The sample was relatively heterogeneous, with a large predominance of people with physical disabilities and users of manual wheelchairs and walking sticks. This imbalance prevented us from conducting sub-analyses to verify the variation in participants’ scores between groups. Furthermore, the small sample size combined with the fact that there were only three types of disabilities (disproportionately represented) also limit the possibility of generalizing the findings of this study to all people with disabilities. The last limitation also pertained to the inability to capture the same information in the older age groups, where social economic status might be more determined by wealth. Future research could attempt to use randomized trials to evaluate the effectiveness of a public transportation familiarization program not only for people with physical, visual, and language disabilities, but also for people with intellectual and developmental disabilities, autism spectrum disorders and hearing loss.

7. Conclusions

This study shows that people with disabilities who attended P-SAMI improved their transportation self-efficacy and satisfaction with bus use. This enabled them to fulfill activities of daily living and social participation by using this mode of transport. However, they reported encountering physical and social barriers during their community mobility experience. On the other hand, they suggested that the P-SAMI should include a public transportation familiarization session in a real-life environment, to empower them to use Quebec City’s public transportation network with much greater confidence and independence. Given this, the RTC should continue to deploy efforts, in collaboration with its partners, to improve the accessibility of its transportation network because working on accessibility is a continuous and holistic process, involving engineers, policymakers, researchers, etc., where current conditions are always being improved and made more accessible.