Disability Inclusion Research Articles

The process of developing and piloting a tool in the Maldives and Zimbabwe for assessing disability inclusion in health systems performance

There are 1.3 billion people with disabilities globally. On average, they experience greater healthcare needs and more barriers accessing healthcare. Yet, health systems have failed to adequately include people with disabilities. The purpose of this study was to develop and pilot-test a tool for assessing disability inclusion in health system performance. We presented the “Missing Billion” disability-inclusive health system framework, which includes 4 system-level components and 5 service delivery components, and outputs and outcomes. We developed a tool, consisting of 48 indicators related to the framework components. We consulted international experts, who considered the framework and indicator set to be logical and comprehensive. The tool was pilot-tested in the Maldives (2020) and Zimbabwe (2021), working with local researchers to collect relevant data through document review and key informant interviews. The pilot data demonstrated that collecting data on the indicators was feasible. The tool highlighted areas where the health systems were performing well in terms of disability inclusion (e.g. governance) and other areas where there were large gaps (e.g. leadership) or lack of data (e.g. accessibility, outputs and outcomes). The indicators were updated and refined. We established a process for undertaking the assessment, highlighting the importance of leadership and ownership by the Ministry of Health, to facilitate data collection and implementation of recommendations. In conclusion, this new tool for assessing disability inclusion in health systems performance can help to identify key issues and guide and monitor action.

Disability and Vulnerable Groups Inclusion in COVID-19 Policy and Planning in Sub-Sahara African Countries

Background: The COVID-19 pandemic has caused an excess burden of disease in disabled and vulnerable populations. These populations may face an increased risk of contracting COVID-19, greater demand for services and social support, and reduced access to treatment. Despite various national and international efforts towards disability rights and inclusion, substantial gaps exist between disability rights legislation and its implementation. Aims: To assess the inclusion of people with disability and other vulnerable groups in policy and planning documents related to the COVID-19 pandemic response in sub-Sahara Africa. Methods: We conducted content analysis using the EquiFrame policy analysis tool and assessed commitment to 12 vulnerable groups and 21 core human rights in policy and planning documents related to the COVID-19 pandemic. We included documents on general pandemic response, stakeholder engagement, risk communication, and the COVID-19 vaccine from five sub-Saharan African countries, including Nigeria, South Africa, Ethiopia, Kenya, and Zambia. Results: The study highlights the varying degrees to which countries integrate disability, vulnerable groups, and other core human rights concepts into their COVID-19 health policies and planning documents. Only Kenya mentioned disability in their pandemic response plan. However, all countries have explicitly mentioned disability in their stakeholder engagement plans. Except for Kenya, all countries have included disability in their risk communication plans. Notably, South Africa and Zambia demonstrated extensive disability inclusion in their stakeholder engagement and vaccine plan. Thus, these countries have the potential for comprehensive and inclusive health policymaking. In contrast, Nigeria and Ethiopia lag, therefore highlighting areas of improvement across all policy domains. Conclusion: The findings emphasize the critical importance of not only mentioning disability and other vulnerable groups, but also ensuring the depth and quality of this inclusion. While there are positive strides in certain areas, there remains a consistent need for deeper and broader inclusion across all policy domains. Received: 10 September 2024 | Reviewed: 16 October 2024 | Revised: 03 November 2024 | Accepted: 05 November 2024.

An assessment of the Education Management Information System in Sierra Leone and potential for enhanced disability inclusiveness

Millions of children live with disabilities worldwide and many of them are at risk of being excluded from education, particularly in low- and middle-income countries (LMICs). For children with disabilities enrolled in schools, learning outcomes and completion rates are often lower compared to that of their peers without disabilities. The effective and equitable access to education for all requires robust education data systems to monitor potential inequalities. For this purpose, Education Management Information Systems (EMIS) have been deployed, with varying degrees of effectiveness. In Sierra Leone, EMIS was established in 2006 but the evidence on its effectiveness and inclusiveness remains limited. This study aimed to examine the strengths and weaknesses of the current EMIS and determine how it can be made more disability inclusive. Guided by the System Approach for Better Education Results (SABER) EMIS framework, the study collected data through a documentary review, interviews and focus group discussions with purposively selected education stakeholders. The study revealed that EMIS in Sierra Leone is at the emerging stage of development and while it is a major government priority, there are several weaknesses that need to be addressed in order to maximise its overall performance. At present, EMIS equates to the annual school census; it presents data on a number of indicators, including disability status, but only in the aggregate format. EMIS does not contain any individual student data making educational planning challenging. The study provides a number of recommendations for system strengthening.

Constituencies of Care: Imagining Possibilities of Access in US Theatre Pedagogy and Production

Abstract: Conversations about accessibility and representation in US theatre have increased over the past decade, but few articles address how these topics might be incorporated into our classrooms and educational rehearsal spaces. Using as a case study the rehearsal and production processes devised for the Broadway musical How to Dance in Ohio , this Note considers how access initiatives implemented in the nonprofit and professional theatre spheres might be adapted and included in US theatre pedagogical practices for introducing students to comprehensive and holistic approaches to disability inclusion and accordant access initiatives.

Selection of a classroom observation tool for disability inclusion in Uganda.

Obuntu Bulamu is a Ugandan intervention promoting inclusive education for children with disabilities. This culturally appropriate approach, based on the Ubuntu philosophy, utilises peer-to-peer support activities for children, parents and teachers. To effectively measure the intervention's impact on disability inclusion, the study aimed to select, adapt and test classroom observation instruments suitable for the Ugandan context. Three structured classroom observation tools were selected and piloted in 10 primary schools in Wakiso District: The Classroom Observation Checklist (CoC), the Teacher-Pupil Observation Tool (T-POT) and the Interaction Engagement Scale (IES). These tools were adapted to ensure cultural relevance and applicability within Ugandan school settings. Factors like class size, teaching methods, cultural relevance, language and ease of use influenced the suitability of the selected tool. The CoC emerged as a more effective tool with a strong internal consistency (Cronbach's alpha of 0.80) for capturing inclusiveness and peer-to-peer support in the classroom compared to the T-POT and IES. The study findings emphasise the significance of adapting and testing tools in specific cultural contexts and low-income country settings and considering culturally contextual factors like class size, teaching methods, language complexity and ease of use when measuring disability inclusion in primary schools. The selection of a classroom observation tool for the Obuntu Bulamu randomised control trial contributed to African disability knowledge and practices designed on and for the continent.

Mindful Transportation: A Conceptual Framework for Enhancing Accessibility for People with Disabilities in Malaysia

This conceptual paper explores the integration of mindfulness principles into the development of transportation services for people with disabilities (PWDs) in Malaysia. Transportation plays a critical role in promoting inclusivity and enhancing the quality of life for PWDs, yet accessibility remains a significant challenge due to infrastructural barriers, lack of awareness, and limited empathy from service providers. Drawing on the concepts of mindfulness, which are rooted in awareness, empathy, and responsiveness, this paper proposes a framework that emphasizes inclusivity, respect, and collaboration among key stakeholders. The proposed framework emphasizes the need for a holistic approach that incorporates physical accessibility, staff training, and policy reforms. Inclusivity involves modifying infrastructure to meet universal design standards, while empathy requires transport providers to understand the unique challenges faced by PWDs and offer compassionate, tailored services. Responsiveness, a key element of mindfulness, calls for flexible and adaptive transport services that cater to the real-time needs of PWDs, ensuring that they can access public transportation with ease and dignity. By applying this mindful approach, the transportation system can become more accommodating and respectful toward PWDs, thereby reducing social exclusion and improving their mobility. This paper contributes to the growing body of literature on disability inclusion and provides actionable strategies for policymakers, transport providers, and disability organizations to work together in creating a more accessible public transportation system. Future research should investigate the practical application of this framework and its potential to drive policy changes that benefit PWDs across Malaysia.

Counting the costs: understanding the extra costs of living with disability in Indonesia to advance inclusive policies within the SDG framework.

The Sustainable Development Goals (SDGs) are a multidimensional framework for monitoring progress on disability inclusion over time and among countries where reliable, disability disaggregated data is available. However, the SDGs alone do not provide insights into the causes of the social and economic disparities that people with disabilities face or offer specific policy solutions to alleviate them. This paper highlights the extra costs of living with disability in Indonesia to advance the country's commitment to further the rights of people with disabilities. It utilizes three primary estimation methods, combining an analyses of national survey data with primary data from interviews and focus group discussions. Findings reveal significant and varying costs based on disability type, severity and life cycle stages. It also highlights the unaffordability of these costs for most individuals with disabilities and their families. Leveraging these estimates, the paper proposes 'disability concessions' aligned with Indonesia's legal framework on disability inclusion, aiming to alleviate financial burdens through discounts across health, education, utilities and transportation. By contributing to methodological approaches in understanding extra costs of living with disability inclusion in emerging country context and promoting discussions on leveraging the results for disability inclusive policymaking, this paper supplements the SDG framework to foster disability inclusion.

Breaking the mold when organizing: Disability inclusion and countercultural practices

This paper explores the potential and limits of countercultural practices in reshaping arts-based approaches to disability inclusion, as increasingly advocated by alternative and community-based organizations. Adopting the framework of crip theory, the study focuses on the use of noise music in a French association of alternative organizations dedicated to mutual aid. We find that countercultural practices in that context rework disability inclusion in three ways: (1) By considering accessibility as not merely the removal of barriers, but also as a cultural transformation characterized by friction; (2) By emphasizing the importance of disharmony to challenge normalizing and assimilatory expectations related to the climate of inclusion; (3) By fostering economic eccentricity that shifts the valorization of disability from an individual to a collective level. We consider these practices as examples of an approach that overcomes the simple inclusion/exclusion dichotomy and claims the value of being in the margins. At the same time, these practices are also characterized by an essential tension between margins and center, as they often rely on the very organizational forms they want to counter. We propose the term “dis-including” to conceptualize this ambivalent, as well as contestatory and non-dichotomous character of the countercultural way of practicing inclusion. Dis-including is not a simple way out of marginalization, but a practice that questions established values, shifts the focus from the individual to the collective and requires breaking the mold when organizing. We therefore highlight the potential of dis-including to reshape mainstream notions of disability inclusion, extending beyond alternative organizations.

Using participatory and inclusive methodologies to explore inclusive education in Africa.

This paper presents researchers' experiences using participatory, inclusive research methodologies to explore aspects of inclusive education, with children with disabilities, parents, and teachers in Nigeria and Kenya. The objective is to describe working with children and adults with disabilities, as research collaborators, alongside local INGO staff and OPD partners. In Kenya we worked with 9 peer researchers with disabilities to run focus groups and interviews with children with disabilities, parents and teachers about inclusive pre-school education. In Nigeria we ran participatory workshops with children with disabilities, and their parents discussing what makes school and community settings inclusive, to inform the design of a Wellbeing and Inclusion checklist. The studies were based in pilot primary schools and Early Childhood Development and Education (ECDE or pre-school) classes in Nigeria and Kenya respectively. The data produced were recordings and notes from focus group discussions, interviews and activities and reflections from the peer researchers. Data analysis was an inclusive participatory process of thematic analysis carried out in person and online. These innovative approaches demonstrate that with careful planning and support, both adults and children with disabilities can be involved very directly in research processes not just as participants but as researchers. We argue that using participatory, disability-inclusive approaches helps to make the findings more nuanced and genuine and the data and outputs generated uniquely grounded in people's realities and perspectives. These methods can potentially inform the mainstreaming of a disability inclusion approach into international development debates and activities.

Health sciences training for disability inclusion: the need to engage with emotion

Material aspects of disability inequality, such as access to quality services, housing and employment, are an urgent, worldwide concern. Less recognised though, are psychological layers of prejudice and discrimination, which...

Access and Inclusion Go to the Zoo

ABSTRACT Organizations such as zoos and museums offer educational experiences, along with opportunities for leisure and enjoyment, which should not be denied due to lack of access. In this case study, we present a process through which professionals in disability-related fields collaborated with a local community zoo to improve accessibility and inclusive experiences for visitors with disabilities. Recommendations are provided for conducting needs assessments and identifying and implementing new initiatives. We posit a four-stage process for accessibility improvement: Compliance, Commitment, Capacity, and Change. Organizations can use this framework to engage in meaningful work around disability access and inclusion.

Disabilities in Nutrition and Dietetics MIG ('Disabilities MIG') Grant-funded Project Enhances Disability Inclusion via Presentations, Exhibit and Registration Packet Inserts at 5 Affiliate Annual Conferences in Spring 2024

Disabilities in Nutrition and Dietetics MIG ('Disabilities MIG') Grant-funded Project Enhances Disability Inclusion via Presentations, Exhibit and Registration Packet Inserts at 5 Affiliate Annual Conferences in Spring 2024

Opportunities promoting social inclusion in elementary school learning context: study of Merdeka Curriculum the Indonesian policies on GEDSI (Gender, Disability, and Social Inclusion) framework

Social inclusion is an effort to improve the dignity of disadvantaged individuals so that they can engage in social life. This research explains how the Merdeka Curriculum can direct students as social beings who have character and can accept various roles in the surrounding community. In essence, social inclusion is beginning to take shape and play a crucial role in education. The purpose of this research is to examine the potential of the Merdeka Curriculum policy in promoting social inclusion in the elementary school learning context. Bibliometric analysis is employed to examine publication trends using the Google Scholar database from 2013 to 2023. A total of 760 articles gathered from Publish or Perish are then subjected to data visualization analysis using a VOS viewer to obtain network, overlay, and density visualization. The research findings indicate that studies related to the Merdeka Curriculum significantly increased in 2023 in line with its implementation, but studies addressing social inclusion were relatively scarce. Based on network visualization, 59 terms are grouped into 9 clusters. The term 'Multiculturalism' exhibited a relatively high link strength in connection with terms such as 'new curriculum,' 'modern,' and 'national curriculum' in the current context of the Merdeka Curriculum policy. Other terms found include 'diversity,' 'social inclusion,' and 'social cohesion.' The co-authorship analysis identified 1543 contributing authors. Given Indonesia's multicultural nature, characterized by diversity in various dimensions, Researchers focus the findings of this research as a guide for educators to consistently provide inclusive, comprehensive, and interesting teaching approaches to all students.

Digital storytelling to promote disability-inclusive research in Africa

Background: Digital stories have been shown to be effective in sharing information. The Partnerships for Inclusive Research and Learning (PIRL) was a 4-year international participatory research project focussed on the digital divide in inclusive research.Objectives: Members of PIRL share their experience of using digital storytelling to get key messages from the project to a wide range of people.Method: Members of PIRL were invited to develop digital stories and create project-specific guidelines for digital story development. Seven people participated in workshops given by experts, read literature, watched digital stories and discussed how to create digital stories.Results: The group created six digital stories, each one addressing a different aspect related to disability-inclusive research, with many having a focus on Africa and the creation of credible African evidence. The importance of assisting community members to think about and support research and evidence creation was one of the goals of the project. The videos provide an avenue to share insights about disability-inclusive development research. Group members stated that being part of the process significantly improved their understanding of translating evidence into formats that are more understandable.Conclusion: Creating digital stories requires commitment, a significant amount of time, access to digital tools, and financial resources. Working collaboratively on this project was not only meaningful but also encouraged positive working relationships and fostered critical thinking.Contribution: This article contributes to a better understanding of ways in which digital storytelling can be used in knowledge-sharing strategies to promote disability inclusion.

Disability Inclusion in Development Efforts: Analyzing the United States Agency for International Development’s Funding Solicitations for Evidence of Inclusive Practices

In 1997, the United States Agency for International Development established a policy focused on including people with disabilities in its development efforts. For the past two decades, this initiative has been echoed globally, yet research on its effectiveness remains limited. This study revisits a previous 2015 analysis by examining the language in the agency’s 2021 solicitations, a total of 194, which detail program requirements and activities. The research reveals an incomplete adherence to the commitment to including persons with disabilities. Of the solicitations, 44% did not mention persons with disabilities. Thirty-eight percent ( n = 92) of Requests for Applications included some or significant inclusive language, while 23% ( n = 22) of Annual Program Statement solicitations did. All ( n = 11) Requests for Proposals had some degree of inclusive language. Education and global health are the most inclusive sectors. This study also identifies four practices in the more inclusive solicitations: (a) explicit clarity on who to engage, (b) inclusion of instruments to protect persons with disabilities, (c) the outlining of indicators linked directly to persons with disabilities, and (d) mandated co-design and engagement with persons with disabilities. This highlights a need for more consistent inclusion of disability considerations in development solicitations.

Factors influencing persons with disabilities perception in entrepreneurship: The mediating effect of entrepreneurial motivation

Disability inclusion is important to ensure everybody has the same opportunities in society, which is critical in achieving the Sustainable Development Goals. Persons with Disabilities (PWDs) are one of the marginalized communities and most of them are living in poverty. Disabilities encounter many challenges internally and externally due to their disabilities. They are struggling to keep their jobs due to their own self-confidence and social stigma and entrepreneurship is said to be the best option for PWDs to gain economic liberation. However, many PWDs still depend on government assistance and public donations instead of starting their own business. This study investigates the mediating effect of entrepreneurial motivation on the relationship between internal and external factors of PWDs’ perceptions of entrepreneurship in Malaysia. A quantitative approach to the survey was carried out. A sample of seventy-seven PWDs was gathered using face-to-face and online surveys through purposive sampling. The data were analyzed using structural equation modelling. The results show that only internal factors influence PWDs’ entrepreneurial personal perception. Entrepreneurial motivation plays a crucial mediating role in the relationship between internal and external factors and entrepreneurial personal perception. The study is helpful for the relevant parties to assist PWDs in becoming financially independent through entrepreneurship by focusing more on their internal strengths. Proper training and coaching assist PWDs in being more resilient when facing adversity.

Growing a Healthy Church: A Theological Reflection on Disability Inclusivity in Ghana

The interplay of medical, social, cultural and religious factors has led to stigma and marginalization of people with disabilities (PWDs) in the Ghanaian context. Observable church beliefs and practices render the relations between so-called abled-bodied people and people with disabilities (PWDs) as an ‘us and them’ relationship. Ironically, the church is supposed to be a place of welcome, restoration and integration. However, with its emphasis on ‘healing before integration,’ the church space has become a place of exclusion for many PWDs. The study argues that the various ways of modelling disability, and the contemporary Ghanaian Christian response to disability are inadequate and lead to the exclusion of PWDs. The study being a qualitative one used both primary and secondary sources. Observations were made at traditional healing centres and healing and revival church services of some churches in the Kumasi Metropolitan Area (KMA) where PWDs were present. Also, journal articles, books, unpublished dissertations, and church documents on the subject matter were consulted. The study points to the fact that a disability-friendly theology must be constructed in order to guide the church to be disability inclusive and hence engender full participation of PWDs in the various ministries of the church in Ghana. The study recommends ways of constructing a disability-inclusive theology in view of the intersection between Akan traditional religion and contemporary Christian response to disability. This article seeks to contribute to the debate on disability inclusivity in the contemporary Ghanaian church, focusing on its importance in promoting comprehensive healing and inclusion for PWDs. Keywords: PWDs (Persons With Disability), Pentecostalism/neo-Pentecostalism, Exclusivity, Inclusivity, Theology of Disabilty.

Inclusion of disability in primary healthcare facilities and socioeconomic inequity in Brazil.

To describe disability-related performance and inequality nationwide in Brazil, and the changes that took place between 2012 and 2019 after the introduction of Programme for Improving Primary Care Access and Quality (PMAQ). We derived scores for disability-related care and accessibility of primary healthcare facilities from PMAQ indicators collected in round 1 (2011-2013), and round 3 (2015-2019). We assessed how scores changed after the introduction of PMAQ. We used census data on per capita income of local areas to examine the disability-specific care and accessibility scores by income group. We undertook ordinary least squares regressions to examine the association between PMAQ scores and per capita income of each local area across implementation rounds. Disability-related care scores were low in round 1 (18.8, 95%CI 18.3-19.3, out of a possible 100) and improved slightly by round 3 (22.5, 95%CI 22.0-23.1). Accessibility of primary healthcare facilities was also poor in round 1 (30.3, 95%CI 29.8-30.8) but doubled by round 3 (60.8, 95%CI 60.3-61.3). There were large socioeconomic inequalities in round 1, with both scores approximately twice as high in the richest compared to the poorest group. Inequalities weakened somewhat for accessibility scores by round 3. These trends were confirmed through regression analyses, controlling for other area characteristics. Disability-related and accessibility scores also varied strongly between states in both rounds. People with disabilities are being left behind by the Brazilian healthcare system, particularly in poor areas, which will challenge the achievement of universal health coverage.

A collaborative approach to support people with a disability living in Australian group homes during the COVID-19 pandemic: a case study.

In this case study we describe how Sydney Local Health District (SLHD) Disability Inclusion and Advice Service (DIAS) provided support to disability group homes during the COVID-19 Delta and Omicron waves. The study provides insights into group home providers' experience of supports implemented by SLHD and other stakeholders. A mixed method approach was undertaken that included analysing data from a database and electronic medical records and a survey of disability group home managers. DIAS developed a range of processes to support prevention, outbreak preparedness and response. This included developing a Disability Shared Living COVID-19 Pathway, engaging with group home providers through a fortnightly Community of Practice, assisting with improving vaccination status and procuring personal protective equipment. During an outbreak DIAS provided a 24h, 7days per week on call support, coordinated outbreak management team meetings and collaborated with several internal and external stakeholders. SLHD infection prevention and control nurses were recruited to undertake a process of reviewing outbreak management plans and providing support during an outbreak. Most disability providers (86%) reported that they felt very prepared to manage outbreaks at the time of the survey (August 2022) compared with the pre-Delta wave, for which 36% reported feeling 'not prepared'. The proportion who rated the support from the stakeholders as very supportive/supportive was as follows: SLHD (100%), NSW Health (64%), National Disability Insurance Agency (50%) and National Disability Insurance Scheme Quality & Safeguards Commission (37%). Our case study provides insights into the support that LHDs can provide to disability homes in response to future outbreaks.

Improving access in medical physics residency programs for physicists with disabilities.

Within the landscape of medical physics education, residency programs are instrumental in imparting hands-on training and experiential knowledge to early-career physicists. Ensuring access to educational opportunities for physicists with disabilities is a legal, ethical, and pragmatic requirement for programs, considering that a significant proportion of the United States population has a disability. Grounded in conceptual frameworks of competency-based medical education and the social model of disability, this work provides an introduction to some practical recommendations for medical physics residency programs. Strategies include embracing universal design principles, fostering partnerships with disability service offices, using inclusive language, developing and publicizing clear procedures for disclosing disabilities and requesting accommodations, and maintaining an overall commitment to equitable access to education. This work urges medical physics residency leadership to proactively move towards training environments that support the needs of residents across the spectrum of disability, highlighting why disability inclusion fundamentally enriches diversity.