Disability Survey Research Articles

Prevalence and patterns of youth responses to standard disability survey questions

BackgroundIn 2011, the US Department of Health and Human Services adopted a minimum set of six standardized questions about disability to be used in population-based health surveys. These questions have been validated for self- and proxy-report use by adults, but how they perform for adolescents is unknown. ObjectiveTo describe how 8th grade students, 11th grade students, and young adults aged 18–24 years in Oregon answer these questions. MethodsCross-sectional study design. Data for the 8th and 11th grade students were derived from the Oregon Health Teens survey (OHT; 2017 and 2019); data for young adults aged 18–24 were from the Behavioral Risk Factor Surveillance System (BRFSS; 2017 and 2018). Unweighted counts, weighted proportions and 95% confidence intervals were calculated for socio-demographic characteristics, the six disability questions, and overall disability status (yes/no) among 8th graders (n = 14,396), 11th graders (n = 23,517), and young adults (n = 1112). ResultsResponses for 8th and 11th grade students were materially consistent for all six questions. Young adults were markedly less likely to report cognitive disability compared to 8th and 11th graders (17.2% vs. 24.9% and 27.0%, respectively) and somewhat less likely to report an independent living disability (6.5% vs. 8.6% and 9.8%, respectively). ConclusionDifferences in cognitive disabilities between adolescents and young adults may either be due to differences in underlying impairment or the result of youth interpreting this question differently than adults. Validation of the standardized disability identifiers for self-report in adolescents is needed.

Generating comprehensive functioning and disability data worldwide: development process, data analyses strategy and reliability of the WHO and World Bank Model Disability Survey

BackgroundData on functioning and disability collected at population level is essential to complement mortality and morbidity, to estimate rehabilitation needs of countries and regions and to monitor the Convention on the Rights of Persons with Disabilities (CRPD) and the Sustainable Development Goals (SDGs). The objective of this paper is to briefly report the development process of the WHO Model Disability Survey, its data analysis strategy as well as its reliability and ability to measure low to high levels of functioning and disability across countries.MethodsThe development process is described in detail, and a secondary analysis using Rasch methods is conducted to report reliability and targeting using data from eight national and two regional implementations of the survey.ResultsThe currently available versions of the Model Disability Survey are presented. The survey has good to very good internal reliability and good targeting in all included countries.ConclusionThe participatory and evidence-based development, consideration of the expertise of stakeholders, the availability of previously developed ICF-based surveys, and WHO tools targeting functioning and disability are reflected in its good to very good psychometric properties. The survey has been implemented to date in Afghanistan, Cameroon, Chile, Costa Rica, India, Laos, Pakistan, Philippines, Sri Lanka, and Tajikistan, and is used to inform policy-making, to monitor the CRPD and SDGs and to plan the delivery of rehabilitation services.

The impact of COVID-19 on the lifestyles of adolescents with cerebral palsy in the Southeast United States

BackgroundThe impact of COVID-19 on adolescents with cerebral palsy (CP) and their families is underinvestigated, particularly in the Southeastern United States. Objective/HypothesisThe objective of this study was to examine the impact of COVID-19 on lifestyle activities, general and mental health, and basic needs among a cohort of adolescents with CP in the Southeast U.S. The second purpose was to identify key factors that impacted their lifestyles. MethodsThis was a cross-sectional survey of adolescents with CP (aged 10–19 years) who completed a child-modified version of the Coronavirus Disability Survey. Health and behavior items were associated with the perceived lifestyle impact of COVID-19. ResultsA total of 101 respondents completed the survey (mean age: 14 ± 2 years). Respondents reported minimal to no change in general health since the COVID-19 outbreak. Basic needs were met for most families. Nearly all participants (94.1%) reported a mental health concern that resulted from COVID-19: 32.7% felt down or depressed; 47.5% felt little pleasure in doing things; and 64.4% felt isolated. Moreover, 74.3% reported decreased socialization, 51.5% reported reduced exercise participation, and 43.6% reported difficulties in obtaining medical care. Most participants (90.1%) were negatively affected by COVID-19, and key associated factors were reduced interactions with friends and family (p = 0.001), exercise participation (p = 0.016), interest in doing things (p = 0.005), worsened depression (p = 0.015), increased isolation from others (p = 0.02) and at home (p = 0.006), technological communication (p = 0.00), and virus exposure (p = 0.008). ConclusionsStudy findings highlight problem areas that warrant urgent intervention among adolescents with CP located within the Southeast U.S.

Outcomes of Intervention in Children with Language Difficulties in Bangladesh

Background: Both clinical audits within hospitals, and population-based surveys of childhood disability in Bangladesh, have shown that large numbers of children have speech and language difficulties. This study determined the improvement of language skills of children presenting with difficulties to the Speech, Language and Communication (SLC) clinic of the Child Development Center (CDC) in Dhaka Shishu (Children) Hospital (DSH).
 Methodology: This is a retrospective study where records of children enrolled from April 2009 to March 2014, who had visited the SLC Clinic at least 3 times over a span of 6 months were analyzed. Preverbal language skills, comprehension, and expressive language levels were measured informally based upon play and interactive sessions and observation of function. Interventions involved training parents on informal intervention techniques following some international standard guidelines. Pre and post-intervention observations on preverbal, comprehensive, and expressive language skills were recorded to determine outcomes.
 Results: Of the 706 enrolled children 11.0%, 79.2%, 9.5%, .3% were 0-<2 years, 2-<5 years, >5-9 and 10-16 years old, respectively. 69.5% of children were males. Preverbal skills (attention span, awaiting, eye contact, attention sharing, turn-taking, copying), comprehension, and expressive language status showed significant improvement between the first and last visit (p= 0.000) 
 Conclusions: Interactive play, music, books, etc. are important means of improving communication between parents and children. Professionals working with developmentally delayed children need to be trained to utilize these strategies, with the provision of appropriate facilities within clinical settings. A large majority of children can be assisted to overcome delays and optimize their potential.

Association of disability with mortality in the Spanish adult non-institutionalised population

BackgroundThere are scant studies focused on measuring the association between disability and all-cause mortality based on large representative national samples of the community-dwelling adult population; moreover, the number of such...

Role of radiofrequency ablation and cement injection for pain control in patients with spinal metastasis

BackgroundThe study aimed to investigate the effects and reliability of simultaneous vertebroplasty and radiofrequency ablation or radiofrequency ablation applied alone for pain control in patients with painful spine metastasis, and to investigate the effect of preventing tumor spread in long-term follow-up.MethodsPatients with painful vertebrae metastasis in the Afyonkarahisar Health Sciences University, Medical Faculty, Hospital Neurosurgery Clinic between 01.01.2015 and 01.06.2020 were recruited. They were divided into groups according to the surgical procedures applied. Group 1 included 26 patients who underwent radiofrequency ablation only, and group 2 included 40 patients who underwent vertebroplasty with radiofrequency ablation. Computed tomography and magnetic resonance imaging were performed in all patients pre-operation. The patients were followed for at least 6 months. Magnetic resonance imaging was performed at the end of the 6th month in neurologically stable patients. The metastatic lesion, pain, and quality of life were evaluated with Visual Analog Scale and Oswestry Disability Survey before and after the procedure.ResultsThe mean VAS score before the procedure was 8.3 ± 1.07 in the RFA group, and a statistically significant difference was observed in VAS scores at all post-procedural measurement time-points (p < 0.001). The pain scores decreased at a rate of 58.8 and 69.6% of patients showed significant improvements in the QoL in the RFA-only group. The mean VAS score was 7.44 ± 1.06 in group RFA + VP before the procedure; the difference in the mean VAS scores was statistically significant at all measurement time-points after the procedure (p < 0.001). The mean pre-treatment Oswestry Index (to assess the QoL) was 78.50% in the RFA + VP group, which improved to 14.2% after treatment.ConclusionAblation + vertebroplasty performed to control palliative pain and prevent tumor spread in patients with painful vertebral metastasis is more successful than vertebroplasty performed alone.

The relationship between unmet need for home and community-based services and health and community living outcomes

BackgroundFew studies have examined user-reported perspectives about the quality and sufficiency of home and community-based services (HCBS) and their relationship to key health and community living outcomes. ObjectiveTo examine the association between unmet need for HCBS and health and community living outcomes in a multi-state, multi-program sample of Medicaid HCBS users. MethodsWe used data from the 2017–2018 National Core Indicators-Aging and Disability (NCI-AD) survey, collected among older adults and adults with physical disabilities who were receiving Medicaid HCBS across 13 states (N = 10,263). We conducted descriptive analysis on the demographic, functional, and health characteristics of the sample, and examined the prevalence of unmet need for HCBS across five domains: 1) assistance with daily activities, 2) assistive technology, 3) home modifications, 4) transportation, and 5) sufficiency of services for meeting user needs and goals. We used logistic regressions to estimate adjusted odds ratios for the association between unmet need for HCBS and health care utilization (ED visits, hospital/rehab stays, preventative care) and community living outcomes (active in the community, interacting with family/friends, satisfaction, control). ResultsAcross the five domains, prevalence of unmet need ranged from 21% (unmet need for assistance with self-care or other daily activities) to 54% (unmet need for assistive technology). Individuals who experienced unmet need had consistently worse health and community living outcomes than those who reported no unmet need, after adjusting for key user demographic, functional, and social characteristics (p < 0.05). ConclusionsUnmet need for HCBS is consistently and significantly associated with poor health and community living outcomes among Medicaid users.

Racial and ethnic differences in perception of provider cultural competence among patients with depression and anxiety symptoms: a retrospective, population-based, cross-sectional analysis

Racial and ethnic minorities face disparities in access to health care. Culturally competent care might lessen these disparities. Few studies have studied the patients' view of providers' cultural competence, especially in psychiatric care. We aimed to examine the associations of race, ethnicity, and mental health status with patient-reported importance of provider cultural competence. Our retrospective, population-based, cross-sectional study used data extracted from self-reported questionnaires of adults aged at least 18 years who participated in the US National Health Interview Survey (NHIS; 2017 cycle). We included data on all respondents who answered supplementary cultural competence questions and the Adult Functioning and Disability survey within the NHIS. We classified participants as having anxiety or depression if they reported symptoms at least once a week or more often, and responded that the last time they had symptoms the intensity was "somewhere between a little and a lot" or "a lot." Participant answers to cultural competency survey questions (participant desire for providers to understand or share their culture, and frequency of access to providers who share their culture) were the outcome variables. Multivariable ordinal logistic regressions were used to estimate adjusted odds ratios (aORs) for the outcome variables in relation to sociodemographic characteristics (including race and ethnicity), self-reported health status, and presence of symptoms of depression, anxiety, or both. 3910 people had available data for analysis. Mean age was 52 years (IQR 36-64). 1422 (39·2%, sample weight adjusted) of the participants were men and 2488 (60·9%) were women. 3290 (82·7%) were White, 346 (9·1%) were Black or African American, 31 (0·8%) were American Indian or Alaskan Native, 144 (4·8%) were Asian American, and 99 (2·6%) were Mixed Race. 380 (12·5%) identified as Hispanic ethnicity and 3530 (87·5%) as non-Hispanic. Groups who were more likely to express a desire for their providers to share or understand their culture included participants who had depression symptoms (vs those without depression or anxiety symptoms, aOR 1·57 [95% CI 1·13-2·19], p=0·008) and participants who were of a racial minority group (Black vs White, aOR 2·54 [1·86-3·48], p=0·008; Asian American vs White, aOR 2·57 [1·66-3·99], p<0·001; and Mixed Race vs White, aOR 1·69 [1·01-2·82], p=0·045) or ethnic minority group (Hispanic vs non-Hispanic, aOR 2·69 [2·02-3·60], p<0·001); these groups were less likely to report frequently being able to see providers who shared their culture (patients with depression symptoms vs those without depression or anxiety symptoms, aOR 0·63 (0·41-0·96); p=0·030; Black vs White, aOR 0·56 [0·38-0·84], p=0·005; Asian American vs White, aOR 0·38 [0·20-0·72], p=0·003; Mixed Race vs White, aOR 0·35 [0·19-0·64], p=0·001; Hispanic vs non-Hispanic, aOR 0·61 [0·42-0·89], p=0·010). On subgroup analysis of participants reporting depression symptoms, patients who identified their race as Black or African American, or American Indian or Alaskan Native, and those who identified as Hispanic ethnicity, were more likely to report a desire for provider cultural competence. Racial and ethnic disparities exist in how patients perceive their providers' cultural competence, and disparities are pronounced in patients with depression. Developing a culturally competent and humble approach to care is crucial for mental health providers. None.

A Synthesis of Findings from 'Rapid Assessments' of Disability and the COVID-19 Pandemic: Implications for Response and Disability-Inclusive Data Collection.

Introduction: People with disabilities are disproportionately impacted by disasters, including health emergencies, and responses are not always inclusive or accessible. Disability-inclusive response and recovery efforts require rapid, contextually relevant data, but little was known about either the experience of people with disabilities in the first phase of the COVID-19 pandemic, or how rapid needs assessments were conducted. Methods: We reviewed the available results from rapid assessments of impacts of COVID-19 on people with disabilities in low- and middle-income countries in Asia and the Pacific. Rapid assessment methods and questions were examined to describe the current approaches and synthesise results. Results: Seventeen surveys met the inclusion criteria. The findings suggest that people with disabilities experienced less access to health, education, and social services and increased violence. The most rapid assessments were conducted by or with disabled person’s organisations (DPOs). The rapid assessment methods were varied, resulting in heterogeneous data between contexts. Efforts to standardise data collection in disability surveys are not reflected in practice. Conclusions: Persons with disabilities were disproportionately impacted by the ‘first wave’ of the COVID-19 pandemic. Despite complex implementation challenges and methodological limitations, persons with disabilities have led efforts to provide evidence to inform disability-inclusive pandemic responses.

817Official small area health statistics using the stratified reweighting method

Abstract Background The Australian Bureau of Statistics (ABS) presently produces health data for small population groups using a Generalised Linear Mixed Model (GLMM) method. Although this method is highly effective at producing reliable local level health data, it takes several months to compile data once it’s collected. The Stratified Reweighting Method (SRM) was investigated as an innovative efficient method for producing local level health data. Methods The SRM harnesses information from both health survey and Census data. A cluster analysis of 12 Census data items creates 13 area groups with similar population demographics. A replicated survey data set is then created where each small area is bolstered by the other small areas within its area group. The survey weights from this dataset are adjusted to match Census data of each small area across several demographic variables. A final survey weight adjustment ensures consistency of the small area predictions with national survey estimates. Results Health statistics were produced for over 20 health outcomes in the latest ABS National Health Survey; and the ABS Survey of Disability, Ageing and Carers. It was found that, compared to the GLMM method: the models had lower, but still acceptable quality; the errors of prevalence estimates were similar magnitude; and the data compilation time was reduced to within two weeks. Conclusions The SRM is an efficient approach for producing acceptable quality official local health statistics. Key messages The SRM is an innovative and efficient weight-based method using health survey and population Census data to produce official local health statistics.

The role of workplace accommodations in explaining the disability employment gap in the UK

There has been limited theoretical and empirical research into the role of workplace accommodations in enabling workers with and without impairments to remain in work. This study used the International Classification of Functioning, Disability and Health (ICF) model to examine (a) whether workplace accommodations enable workers, particularly those with different impairments, to remain economically active; and (b) the predictors of the onset of work accommodations. Data from two waves of a large-scale longitudinal survey of disability in Great Britain, the Life Opportunities Survey (2009–2012) were analysed. 2307 workers with an impairment and 4308 workers without an impairment were followed up for a year. Work accommodations appear to enable workers with impairments to remain economically active, especially those with mental impairments. There was no difference in the employment rates of workers with and without mental impairments who had two or more work accommodations, in contrast to the 10% employment gap between workers with and without mental impairments who did not have any work accommodations. While there was no gender difference in the disability employment gap, barriers to employment related to caregiving were much greater for women compared to men. Moreover, only workers with incident pain impairments were associated with an increase in their work accommodations, not workers with incident mental impairments. Despite the evidence that workers with mental impairments could benefit considerably from workplace accommodations, they are less likely to have their workplace adjusted. The ICF model is particularly useful in analysing the role of work accommodations because it considers a much wider range of factors that are relevant not just to workers with different types of impairments, but are also relevant to the wider group of workers who use workplace accommodations.

Measuring Environmental Factors and School Participation for Children with Disabilities

ABSTRACT To assess whether every child’s right to education is met, it is necessary to measure the participation of children with disabilities in school through statistically sound and internationally comparable measures. We conducted a scoping study to identify existing instruments that measure environmental factors related to the participation of children with disabilities in school. The review identified 12 measures for a total of 282 question items. Most measures were used in disability surveys and answered by a proxy respondent. Many used definitions of disability framed under the medical model, focusing on impairments as the primary cause of the lack of school participation. No one set of questions on school environment and participation that would produce internationally comparable data was identified. School environment and participation measures have the potential to provide a statistical summary of the environmental factors that act as barriers to or facilitators of participation in school. This could help identify key bottlenecks that can be addressed to promote every child’s right to education. A statistically sound, internationally comparable measure has yet to be developed.

Measuring functioning and disability using household surveys: metric properties of the brief version of the WHO and World Bank model disability survey

BackgroundThe Model Disability Survey (MDS) is the current standard recommended by WHO to collect functioning and disability data. Answering calls from countries requesting a version to be implemented as a module that could be integrated into existing surveys and be used for monitoring disability trends and for data disaggregation, WHO developed the brief MDS. The objectives of this paper are to evaluate the metric properties of the disability metrics generated with the Brief MDS and the precision of the Brief MDS in comparison with the full MDS.ResultsThe partial credit model, a unidimensional model for polytomous data from the Rasch family, was applied to evaluate psychometric properties using data from national MDS implementations in Chile (N = 12,265) and in Sri Lanka (N = 3000). The Brief MDS generates valid metrics for measuring disability, from the perspectives of capacity and performance, thereby achieving good levels of measurement precision in comparison with its full counterpart.ConclusionGiven the scarcity of valid functioning and disability modules for household surveys, the Brief MDS represents a milestone in disability measurement. The Brief MDS is currently used by countries to monitor disability trends over time, which is especially important to evaluate the impact of health policies and public health interventions, to disaggregate indicators of the Sustainable Development Goals, and to monitor the implementation of the UN Convention on the Rights of Persons with Disabilities (CRPD).

Disability among Older People: Analysis of Data from Disability Surveys in Six Low- and Middle-Income Countries.

This analysis of surveys from six low- and middle-income countries (LMICs) aimed to (i) estimate the prevalence of disability among older adults and (ii) compare experiences and participation in key life areas among older people with and without disabilities which may show vulnerability during the COVID-19 pandemic. Data were analysed from district-level or national surveys in Cameroon, Guatemala, Haiti, India, Nepal and the Maldives, which across the six databases totalled 3499 participants aged 60 years and above including 691 people with disabilities. Disability was common among adults 60+, ranging from 9.7% (8.0–11.8) in Nepal to 39.2% in India (95% CI 34.1–44.5%). Mobility was the most commonly reported functional difficulty. In each setting, older people with disabilities were significantly less likely to be working and reported greater participation restrictions and environmental barriers in key life areas compared to people in the same age categories without disabilities (p < 0.05). Disability is common in this population, and older people with disabilities may have greater difficulties participating in COVID-19 responses and have high economic vulnerabilities. It is imperative to prioritise the needs of older people with disabilities in the COVID-19 pandemic, including ensuring accessibility of both health services and the community in general.

The Impact of COVID-19 and Pandemic Mitigation Measures on Persons With Sensory Impairment

PurposeTo assess the impact of the COVID-19 pandemic and associated mitigation measures on persons with sensory impairments (SI), including visual impairments (VI) and hearing impairments (HI).DesignCross-sectional survey.MethodsAdults with VI (best-corrected visual acuity <20/60 in the better-seeing eye), HI (International Classification of Diseases, Tenth Revision, codes), and age- and sex-matched controls (n = 375) were recruited from the University of Michigan. The 34-item Coronavirus Disability Survey was administered. Both χ2 tests and logistic regression were used to compare survey responses between groups.ResultsAll groups reported high levels of disruption of daily life, with 80% reporting “a fair amount” or “a lot” of disruption (VI: 76%, HI: 83%, CT: 82%, P = .33). Participants with VI had greater difficulty with day-to-day activities and were more likely to cite the following reasons: caregiver was worried about COVID-19 (odds ratio [OR]VI = 7.2, 95% CI = 3.5-14.4, P < .001) and decreased availability of public transportation (ORVI = 5.0, 95% CI = 1.5-15.6, P = .006). Participants with VI, but not HI, showed a trend toward increased difficulty accessing medical care (ORVI = 2.0, 95% CI = 0.99-4.0, P = .052) and began relying more on others for day-to-day assistance (ORVI = 3.1, 95% CI = 1.6-5.7, P < .001). Overall, 30% reported difficulty obtaining trusted information about the pandemic. Those with VI reported more difficulty seeing or hearing trusted information (ORVI = 6.1, 95% CI = 1.6-22.1, P = .006). Employed participants with HI were more likely to report a reduction in wages (ORHI = 2.5, 95% CI = 1.2-5.3, P = .02).ConclusionsIndividuals with VI have experienced increased disruption and challenges in daily activities related to the pandemic. People with SI may benefit from targeted policy approaches to the current pandemic and future stressors. Minimal differences in some survey measures may be due to the large impact of the pandemic on the population as a whole.The SARS-CoV-2 (COVID-19) pandemic and public health mitigation measures have had an exceedingly large impact around the globe. As of the time of writing, more than 114 million global cases (28 million US) had been diagnosed, and there had been more than 2.5 million fatalities attributed to COVID-19 (517,000 US).1,2

Environmental barriers and participation restrictions in community-dwelling individuals with spinal cord injury in Jiangsu and Sichuan Provinces of China: Results from a cross-sectional survey

Objective: (1) to describe environmental barriers and participation restrictions experienced by people with spinal cord injury (SCI) from China, (2) to examine associations between lesion characteristics and participation restrictions, considering a mediating role of environmental barriers, (3) to identify those environmental barriers that have the largest influence on participation. Design: Cross-sectional study. This study is part of the International Spinal Cord Injury Survey (InSCI). Setting: Community, Jiangsu and Sichuan Province, China. Participants: 1355 persons with SCI. Interventions: Not applicable. Outcome Measures: Participation restrictions were measured with items from the Model Disability Survey, Environmental Barriers were measured with the Nottwil Environmental Factors Inventory-Short Form. Results: Participants experienced a median of five (IQR 1-9) environmental barriers and five (IQR 0-9) participation restrictions. Environmental barriers were mainly reported in relation to climate, insufficient resources and accessibility, and participation restrictions mainly occurred in using public transportation, taking care of others, and getting to places. In an adjusted zero-inflated Poisson model, people with more severe injuries reported a greater number of environmental barriers (complete injury: IRR = 1.31, 95%CI = [1.24,1.38]) and participation restrictions (tetraplegia: IRR = 1.15, 95%CI = [1.10,1.21]; complete injury: IRR = 1.25, 95%CI = [1.18,1.31]). Moreover, environmental barriers (IRR = 1.07, 95%CI = [1.06,1.08]) were a significant predictor of participation restrictions and partially mediated the association of lesion completeness with participation restrictions. Barriers related to accessibility of public places (IRR = 1.47, 95%CI = [1.33,1.62]), accessing homes (IRR = 1.32, 95%CI = [1.21,1.44]), long distance transportation (IRR = 1.11, 95%CI = [1.04,1.20]), communication devices (IRR = 1.07, 95%CI = [1.01,1.15]) and state services (IRR = 1.10, 95%CI = [1.02,1.19]) had the greatest negative impact on participation. Conclusion: Social participation of people with SCI is seriously restricted in China. Removing environmental barriers will be an important element of programs to address this problem.

Identifying key environmental barriers experienced by persons with mild, moderate, or severe disability in Bankim Health District, Cameroon: a policy-targeted secondary analysis of data obtained with the World Bank and WHO model disability survey

BackgroundComprehensive data is key for evidence-informed policy aiming to improve the lives of persons experiencing different levels of disability. The objective of this paper was to identify the environmental barriers — including physical, social, attitudinal, and political barriers — that might become priorities for cross-cutting policies and policies tailored to the needs of persons experiencing severe disability in Cameroon.MethodsA secondary analysis of data obtained with the WHO Model Disability Survey was completed in the Bankim Health District (N = 559) using random forest regression to determine and compare the impact of the environmental factors on the experience of disability.ResultsThe physical environment had by far the highest influence on disability, with transportation, toilet of the dwelling, and the dwelling itself being the most important factors. Factors inside one’s own home (toilet of the dwelling, and the dwelling itself) were the most important for persons with moderate and severe disability, followed by attitudes of others and issues with accessing health care.ConclusionOur study provides country policy makers with evidence for setting priorities and for the development of evidence-informed policies for the Bankim Health District in Cameroon.

Perceived community disability stigma in multicultural, low-income populations: Measure development and validation

BackgroundStigma and knowledge about disabilities differ across groups, impacting care. No validated measures of perceived community disability stigma exist for families in multicultural communities, at risk for disparities. AimsDevelop and validate a brief bilingual (i.e., English/Spanish) perceived disability stigma measure, compare perceived disability and autism stigma, and examine perceived disability stigma by parent sociodemographic characteristics and disability familiarity. Methods and proceduresSecondary data from 522 parents with children ages 2–5 years were recruited from Oregon WIC Special Supplemental Nutrition Program agencies for a child development and disability survey in 2015. The study sample included items regarding disability familiarity and stigma, among the survey population, which was 50 % Latino. Internal consistency, reliability and structural validity were examined. Secondary data on perceived disability and similar autism stigma items were compared. Nested multivariable linear regression assessed associations of perceived disability stigma with sociodemographic characteristics and disability familiarity. Outcomes and resultsFive perceived disability stigma items had reasonable internal consistency and performed well in the confirmatory factor analysis. Perceived autism stigma was greater than perceived disability stigma. Latino parents reported less perceived disability stigma than white parents. Parents who knew 1+ individual(s) with a disability reported greater perceived disability stigma. Conclusions and implicationsThe perceived disability stigma scale demonstrated sound psychometric properties. Results suggest differences in how stigma is perceived across sociodemographic characteristics and disability familiarity.

Associations between physical activity and functional limitations in Native Hawaiian and Pacific Islander middle-aged and older adults in the United States

ABSTRACT Objectives Physical activity (PA) can help individuals maintain physical function and independence. The association between PA and functional limitations (FL) has not been explored in the Native Hawaiian and Pacific Islander (NHPI) population. The purpose of this study was to examine relationships between PA and FL among NHPI adults (age ≥ 45 years) living in the United States. Design Cross-sectional data from the 2014 NHPI-National Health Interview Survey (N = 628) was used to create three constructs of FL based on responses from the Functioning and Disability Survey Module: needing equipment/assistance, having difficulty walking, and having difficulty with performing self-care and other fine motor activities. We used 2-stage least squares regression to examine the relationship between PA and FL of NHPI adults while accounting for the potential endogeneity of PA to FL. Results Compared to NHPI adults who met the guideline for recommended levels of aerobic and strengthening PA, those who met only the strengthening guideline experienced less difficulty in two FL constructs (use of medical equipment/assistance and difficulty walking). Those who met the aerobic guideline reported even less difficulties in all three FL constructs. NHPI adults who met both the aerobic and strengthening guidelines experienced the least difficulties in all three FL constructs compared to those who met neither PA guidelines. Conclusions PA is associated with function in this adult NHPI population. Aerobic guidelines alone may be more beneficial than meeting the strengthening guideline alone; however, meeting both the aerobic and strengthening guidelines is most protective against FL.

Understanding Persons With Disabilities’ Reasons for Not Seeking Employment

Unemployment is common for persons with disabilities but little is known about the different reasons why people with disabilities may not be seeking employment. This study identified the reasons that people living with disabilities in the United States report for not seeking employment, from the 2015 Kessler Foundation National Employment and Disability Survey (KFNEDS), and categorization of reasons by demographic, socioeconomic, and disability characteristics. We conducted a content analysis of responses to an open-ended question on the KFNEDS. The analytic sample ( n = 1,254) consisted of adults (ages 18–64) living with disabilities who self-identified as either unemployed or not seeking employment. Team coding used a hybrid inductive/deductive approach to identify nine meaningful reasons why people with disabilities may not seek employment. Overall, medical conditions, functional limitations, or their disability were more likely to be reported as reasons for not seeking work, rather than situational reasons associated with workplace engagement, such as “lack of job opportunities.” Bivariate comparisons of codes across demographic, socioeconomic, and disability characteristics noted variability in reasons reported by respondents by sex, race/ethnicity, age, household income, and disability. These findings provide an understanding of diverse reasons for not seeking employment, which can inform programs and policies that promote labor force participation of people with disabilities.