Disability Inclusion Research Articles

Traversing Disability: Employers’ Perspectives of Disability Inclusion

Persons with disabilities still experience challenges in obtaining employment even though obligations associated with their employment are in place in legislative frameworks that strive to support transformation within the labour market. This paper explores employers’ perspectives on the employment of persons with disabilities in South Africa identified in a case study. The influence of social capital on disability inclusive employment was explored from the perspective of two employers who employed trainees who completed an auxiliary training programme for persons with disabilities, which provides opportunities to facilitate pathways to economic inclusion and/or employment. Findings reveal that despite the call for increased labour inclusivity, the development of social capital is not clearly apparent when persons with disabilities are considered for employment. Organisational attitudes and beliefs seem to stem from the obligatory standpoint of the organisations. The paper highlights the need for employers to look beyond impairments so that employment goals are shared and re-enforced by understanding and possibly re-evaluating their views on their organisation’s obligations, norms, values and mission, and goals. Insights can guide employers to think more holistically about ways to facilitate the economic inclusion of persons with disabilities.

A path toward disability-inclusive health in Zimbabwe Part 1: A qualitative study on access to healthcare.

BackgroundOn average, people with disabilities have greater healthcare needs, yet face a range of barriers in accessing care.ObjectivesOur objectives were to explore the experiences of people with disabilities in accessing care and identify opportunities for the health system to be designed for inclusion in Zimbabwe.MethodsIn-depth qualitative interviews were conducted between May and June 2021 with 24 people with disabilities (identified through purposive sampling) and with 10 key informants from local and national health authorities (identified through expert recommendations). Interviews explored the experience of accessing healthcare prior to the coronavirus disease 2019 (COVID-19) pandemic. Interviews were transcribed, coded and thematically analysed. We used the disability-inclusive health ‘Missing Billion’ framework to map and inform barriers to inclusive healthcare and disparities in outcomes faced by people with disabilities.ResultsPeople with disabilities experienced difficulties accessing health services in Zimbabwe prior to COVID-19. These experiences were shaped by health literacy, self-stigma and affordability of services, which limited demand. Supply of health services was constrained by the perceived poor capacity of health workers to treat people with disabilities and discrimination. Inclusion was facilitated by clinic staff support of people with disabilities’ access to medication through referral to mission hospitals and private clinics, and the lobbying of organisations of people with disabilities.ConclusionStrategies to promote disability inclusion in healthcare include meaningfully engaging people with disabilities, investing in organisations of people with disabilities, protecting funding for disability inclusion, collecting and analysing disability-disaggregated data and strengthening a twin-track approach to health service provision.

Disability inclusiveness in Covid-19 pandemic policies in West Africa: “Are we left behind?”

Disability inclusiveness in Covid-19 pandemic policies in West Africa: “Are we left behind?”

Death with Dignity in Canada

Death with Dignity in Canada

Monitoring disability inclusion: Setting a baseline for South Africa.

BackgroundThe progressive realisation of disability inclusion requires political will and commitment, and comprehensive monitoring is necessary to give a clear understanding of what needs to be addressed and to highlight the gaps and barriers to the achievement of social inclusion of people with disabilities.ObjectivesThis article uses an existing dataset to present a baseline assessment of inclusion for men and women with no, mild or moderate disability severity and with no or moderate affect difficulties in South Africa.MethodsAn existing dataset, capturing individual-level data for 8499 individuals, collected in 2019 across South Africa was analysed. Variables were utilised to represent aspects of nine domains of disability inclusion, and outcomes were compared using chi-squared tests (with Bonferroni adjustments) for groups categorised by disability severity and gender, and for affect severity and gender.ResultsOverall, inclusion levels declined with increasing disability severity, and there were fewer differences in inclusion levels between those with and without affect difficulties than for those with functioning difficulties (as measured using the Washington Group on Disability Statistics’ Short Set of six questions on functioning).ConclusionsThe article concludes by discussing several approaches to using the data to design policy responses, each of which results in a different range of domains that may initially be prioritised and targeted.

Inclusive Research in Health, Rehabilitation and Assistive Technology: Beyond the Binary of the ‘Researcher’ and the ‘Researched’

The principle of ‘working with, not on’ people with disabilities is widely espoused within inclusive research, yet historically such opportunities have not been fully realized. This paper speaks from the perspective of users of health, rehabilitation, assistive technology services, and the academics with whom they collaborate. We draw on Australia’s Disability Inclusive Research Principles to reflect on the practice of inclusive research across the areas of assistive technology policy, digital information, and health access, as well as the co-design of allied health resources. We consider and provide examples of how power and knowledge play out in health and rehabilitation, the developing discourse around consumer co-design and co-production, and the challenges of enacting inclusive research. This paper is about shared power in the mechanisms of research production and our journeys towards it. Engaging in inclusive research has enabled us to assume roles beyond the binary of the ‘researcher’ and the ‘researched’. We conclude by proposing an adaptation of the ladder of participation for inclusive research.

Physical Disability and Psychedelic Therapies: An Agenda for Inclusive Research and Practice.

Over the past decade, there has been an increase in the number of clinical trials for psychedelic therapies as treatments for a wide range of psychiatric conditions. We are concerned that research organizations overseeing these trials have neglected the inclusion of individuals with physical and sensory disabilities. We suggest that psychedelic research organizations should prioritize and plan for the inclusion of individuals with physical and sensory disabilities to address the mental health burdens they confront. Not doing so risks reinforcing structural ableism in healthcare: the discriminatory manifestation of lowered expectations toward people with disabilities on the part of medical providers. Drawing on scholarship from disability studies and medical ethics, we offer four recommendations for disability inclusion in research. We recognize particular populations shoulder significant mental health burdens; these populations deserve priority and should be given a range of accommodations. We emphasize the need for extensive disability awareness training for those facilitating psychedelic therapies and encourage psychedelic researchers and therapists to exercise cultural humility toward individuals with physical and sensory disabilities. This article should be the impetus for further scholarship and debate about how psychedelic research and therapies can be made accessible to members of disability communities who might benefit.

Navigating Stigma and Discrimination: Experiences of Migrant Children with Special Needs and Their Families in Accessing Education and Healthcare in Hong Kong

This paper explores the barriers to supporting South Asian (Pakistani, Nepalese and Indian) migrant children with special needs and their families encountered navigating Hong Kong’s special needs system and accessing education and healthcare services. It adopts concepts of stigma and disability rights. It draws on semi-structured interviews with fifteen South Asian children and young people with special needs (age 5–21; M = 10; F = 5) and their families, and seven professional practitioners based on the qualitative descriptive method. Informants experienced intersecting stigmatization that included (1) institutional exclusion, (2) daily life microaggressions, and (3) misunderstandings and a lack of awareness education. Simultaneously, some were empowered through (4) support and accommodation, and (5) spiritual support from religion. This paper reveals a paradox embodied by Hong Kong; it is an Asian multicultural city committed to embracing the vision of disability inclusion while failing to ensure necessary support to reduce the stigma experienced by culturally diverse children with a disability. It makes recommendations based on a socioecological framework and concludes that concerted efforts by relevant authorities and organizations should be made to reduce stigma by taking into consideration the intersecting stigmas, specific resources unique to migrant communities, disability rights and cultural sensitivity.

Zimbabwe’s fast-track land reform at 20: exploring disability inclusion and the attendant policy implications

This article interrogates disability inclusion two decades after Zimbabwe’s fast-tracked land reform and the associated policy pathways for improving the situation of people with disabilities in an agrarian context. Exploring the country’s land reform through disability inclusion lenses is largely missing in literature and policy. Using disability inclusion and interpretivism as the evaluative conceptual framing and heuristic research approach in a rural district respectively, the article shows that latent and manifest politics of inclusion and exclusion influence people with disabilities’ formal and informal access to land and agrarian support. Accordingly, the article advances the significance of a sturdy transformative agenda that prioritizes this often-sidelined group in the productive, redistributive, reproductive, protective and social compact outcomes of the land reform. This approach tackles the structural causes of marginalization, inequality and poverty in pursuit of generating and sustaining the wellbeing of people with disabilities.

MITTI Café: enabling disability inclusion in India through scalable business model

Study level/applicability The case can be used at undergraduate and postgraduate level, in management development programmes or in Executive Education programmes. Subject area Social entrepreneurship, social inclusion, business model innovation, sustainability, strategy design and strategy execution. Case overview The case explores the development of MITTI Café, an organisation that trains and employs individuals with intellectual, physical and/or psychiatric disabilities to work in inclusive kitchens and cafes in India. The protagonist is the founder of the café, Alina Alam, who has won several international awards for her work. The case highlights Alam’s approach and how she is trying to challenge societal and business perspectives relating to disability. From 2017 to 2021, Alam has scaled and operationalised the business, building her core team, leveraging several partnerships with stakeholders and putting into place offerings, processes and procedures that created a sustainable business model and blueprint.MITTI Café aligns itself with several of the Sustainable Development Goals (SDGs), with sustainability and social impact at the core of its strategy. As Alam considers the future in July 2021, what else needs to be taken into consideration to scale either within India or abroad? Expected learning outcomes Following reading and exploring the case, students should be able to identify how social exclusion and inclusion manifests in a business context, and how social entrepreneurship ventures such as MITTI Café can address this challenge; identify capabilities in the context of people with disabilities; recognise how stakeholder relationships can be leveraged as a force for good and for growth, and address SDGs through social enterprise; identify and categorise resources and capabilities within organisations; evaluate opportunities for growth and scale. Social implications The case explores how the protagonist is challenging the concept of “ability” and through her work with the differently abled providing scalable opportunities for social inclusion and dignity. Supplementary materials Teaching notes are available for educators only. Subject code CSS 11: Strategy.

MMSU SAPASAP Framework: Priority Actions for Disability-Inclusive Development in Higher Education Institutions

Aim: To influence the growth of higher education institutions (HEIs) towards disability inclusion (DI) through a disability-inclusive framework to influence policymaking and the inclusion, rights advancement, and protection of PWDs. Methods: Following a non-experimental developmental research design, the study was conducted in Mariano Marcos State University (MMSU) and included MMSU non-disabled and disabled learners and employees and MMSU administrative council (AdCo) members as participants selected through double stratum stratified sampling and purposive sampling, respectively. Data were gathered through an online survey for non-disabled participants, focus group discussion for learners with a disability, and key informant interviews for select AdCo members and employees with disability. Data were statistically analyzed through descriptive statistics and thematically analyzed following the Braun and Clarke thematic analysis process. Results: MMSU is seen as a place where PWDs could thrive. In terms of attitude, environment, policies, and positive perception of DI, Enablers to DI were present. This sets the foundation for disability-inclusive development; however, negative responses towards disability and DI were still present, emphasizing the need for improvement. Conclusion and Implications: The MMSU SAPASAP framework, from the Ilokano term “sapasap," meaning having no one left behind, was developed with the idea of fostering MMSU towards disability-inclusive development. It identified priority actions for MMSU in achieving DI and lays out the process for continual improvement towards being an example towards true disability inclusion for HEIs.

Theorizing Discursive Resistance to Organizational Ethics of Care Through a Multi-stakeholder Perspective on Disability Inclusion Practices

Theorizing Discursive Resistance to Organizational Ethics of Care Through a Multi-stakeholder Perspective on Disability Inclusion Practices

Gym staff perspectives on disability inclusion: a qualitative study

Purpose To explore gym staff perspectives on the inclusion of people with disability in the gym setting. Materials and methods Semi-structured interviews were conducted with 16 staff at four urban gym facilities, exploring perspectives on disability inclusion. An interpretive descriptive approach was adopted with reflexive thematic analysis of interview data and subsequent mapping of themes to the socioecological model. Results Consistent with the socioecological model, the themes identified were “people with disability benefit from participation in gym settings” (personal); “positive interactions with people with disability” (interpersonal); “managing expectations of other gym users” (interpersonal); “inclusion is supported by a positive ethos, staff training and accessible facilities” (organisational); “people with disability lack awareness of inclusive exercise opportunities” (community); “desire to increase collaboration with healthcare professionals” (community); “access to transport can facilitate gym attendance” (community) and “local gym policy” (policy). Conclusion Although an overall ethos of inclusion was apparent, areas identified for enhancement were: awareness of gym services in the community; inter-sectoral collaboration with healthcare and disability organisations; comprehensive disability inclusion training; transport systems and accessibility; engaging people with disability in gym service planning. Implications for rehabilitation Gym staff value collaboration with healthcare and rehab professionals to support inclusion of people with disability in exercise. Standardised disability inclusion training for gym staff is recommended. Individuals with disability should be empowered to contribute to the development of inclusive gym facilities and services. Rehab professionals have a role to play in raising awareness and advocating for inclusive exercise opportunities.

Is There an Ableist Paradox in Frontline Workers’ Success Stories About Disability and Work Inclusion?

Frontline workers are tasked with enabling the employment of disabled people. They engage with an ableist narrative that constructs disabled people as less worthy, less productive, and subordinate when they formulate contrasting narratives of disabled people as productive and capable workers. To better understand how frontline workers engage with the ableist narrative, focus group interviews were conducted with frontline workers (counsellors, employment specialists, and market coordinators) within the Norwegian Labour and Welfare Administration. Focus group interviews generate interaction data resulting from discussions amongst informants revealing aspects of frontline work assumed to be otherwise less accessible, such as success stories. The primary finding is that frontline workers bring up success stories when they are talking about disability and work inclusion. Three narrative practices of these success stories are explored, each with specific contexts and circumstances: learning, motivating, and disability branding. While these narratives aim to redress disabled people’s subordinated position, they still display ableist norms, thus suggesting that an ableist paradox exists in frontline workers’ success stories.

Institutional Accountability for Students With Disabilities: A Call for Liaison Committee on Medical Education Action.

Medical educators and leaders have called for greater diversity among the physician workforce, including those with disabilities. However, many students with disabilities are precluded from entering and completing medical training due to historically restrictive technical standards and poor internal practices to protect student privacy. This limits the possibilities for growing this part of the workforce and making progress toward the ultimate goal of having a physician workforce that better represents the patients it serves. To achieve diversity among the physician workforce, medical education must create environments that allow students with disabilities to apply to, flourish in, and feel well supported in medical school. Recent additions to Accreditation Council for Graduate Medical Education requirements have helped to catalyze work in the area of disability inclusion by incorporating disability-focused mandates into graduate medical education accreditation standards. However, similar mandates for undergraduate medical education have not yet materialized. In this article, the authors call for the Liaison Committee on Medical Education (LCME) to elevate disability as a valued part of medical school diversity in its accreditation standards and to include protections for disabled students. The authors propose that the LCME can take 5 actions to promote institutional accountability toward students with disabilities: (1) define disability as diversity, (2) mandate disability support, (3) protect from conflicts of interest, (4) protect privacy, and (5) verify schools' technical standards comply with the Americans with Disabilities Act. By adopting these recommendations, the LCME would send the powerful message that students with disabilities bring welcome expertise and value to the medical community.

A community-based evaluation of disability resources and inclusion practices in rural Botswana

BackgroundCommunity-based approaches to enhance the inclusion of persons with disabilities have proven effective; however, not much is known about cultural and contextual factors that influence the capacity of policy implementation and inclusion practices in rural Botswana. ObjectiveThe study evaluated local disability education and health resources in rural Botswana to develop a deeper understanding of cultural and contextual factors impacting inclusion practices. MethodResearchers used socio-demographic and qualitative research methods to conduct a comprehensive community-based needs assessment. Sampling techniques included maximum variation and snowball sampling. Thirty-two individuals participated in the study. Data were collected between June and August of 2019 through participant observation, in-depth interviews, and focus group discussions. An inductive thematic analysis was conducted by examining participants’ attitudes, perceptions, and experiences of community members with disabilities. ResultsFour primary themes emerged identifying factors that affect people living with disabilities in the rural community: (1) culture of vulnerability, (2) determinants of disability, (3) educational resources for persons with disabilities, and (4) effective systems integration. Findings suggested that while policies associated with disability at the government level are in place, disparities among rural communities’ hindered local responses to managing the needs of persons with disabilities. ConclusionsSocial, environmental, and physical barriers prevent the full implementation of policies that advocate for the rights of persons with disabilities in Botswana's rural settings. Increasing awareness of cultural and contextual factors may help community stakeholders facilitate inclusive practices in Botswana.

Disability-inclusive employment, cancer survivorship, and the Americans with Disabilities Act.

PurposeThis special section of the Journal of Cancer Survivorship examines disability-inclusive employment policy and practice, cancer survivorship, and the Americans with Disabilities Act (“ADA”) of 1990. It considers current issues in research, policy, practice, and law in the United States, including new questions arising in light of COVID-19, such as the nature of disability disclosure, workplace accommodations and remote work, emerging workplace health surveillance technologies, and inclusive employment practices for cancer survivors. It also presents, for comparative purposes, a current analysis of cancer-related disability discrimination in the media in the United States and Israel.MethodsAfter the “Introduction,” this special section presents two studies on disclosure of disability in employment: the first addressing disclosure during a job interview of the need for accommodations, and the second addressing disclosure as related to individual and organizational characteristics. The next two articles examine the effects of the COVID-19 pandemic on the work experience: first, for people with disabilities working remotely, with implications for cancer survivors, and second, for cancer survivors and people with disabilities facing potential algorithmic health discrimination due to workplace health surveillance. The final article considers cancer-related stigma and discrimination, as faced in the United States and Israel (using a comparison of mass media).ResultsDisability-inclusive employment laws such as the ADA promote two central requirements: First, social institutions affirmatively remove attitudinal and structural barriers and discrimination confronting people with disabilities as they exercise their rights to participate fully in society. Second, employers, governmental entities, and public accommodations comply with the “accommodation principle,” which requires them to make reasonable adjustments to job tasks, places of work, and public places in society, to enable equal participation by qualified individuals with disabilities. The articles in this special section consider these principles in innovative ways from a disability-inclusive paradigm.ConclusionsThe COVID-19 pandemic has highlighted the need for a robust research literature on disability-inclusive employment policy and practice for people with disabilities and for cancer survivors. This special section offers five articles as a start. The section’s “Introduction” also highlights recent ADA case law and introduces two new national Rehabilitation Research and Training Centers, one on Disability Inclusive Employment Policy (“DIEP RRTC”) and one on Employer Practices Leading to Successful Employment Outcomes Among People with Disabilities (“Employer Practices RRTC”), both designed to help fill this need. The centers are currently examining ways organizations, including those in the gig economy, can facilitate inclusive employment of people with disabilities.Implications for Cancer SurvivorsAs highlighted in the Introduction’s discussion of recent ADA cases involving cancer-related employment discrimination, as well as in the special section’s articles, discrimination in employment persists and, indeed, is worsening for cancer survivors and those with disabilities. This discrimination affects people across the demographic spectrum, and it can be especially harmful to people in groups not always acknowledged, such as individuals with multiple, intersectional minority identities associated with race, ethnicity, sexual orientation, and gender identity, as well as people at different stages of the life course. Furthermore, the impact of discrimination in employment is often exacerbated by life experiences such as unemployment and underemployment, financial insecurity, ableism, racism, and sexism.

Research on Disability and Congregational Inclusion: What We Know and Where We Might Go

The United States is home to more than 60 million Americans with disabilities and more than 300,000 churches. Yet the relationships among these individuals and congregations is alternately described as encouraging or concerning—sometimes stellar, other times deeply disappointing. Although anecdotes have characterized much of these depictions, a growing body of research also focuses on this area. This research review addresses the current landscape of congregational participation and practices related to individuals with disabilities and their families. What is known about the participation of individuals with disabilities in relation to faith community life? What is known about the practices of local congregations in relation to individuals with disabilities? This paper highlights key findings, identifies gaps in the current literature, and concludes with recommendations for future research.

Exploratory Evaluation of Inclusion Wheel Model for Public Health Practice to Include People With Disabilities: Implications for Leadership and Training to Serve the Whole Community.

This study evaluated the presence of the Inclusion Wheel Model's factors and conditions across programs on a variety of public health topics, in which people with disabilities were intentionally included. We used an action research approach to facilitate three learning groups and two communities of practice, including participants from the national disability community, nonprofit, university, and government public health partners. We conducted a qualitative analysis using virtual meetings, meeting notes, and the series of feedback surveys as data sources. A primary coder and secondary coder reviewed, coded, and analyzed each data source according to preset coding schemes, using a previously developed codebook based on the Model. All supports and factors of the Inclusion Wheel were identified, including adaptive leadership supports, readiness for the change of including people with disabilities in public health efforts, capacity building activities, and capacity efforts across settings and topics. This examination has critical implications for public health trainers, leaders, and program designers on the inclusion of people with disabilities and other underserved populations in health promotion efforts. Public health practitioners must serve the whole community, including underserved and marginalized demographic groups, like the one in four Americans living with a disability. The Inclusion Wheel may be used as a model to guide disability inclusion training among public health partners and leaders in nonprofit, corporate, and government sectors, as well as to prioritize involvement of marginalized and underserved population groups in planning health promotion efforts.

Beyond inclusion: practical lessons on striving for gender and disability transformational changes in WASH systems in Cambodia and Timor-Leste

Abstract Women and girls, and people with disabilities are often excluded from governance systems and decision-making on water, sanitation and hygiene (WASH) at all levels – from household to the national level. This paper analyses inclusion and empowerment outcomes for these two groups in three WASH system-strengthening programmes in Cambodia and Timor-Leste. The analysis used WaterAid's ‘Equality and Inclusion Framework’ to assess the quality of inclusion and empowerment outcomes at different levels of WASH systems. The review found that household gender equality changes in Timor-Leste were empowering because they shifted women's and men's roles, relationships and attitudes. It found that women's leadership and disability-inclusive approaches in Cambodia achieved inclusive outcomes because they enhanced women's critical consciousness and increased WASH leaders' awareness of the importance of disability inclusion. There was evidence of either individual/self-empowerment changes or changes to the enabling environment; however, no intervention achieved a comprehensive combination of both. The authors conclude that both individual and environmental outcomes contribute to empowerment outcomes in WASH systems at different levels that can shift gender norms, redistribute power and benefit women and people with disabilities. These findings will enable WASH practitioners to better understand empowerment outcomes and how to integrate them with system-strengthening approaches.