Reasonable Accommodation Research Articles

Adapting and pilot testing a tool to assess the accessibility of primary health facilities for people with disabilities in Luuka District, Uganda

Abstract Background People with disabilities frequently experience barriers in seeking healthcare that lead to poorer health outcomes compared to people without disabilities. To overcome this, it is important to assess the accessibility of primary health facilities – broadly defined to include a disability-inclusive service provision – so as to document present status and identify areas for improvement. We aimed to identify, adapt and pilot test an appropriate tool to assess the accessibility of primary health facilities in Luuka District, Uganda. Methods We conducted a rapid literature review to identify appropriate tools, selecting the Disability Awareness Checklist (DAC) on account of its relative brevity and development as a sensitization and action tool. We undertook three rounds of adaptation, working together with youth researchers (aged 18–35) with disabilities who then underwent 2 days of training as DAC facilitators. The adapted tool comprised 71 indicators across four domains and 12 sub-domains. We also developed a structured feedback form for facilitators to complete with healthcare workers. We calculated median accessibility scores overall, per domain and per sub-domain, and categorised feedback form suggestions by type and presumed investment level. We pilot-tested the adapted tool in 5 primary health facilities in one sub-district of Luuka, nested within a pilot healthcare worker training on disability. Results The median overall facility accessibility score was 17.8% (range 12.3–28.8). Facility scores were highest in the universal design and accessibility domain (25.8%, 22.6–41.9), followed by reasonable accommodation (20.0%, 6.7–33.3). Median scores for capacity of facility staff (6.67%, 6.7–20.0), and linkages to other services were lower (0.0%, 0–25.0). Within the feedback forms, there were a median of 21 suggestions (range 14–26) per facility. Most commonly, these were categorised as minor structural changes (20% of suggestions), with a third categorised as no (2%) or low (33%) cost, and the majority (40%) medium cost. Conclusions Overall accessibility scores were low, with many opportunities for low-cost improvement at the facility level. We did not identify any issues with the implementation of the tool, suggesting few further adaptations are required for its future use in this setting.

Exploring the Perspectives of Students with Disabilities on the Reasonable Accommodations Provided in Higher Education Institutions

The purpose of this study was to explore the available treatment for students with disabilities (SWD) in post-secondary education. the main research question focuses on exploring the perspectives of SWD about the reasonable accommodation focuses they received at King Saud University (KSU), and Princess Nourah University (PNU). A qualitative research methodology was used, information was subsequently collected from 12 SWD via a semi-structured interview format and using Thematic analysis to write the result report. some significant results arose, such as that the majority of SWDs stated that CDSS helps assist with their schooling. Many, however, said that the faculty did not understand their demands and that they needed instruction in this area. They also expressed dissatisfaction with admissions procedures that bar them from enrolling in certain departments. Received: 16 May 2024 / Accepted: 16 September 2024 / Published: 05 November 2024

The Criticality of Reasonable Accommodations: A Scoping Review Revealing Gaps in Care for Patients with Blindness and Low Vision

The Criticality of Reasonable Accommodations: A Scoping Review Revealing Gaps in Care for Patients with Blindness and Low Vision

A systematic literature review on the obstacles to workplace success among visually impaired individuals

Encountering individuals with visual impairments at organisations has become more commonplace than before. As the proportion of visually impaired individuals rises inside companies, the obstacles to achieving workplace success become more apparent. A systematic literature review was conducted to present the obstacles individuals with vision impairment face in achieving workplace success. Three hundred ninety-eight relevant papers were collected from reputable databases, including Mendeley, Web of Science, Scopus, and Springer e-databases. The analysis focused on 12 non-duplicate, original (research), English-language, open-access, and full papers published between 2019 and 2023. These studies were selected and widely covered obstacles to workplace success among visually impaired individuals based on the eligibility criteria. Most focused on visually impaired individuals employed in the United States. These studies primarily used quantitative research methods and were published between 2021 and 2022. The significant obstacles to workplace success among individuals with vision impairment in the 12 selected studies were unfitting to the workplace environment, job insecurity, lack of reasonable accommodation and rehabilitation services, poor psychological conditions, and unsatisfactory wages.

Conventionalized phrases and disability policy: a corpus analysis of 2-year and 4-year public colleges in California

This corpus-based study analyzes the use of conventionalized phrases in disability policy. Specifically, it focuses on the three phrases made common by the Americans with Disabilities Act: qualified individual with a disability, reasonable accommodations, and interactive process. These three phrases are analyzed in the context of disability policy at 2-year and 4-year public colleges in California. A corpus of disability policies was created for each of these contexts and analyzed to better understand the varied implementation of conventionalized phrases across contexts. The study finds that the three phrases from the ADA have been diffused across higher education disability policies in the corpora created and are highly conventionalized in these contexts. Additionally, these phrases can be used with slightly different valences depending on the context. These differences in use appear to be directly related to the relationship between the three phrases themselves and they mirror debates in disability policy such as that around the modal ‘may’ in relation to whether or not an institution implements an interactive process. Furthermore, institutional differences in the implementation of these phrases is potentially related to the stances institutions take towards disability and disability policy.

Parents' lived experiences regarding the decision‐making process on reasonable accommodations for their child with SEN—An IPA analysis

AbstractReasonable accommodations (RA) for children with special educational needs (SEN) need to be decided in collaboration with all stakeholders. Even though parents play a crucial part in the inclusive school trajectory or their child with SEN, they often miss a clear role in this decision‐making process. In this research, using interpretative phenomenological analysis (IPA), six parents of children with SEN were questioned. The analysis showed that parents are bound to the decisive character of school professionals and find themselves along the spectrum of being actively involved to being followers. There are often opposite perspectives, and in many cases insufficient RA are decided upon according to parents. This resulted in diagnostic trajectories and a search for support outside the school environment. In many cases, parents perceived the decision‐making process on RA for their child with SEN as a life‐long journey and a never‐ending process. In the end, enabling factors were expressed by parents that facilitated the decision‐making process on RA.

Formation of communicative competence of massage therapists with visual impairments: A research study

BackgroundCommunicative competence for massage therapists with visual impairments is an important aspect in ensuring their successful integration into the profession and society. However, visually impaired massage therapists face numerous barriers to effective communication during their education, hiring process, and professional employment. AimTo study why communicative competence is important for students with visual impairments; to research features of communication of persons with visual impairments; to identify barriers and effective strategies for formation of communicative competence in the educational process. DesignA qualitative descriptive study with focus groups and semi-structured interviews. SettingsHigher education institution in Lviv (Ukraine) offering a nursing programme for students with visual impairments. ParticipantsThree groups of respondents, namely visually impaired alumni of Lviv Medical Academy, Ukraine (n = 6), alumni's employers and co-workers (n = 4), and experts in the education of visually impaired persons (n = 11), participated in the research. MethodsTwo focus groups and in-depth semi-structured interviews were used to collect data. Interviews were transcribed verbatim and thematic coding was used to analyze transcripts. ResultsFive themes arose: significance of communication for nurse massage therapists with visual impairments; features of communication of persons with visual impairments; barriers to communication of persons with visual impairments; tools and approaches to improve communicative competence of massage therapists with visual impairments; ineffective methods in teaching communication to visually impaired students. ConclusionsCommunication barriers faced by visually impaired nursing students include isolation in specialized institutions, parental hypervigilance, and the challenge of establishing eye contact, which impedes reading nonverbal cues. To enhance communicative competence, it is essential to implement interactive teaching methods, involve students in various activities, ensure educational accessibility, and adopt an individualized and empathetic approach. Both inclusive and special education have advantages and disadvantages. It is recommended to advocate for a “reasonable accommodation” model to ensure high-quality education for visually impaired massage therapists.

Suggested solutions to barriers in accessing healthcare by persons with disability in Uganda: a qualitative study

BackgroundThere are 1.3 billion people with disabilities globally, and they frequently face barriers to accessing healthcare, contributing to their worse health and higher mortality. However, little research has explored patient-reported approaches to improve healthcare for persons with disabilities. Consequently, this study aimed to explore possible solutions and recommendations to address the existing barriers to access to healthcare for persons with disabilities in rural Uganda.MethodsWe conducted 27 semi-structured interviews with individuals with various disabilities in rural Luuka district, Eastern Uganda, between September and November 2022. The participants included individuals with visual impairment (n = 5), physical impairment (n = 5), hearing impairment (n = 6), multiple impairments (n = 5), intellectual/cognitive impairment (n = 5), and albinism (n = 1). Interviews were recorded, transcribed verbatim, and thematically analysed. We categorized the solutions using the Missing Billion disability-inclusive health systems framework.ResultsOur findings, framed within the health systems framework, revealed several critical themes. On the demand side, suggested solutions emphasized advocacy and sensitization for persons with disabilities, their communities, and caregivers about healthcare needs. Socio-economic empowerment and community-based health services were also highlighted as essential. On the supply side, participants stressed the importance of training healthcare workers on disability, facilitating dialogue and experience-sharing sessions, and employing health workers with disabilities. Additional recommendations included improving accessibility and reasonable accommodation, organizing inclusive services like special clinic days and outreaches, ensuring representation in health facility management, and establishing comprehensive rehabilitation services with affordable assistive devices.ConclusionThe multifaceted solutions proposed by persons with disabilities highlight the complex challenges they face in accessing healthcare services and highlight the necessity for comprehensive, sustainable interventions. The call to action for policymakers and healthcare providers is to prioritise the incorporation of disability-inclusive practices and explore multi-dimensional approaches that foster a more inclusive healthcare environment that adequately meets the needs of persons with disabilities.

"A Liability to the University"-Addressing Student Mental Health Needs on Campus.

Students at colleges and universities report high rates of mental disorders, including depression and anxiety, and frequent suicidal ideation. School policies toward such students, however, often have appeared punitive or aimed primarily at reducing the institution's potential liability. A recent lawsuit against Yale University highlighted allegations of practices that violated several federal statutes by failing to provide reasonable accommodations for students with psychiatric disabilities. The resolution of those claims in a sweeping settlement agreement can provide a model for the many other universities that need to align their policies with federal disability law.

Linguistic and cultural adaptation of the National Quality of Life Survey in Colombia for the deaf population

Abstract This article reports on the linguistic and cultural adaptation of Items of the National Quality of Life Survey (NQLS 2018), which are included in a National Survey that explores the availability of reasonable accommodation for Deaf users in a health care setting as well as health care access. We document the cultural and linguistic adaptation step-by-step, guided by a literature review, participatory group discussions, and qualitative testing. This research addresses the dearth of accessible research instruments for D‍/‍deaf persons in low and middle-income countries. This lack of accessible tools leads to double layers of exclusion, and data gaps often lead to erroneous generalizations that do not accurately represent D‍/‍deaf populations. Evidence gaps may result in poor service planning and inadequate policymaking. This study contributes to good practices in language interpreting in research settings, disability research, and global health.

Advice for dementia carers: A critique of the literature

Although hundreds of advice manuals for dementia carers have been published, most have serious limitations. They emphasize the various problems family members experience without noting the social and political context within which caring unfolds. As a result, they eschew structural reforms in favor of individual solutions, including self-care. The manuals also encourage carers to detach emotionally from people with dementia by viewing them in terms of their disease. In addition, the books hew so closely to the medical model of dementia that they ignore newer perspectives. Narratives by people with dementia provide a critical corrective. Those works argue that the disproportionate attention directed toward carers has eclipsed the perspective of people with dementia, that people remain individuals despite a dementia diagnosis, that issues of stigma and discrimination shape the experience of living with dementia, that more emphasis should be placed on promoting the autonomy of people with dementia, that they are entitled to reasonable accommodations, and that they should have more opportunities for growth.I have reviewed the policies detailed in the guide and have no competing interests.

International and national legal guarantees for the realization of the status of groups of people with low mobility

The article analyses the international and national legal guarantees for the implementation of the status of groups of people with low mobility. The article identifies the key principles of international normative acts in the field of rights and freedoms of groups of people with low mobility. Their significance lies in guaranteeing the relevant areas of activity of Ukraine as a State party to create legal, economic, social, and other conditions for ensuring the rights and opportunities of persons with low mobility on an equal footing with other participants in legal relations. The status of implementation of international guarantees of the status of groups of people with low mobility in national legislation is analysed. The Constitution of Ukraine, the primary laws of Ukraine ‘On the Fundamentals of Social Protection of Persons with Disabilities in Ukraine’, ‘On the Status of War Veterans, and Guarantees of Their Social Protection’, normative acts of the President of Ukraine “On the National Program of Vocational Rehabilitation and Employment of Persons with Disabilities for 2001-2005”, “On Measures to Strengthen Social Protection of Persons with Disabilities; the Cabinet of Ministers of Ukraine’s regulations on Measures to Improve the Situation of Persons with Disabilities, On Approval of the Action Plan for Creating an Unhindered Living Environment for Persons with Disabilities and Other Low-Mobility Groups for 2009-2015 ‘Barrier-Free Ukraine’, and many others are studied. The implementation of the regulations has resulted in the creation of an unhindered living environment for groups of people with low mobility, the functioning of training courses on creating an unhindered environment for the life of people with disabilities, etc. The author substantiates the view that the provisions of the analysed current legal acts are the basis for the further formation and implementation of the State policy on the development and adoption of State social guarantees in general and for groups of people with low mobility in particular, national standards and technical specifications, and also for conducting research and development and research work on the implementation of the principles of reasonable accommodation and universal design.

Informed Inclusion Model: Medical Student Wheelchair User in an Obstetrics and Gynecology Clerkship.

Students with physical disabilities are underrepresented in medicine, driven in part by ableist beliefs about the ability of individuals with disabilities to complete procedure-based or surgically oriented clerkships, including obstetrics and gynecology (Ob/Gyn). There is a growing commitment to disability inclusion by medical and specialty training associations. Yet published case studies and accommodation protocols for medical student wheelchair users navigating an Ob/Gyn clerkship are absent in the literature. This article describes successful disability inclusion for an Ob/Gyn clerkship, including accommodations for medical student wheelchair users. The authors share mechanisms to address and combat ableist assumptions and facilitate access for future medical students by working collaboratively with student and key stakeholders to develop an inclusive and accessible training experience.These recommendations are shared through the story of a third-year medical student who rotated through the longitudinal clerkships at the Cleveland Clinic Lerner College of Medicine. The student, an individual with osteogenesis imperfecta who uses a power wheelchair with a seat elevator, completed third-year rotations and thrived in her clinical experiences. The authors describe her journey through a robust 4-week Ob/Gyn clerkship, in which she fulfilled the required clinical core conditions and observation skills with reasonable accommodation. Given the high acuity, surgery, and outpatient demands in Ob/Gyn-and the transferrable skills to other clerkships-the student's experience is an excellent exemplar for demonstrating disability inclusion and reasonable accommodation.Ob/Gyn clerkship directors and clinical faculty can broadly use the recommended timelines and communication protocols to create accessible training environments. With student input, minor scheduling adjustments, ongoing communication, reasonable accommodations, and an open mind, medical students on the clinical wards who are wheelchair users can successfully navigate the required expectations of medical training.

Exploring Virtual Reality as an Employment Accommodation for Individuals With Albinism

Advances in virtual reality (VR) technology have created a wide range of remote work options. The goal of this study was to explore the experiences of individuals with albinism using VR work environments as a reasonable accommodation for remote work. Four cohorts of five participants each worked for 6 months at their leisure in a variety of virtual environments and met monthly with the research team to discuss positive and negative experiences with the technology and accessibility features. Using inductive thematic qualitative analysis, we followed a three-step coding process to identify themes in recorded transcripts of individual interviews and focus group discussions. The participants spent an average of 3.8 hours per week in VR, with an average session lasting 0.85 hours. From the coding analyses conducted by five coders, four themes were developed including the following: difficulties with VR’s limitations, recommendations for improving accessibility in VR, benefits that VR could bring to the workplace, and navigation practice applications for VR. While VR provided improved visual experiences for nearly all participants, there are needed features that could dramatically improve accessibility. Although individuals with low vision can customize many features of VR to optimize their visual experience, many of these accessibility features are specific to applications and not consistent across developers and hardware ecosystems. Despite its shortcomings, VR shows great promise as an accommodation for people with low vision. In particular, individuals participating in the current study found great utility in VR’s ability to assist with navigation of unfamiliar environments and its potential use in the workplace.

How does work during pregnancy affect maternal and infant health and development?

AbstractIn the United States, most mothers work during pregnancy. Yet, until the passage of the Pregnant Workers Fairness Act in 2022, pregnant employees did not have a right to reasonable accommodations to work under safe conditions. This law is expected to increase employment among pregnant women, making it critical to understand the effects of work during pregnancy on health and the potential benefits of the law. Because the prenatal period has long‐lasting consequences for health, employment during pregnancy can affect children's health and development in childhood and beyond. In this article, we review theory and empirical evidence on the effects of work during pregnancy on maternal and infant health. We propose a conceptual framework that outlines the pathways through which work during pregnancy affects health, discuss policies that are expected to affect work during pregnancy and health and conclude with priorities for future research.

Neurodiversity & nursing: Reflection of a final year general nursing student

Autism Spectrum Disorder is neurodevelopmental disorder, the manifestations of which and levels of support individuals may require vary greatly. Although there is a plethora of information regarding supporting autistic individuals in higher education and the workplace, there is a paucity of information regarding both autistic nurses and nursing students. This paper presents an overview of autism spectrum disorder, the particular features of which are relevant in nursing professions and in the context of higher education; and highlights issues surrounding disclosure and implementing reasonable accommodations. It concludes with a reflection of the author's experience as an autistic nursing student.

Caregivers’ Perspectives on Reasonable Accommodation for Persons with Severe Mental Disorders at the Workplace

Background: Reasonable accommodation (RA) refers to adjustments or modifications that an employer makes to the workplace to enable an employee with a mental illness to perform the essential functions of their job. Employer and employee should work together to determine the most beneficial accommodations that would not impose an undue hardship on the employer. Materials and Methods: An exploratory study design with a purposive sampling technique was used in the current study. Ten in-depth interviews have been conducted with the caregivers (CGs) of persons with severe mental disorders (SMDs). Results: The CGs’ mean age is 55 years. The data have been collected from November 2022 to January 2023. Out of ten CGs, three were female and seven were male. The content analysis of CG interview transcripts suggests that persons with SMD lost or discontinued their jobs due to leaves, lack of peer support/supervision, more targets, shift work, discrimination at the workplace, and lower salaries. The CGs opined that the RAs for persons with SMD are adjustments in the work environment, policy, or procedure modifications that enable the individual to perform their job, allowing them to work from home. Conclusion: RAs for persons with SMDs are essential from the CGs’ perspective. RA for persons with SMD at work can promote their job continuation and social support.

Reasonable accommodation and interdependence: revisiting the dynamics of disability inclusion in higher education in India

ABSTRACT The principle of reasonable accommodation according to Article 2 of the UNCRPD is defined as ‘necessary and appropriate modification and adjustments not imposing a disproportionate or undue burden, where needed in a particular case, to ensure to persons with disabilities the enjoyment or exercise on an equal basis with others of all human rights and fundamental freedoms’. Exploring the relationship between inclusive policies enacted in institutions of higher education in India, and their impact on those who claim accommodation, we discuss the nature of care that informs and animates such interactions. Drawing on feminist disability studies scholarship on care, particularly, Akemi Nishida’s recommendation that care is inherently collective we analyse two sets of transactions selected for study as enabling care in patronizing and charitable manners, while simultaneously ignoring the politics of responding to and providing accommodations. We find that institutional responses to accommodation claims are less reflective of the socio-political and affective aspects integral to the RA principle. Instead, the focus seems to be on providing either technocratic solutions or interpreting RA claims as causing undue burden. By reading the RA principle through the lens of scholarship on interdependence, we aim to broaden the scope of adopting and interpreting the RA principle.

Occupational Physicians' Management of Workers With Multiple Sclerosis in Italy: Results From a Survey.

This study, conducted on a sample of Italian occupational physicians (OPs), aimed to gather data regarding professional activity and their needs in managing workers with multiple sclerosis. A convenience sample of OPs recruited by e-mail invitation to the list of Italian Society of Occupational Medicine members was considered. A total of 220 OPs participated between July and October 2022. An ad hoc questionnaire was developed based on previous survey experiences. It investigated, among others, the characteristics of OP respondents, the evaluation of fitness for work issues, and the OP training and updating needs on multiple sclerosis and work. Ninety-one percent of OPs had to assess the fitness for work of workers with multiple sclerosis during their activity. Sixty-four percent experienced particular difficulties in issuing a fitness for work judgment. Regarding the level of knowledge on multiple sclerosis, 54% judged it sufficient. The "Assessment of fitness for work for the specific task" and the "Role of the OPs in identifying reasonable accommodations" were the most interesting training topics regarding MS management in work contexts chosen by the respondents. The interest in the work inclusion and job retention of people with disability, particularly the aspects linked to the Identification and implementation of reasonable accommodations, will require integration with the occupational safety and health protection system and will undoubtedly impact the OP's activities.

“The University Is Made for Those Who Can Climb the Stairs”: Dialoguing With Counterstories in Higher Education

Entering higher education presents significant challenges for students whose learning styles differ from the norm of the “(neuro)typical student.” In Flanders, the prevailing notions persist in asserting that people with disabilities do not belong in a higher education system due to perceived shortcomings in meeting the traditional standards. In this article, we focus on a podcast “ I write so I am: The power of the dyslexic brain” created by a former student. By drawing on a critical dialogical methodology we engage with the stories presented in the podcast, contemplating ways to progress toward an affirmative and relational approach to disability. We make this more concrete by plugging-in concepts such as “recognition,” “relational accessibility,” and “caring communities” as they guide us in challenging ableist structures. The practice of dialoguing calls for engaging communities where listening with care opens negotiations to bypass the current rigid system of “reasonable accommodations.”