Utility of the Community Integration Questionnaire in a sample of adults with neurological and neuropsychiatric disorders receiving prevocational training

Purpose: To investigate utility of the Community Integration Questionnaire (CIQ) in a mixed sample of adults with neurological and neuropsychiatric disorders. Method: Cross-sectional, interview-based study. Participants were community-dwelling adults with disabilities resulting from neurological and neuropsychiatric disorders (N?=?54), who participated in a pre-vocational readiness and social skills training program. Psychometric properties of the Community Integration Questionnaire (CIQ) were assessed and validated against Mayo-Portland Adaptability Inventory (MPAI) and The Problem Checklist from the New York University Head Injury Family Interview (PCL). Results: Based on the revised scoring procedures, psychometric properties of the CIQ Home Competency scale were excellent, followed by the Total score and Social Integration scale. Productive Activity scale had low content validity and a weak association with the total score. Convergent and discriminant validity of the CIQ were demonstrated by correlation patterns with MPAI scales in the expected direction. Significant relationship was found with PCL Physical/Dependency scale. Significant associations were found with sex, living status, and record of subsequent employment. Conclusions: The results provide support for the use of the CIQ as a measure of participation in individuals with neurological and neuropsychiatric diagnoses and resulting disabilities.

• Implications for Rehabilitation

• An important goal of rehabilitation and training programs for individuals with dysfunction of the central nervous system is to promote their participation in social, vocational, and domestic activities.

• The Community Integration Questionnaire (CIQ) is a brief and efficient instrument for measuring these participation domains.

• This study demonstrated good psychometric properties and high utility of the CIQ in a sample of 54 individuals participating in a prevocational training program.

     

The experiences and needs of individuals with disabilities exposed to chronic political violence

Purpose The main objective of this study was to understand, describe and map the experiences, challenges and needs of individuals with lifelong disabilities, who have been exposed to chronic politically violent events (terror, war or continuous missile attacks) in Israel. Method The study was conducted within the qualitative-constructivist paradigm. Three focus groups consisting of 18 individuals with lifelong disabilities were conducted; each focus group included a specific disability type (physical, visual and hearing impairment). Results The participants reported encountering environmental barriers, such as inaccessibly of the physical environment and information as well as dependency on others. These barriers limited the participants' functioning during emergency period and thus increased their level of distress. The participants also emphasized their physical, social and psychological needs. Conclusions The needs of individuals with disabilities in emergency situations can be met if they have a safe place to stay in, are with someone else, and plan every daily action in advance. It is also imperative to provide accessible services and information. Furthermore, it is recommended to develop training sessions for individuals with disabilities and for service providers regarding how to locate, communicate with and assist individuals with disabilities during security threat situations.

• Implications for Rehabilitation

• Successful coping of individuals with lifelong disabilities with chronic politically violent events depends on personal and organizational accommodations.

• Besides an accessible physical environment, the information provided should be available and accessible through mass media and assistive technologies.

• A comprehensive emergency service for various disabilities is needed.

• Service providers should be trained on how to locate, communicate with, and assist individuals with disabilities during security threat situations.

     

The perceived needs-access gap for health services among persons with disabilities in a rural area within South Africa

Abstract

Purpose: Health should be a universal phenomenon. However, little is known about the relationship between disability status and health issues – particularly in rural areas. This study looks at health issues of persons with disabilities in Madwaleni, a rural impoverished area in South Africa in 2011, and compares them to persons with no disabilities.

Materials and Methods: Standardized questionnaires were used in the survey to assess disability and health status. The sample comprised of 773 individuals – 322 persons with disability and 451 comparisons (without disability) – covering 527 households. Children under the age of five were excluded from the sample. We used purposive sampling.

Results and Conclusion: This study found that persons with disabilities have poorer reported health outcomes than persons with no disabilities. There is also an association between disability severity and mental health issues as assessed by the GHQ-12. A significantly higher percentage of persons with disability did not get health care when needed. Persons with disabilities also have less favorable attitudes toward competence of health care workers. This study has shown greater health needs and less satisfaction with services, which strongly indicates insufficient access for persons with disabilities in a rural impoverished are within South Africa.

• Implications for rehabilitation

• Persons with disabilities in rural South Africa have poorer reported health outcomes.

• Persons with disabilities have less favorable attitudes towards competence of health care workers in rural South Africa.

• Better access to health care for persons with disabilities is needed in rural South Africa.

     

Disability in post-earthquake Haiti: prevalence and inequality in access to services

Abstract

Purpose: To assess the prevalence of disability and service needs in post-earthquake Haiti, and to compare the inclusion and living conditions of people with disabilities to those without disabilities. Methods: A population-based prevalence survey of disability was undertaken in 2012 in Port-au-Prince region, which was at the centre of the earthquake in 2010. Sixty clusters of 50 people aged 5?+?years were selected with probability proportionate to size sampling and screened for disability (Washington Group short set questionnaire). A case-control study was undertaken, nested within the survey, matching cases to controls by age, gender and cluster. There was additional case finding to identify further children with disabilities. Information was collected on: socioeconomic status, education, livelihood, health, activities, participation and barriers. Results: The prevalence of disability was 4.1% (3.4–4.7%) across 3132 eligible individuals. The earthquake was the second leading cause of disability. Disability was more common with increasing age, but unrelated to poverty. Large gaps existed in access of services for people with disabilities. Adults with disabilities were less likely to be literate or work and more likely to visit health services than adults without disabilities. Children with disabilities were less likely to be currently enrolled at school compared to controls. Children and adults with disabilities reported more activity limitations and participation restriction. Conclusion: Further focus is needed to improve inclusion of people with disabilities in post-earthquake Haiti to ensure that their rights are fulfilled.

• Implications for Rehabilitation

• Almost one in six households in this region of Haiti included a person with a disability, and the earthquake was the second leading cause of disability.

• Fewer than half of people who reported needing medical rehabilitation had received this service.

• The leading reported barriers to the uptake of health services included financial constraints (50%) and difficulties with transport (40%).

• People with disabilities did not participate equally in education or employment and had poorer access to health care.

     

“They don’t understand that we also exist”: South African participants in competitive disability sport and the politics of identity

Purpose: To describe how athletes with disabilities talk about their experiences of participating in competitive disability sport in South Africa.

Method: In-depth semi-structured interviews were conducted with 20 athletes with disabilities. Data were analysed via thematic content analysis using an inductive data driven process.

Results: Participants described their involvement in competitive sport as a positive experience; they described it as a catalyst for the recasting of identities and reframing an understanding of physical impairment, a context for empowerment and resistance of disablist attitudes, and an arena in which a sense of inclusion and belonging is experienced. However, their narratives also lay bare something of the struggle on the part of persons with disabilities to be seen as fully human and reveal how participants reproduce some unhelpful disablist discourses.

Conclusions: There are complex contradictions and cross-currents in the way athletes with disabilities describe their participation in competitive disability sport. These narratives highlight political and ideological tensions about inclusion and representation and remind us of the need to document the experiences of persons with disabilities and the potential dangers inherent in idealizing disability sport.

• Implications for Rehabilitation

• Competitive sport is a useful context for rehabilitation and the empowerment of persons with disabilities.

• Athletes with disabilities say that they are able to resist dominant stereotypes about disability and recast their identities through participation in competitive sport.

• Disability sport seems to provide a setting in which persons with disabilities can reproduce unhelpful disablist discourses.

• There are dangers inherent in idealizing competitive disability sport.

• Even where athletes with disabilities are competing at the highest level and are successful, rehabilitation professionals must be aware of these issues, must be able to listen for experiences of exclusion and low self-esteem, and to engage with athletes on these issues.

     

Examining occupational health and safety vulnerability among Canadian workers with disabilities

Objective: To compare workers with and without disabilities on their reported workplace hazard exposure and the presence of occupational health and safety vulnerability factors.

Methods: Working-aged adults in Ontario or British Columbia were recruited to participate in a cross-sectional survey (n?=?1988). Self-reported measures included demographic factors, work-related variables, perceived level of activity limitation at work, and presence of work safety vulnerability factors utilizing a novel framework.

Results: Reporting a disability at work was significantly associated with greater hazard exposure than those without a disability. In addition, those reporting a disability at work were more likely to be employed in conditions where hazard exposure was combined with inadequate policies and procedures, or hazard exposures were combined with inadequate empowerment.

Conclusions: Work safety vulnerability is one way that health inequalities can be perpetuated even among those with disabilities who have found work. Our results suggest that employers and policy makers need to focus on assessing and addressing hazard exposures and targeting occupational health and safety resources in the workplace in a way that includes workers with disabilities.

• Implications for Rehabilitation

• Workers with disabilities experience greater hazard exposure than those without a disability.

• Those with moderate and severe disabilities reported occupational health and safety vulnerability, suggesting that workplace accommodations should be available to a broader range of disability levels.

• It appears that, above and beyond standard safety procedures, providing workplace accommodations for people with disabilities may further reduce their hazard exposure and improve their safety.

     

“Knocking on Doors that Don’t Open”: experiences of caregivers of children living with disabilities in Iquitos and Lima,Peru

Abstract

Background: More than one billion people worldwide live with a disability. Despite advances in recognising inequalities experienced by people with disabilities, barriers to services and stigmatisation still exist. The aims of this study were to explore: (1) perceptions and experiences of services specifically available to people with disabilities and their caregivers and (2) the perception of disability.

Methods: In-depth interviews were conducted with 20 caregivers of persons with a disability and 14?key informants in two cities in Peru; Lima and Iquitos. The social-ecological model was used as a framework to analyse and present data, stratifying the key barriers and opportunities at each level.

Results: At the individual level, interviewees reported a lack of support at the time of diagnosis, poor coping strategies, and communicated their desire for, and willingness to participate in support groups if they were established. On the community level, education and awareness were reportedly lacking and acts of discrimination and stigmatisation were common. Participants described opportunities for community-level campaigns to increase exposure and awareness of disability rights and inclusion. A dissatisfaction with government programmes was reported, as services were not available to everyone, in part due to geographical and socio-economic barriers.

Conclusions: The main findings were the lack of emotional, informational, and tangible support available to caregivers of people with disabilities, often exacerbated by lower socio-economic status; a lack of transparency of care pathways available to people with disabilities; and a lack of visibility of people with disability in both Lima and Iquitos.

• Implications for Rehabilitation

• Support groups could offer additional support to caregivers of people with disabilities in Lima, mitigating existing gaps in services for people with disabilities, and their families.

• Education campaigns implemented on a community level could start to curb discrimination and stigmatisation of people with disabilities in Lima and Iquitos.

• A national census with inclusive language and methodology specifically designed to capture the percentage of the population currently living with a disability would give a real indication of what services are needed in Peru.

• The provision of clear, publically available routes of attention would assist caregivers and families to access services for people with disabilities.

     

A model for developing disability confidence

Purpose: Many clinicians, educators, and employers lack disability confidence which can affect their interactions with, and inclusion of people with disabilities. Our objective was to explore how disability confidence developed among youth who volunteered with children who have a disability.

Methods: We conducted 30 in-depth interviews (16 without a disability, 14 with disabilities), with youth aged 15–25. We analyzed our data using an interpretive, qualitative, thematic approach.

Results: We identified four main themes that led to the progression of disability confidence including: (1) “disability discomfort,” referring to lacking knowledge about disability and experiencing unease around people with disabilities; (2) “reaching beyond comfort zone” where participants increased their understanding of disability and became sensitized to difference; (3) “broadened perspectives” where youth gained exposure to people with disabilities and challenged common misperceptions and stereotypes; and (4) “disability confidence” which includes having knowledge of people with disabilities, inclusive, and positive attitudes towards them.

Conclusions: Volunteering is one way that can help to develop disability confidence. Youth with and without disabilities both reported a similar process of developing disability confidence; however, there were nuances between the two groups.

• Implications for Rehabilitation

• The development of disability confidence is important for enhancing the social inclusion of people with disabilities.

• Volunteering with people who have a disability, or a disability different from their own, can help to develop disability confidence which involves positive attitudes, empathy, and appropriate communication skills.

• Clinicians, educators, and employers should consider promoting working with disabled people through such avenues as volunteering or service learning to gain disability confidence.

     

Education and social inclusion of people with disabilities in five countries in West Africa: a literature review

Abstract

Purpose: An estimated 1 billion people worldwide live with some form of disability. With the adoption of the Sustainable Development Goals and the “Leave no one behind” agenda, there is a global momentum to ensure that disadvantaged groups, not least people with disabilities, are included and accounted for, in mainstream development efforts. However, in many low-income settings little is known about disability and the policies and programs in place to improve the lives of those affected.

Method: This literature review describes the extent and quality of published and unpublished literature on education and social inclusion of people with disabilities in five West African countries: Cameroon, Liberia, Mali, Sierra Leone and Senegal.

Results: Fifty-four unique documents met inclusion criteria of the review and described related policy and legislation; national and international stakeholders; intervention programs and primary research related to disability and inclusion. The majority of documents were from Sierra Leone (19); and four described more than one country. Primary research included mainly qualitative studies and cross-sectional surveys; 33 sources were critically appraised with the majority being attributed unclear risk of bias (20).

Conclusions: The findings call for (i) standardized tools for monitoring the implementation of programs and policies at national level; (ii) improved stakeholder coordination mechanisms; (iii) development and adoption of coordinated approaches to measuring disability and social exclusion; (iv) rigorous evaluations of the effectiveness of disability programs and (v) disaggregation of routine data by disability.

• Implication for Rehabilitation

• There is a need for standardized tools for monitoring the implementation of programs and policies at national level.

• Countries that have not yet ratified the UNCRPD or the protocol should be supported to do so.

• Stakeholder coordination mechanisms need to be improved.

• Improved coordination between stakeholders involved in disability at the country level could help improve the quality of services delivered.

• Development and adoption of coordinated approaches is key to measuring disability and social exclusion.

• There are few, if any, rigorous evaluation of the effectiveness of disability-specific evaluations in the five countries.

• There is a need for disaggregation of routine data from development programs by disability to inform implementation.

     

The intersection of disability and healthcare disparities: a conceptual framework

Abstract

Purpose: This article provides a conceptual framework for understanding healthcare disparities experienced by individuals with disabilities. While health disparities are the result of factors deeply rooted in culture, life style, socioeconomic status, and accessibility of resources, healthcare disparities are a subset of health disparities that reflect differences in access to and quality of healthcare and can be viewed as the inability of the healthcare system to adequately address the needs of specific population groups. Methods: This article uses a narrative method to identify and critique the main conceptual frameworks that have been used in analyzing disparities in healthcare access and quality, and evaluating those frameworks in the context of healthcare for individuals with disabilities. Specific models that are examined include the Aday and Anderson Model, the Grossman Utility Model, the Institute of Medicine (IOM)’s models of Access to Healthcare Services and Healthcare Disparities, and the Cultural Competency model. Results: While existing frameworks advance understandings of disparities in healthcare access and quality, they fall short when applied to individuals with disabilities. Specific deficits include a lack of attention to cultural and contextual factors (Aday and Andersen framework), unrealistic assumptions regarding equal access to resources (Grossman’s utility model), lack of recognition or inclusion of concepts of structural accessibility (IOM model of Healthcare Disparities) and exclusive emphasis on supply side of the healthcare equation to improve healthcare disparities (Cultural Competency model). In response to identified gaps in the literature and short-comings of current conceptualizations, an integrated model of disability and healthcare disparities is put forth. Conclusion: We analyzed models of access to care and disparities in healthcare to be able to have an integrated and cohesive conceptual framework that could potentially address issues related to access to healthcare among individuals with disabilities. The Model of Healthcare Disparities and Disability (MHDD) provides a framework for conceptualizing how healthcare disparities impact disability and specifically, how a mismatch between personal and environmental factors may result in reduced healthcare access and quality, which in turn may lead to reduced functioning, activity and participation among individuals with impairments and chronic health conditions. Researchers, health providers, policy makers and community advocate groups who are engaged in devising interventions aimed at reducing healthcare disparities would benefit from the discussions.

• Implications for Rehabilitation

• Evaluates the main models of healthcare disparity and disability to create an integrated framework.

• Provides a comprehensive conceptual model of healthcare disparity that specifically targets issues related to individuals with disabilities.

• Conceptualizes how personal and environmental factors interact to produce disparities in access to healthcare and healthcare quality.

• Recognizes and targets modifiable factors to reduce disparities between and within individuals with disabilities.

     

Risk factors for failure to enter vocational rehabilitation services among individuals with disabilities

Purpose: To investigate the risk factors for failure of individuals with disabilities to enter the vocational rehabilitation (VR) programme, including the cases where they had been formally accepted but were yet to receive any service.

Methods: We used prospective cohort data from a Midwestern US state, and analysed 126,251 and 94,517 individuals, respectively, for acceptance and admission into VR services. Statistical analysis was conducted using Poisson regression models with robust variance estimator.

Results: Individuals with blind/visual disability, had prior history of employment, and who received public support tended to have lower risks of non-acceptance and non-admission. Being non-White, at higher education, ever/currently married, and with physical/orthopaedic disability appeared to increase the risks of both outcomes. The adjusted relative risk of non-acceptance was 0.58 (95% confidence interval: 0.52, 0.64) if the individuals had 4 or more functional limitations as compared with those with fewer limitations. This factor was not significant for VR admission.

Conclusion: Disability factors, demographic determinants, and certain miscellaneous characteristics were associated with the risks of non-acceptance and non-admission into VR.

• Implications for Rehabilitation

• Individuals with disabilities are more likely to be unemployed than the population without disabilities, and they are thus more prone to adverse health effects of unemployment.

• Vocational rehabilitation (VR) is a proven intervention to improve employment outcomes among individuals with disabilities.

• Our study indicates that the complexity of the selection process for entering VR and various factors beyond disability may prevent individuals to benefit from the VR programme.

• Rehabilitation programme authorities need to monitor and simplify the selection process into VR services and, together with rehabilitation practitioners, promote a selection process that pays careful attention on the factors that are related to individual risk of failure for entering VR.

     

Experiences of attitudes in Sierra Leone from the perspective of people with poliomyelitis and amputations using orthotics and prosthetics

Purpose: The aim of this study was to describe experiences of attitudes in the society of Sierra Leone from the perspective of individuals with poliomyelitis and people with amputations using orthotic or prosthetic devices.

Methods: Individual interviews were conducted using open-ended questions. Twelve participants with amputations or polio were included. Content analysis was applied to the data.

Results: The following six themes emerged during data analysis: Experience of negative attitudes; Neglected and respected by family; Traditional beliefs; The importance of assistive devices; People with disability struggle with poverty; and The need for governmental and international support.

Conclusions: In Sierra Leone, people with disabilities face severe discrimination. They need to be included, recognized, and supported to a greater extent by the society, the community, and the family, as well as by the government and international organizations. Traditional beliefs have a negative impact on people with physical disabilities and are an important cause of discrimination in Sierra Leone. Prosthetic and orthotic devices are vital for people with physical disability and offer increased dignity. Prosthetic and orthotic services need to be accessible and affordable. Poverty affects access to education, employment, and health care for Sierra Leoneans with physical disabilities, forcing them to resort to begging to cover basic living needs.

• Implications for Rehabilitation

• In Sierra Leone, traditional beliefs related to disability and public attitudes need to change in order to protect the human rights of people with disabilities.

• Increased public awareness of disability and implementation of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) at different levels in society is needed.

• To increase access to prosthetic and orthotic services in Sierra Leone, these services need to be affordable and related costs, such as transport, need to be covered by support.

• Increased access to education, employment, and financial support could contribute to an improved standard of living for people with physical disabilities.

• Governmental and international support is needed to decrease attitudinal and environmental barriers for people with disabilities in Sierra Leone.

     

The politics of cinematic representation of disability: “the psychiatric gaze”

Abstract

Purpose: Social representations as cultural products rooted in praxis are considered to play dominant role in the structuring of identities or self representations. It is a common belief that people with disabilities analyze their experiences in light of the existing meanings and practices prevalent in society. The paper addresses the matrices of recurring themes in representation of disability and discourses of “normalcy” in films in the nineteenth and twentieth century invoking reductionistic attitude, whereby “disability” becomes a condition subject to neurotypical display and narrative coding in the films in question in the context of India. It will especially seek to analyze the theoretical outlook based on the social model of disability, a perspective that includes specific analyses of the representation of people like themselves in popular culture. Method: A systematic and thorough review of 26 Hindi films ranging from the 1960s to 2010 and six English movies. Apart from these, several books and articles have also been critically reviewed. Result and conclusion: The paper concludes with the argument that the idea of disability in mainstream contemporary cinema has been created and perceived as a speculative fantasy and for public consumption, thus reflecting the current status of people with disabilities as the present preferred “enigmatic” condition.

• Implications for Rehabilitation

• Films play significant role in communicating characters which have deep impact on peoples’ perspective of persons with disabilities.

• Filmmakers need to adopt more intensely researched and more sensitized approach in creating movies centering on people with disabilities.

• Films need to focus more on the potentialities rather than the shortcomings of people with disabilities.

• Filmmakers need adequate training in order to recognize the needs of the concerned population and adopt appropriate resources and interventions to address various issues for their rehabilitation into the mainstream society.

     

Cultural models of child disability: perspectives of parents in Malaysia

Abstract

Background: This study examined parents’ developmental concerns for their children within the context of systems of care in Malaysia.

Methods: Focus groups and interviews were conducted in peninsular Malaysia and Borneo.

Results: Parents’ perceptions of developmental delay stemmed from three sources: the cultural, resource, and the social environments.

Conclusion: There is a need to develop a medical support system in Malaysia that considers a life-course perspective, including prenatal care, screening/diagnosis, and services. This system should embrace a family-centered approach to diagnosis, referral, intervention, and support with sensitivity to cultural beliefs, family preferences, and barriers to care.

• Implications for Rehabilitation

• Parental perceptions of disability affect the strategies they use to cope.

• This research found that cultural conceptions of disability, available resources, and social support affect parental perceptions of disability.

• The resource environment in Malaysia significantly restricts parents’ ability to cope with their child's disability.

• This research recommended that the medical system of Malaysia develops a life-course perspective to disability to provide a range of care for children with disabilities including prenatal care, screening and rehabilitation or coping services.

     

The progression of disability among older adults in Mexico

Purpose: This paper seeks to document the progression of disability in a developing country and to examine gender differences in this process.

Methods: The data come from the Mexican Health and Aging Study (MHAS), a nationally representative sample of older adults. An ordinal logistic regression (n?=?3283) is used to measure the progression of disability that considers: (1) no disability, (2) mobility problems, (3) mobility problems with IADLs limitations, (4) mobility problems with ADLs limitations, (5) combinations of the latter three and (6) death.

Results: Approximately 43% of the sample remained in the same level of disability after 2 years. The patterns of progression with two disabilities differ for men and women.

Conclusions: Our model reflects the importance of separating ADLs and IADLs in the study of disability progression in Mexico. Varying risk profiles and cultural differences might influence the divergent disability paths followed by each gender.

• Implications for Rehabilitation

• The disablement process involving transitions from mobility impairments to IADL and ADL limitations seen in developed countries differs for older adults in Mexico.

• Cultural differences may influence the progression from non-disabled to becoming disabled in different ways for females in developing countries like Mexico.

• One-fifth of individuals showed greater function and independence over time, suggesting that the disablement process is reversible. This finding highlights the need to focus on improving mobility, ADL, and IADL skills to facilitate successful aging.

• Although disability is often conceptualised as a combination of ADL and IADL limitations, gender differences seen in Mexico indicate the need to separate ADL and IADL when developing approaches to prevent or ameliorate disability.

     

People with disabilities as product innovators: a pilot study

Abstract

Purpose: The purpose of this study is to explore the rate of product innovation among persons with disabilities, how they are diffused and the general value of these developed solutions for persons without disabilities.

Materials and methods: A sample of participants (n?=?178) completed a self-administered questionnaire, which included information about their disability, disability burden, general unmet product needs, the impact of the developed solution on their quality of life and how solutions were diffused. We analyzed solutions both for their novelty and for their general value.

Results: Close to 45% of respondents reported having developed a solution, with 9.55% solutions judged as novel. Additionally, 6.8% of respondents developed a solution of general value to non-disabled users.

Conclusions: Our results suggest that people with disabilities are actively involved in product development and that their solutions have a positive impact on their lives. Furthermore, many reported solutions also provide value for non-disabled persons, suggesting that persons with disabilities may be an important source of innovation.

• Implications for Rehabilitation

• Persons with disabilities are frequently engaged in developing solutions that meet their unmet product needs.

• Most solutions are not diffused beyond their immediate social circle.

• Solutions have a significant impact on the self-reported quality of life of participants.

     

A comparative review of measurement instruments to inform and evaluate effectiveness of disability inclusive development

Abstract

Purpose: A review of existing measurement instruments was conducted to examine their suitability to measure disability prevalence and assess quality of life, protection of disability rights and community participation by people with disabilities, specifically within the context of development programs in low and middle-income countries. Methods: From a search of PubMed and the grey literature, potentially relevant measurement instruments were identified and examined for their content and psychometric properties, where possible. Criteria for inclusion were: based on the WHO’s International Classification of Functioning Disability and Health (ICF), used quantitative methods, suitable for population-based studies of disability inclusive development in English and published after 1990. Characteristics of existing instruments were analysed according to components of the ICF and quality of life domains. Results: Ten instruments were identified and reviewed according to the criteria listed above. Each version of instruments was analysed separately. Only three instruments included a component on quality of life. Domains from the ICF that were addressed by some but not all instruments included the environment, technology and communication. Conclusion: The measurement instruments reviewed covered the range of elements required to measure disability-inclusion within development contexts. However no single measurement instrument has the capacity to measure both disability prevalence and changes in quality of life according to contemporary disability paradigms. The review of measurement instruments supports the need for developing an instrument specifically intended to measure disability inclusive practice within development programs.

• Implications for Rehabilitation

• Surveys and tools are needed to plan disability inclusive development.

• Existing measurement tools to determine prevalence of disability, wellbeing, rights and access to the community were reviewed.

• No single validated tool exists for population-based studies, uses quantitative methods and the components of the ICF to measure prevalence of disability, well-being of people with disability and their access to their communities.

• A measurement tool that reflects the UNCRPD and addresses all components of the ICF is needed to assist in disability inclusive development, especially in low and mid resource countries.

     

Exploring employment readiness through mock job interview and workplace role-play exercises: comparing youth with physical disabilities to their typically developing peers

Abstract

Purpose: To assess performance differences in a mock job interview and workplace role-play exercise for youth with disabilities compared to their typically developing peers. Methods: We evaluated a purposive sample of 31 youth (15 with a physical disability and 16 typically developing) on their performance (content and delivery) in employment readiness role-play exercises. Results: Our findings show significant differences between youth with disabilities compared to typically developing peers in several areas of the mock interview content (i.e. responses to the questions: “tell me about yourself”, “how would you provide feedback to someone not doing their share” and a problem-solving scenario question) and delivery (i.e. voice clarity and mean latency). We found no significant differences in the workplace role-play performances of youth with and without disabilities. Conclusions: Youth with physical disabilities performed poorer in some areas of a job interview compared to their typically developing peers. They could benefit from further targeted employment readiness training.

• Implications for Rehabilitation

• Clinicians should:

• Coach youth with physical disability on how to “sell” their abilities to potential employers and encourage youth to get involved in volunteer activities and employment readiness training programs.

• Consider using mock job interviews and other employment role-play exercises as assessment and training tools for youth with physical disabilities.

• Involve speech pathologists in the development of employment readiness programs that address voice clarity as a potential delivery issue.

     

Assessing health and rehabilitation needs of people with disabilities in Cameroon and India

Purpose: To assess the association between disability and serious health problems, and the access and uptake of health and rehabilitation services in Cameroon and India.

Methods: We undertook a population-based case–control study, nested within a survey in Fundong Health District, North West Cameroon (August–October 2013) and in Mahbubnagar District, Telangana State, India (February–April 2014). Disability was defined as the presence of self-reported difficulties in functioning or clinical impairments. One control without disability was selected per case, matched by age, gender and cluster. Information was collected using structured questionnaires on: socioeconomic status, health, access to health services and rehabilitation.

Results: Cases with disability were significantly more likely to report a serious health problem in the last year compared to controls in both India (OR?=?3.2, 95% CI 2.1–4.8) and Cameroon (OR?=?1.9, 1.4–2.7). The vast majority of people sought care when seriously ill, and this did not vary between cases and controls. Awareness and use of rehabilitation services was extremely low in both Cameroon and India.

Conclusions: Further focus is needed to improve awareness of rehabilitation services among people with disabilities in India and Cameroon to ensure that their rights are fulfilled and to achieve the goal of Universal Health Coverage.

• Implications for Rehabilitation

• People with and without disabilities equally seek health care in India and Cameroon.

• However, people with disabilities experience more frequent serious health problems than people without.

• Extremely few people with disabilities were aware of rehabilitation services despite their existence in the study settings.