Lessons from the 2015 earthquake(s) in Nepal: implication for rehabilitation

Purpose: There has been an increase in the number of natural disasters in recent history, and the rate of disability is increasing among survivors. The most recent major natural disaster was the earthquake(s) that occurred in Nepal on 25 April 2015 and 12 May 2015. In total, more than 8500 people were killed and over 18?500 people were left injured. This article aims to demonstrate the role of rehabilitation professionals in post-disaster relief and beyond in Nepal. Method: This is an experiential account of physiotherapists present during the earthquake and participating in the post-disaster relief. Results: Rehabilitation professionals played an important role in the acute phase post-disaster by providing essential services and equipment. However, discharge planning emerged as an important role for rehabilitation providers in the early days of post-disaster and signaled a relatively new and innovative function that facilitated the heavy imbalance between little supply and tremendous demand for care. In the coming years, rehabilitation will need to support local initiatives that focus on minimizing the long-term effects among people with a newly acquired disability. Conclusions: Rehabilitation serves an important role across the continuum in post-disaster relief from the initial stages to the months and years following an event.

• Implications for Rehabilitation

• Driven by medical advances in acute field medicine, the relative proportion of casualties following natural disasters is decreasing, while relative rates of disability are rising among survivors.

• In post-disaster settings, the growing number of people with newly acquired disabilities will be added to the existing proportion of the population who lived with disabilities, creating a significant growth in the total number of people with disabilities (PWDs) in communities that are often ill prepared to provide necessary services.

• Rehabilitation interventions in the initial stages of emergency humanitarian response can minimize the long-term effects among people with newly acquired disabilities through early activation and prevention of secondary effects.

• Rehabilitation providers thus appear to have an important mediating effect on outcomes of disabilities in the early stages, but must also be strong partners with PWDs to advocate for social and political change in the long term.

     

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.

     

Children’s contact with people with disabilities and their attitudes towards disability: a cross-sectional study

Purpose: To explore the association between children’s self-reported contact with people with disabilities and attitudes towards them, as well the potential mediating influence of anxiety about interacting with people with disabilities and empathy for them. Method: 1881 children, aged 7–16 years, from 20 schools in South West England completed a survey assessing their contact with people with disabilities and their attitudes towards them. Anxiety about interacting with people with disabilities and empathy towards them were examined as potential mediators. Gender, school year, perceived similarity between people with and without disabilities, proportion of children with additional needs at the school and socioeconomic status (SES) were assessed as moderators. A random effects (“multilevel”) regression model was used to test the contact–attitude association and moderation, and path analysis was used to test for mediation. Results: Participants with more self-reported contact reported more positive attitudes towards disability (p?Conclusions: Self-reported contact was observed to be associated with more positive attitudes towards disability, which was partially mediated by empathy and anxiety. Providing opportunities for contact with people with disabilities that reduces anxiety and increases empathy may improve attitudes to disability and merits evaluation in interventions.

• Implications for Rehabilitation

• Children who reported greater levels of contact with people with disabilities had more positive attitudes towards disability.

• Anxiety about interacting with people with disabilities and empathy towards them partially mediated the contact–attitude associations.

• Providing opportunities for contact with people with disabilities, reducing anxiety and increasing empathy may improve children’s attitudes to disability.

     

“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.

     

Disability studies in Sri Lanka: priorities for action

Abstract

Purpose: To review the published literature relating to disability in Sri Lanka, identify research gaps and inform priorities for action. Methods: A narrative literature review was undertaken and relevant articles extracted using electronic databases such as Medline and PubMed. The available literature was examined in relation to the nine key recommendations of the World Report on Disability. Results: Over the past 30 years, published disability research in Sri Lanka has primarily focussed on mental health, visual impairment and healthcare delivery. Significant gaps were apparent in evidence relating to the status and services for people with intellectual disability, policies and their impact, provider attitudes, barriers to education and employment, health workforce training and access to healthcare. Conclusions: While published studies provide insights on several dimensions of disability, there are important research gaps pointing to unmet needs that require attention to support the health and wellbeing of people living with disability in Sri Lanka. To address these gaps, it is imperative that a critical mass of multi-disciplinary researchers including people living with disabilities collaborate on a strategic program of research using effective participatory approaches that engage all sectors and communities relevant to uphold the rights of people living with disability.

• Implications for Rehabilitation

• All nine key recommendations in the World Report on Disability are highly pertinent to the needs and status of people living with disabilities in Sri Lanka.

• Significant gaps in research on disability-related health issues exist and warrant more focussed attention by researchers, funders and policy makers.

• It is imperative that national stakeholders including the Ministries of Health and Social Welfare, organisations representing people living with disability and related advocacy groups, work collaboratively to identify and implement a research strategy that would better inform disability policies and programmes that have access and equity as core principles.

• Implementation of a national disability survey by the Department of Census and Statistics, will help prioritize disability research in the country.

     

Negotiating disability in everyday life: ethnographical accounts of women with rheumatoid arthritis

Abstract

Purpose: Drawing on data from a larger study, the aim of this paper is to illuminate how the everyday doings of women with disabilities are coordinated to and shaped by organizational processes and social context, particularly as these relate to the potential of being labelled disabled. Methods: An institutional ethnography was conducted with seven Austrian women diagnosed with rheumatoid arthritis (RA). Interviews and participant observations were conducted, and texts about the historical development of disability policies were identified. Data analysis included grouping similar doings of participants together to subsequently explore links between what the women did and how their doings are shaped by disability policies and the social context. Results: The women, who participated in this study, spent time and effort to keep the disease invisible, resist disability and negotiate a disability pass. By drawing upon the historical development of Austrian disability policies, the interpretation reveals how this development infiltrates into participants’ lives and shapes their everyday doing. Conclusion: This study furthers understanding of how broader policies and practices, shaped over historical time, infiltrate into the daily lives of women with disabilities. It illustrates how full participation may not necessarily be a lived reality for people with disabilities at this point in Austria.

• Implications for Rehabilitation

• Maximising full participation for people with rheumatoid arthritis is important.

• This requires focusing not only on the bodily health of people with rheumatoid arthritis but also on their interaction with the social, cultural and political context in their daily lives.

• This requires also understanding how knowledge about disability is passed on from previous generations.

     

Contemporary vocational rehabilitation in Australia

Abstract

Purpose: There is a strong connection between disability and decreased participation rates in the Australian labour market. Australian government policy recognises vocational rehabilitation as a key strategy to increase employment rates of people with disabilities. Methods: This paper examines current Australian disability employment policies and practices. It also reviews vocational rehabilitation competency research to identify knowledge and skill domains central to quality service provision, and explores the delivery of tertiary level vocational rehabilitation education. Results: Policy changes in Australia over the last decade have been aimed at addressing the unsustainable increase in disability benefits. In this context vocational rehabilitation services continue to be viewed as crucial in assisting people with disabilities to maintain employment and reduce disengagement. Competencies research has consistently identified vocational counselling, personal counselling, professional practice and case management as central to quality vocational rehabilitation service provision. Two competencies identified in recent research, workplace disability case management and workplace interventions and program management, reflect the centrality of vocational rehabilitation to disability management. Conclusions: Changes in the policy environment to reduce the number of disability pension recipients will inevitably lead to an increased demand for trained vocational rehabilitation personnel. Given the development of strong accreditation standards for vocational rehabilitation education and practice that underpin the provision of tertiary level rehabilitation counselling training programs, professionally qualified rehabilitation counsellors are ideally placed to address the complex employment needs of people with a disability.

• Implications for Rehabilitation

• It is important to understand changes that may occur in policy environments in terms of their impact on vocational rehabilitation service delivery for people with disabilities.

• Variable levels of training in the vocational rehabilitation sector result in people with complex needs not consistently receiving the services they need to access and maintain employment.

• Practitioners need to focus increasingly on individualized service delivery where the client has significant control over decisions about their rehabilitation program.

     

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.

     

Impact of a film portrayal of a police officer with spinal cord injury on attitudes towards disability: a media effects experiment

Abstract

Purpose: The portrayal of disabled people in the media can influence the public’s perception of disability in both positive and negative ways. In this article, an experimental before and after design is used to determine the effects of a short film on the attitudes of non-disabled and disabled persons concerning employment and productivity of persons with disabilities.

Method: Three questions were posed to 480 study participants prior to and following a short film featuring a police officer with paraplegia. Linear mixed models were used to assess the effects of time point and disability status on the responses.

Results: The non-disabled participants’ ratings of eligibility for employment of a paraplegic man and estimates of the employment rate of disabled people were significantly enhanced following the film. Nevertheless, the film had no significant effects on the ratings given by participants with disabilities in terms of eligibility, employment rate or productivity.

Conclusions: This investigation highlights the potentially important influence of media portrayal and coverage of people with disabilities on attitudes of the public concerning disability.

• Implications for Rehabilitation

• Restrictions in participation may result from an interaction of persons with impairments with an environment that is dominated by negative attitudes towards disability

• The portrayal of disabled people in the media can influence the public’s attitudes towards disability in both positive and negative ways

• In this experimental study, attitudes of the general public were significantly improved following viewing a short film featuring a positive media portrayal of a police officer with paraplegia

     

Benefits and barriers to physical activity for individuals with disabilities: a social-relational model of disability perspective

Abstract

Purpose: To provide a qualitative overview of selected research on physical activity (PA) engagement by people with physical disabilities from a social relational model perspective. Method: Selected articles that exemplify some of the paradoxes, nuances, contrasting perspectives and complexities of the knowledge base in this area are discussed within a disability studies framework. Results: PA is arguably more important for people with disabilities relative to people without disabilities although they are quite inactive. Individuals who are physically activity enjoy a range of benefits spanning physiological, emotional, cognitive and social categories. Unfortunately many people cannot enjoy the benefits of PA because of the many medical, psychological, social and environmental barriers they face making PA quite difficult. Conclusions: Rehabilitation professionals can provide a better standard of care to clients if they are aware of the benefits and barriers of PA.

• Implications for Rehabilitation

• Rehabilitation professionals should understand behavior change strategies and their application to people with disabilities in order to help their clients initiate and maintain physical activity (PA).

• Rehabilitation professionals should be aware of how they might convey low PA expectations to their clients and simultaneously understand the unique challenges faced by their clients in attempting to incorporate PA into their lives on a regular basis.

• Rehabilitation professionals should be familiar with local disability friendly exercise facilities and adapted sport programs in order to steer their clients towards such opportunities.

     

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.

     

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.

     

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 stigma of disability: Croatian experiences

Purpose: The aim of this paper is to get an insight into understanding the stigma of disability based on the experience and perception of people with disabilities and professionals who work with them. Methods: Qualitative research methods were used with two focus groups: one with people with disabilities (five participants) and other with professionals (seven participants). After data were collected, a qualitative content analysis was made. Results: The results indicated that participants perceived and experienced stigma of disability through intrinsic and extrinsic elements of stigmatization. The intrinsic elements refer to the feeling of being different as a result of negative attitudes, prejudices and stereotypes. The extrinsic elements derive from the relationship of the system towards people with disabilities: discrimination and labelling. Some of the major findings of this research are that the stigma of disability is shown through the inability of the people with disabilities to make their own decisions, the perception of the disability as the main feature of the person, the lack of criteria during education, perceiving disability as a precondition in choosing a partner and parental capability, parents’ decision-making about their children’s lives, overprotection and stigmatization in education and employment. Stigmatization leads to social exclusion and influences the quality of life. Conclusion: The stigma of disability is manifested through the impossibility of realizing basic human rights, of living life independently and of taking equal part in a local community.

Implications for Rehabilitation

• Members of both formal and informal social networks stigmatize people with disabilities in many aspects of their life.

• The realization of basic human rights is often limited or impossible for people with disabilities because of stigmatizing attitudes in Croatian society.

• The disability stigma determines lives of people with disabilities in Croatia.

     

Perceived social support as a moderator between perceived discrimination and subjective well-being among people with physical disabilities in Israel

Purpose: Perceived social support has gained importance as a significant preventive factor of depressive symptoms and as helpful for rebuilding feelings of self-worth and subjective well-being among people with physical disabilities. The current study examined whether perceived social support moderates the association between perceived discrimination and subjective well-being among people with physical disabilities in Israel.

Materials and methods: Data were collected by means of structured questionnaires among a convenience sample of 433 people with physical disabilities in Israel and hierarchical multiple regression was performed.

Results and conclusions: The findings reveal that perceived social support has a moderating role in the association between perceived discrimination and subjective well-being among people with physical disabilities, such that those with low and moderate levels of perceived social support showed a negative association between perceived discrimination and subjective well-being, while those with high levels of perceived social support showed no association between perceived discrimination and subjective well-being. Findings are discussed in light of the social model of disability, and practical implications are suggested.

• Implications for Rehabilitation

• A negative association was found between perceived discrimination and subjective well-being among people with physical disabilities with low and moderate levels of perceived social support.

• Professionals working with people with physical disabilities must acknowledge the importance of social support for people with physical disabilities and for their families.

• Professionals working with people with physical disabilities should take a proactive approach to locating disabled people who do not receive or do not have adequate social support and offer them assistance.

• Professionals working with people with physical disabilities should engage in wide social activities aimed at providing resources and opportunities to service beneficiaries.

• Society bears the collective responsibility to act in order to reduce the social problem of discrimination against people with disabilities, as well as to raise public awareness of this issue.

     

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.

     

Vocational rehabilitation case manager factors associated with vocational rehabilitation service program outcomes for people with disabilities in Taiwan – an exploratory study

Purpose The aim of this study is to explore whether/which vocational rehabilitation case manager (VRCMer) factors were significantly associated with the vocational rehabilitation service (VRS) program outcomes in Taiwan. Method This study used the 2011 VRS Program for People with Disabilities Database in a metropolitan city in Taiwan (N?=?466) to do a secondary data analysis using hierarchical logistic regression. Results This study found that the employment rate and stable employment rate created by the 2011 VRS program in a metropolitan city in Taiwan were 48.7% and 42.1%, respectively. For the predictors of employment/stable employment, “occurrences of the services provided by the VRCMer” variable was definitely dominant. In addition, “level of the disability” was the second-ranking predictor, and was significantly negatively correlated with both employment and stable employment outcomes. Conclusions Vocational rehabilitation case manager factors in this study were significantly correlated with VRS program outcomes for people with disabilities in Taiwan after controlling for the clients’ socio-demographic variables. The results indicate that greater input by VRCMers for people with disabilities equates to better employment outcomes in metropolitan Taiwan.

• Implications for Rehabilitation

• This is the first study to build an inferential statistical model in attempt to explain and predict the association between vocational rehabilitation case manager factors and vocational rehabilitation service program outcomes for people with disabilities in Taiwan.

• In cases of severe disability, a vocational rehabilitation case manager should seek out more in-kind and in-cash resources, and choose a suitable job coach to cooperate in assisting the client to become employed.

• Based on the findings, government has to continue implementing opportunities for people with disabilities to attain higher and better quality educational levels, for increasing their employment rate.

• Vocational rehabilitation case managers should raise the referral rate and cooperation with job coaches as this directly affects the quality of services and clients’ employment rate.

     

Using intersectionality to explore experiences of disability and HIV among women and men in Zambia

Abstract

Purpose: Little is known about the experiences of people with disabilities (PWD) who live with HIV. Existing research largely assumes a “double burden” approach, which views HIV as doubling the load for people already burdened by disability. Intersectionality (a dynamic process of converging systems of relationships) offers an alternative approach for understanding differences in experience. This study uses an intersectional approach to explore the experiences of PWD in Zambia who have become HIV-positive. Methods: We conducted semi-structured, in depth interviews with 21 PWD who live with HIV in Zambia (12 women, 9 men). Participants had various impairments (visual, hearing, mobility, intellectual). Interviews were conducted to meet participants’ accessibility preferences. Results: Our intersectional analysis demonstrates the dynamic and situational emergent meanings and consequences for PWD who are living with HIV related to: (1) meanings of HIV and disability linked with time and trajectory; (2) oppression and negotiation related to accessing health services and (3) social roles and relationships. Three case studies illustrate these circumstances. Conclusions: Intersectionality offers a complementary approach for examining the complex interrelationship among HIV, disability, gender and time among PWD living with HIV. Findings illustrate directions for improved services and policies for this important group.

• Implications for Rehabilitation

• Rehabilitation services need to take a cross-disability (multiple disabilities) approach working with people living with HIV and disability.

• Rehabilitation, as illustrated by a CBR approach, needs to include services that will facilitate not only health, but education, jobs and housing for people living with HIV and disability.

• Rehabilitation needs to make more direct connections with Zambia social service sector to help address the fluctuating experience of living with HIV and disability.

     

Closing the gap: training for healthcare workers and people with disabilities on the interrelationship of HIV and disability

Abstract

Background: HIV and disability are interrelated providing a double burden to HIV endemic countries in East and Southern Africa and their already fragile health systems. Although literature reveals that people with disabilities are particularly vulnerable to HIV and that HIV, its opportunistic infections and treatments can cause disability, only few interventions target this issue and none have been evaluated in this region. Methods: Formative evaluation was undertaken with regard to the effectiveness of a workshop-based intervention for healthcare workers and people with disabilities on the intersection of disability and HIV in order to inform the further development of this intervention. The formative evaluation assessed participants’ perception of the inclusion of disability in HIV services and of opportunities to initiate change after the workshops. It also captured their experiences in utilising knowledge and skills after the workshops using quantitative (short checklist and ranking exercise) and qualitative (semi-structured interviews) methods of inquiry. Frequencies and conventional content analysis were used in the analysis of the data. This study presents an example of applied research conducted under real-world conditions. Results: 60 healthcare workers and people with disabilities took part in this pilot workshop training and participated in the formative evaluation. Healthcare workers and people with disabilities alike identified various barriers to access health services. Reasonable accommodation was perceived as being mainly absent by most participants, while some participants indicated a lack of physical accessibility in the form of universal design. Participants also identified a lack of integration of services and disability-related skills within the healthcare staff. Participants reported a number of enablers, success and challenges while implementing the knowledge from the workshops related to structural issues, service provision and integration. While participants worked on health workers’ attitudes and accessibility of services, screening and referrals practice was not improved through the workshops. Conclusions: Formative evaluation indicates that the workshops can be effective not only in sensitising healthcare workers and people with disabilities to opportunities to improve services for people with disabilities but also to provide knowledge and skills to initiate improvements. Skills that need more practical training (e.g. screening for disability) need to be trained in more detail, and this will inform the adaptation of the workshops. However, the workshop evaluation also revealed that without policy implementation and budget allocations this change would only be limited.

• Implications for Rehabilitation

• HIV, its co-morbidities and treatments cause health conditions and impairments that have the potential to develop into disability.

• People with disabilities are at increased risk of exposure to HIV.

• Rehabilitation professionals, healthcare workers and people with disabilities can be sensitised in a three-day workshop on the relationship of disability and HIV.

• However, the trained participants can only implement no or low-cost elements of interventions, while high-cost interventions need budget allocations at provincial and national level.

     

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.