Disabilities

Within Australia’s National Disability Insurance Scheme (NDIS), nominees may be appointed to support participants in their interactions and decision-making with the scheme. However, limited evidence has examined why people become or remain nominees and how they understand and enact the role in practice. This qualitative study explored the accounts of 24 NDIS nominees. Reflexive thematic analysis of semi-structured telephone interviews generated two overarching themes: internal beliefs and relational responsibilities, comprising acting in perceived best interests, deficit-based thinking, strengths-based thinking and feelings of obligation; and external systemic pressures, comprising safety and risk management, complexity of the NDIS system and insufficient support for NDIS participants. The analysis identified relationships between participants’ motivations for taking on or remaining in the role, their beliefs about capacity and responsibility, the pressures they encountered, and how they described exercising decision-making authority. The findings highlight the need for clearer guidance, education, conflict-of-interest safeguards and ongoing support to assist nominees to distinguish supported decision-making from representative or substitute decision-making. Although specific to the Australian NDIS, the findings offer insights for other individualised funding and decision-support systems in which supporters mediate access to services and resources.

Appropriate wheelchairs are essential for mobility and participation, but their benefits depend on device suitability, user training, maintenance, and accessible environments. This mixed-methods study examined wheelchair provision, functionality, accessibility barriers, and factors associated with reported independent wheelchair use in Albania. Survey data from 807 respondents, including 662 wheelchair users and 145 family proxy respondents, were integrated with five focus group discussions involving 40 wheelchair users. The primary outcome was self- or proxy-reported independent wheelchair use, assessed using a single Yes/No questionnaire item. Among respondents with valid outcome data, 30.9% reported independent wheelchair use. Most wheelchairs were folding models (80.6% of respondents with valid wheelchair-type data). In the complete-case multivariable model (n = 538), wheelchair-use training (OR = 2.14, 95% CI [1.34, 3.42]), wheelchair functionality (OR = 1.41, 95% CI [1.14, 1.76]), ramp access (OR = 3.41, 95% CI [2.10, 5.54]), and male gender (OR = 2.19, 95% CI [1.38, 3.46]) were associated with independent use; maintenance services showed a smaller association (OR = 1.56, 95% CI [1.02, 2.40]). Sensitivity analyses, including multiple imputation and analyses restricted to direct respondents or the two predominant wheelchair types, supported the principal associations. The findings should be interpreted as sample-specific associations rather than causal or population-level estimates and support continued attention to structured wheelchair services, user training, and accessible environments.

Historic heritage places, which reflect the history of a society and are important for culture, were constructed before the formal recognition of the rights of people with disabilities and the establishment of accessibility standards. Therefore, they frequently present accessibility challenges. This study aimed to identify the most frequent perceived obstacles to the accessibility of historic heritage places observed from photographs and to explore potential patterns in obstacles across disability groups and respondent profiles. Data were collected through an online survey in which 100 participants provided responses (people with disabilities, caregivers, and students or professionals with expertise in universal accessibility or heritage). Participants were asked to select the most significant obstacles to accessibility across six different image-based situations. They were also asked about their understanding and perception of the meaning and importance of heritage. Results show that steps, lighting, lack of handrail, the location of washroom accessories and grab bars, circulation space, entrances to shops, and ground slope and surface were among the most frequently reported obstacles depending on the site area considered. Reported obstacles also varied across disability groups. Otherwise, most participants associated heritage with history, culture, and identity, and considered it important or very important. In conclusion, these findings underscore the importance of balancing heritage preservation and accessibility while considering the diverse needs, experiences, and obstacles encountered by people with different disabilities.