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Background:
Study Protocol

Strategies for Increasing Accessibility and Equity in Health and Human Service Educational Programs: Protocol for a National, Mixed Methods Study

by
Tal Jarus
1,*,
Lindsay Stephens
2,
Tracey Edelist
3,
Erika Katzman
4,
Cheryl Holmes
5,
Stuart Kamenetsky
6,
Iris Epstein
7 and
Shahbano Zaman
1
1
Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, BC V6T 2B5, Canada
2
Department of Geography and Planning, University of Toronto, St. George, ON M5S 1A1, Canada
3
Department of Speech-Language Pathology, Université du Québec à Trois-Rivières, Trois-Rivières, QC G9A 5H7, Canada
4
Department of Disability Studies, King’s University College (Western University), London, ON N6A 2M3, Canada
5
Division of Critical Care, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
6
Department of Psychology, Institute for the Study of University Pedagogy, University of Toronto, Mississauga, ON L5L1C6, Canada
7
Department of Nursing, York University, Toronto, ON M3J 1P3, Canada
*
Author to whom correspondence should be addressed.
Disabilities 2024, 4(3), 444-458; https://doi.org/10.3390/disabilities4030028
Submission received: 4 March 2024 / Revised: 11 June 2024 / Accepted: 19 June 2024 / Published: 26 June 2024
(This article belongs to the Collection Exclusive Papers Collection of Editorial Board Members of Disabilities)
Browse Figures
Review Reports Versions Notes

Abstract

:
Introduction: Despite legislation mandating accommodation policies in higher education, support for learners with disabilities is often not implemented within health and human services (HHS) education programs, particularly in fieldwork settings. This paper will describe the protocol of a study aimed to (a) explore challenges and opportunities of current practices for supporting learners living with disabilities in a fieldwork context, across 10 HHS programs; and (b) develop, pilot and evaluate innovative accessibility practices to decrease existing barriers faced by educators and learners. Method: Using a critical disability studies framework, we designed a national, multi-profession, mixed methods design. Data are collected through interviews (qualitative) and an online survey (quantitative) that participants complete prior to the interview. Additionally, an online mapping diary is used to facilitate the understanding of accessibility in fieldwork education from the perspective of the learners. Participants include learners living with disabilities, academic fieldwork coordinators, fieldwork educators, accessibility advisors and professional organizations representatives. Implications: Learners living with disabilities navigate systemic barriers: (a) the additional “work of being a disabled learner”, during a rigorous academic program, and (b) absent or inadequate fieldwork accommodations. Exploring those systemic barriers as faced by all partners offers the potential to develop strategies and tools to foster inclusive and accessible HHS education.

1. Introduction

In health and human service (HHS) occupations, professional education programs are the gateway to entry-level practice. There are no official Canadian data on the number of HHS learners living with disabilities, but recent studies in the US suggest a significant increase over the past decade [1]. In this project, we consider people living with disabilities to be those living with diagnosed or self-perceived bodily, mental or sensory differences, which simply reflect the range and diversity of human ability. The learners in our study used various terms to identify themselves in relation to disability. Because of centering disabled learners, we intentionally move between “person-first” (e.g., person living with a disability), “identity-first” (e.g., disabled person) as well as “learners seeking/requiring accommodations” language to honor disabled learners’ varied linguistic preferences and to acknowledge the contested nature of disability language in disability and scholarly communities.
Despite recent international, federal and provincial legislation mandating equitable access, persons living with disabilities continue to have low enrolment in higher education [2], high dropout rates [2,3] and require significantly more time (on average twice as long) than non-disabled peers to complete HHS programs [4]. Accessibility for learners living with disabilities is required in all phases of preparation for and participation in clinical practice, from entering HHS programs, satisfactorily completing and graduating from these programs, to securing and maintaining gainful employment. This protocol paper will describe the methods used in a large national study to explore barriers to accessibility in HHS fieldwork education. Fieldwork—or the practicum component of an HHS education—refers to education outside the classroom. In our study and in this paper, fieldwork is the term we use to cover a broad range of related (or alternate) terminology such as fieldwork education, field, clinical education, professional practice education, placement, externship, preceptorship, practicum, clerkship or internship.
By understanding how to make HHS education and practice more accessible, this high-impact project has the potential to inform inclusion strategies for greater participation and to enhance HHS professional practice with an ultimate benefit for service provision. Not only do disabled practitioners bring unique knowledge and perspectives relevant for practice [5,6], but it is also well documented that organizations that include people with diverse lived experiences outperform other organizations that are more homogenous [7,8,9,10]. However, at present, these professions have very limited representation of disabled workers [11], suggesting discriminatory systems in health education and employment.
One way discrimination happens is through the way required competencies for both academic and practice contexts are framed within the HHS education. These competency expectations are situated within a medically oriented dominant paradigm that views disability as an individual issue. It often associates having an “able body” and mind with “safe practice” and considers disabled bodies as more risky, vulnerable and unsafe [12,13,14,15,16,17,18,19,20,21,22,23,24,25,26]. Previous studies that have investigated experiences of multiple HHS professions and have found similar barriers encountered across professions, and among learners and clinicians [27,28,29,30,31]. Barriers to full participation by disabled learners include stigma, disabling discourses, discriminatory program design, lack of support and oppressive interactions [27,28,29,30,31,32,33,34,35,36,37]. These studies provide evidence that educators, clinicians and employers lack an understanding of the barriers learners living with disabilities face or the support they need in their fieldwork of education [29,30,32,34,36,37].
Currently, there are no clear frameworks or procedures to guide promising practices to address these barriers and support disabled learners within and across diverse HHS practice contexts [27,28,37,38,39]. Effective approaches must consider the deep-rooted Western, ableist medical and educational discourses that frame ideas and assumptions about both disability and professional competence [40,41]. An effective approach to inquiry must be grounded in honest, reflective discussions with all relevant partners, including academic and fieldwork educators, learners living with disabilities, professional regulatory bodies and professional associations. An effective approach must also address intersections of disability with gender, race and ethnicity, sexual orientation, age, social class and religion.
This project provides such an approach to explore the current practices and barriers to providing non-discriminatory, accessible fieldwork education in HHS. The research questions we addressed are as follows: (a) what are the challenges and opportunities of current practices for supporting learners living with disabilities in a fieldwork context, across 10 HHS programs; and (b) what might be some innovative accessibility practices to decrease existing barriers faced by educators and learners?
This paper presents the protocol of this project where recruitment targeted ten HHS disciplines at universities across Canada: Audiology, Dental Hygiene, Dentistry, Medicine, Nursing, Occupational Therapy, Physical Therapy, Psychology, Social Work and Speech Language Pathology. Given that this is a protocol paper, and due to the ongoing nature of the study, it must be noted that the analysis of the data is still in progress and has yet to be presented. Therefore, none of the current findings will be shared in this article.

2. Materials and Methods

2.1. Overview

This study is guided by critical disability studies (CDS) methodologies. CDS centers academics and activists spanning across multiple interdisciplinary fields (including cultural studies and humanities, feminist, postcolonial and queer thinkers, etc.). CDS examine and challenge how disability, along with other social marginalities, are socially constructed in relation to societal ideals of normalcy. Normative standards are enmeshed within the HHS professions which often rely on an individual deficit understanding of disability. CDS challenges this individual-as-problem understanding by drawing attention to how societal structures might marginalize and oppress and by working to change inequitable systems and practices [42,43,44]. The study team includes interdisciplinary researchers and scholars, some of whom are HHS professionals, some who identify as disabled scholars and contributed as experts and consultants on the CDS theoretical framework adopted in this project. This is important for this study, as the CDS approach as well as the composition of the team provide the necessary sensitivity to the intersectional diversity of experiences of individuals who identify with multiple underrepresented and/or marginalized groups. Conversations about openness to diverse perspectives, particularly those grounded in experiential knowledge and diverse ways of knowing, are foundational in this field and enrich the study and the interpretation of the findings.
This study uses a mixed methods design. Qualitative data are collected through Individual and group interviews. Quantitative data are collected using an online survey that participants complete prior to the interview. In addition, an online mapping diary is used to facilitate the understanding of accessibility in fieldwork education from the perspective of the learners.

2.2. Participants and Eligibility Criteria

Participants are recruited from 10 different HHS programs from 61 universities across Canada (Supplementary File S1). The number of programs for each HHS profession across the provinces range between four (dental hygiene) to 47 (nursing) for a total of 192 programs (Table 1). The participants are divided into two groups: core participants, who participated in both the survey and interviews, and professional partners who are invited only for interviews. Core participants are the individuals directly involved in the fieldwork accommodations process, specifically learners living with disabilities, Academic fieldwork Coordinators (ACs), Fieldwork Educators (FEs) and Accessibility Advisors (AAs). Professional partners are key informants that establish the structures governing each profession, such as licensure, accreditation, professional development and national examinations.

2.2.1. Core Participants

o
Disabled learners: Current learners or up to a year after completion of the program who self-identify as living with disability and/or learners requiring accommodations in fieldwork.
o
Academic Fieldwork Coordinators (ACs): The person at a university program who oversees fieldwork aspects of the curriculum and finds suitable fieldwork sites for learners in their program to attend. They are often university faculty members. AC is the term we use to cover a broad range of related (or alternate) terminology such as fieldwork coordinator, field coordinator, field education coordinator, academic fieldwork coordinator, program coordinator for practicum and academic coordinator of clinical education.
o
Fieldwork Educators (FEs): The person at a fieldwork site who is a practicing HHS professional who supervises learners during fieldwork. FE is the term we use to cover a broad range of related (or alternate) terminology such as preceptor, supervisor, field placement supervisor, practicum supervisor, professional practice educator, faculty advisor and clinical instructor.
o
University Accessibility Advisors (AAs): Accessibility Advisors are employed by universities to support learners seeking and receiving accommodations. They are legally required to recommend and confirm accommodations for learners that require them.

2.2.2. Eligibility

  • To be eligible to participate, ACs, FEs and AAs need to be in their respective roles for at least six months.

2.2.3. Professional Partners

o
Regulatory bodies or colleges: These are typically provincial bodies that regulate their respective professions with a mandate to serve the public. They are responsible for overseeing the professional standards, requirements and conditions for licensing. Examples of potential participants will include the Registrar, Chief Executive Officer, Deputy registrar, Managers or chairs of committees.
o
Professional Associations: both provincial and national associations representing practitioners from their respective professions. They represent and work on behalf of their members and profession. Examples of potential participants will include the Chief Executive Officer, Chief professional practice department, membership department officer or chairs of committees.
o
Accreditation Bodies: These bodies accredit or approve university programs for their respective professions. Accreditation is mostly done by professional associations. Examples of potential participants will include the Commissioners of the accreditation body, or chairs of committees.

2.3. Tools and Measures for Data Collection

2.3.1. Online Surveys

Four different online surveys, each tailored specifically to the four core participant groups, are set up on the Qualtrics XM platform (Supplementary File S2). The surveys are available in English and French, representing the two national languages of Canada. The survey is an adaptation of a similar survey used in a pilot study conducted in a single Canadian university for all HHS programs at that university, and nationally for one of the HHS professions [22]. Prior to being used with study participants for this current study, the survey was reviewed by the research team members and some of the language was slightly modified.
The purpose of the survey was to investigate topics related to the current and preferred processes and practices of securing accommodations (Table 2). The questions explore common topics across the surveys, such as the nature of existing procedures regarding accommodations in FW, and ways to evaluate effectiveness of accommodations. The survey also includes a few questions specific to each participant group, for e.g., AAs’ knowledge of fieldwork sites, ACs’ report of capacity or ACs’ and FEs’ perceptions and attitudes. The surveys included Likert scale questions, mark all that apply, open ended questions and ranking questions. It is estimated it should take between 20–45 min to complete.

2.3.2. Semi Structured Interviews

All participants are given the choice between an individual or group interview. This choice is based on scheduling or confidentiality preferences. Group interviews include core participants from the same group (e.g., only learners or only ACs). Dates and times of the interviews are scheduled based on participants’ availability.
Semi structured interview guides, each tailored specifically to the four core participant groups, are used (Supplementary File S3) and include questions about procedural practices for accessing accommodations in fieldwork and/or supporting disabled learners in fieldwork, communication practices, supports and barriers to these practices and disclosure issues encountered. The interview guide is an adaptation of a similar guide used in the previously mentioned pilot study [22]. Prior to being used with study participants for this current study, the guide was reviewed by the research team members and slightly modified.
The interviews are conducted by either the research coordinator or the research assistants. The research assistants were trained prior to conducting the interviews independently.
All the interviews are conducted online over a secure Zoom university account to allow reaching participants from across the country. The interviews are recorded on a password protected Zoom account and are transcribed using Zoom’s auto transcribing feature. The Zoom generated transcripts are proofread and edited for accuracy by either the research coordinator or research assistants. When transcribing the interviews, each participant’s name and other proper nouns are replaced with pseudonyms.
At the end of the interviews, participants are asked if they are willing to participate in “member checking” once data analysis is complete. Those who agree will be sent a document with a summary of the results along with guiding questions to encourage feedback.

2.3.3. Online Mapping Diary

Map making, including representative mapping (actual maps of places) and mental mapping (emotional, experiential, interpretive mapping) have been used extensively to explore the intersection of the spatial and the social [45]. Our online mapping diary was designed as a visual and interactive tool to invite participants to create a map and share their experiences on their built and social fieldwork environments. Participants are asked to think about access as an issue that cuts across experiences of disability, racialization, gender, social class and geography [46]. Mapping of emotions and feelings connected to a specific place is a popular visual method to elicit peoples’ experiences and capture the relationship between place, lived experiences and community [47,48,49,50].
The online diary allows learners to map their fieldwork site and indicate areas where they experience barriers and facilitators to access. A barrier could range from attitudes, workplace expectations, timing as well as physical space. For instance, learners might indicate the fast pace of activity at a particular location in the fieldwork site. The diary data collection is done through a secure website with an interactive mapping tool built from an original combination of Wordpress plugins designed for interactive hot spot mapping. Once learner participants click on the link shared with them, they are taken to a website where they are instructed on how to use the online mapping diary. Learners could choose from one of the template maps provided on the website or draw and upload their own map representing their fieldwork environment. The maps could be conceptual or literal and at any scale (Figure 1). The purpose is to help learners describe their varied experiences in relation to different parts of the fieldwork environment. The instructions and templates are freely available on the website however the personal maps are restricted such that each learner could only see their own (chosen or uploaded) map through the secure link shared with them.
The tool allows learners to interact with the map. By clicking on different parts of their map they could identify important places in their fieldwork site (e.g., blue dots in Figure 1). They are then given prompts to help them describe the significance of these spots. The questions are about their feelings, the types of barriers they experienced, the impact of these places on their access in the fieldwork site as well as reflections on formal and informal rules in the fieldwork site (Supplementary File S4). The mapping diary also collects some immediate feedback from learners about their experience with the tool. There are four feedback survey questions asked plus an open-ended comment space. Three questions ask participants to rate their experiences of the tool’s accessibility, ease of use and instructions using one to five stars. An additional question asks about the helpfulness of the tool for thinking about accessibility in a specific fieldwork context using a five-point scale from very helpful to unhelpful. Additionally, if learners choose to also participate in an interview, they are asked to discuss their experience using the online mapping diary, specifically how helpful the tool was in thinking about access in their fieldwork site.

2.4. Procedure

This mixed methods study uses three main data collection tools: an online survey, individual or group interview and online mapping diary (offered only to learners). Participants are first recruited to complete the survey, and at the end of the survey, they are given the option to participate in the other two portions of the study (Figure 2).

2.4.1. Recruitment and Consent

Following ethics approval, customized invitation letters are distributed to all four core participant groups from the targeted HHS programs. Each participant group is invited to different aspects of the study (Figure 2) and contacted as follows:

Core Participants

  • Survey Recruitment
    o
    Learner recruitment: Learners receive the study invite via email from their respective ACs. Student Associations (national groups and associations within universities) and student Facebook groups are also sent invites with a link to the learner survey.
    o
    AC recruitment: Emails with invite letters and consent form attachments are sent out to relevant programs and departments in 61 Canadian universities to forward to their ACs. ACs with publicly available email addresses posted on university websites are also directly emailed. The invite also include the learner and FE invites and ACs are asked to forward them on to relevant individuals and cohorts.
    o
    FE recruitment: FEs receive the study invite via email from the university program for which they supervise learners. Additionally, all regulatory bodies and national associations of participating professions are asked to distribute the study invite to their memberships, and to advertise on their social media platforms (Facebook and Twitter), e-bulletins and newsletters. Finally, we send direct study invites via email to FE listings provided by a few professional associations where members had given permission to be contacted for research purposes. The invites included a link to the FE survey.
    o
    AA recruitment: Accessibility offices in 16 Canadian universities that offer at least three of the 10 targeted HHS professions and had publicly available email addresses posted on their university websites, are emailed the study invite and consent form. Additionally, all members sent the study invite and consent forms to the accessibility offices in their respective universities (N = 10). The invites include a link to the AA survey. Altogether, 26 universities are approached.
    o
    Consent: In addition to attaching the consent forms to all invites, the consent form is also linked at the start of the survey and participants have the opportunity to download it if they wish. Finally, at the end of the survey participants are informed that by submitting the survey they consent to participate in this portion of the study.
  • Post-Survey Interview and Online Mapping Diary Recruitment
At the end of each online survey, core participants are invited to participate in an optional individual or group interview. Learners are also asked if they want to participate in an online mapping diary. Learners could choose to participate in either the interview, online mapping diary or both. Those who express interest are referred to a new survey, disconnected from the one they just filled out, where they provide their contact information for the team to connect with them and schedule the interview.
Consent: Participants that indicated interest in an interview or the online mapping diary are emailed a few weeks after survey completion and asked to confirm if they were still interested. A consent form and invite letter accompany the emails. Those interested to proceed to the interview or the online mapping diary contact the research team by phone or email with either further questions or an expressed interest and signed consent form. Informed consent is obtained prior to participation. Consenting learners are provided with a secure link to the online diary platform along with individual login details.

Professional Partners Recruitment

Regulatory bodies or colleges, professional associations and accreditation bodies for each HHS profession are emailed customized letters of invitation and consent forms inviting representative members of their office to participate in an interview. In particular, we invite members who carry roles such as chairs of committees, executive directors, registrars or deputies.
Consent: Those interested to participate in the study contact the research team by phone or email with either further questions or an expressed interest in the study and signed consent form. Informed consent is obtained prior to the interview.

2.4.2. Honoraria

In recognition of participants’ knowledge, skills and time, honoraria are provided to learners and FEs who participate in the interviews ($30 honorarium each). Learners who participate in the online diary receive an additional $20 honorarium. ACs and AAs who are university paid employees and individuals from professional partner groups who are answering questions about their professional roles in the organization are not offered any honorarium.

2.5. Data Analysis

As data analysis is currently underway, we will describe in past tense what we have done thus far, and in future tense what we are planning to do.

2.5.1. Quantitative Data Analysis

Once the survey is closed, data from all four online surveys will be downloaded from Qualtrics in Excel format and be cleaned, which involves removing data from blank surveys and ineligible respondents (e.g., respondent who is not from one of the 10 targeted HHS programs). Additionally, we will review and aggregate all open-ended responses to “other” categories in the multiple-choice questions. We will create new codes for repeated answers among a few participants.
Data analysis will be divided into two stages. First, we will conduct a preliminary univariate descriptive analysis with frequencies, percentages, averages and standard deviations, using SPSS software, Version 29 (IBM Corp, Chicago, IL, USA). These initial findings will be summarized in tables across five documents: one summary document for each survey and an additional document that will include a cross comparison across the four surveys comparing similar questions.
The second stage of analysis will involve inferential statistical analysis of the data across and within surveys using SPSS Version 29. Type of statistical analysis will be determined based on the distribution of the dependent variables.
Analysis within each survey:
o
Comparing AC, FE and AA participants who identify as having a disability and those who do not have a disability: nonparametric Wilcoxon rank sum test will be for non-normally distributed dependent variables. Parametric t-test will be used for normally distributed dependent variables.
o
Comparing professional programs: nonparametric Kruskal–Wallis one-way ANOVA test will be for non-normally distributed dependent variables. One way Analysis of Variance will be used for normally distributed dependent variables.
o
Comparing between men and women: nonparametric Wilcoxon rank sum test will be for non-normally distributed dependent variables. Parametric t-test will be used for normally distributed dependent variables.
Comparison between the four groups—learners, ACs, FEs and AAs:
We will compare the four groups on resembling questions, as outlined below. Depending on number of participants in sub-groups within each of the survey groups (e.g., disability or gender identity), we might add those independent variables to the following analysis:
o
For dichotomous dependent variables (e.g., Awareness of existing procedures regarding fieldwork accommodations) we will run cross tabulation and chi square.
o
For Likert scale dependent variables (e.g., perceived usefulness of FW accommodations), we will use Kruskal–Wallis one-way Analysis of Variance (ANOVA) test for non-normally distributed dependent variables, and One way ANOVA for normally distributed dependent variables.
o
For repeated measures dependent variables, (e.g., Perceptions about the ability of disabled learners to attain five different core competencies and skills), for non-normally distributed dependent variables we will conduct a nonparametric test that allows control for individual variability in responses called the Friedman test. A post-hoc analysis would then be conducted using the Nemenyi test to see if any significant differences between the different types of competencies were identified from the Friedman test above. For normally distributed data we will use Multiple ANOVA with repeated measures.
All tests use the critical level of 0.05 as this is the common level set in the field.

2.5.2. Qualitative Data Analysis

Individual and group interviews of all the study participants will generate a great deal of qualitative data as these methods emphasize the direct engagement and perspectives of the participants. Analysis for each of the core groups and partner interview data will begin with the coding of transcripts and development of themes and subthemes by a coding working group composed of research assistants and the research coordinator. Coding will begin with each coding working group member reading the same four interview transcripts and making note of their reflexive thoughts, comments and questions. The coding working group will meet weekly or bi-weekly to collectively discuss each other’s comments and identify preliminary codes and issues that will emerge from the data under review. An early draft of a working codebook will be created based on those coding working group sessions. The research coordinator and research assistants will then code the remaining transcripts using the working codebook while adding new codes as needed. The coding working group will code the transcripts in NVivo software, version 14, using thematic line by line analysis. Once all the coding will be done, the group will meet again to further refine the themes and sub-themes and to discuss further analysis and representation of the data and findings that had been coded.

Composite Narratives

Based on previous work of the team, we anticipate developing composite narratives to present the research findings. When it is apparent that there are several shared experiences across participants and considering the amount of data we anticipate, composite narratives might be a useful way to represent the findings. A composite narrative is a single narrative or “story” that draws on data from multiple interviews with overlapping themes and presents findings in a layered, compelling way that connects with the lived experiences of participants while protecting their identities [51].

2.5.3. The Online Mapping Diary Analysis

The mapping data consists of several kinds of data: visual maps, written comments and survey feedback on the tool itself. Each type of data requires its own approach to analysis.
The qualitative comments participants made on the significant locations they identified on the map will be thematically analyzed using Nvivo QDA software, version 14. The quantitative data will be analyzed using means and standard deviations.
The visual format of the maps themselves requires a unique qualitative visual approach to analysis. This is underway and so far, includes analysis of the level of detail in the map as well as relationships between detail and level of description. This analysis also includes attention to aesthetic qualities of the map such as symmetry, scale, line thickness and colour. It is not clear yet what these might reveal but it provides an interesting dimension for consideration [52].

3. Discussion

This Canada-wide study is the first of its kind addressing equity and accessibility in the HHS programs. This is the first study to focus on 10 HHS professions nationally, using a mixed method design and including a broad-based recruitment of many relevant core and partner participants. Such an in-depth approach, guided by CDS, can provide a comprehensive opportunity to highlight systemic barriers identified by participants in the fieldwork accommodation process. Findings might shed light on the often neglected “work of being a disabled learner”—a significant factor that contributes to the exclusion of practitioners and clinicians living with disability in HHS professions.
This study is also unique in its focus on fieldwork education. Fieldwork accommodations are less understood and successfully implemented, if at all, relative to academic accommodations across HHS programs. Given that successful fieldwork experience is a requirement to graduate from any HHS programs, our results might provide insight into lack of equity, particularly in this aspect of the educational experience, and potential strategies to address those inequities.
We anticipate that the findings of such a study will provide a unique contribution where all relevant partners are included, which will allow us to investigate this complex issue from all perspectives. This methodology allows us to see the nuanced challenges each and every partner experiences when dealing with systemic issues and structures that they are all a part of and working within. Understanding the different perspectives might facilitate finding collaborative solutions and will increase the likelihood of impactful change. An additional strength of this study is having researchers in the team who represent each of the professions included in the study. This will allow for nuanced understanding of the different cultures and practices of each profession. It will also allow for better buy-in from the participating programs. Some of the team members brought their experiential knowledge with disability, providing crip wisdom. Having that lens through each stage of the project will bring unique and relevant wisdom to a study of this nature.
Learners living with disabilities navigate systemic barriers: (a) the additional “work of being a disabled learner,” during a rigorous academic program, and (b) a lack of adequate—and often absent—fieldwork accommodations. Exploring those systemic barriers offers the potential to develop strategies and tools to foster inclusive and accessible HHS education. This might include using the mapping diary as a tool to facilitate conversations between all relevant individuals around best ways to support disabled learners in fieldwork. Future research in this area is needed to inform the development and evaluation of such tools and strategies.

4. Limitations

This study has three main limitations. Given the scale of the project and sheer expected quantity of data, while rich and nuanced, managing/overseeing/organizing this amount of data had its challenges. For example, it might mean that not every team member will look at all the data. We will address this by delegating team members who will be familiar with most of the data to collaboratively facilitate analysis by locating relevant data for teams working to develop analyses on specific subtheme clusters. Secondly, although this is a national study targeting 10 professions, some provinces and some professions might be disproportionately represented, despite uniform recruitment efforts. It is important to acknowledge that there is a difference in the size of each participating profession, in addition to a sparsity of available educational programs for some of the professions across the provinces. Therefore, this limits the possibilities of certain nuanced analysis. Third, due to language limitations, while surveys are offered in both English and French, interviews will be conducted only in English. Therefore, the in-depth perspective of French speaking participants will be missing from this Canadian national study.

5. Conclusions

Learners living with disabilities navigate systemic barriers. This study has the potential to explore those systemic barriers and to offer potential strategies and tools to foster inclusive and accessible HHS education. By understanding how to make HHS education and practice more accessible, this high-impact project has the potential to enhance HHS professional practice with an ultimate benefit for service provision and abolish discriminatory systems in health education and employment.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/disabilities4030028/s1, Supplementary File S1: List of participating universities across Canada; Supplementary File S2: Surveys; Supplementary File S3: Interview guides; Supplementary File S4: The mapping diary questions.

Author Contributions

Conceptualization, T.J., L.S., T.E., E.K., C.H., S.K. and I.E.; methodology, T.J., L.S., T.E., E.K., C.H., S.K. and I.E.; investigation, T.J., S.Z., L.S. and I.E.; resources, T.J., L.S. and I.E.; software, L.S. and I.E.; data curation, T.J., L.S., I.E. and S.Z.; writing—original draft preparation, T.J. and S.Z.; writing—review and editing, T.J., L.S., T.E., E.K., C.H., S.K. and I.E.; supervision, T.J.; project administration, T.J.; funding acquisition, T.J. and I.E. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by the New Frontiers in Research Fund (NFRF), grant number NFRFE-2019-00393.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the UBC Behavioural Research Ethics Board (Approval No. H20-01179) on 18 August 2020, followed by ethics approval by all ethics boards of the other universities where team members are affiliated.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Data from survey will be available upon request; data from interviews will be unavailable due to privacy as participants might be identifiable.

Acknowledgments

We would like to thank all the study participants and to acknowledge the ongoing efforts of the entire transcription teams.

Conflicts of Interest

The authors declare no conflicts of interest. The funder had no role in the design of the study; in the collection, analyses or interpretation of data; in the writing of the manuscript; or in the decision to publish the protocol.

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Disabilities 04 00028 g001
Figure 1. Mapping tool.
Figure 1. Mapping tool.
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Figure 2. Study procedure by participants.
Figure 2. Study procedure by participants.
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Table 1. Number of programs based on province.
Table 1. Number of programs based on province.
 ProfessionAud 1SLP 2DH 3Den 4MD 5Nur 6OT 7PT 8Psych 9SW 10
Province 
BC11111111136
Alberta0111251142
Saskatchewan0001120122
Manitoba0011101122
Ontario2502616551115
Québec1403455565
New Brunswick0000030022
NL0000110011
Nova Scotia1111131111
PEI0000010000
Total numbers per Profession512410174714153236
1 Audiology; 2 Speech and language pathology; 3 Dental Hygiene; 4 Dentistry; 5 Medicine; 6 Nursing; 7 Occupational therapy; 8 Physical Therapy; 9 Psychology; 10 Social Work.
Table 2. Survey topics by group.
Table 2. Survey topics by group.
 Learner SurveyFE SurveyAC SurveyAA Survey
1. Capacity
(a) Recent trends in the numbers of learners requesting accommodations ✓✓✓
(b) Fieldwork staff and support at the university  ✓ 
2. Procedures
(a) Awareness and perceptions of existing procedures regarding fieldwork✓✓✓✓
(b) Time spent on communications regarding accommodations before, during and after fieldwork✓✓✓ 
(c) Practices and preferences regarding time spent planning for least and most complex fieldwork accommodations ✓✓ 
(d) Current practices, preferences and satisfaction regarding the involvement of other professional partners in the fieldwork accommodation process✓✓✓✓
3. Accommodations
(a) Types and/or number of fieldwork accommodations received/provided/✓✓✓✓
requested—and the perceived usefulness of those accommodations
4. Accountability/preparedness
(a) Evaluation of the effectiveness of fieldwork accommodations✓✓✓✓
(b) Confidence and satisfaction with one’s own experiences with accommodations in fieldwork and academic settings✓✓✓✓
(c) AAs’ knowledge of fieldwork sites and supporting learners living with disabilities   ✓
(d) Awareness, preferences and/or perceived usefulness of available training, education or resources regarding fieldwork accommodations✓✓✓✓
5. Perceptions and attitudes
(a) Evaluation of the effectiveness of fieldwork accommodations ✓✓ 
(b) Confidence and satisfaction with one’s own experiences with accommodations in fieldwork and academic settings ✓✓ 
6. Impacts of current broken systems
(a) Disabled learners’ confidentiality, emotional energy spent and costs and burdens experienced in relation to accommodations in fieldwork and academic settings✓✓✓✓
(b) Contexts surrounding potential or actual fieldwork breakdown/fails✓✓✓ 
(c) Delayed fieldwork accommodation requests and consequences✓✓✓ 
7. Demographic information✓✓✓✓
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MDPI and ACS Style

Jarus, T.; Stephens, L.; Edelist, T.; Katzman, E.; Holmes, C.; Kamenetsky, S.; Epstein, I.; Zaman, S. Strategies for Increasing Accessibility and Equity in Health and Human Service Educational Programs: Protocol for a National, Mixed Methods Study. Disabilities 2024, 4, 444-458. https://doi.org/10.3390/disabilities4030028

AMA Style

Jarus T, Stephens L, Edelist T, Katzman E, Holmes C, Kamenetsky S, Epstein I, Zaman S. Strategies for Increasing Accessibility and Equity in Health and Human Service Educational Programs: Protocol for a National, Mixed Methods Study. Disabilities. 2024; 4(3):444-458. https://doi.org/10.3390/disabilities4030028

Chicago/Turabian Style

Jarus, Tal, Lindsay Stephens, Tracey Edelist, Erika Katzman, Cheryl Holmes, Stuart Kamenetsky, Iris Epstein, and Shahbano Zaman. 2024. "Strategies for Increasing Accessibility and Equity in Health and Human Service Educational Programs: Protocol for a National, Mixed Methods Study" Disabilities 4, no. 3: 444-458. https://doi.org/10.3390/disabilities4030028

APA Style

Jarus, T., Stephens, L., Edelist, T., Katzman, E., Holmes, C., Kamenetsky, S., Epstein, I., & Zaman, S. (2024). Strategies for Increasing Accessibility and Equity in Health and Human Service Educational Programs: Protocol for a National, Mixed Methods Study. Disabilities, 4(3), 444-458. https://doi.org/10.3390/disabilities4030028

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