Assessment of Disability Occupational and Sociodemographic Correlates in Mayan Communities in Relation to COVID-19 Diagnosis

Abstract

In assessing disability within rural communities, it is crucial to explore the intersection of sociodemographic and health factors. This cross-sectional study, conducted between June and December 2022 in 16 rural locations in Yucatan, aimed to analyze how sociodemographic and occupational factors influence the perception of disability in Mayan communities, with a particular focus on the impact of the COVID-19 pandemic. Disability was evaluated disability in a sample of 1049 participants using the World Health Organization Disability Assessment Schedule (WHODAS). Descriptive analyses and non-parametric tests were performed to characterize the sample and WHODAS scores. The participants’ mean age was 39.26 ± 17.87 years, and significant differences in disability perception were observed in relation to a COVID-19 diagnosis. Individuals with a confirmed diagnosis reported higher levels of disability in the domains of cognition and community participation (p < 0.05). Age strongly influenced disability (p < 0.05). Additionally, education was negatively associated with disability, suggesting that individuals with lower educational attainment were more likely to report higher disability (p < 0.05). These findings contribute to the understanding of disability in the rural Mayan context.

1. Introduction

Recent research has highlighted the heightened vulnerability of people with disabilities to COVID-19 infection and its associated challenges. It has been have shown that disabled populations experience higher infection rates, with sociodemographic factors such as race, ethnicity, and poverty status contributing to increased risk [1,2,3]. Indigenous communities, including Maya populations, have been disproportionately affected [4,5]. Furthermore, individuals with disabilities face greater difficulties in accessing healthcare, housing, and transportation during the pandemic [2]. Long-COVID has also been linked to significant occupational and functional impairments [6]. These findings underscore the urgent need for disability-inclusive public health responses and improved data collection on disability status to address health inequities [7,8].

The assessment of disability and its impact on public health has emerged as a crucial area of research, especially in the context of the COVID-19 pandemic [9]. The complexity of the interaction between gender, disease experience, and various sociodemographic factors such as age and occupation underscores the need to understand variations in disability [10]. Research to date has offered valuable insights into the assessment of functioning and disability, using tools such as the World Health Organization Disability Assessment Schedule [WHODAS] [11,12]. However, few studies have specifically examined the influence of extraordinary events, such as the COVID-19 pandemic, on levels of perceived disability. This gap in research is significant, as the pandemic has impacted not only physical health but also on the mental and emotional health of individuals, aspects that may be reflected in measures of disability. The relationship between age and disability has been studied in various contexts and suggests that disability tends to increase with age, but the nature of this relationship may differ depending on the context [13,14]. Several international studies have been conducted in France, Spain, Mexico, Germany, Turkey, South Korea and Spain, which have confirmed that the WHODAS 2.0 demonstrates high accuracy and detection capacity to assess levels of disability [11].

On the other hand, the long-term sequelae of COVID-19 on functional health, even after apparent recovery, was noted [15,16]. The present study delves into the intersection between disease experience and disability, exploring how individuals affected by the virus experience and manifest disability, and how this differs relative to those without a history of COVID-19. By delving into this exploration, our study aims to fill this gap by analyzing in detail the relationship between COVID-19 diagnosis and levels of disability. This novel perspective will allow us to better understand how the experience of illness, either directly or indirectly through the social and economic context, relates to individual perceptions of disability in different domains [17]. Similarly, the assessment of disability in specific communities, such as Mayan communities, constitutes a crucial field of research to understand the complexities of functional health in culturally diverse contexts. The aim of this study is to address a gap in literature by examining how sociodemographic and occupational factors influence the perception of disability in these communities, especially in the context of the COVID-19 pandemic. Mayan communities, rich in cultural traditions and unique characteristics, have received little attention in studies assessing disability [18]. Understanding the perception and experiences of disability in this specific context is essential to provide culturally sensitive health care tailored to the needs of these populations. Several studies have pointed out that sociodemographic factors, such as gender, age, educational level and occupation, play a crucial role in shaping disability levels in different communities [19,20].

The central objective of this study is, therefore, to analyze how sociodemographic and occupational factors influence the perception of disability in Mayan communities, with a particular focus on the impact of the COVID-19 pandemic. By exploring these interactions, the aim is not only to fill a gap in the existing literature but also to provide knowledge that will contribute to generating culturally appropriate intervention strategies and promote equitable health care in these communities.

2. Materials and Methods

2.1. Data Collection

Between June and December 2022, qualitative data collection was carried out in sixteen rural communities across the state of Yucatán, Mexico, as part of a research project funded to address the needs of highly vulnerable populations, particularly those prioritized by the Kellogg Foundation. These communities were classified according to the predominant modes of land appropriation and productive orientation, providing a territorial lens through which to understand their sociocultural dynamics and structural conditions.

A first group of communities falls within what is commonly referred to as the maize-producing zone, characterized by a strong reliance on subsistence agriculture through the traditional milpa system, involving the cultivation of maize, beans, and squash. The communities of Cantamayec, Chacsinkin, Tahdziu, Tixcacalcupul, and Yaxcaba are part of this region. These localities are marked by high levels of marginalization and a predominantly Maya population. Communal landownership under the ejido system, intergenerational knowledge transmission, and collective forms of labor organization remain central to their way of life.

The citrus-producing zone encompasses the communities of Mama, Mani, Mayapan, and Teabo. While retaining key aspects of Maya cultural heritage, these communities have diversified their agricultural activities, with citrus production (particularly sour and sweet oranges) becoming increasingly relevant. This zone has experienced greater integration into regional development processes, including cultural tourism and small-scale commercialization, leading to shifts in social organization and economic expectations.

A third group corresponds to the henequen-producing zone, including Sotuta, Tekom, and Chimay (a hamlet of Tixcacalcupul). Historically shaped by the monoculture of henequen during the late 19th and early 20th centuries, this region still bears the material and social legacies of that era, such as the presence of former haciendas and a hierarchical land tenure structure. The collapse of the henequen economy generated structural unemployment, internal and international migration, and the fragmentation of community cohesion, contributing to persistent socioeconomic vulnerability.

The livestock-producing zone includes the communities of Chankom, Kancabdzonot, and Santa María (another hamlet of Tixcacalcupul). Characterized by low soil fertility, these areas have oriented their local economies toward extensive cattle and swine ranching. Economic activities are primarily subsistence-based, and these communities face considerable challenges in terms of access to basic services, health care, and educational infrastructure.

Finally, Yaxunah is in an ecological transition zone rather than a coastal region per se. Its proximity to areas of high biodiversity—such as the Ria Lagartos Biosphere Reserve—positions the community within a broader environmental corridor. Yaxunah has emerged as a key site for eco-cultural preservation and community-based tourism, combining traditional milpa agriculture with beekeeping, herbal medicine, and environmental education. Local governance structures exhibit a high degree of organization, enabling active participation in sustainable development initiatives.

2.2. Study Design

Cross-sectional study from a representative sample of rural Maya communities in Southeast Mexico.

2.3. Participants

For sample selection, random sampling was conducted in the studied villages, choosing 380 households and their respective families, defining a total sample size of 1249 participants with an equal gender distribution, comprising 642 males [51%] and 607 females [49%]. The participants’ mean age was 39.26 ± 17.87 years. Regarding the diagnosis of COVID-19, 67 [5%] reported a positive COVID-19 diagnosis, 1188 [93%] reported no diagnosis, and 20 [2%] did not respond.

2.4. Measures

Disability assessment was performed using the World Health Organization Disability Assessment Schedule (WHODAS 2.0), a tool developed by the World Health Organization (WHO) to assess functioning and disability across six domains: mobility, cognition, community participation, personal care, interpersonal relationships, and daily activities. Each item is scored on a 5-point Likert scale, ranging from 1 (no difficulty) to 5 (extreme difficulty). The Spanish version of WHODAS 2.0 has demonstrated robust psychometric properties in various populations. Studies conducted in Mexico have reported high internal consistency, with Cronbach’s alpha values ranging from 0.89 to 0.92 across different clinical groups [21]. The instrument has also shown strong construct and convergent validity, with significant correlations between WHODAS scores and clinical indicators of functional impairment. These findings support the reliability and validity of the Spanish WHODAS 2.0 as a comprehensive measure of disability in diverse sociocultural contexts.

2.5. Procedure

Data collection was conducted through structured, face-to-face surveys administered individually by trained bilingual interviewers who were familiar with the local dialects and cultural context of each community. Prior to data collection, all interviewers received standardized training on ethical research practices, informed consent procedures, and the administration of the WHODAS 2.0 instrument.

Participants were informed about the study’s objectives, their rights as participants, and the voluntary nature of their involvement. Written informed consent was obtained from each participant before beginning the interview.

The WHODAS 2.0 instrument, developed by the World Health Organization, was used in its official Spanish-language version. Since all participants were fluent in both spoken and written Spanish, no additional linguistic or cultural adaptation was required. However, to ensure clarity and appropriateness of the instrument in the specific sociocultural context, a pilot test was conducted with 10 Spanish-speaking individuals from three of the participating communities. These individuals were not included in the final sample. Feedback from the pilot phase was used to refine the administration protocol and confirm that all items were clearly understood.

During the main data collection phase, interviewers followed a standardized protocol to ensure consistency in the administration of the survey across all 16 communities. Interviews were conducted in private settings to ensure confidentiality and to facilitate open and accurate responses. Detailed flow diagram is presented in Figure 1.

2.6. Statistical Analysis

Descriptive analyses were conducted to characterize the sample and WHODAS scores in different domains. The Mann-Whitney U test was used to compare disability levels between groups (e.g., gender, COVID-19 diagnosis), while the Spearman correlation test assessed associations between continuous variables (e.g., age, education). Non-parametric methods were chosen due to the non-normal distribution of WHODAS scores, as confirmed by the Kolmogorov-Smirnov test. Psychometric properties of the WHODAS tool, including internal consistency (α = 0.900) and domain reliability, were also evaluated.

2.7. Ethical Considerations

The study adhered to ethical principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the University Autonomous of Yucatan Faculty of Medicine committee [No 11-2022] before data collection. Participant information confidentiality and privacy were safeguarded throughout the study.

3. Results

The WHODAS comprises six primary domains, which are cognition, mobility, personal care, interpersonal relationships, and daily activities. Descriptive statistics for the six domains and the total score are presented in Figure 2; the scores suggest that, overall, individuals have a low level of disability. However, the domain with the highest average score is mobility, as presented in

Table 1. Descriptive statistics of the six domains and the total score of the WHODAS.

Domains	Median	Mean	SD	CI 95%		KS
				Lower	Upper	z	p-Value
Mobility	1.0	1.08	0.40	1.06	1.10	0.52	<0.001
Cognition	1.0	1.03	0.22	1.02	1.04	0.52	<0.001
Community participation	1.0	1.04	0.28	1.03	1.06	0.52	<0.001
Personal care	1.0	1.02	0.21	1.01	1.03	0.52	<0.001
Relationships	1.0	1.01	0.15	1.00	1.02	0.52	<0.001
Daily activities	1.0	1.05	0.30	1.03	1.07	0.52	<0.001
Total WHODAS	1.0	1.04	0.21	1.03	1.05	0.49	<0.001

Note: SD stands for Standard Deviation, and KS is the Kolmogorov-Smirnov test.

.

To analyze the effect of other variables such as gender, COVID-19 diagnosis, age, and years of schooling, the analysis of the normal distribution of scores for the six domains was conducted using the Kolmogorov-Smirnov test. The results indicate that all domains and the total WHODAS score do not follow a normal distribution; therefore, non-parametric tests were necessary for comparative and correlation inferential analyses.

To compare the disability level medians between men and women, Mann-Whitney U test was performed. Since the p-Values were not significant, it can be inferred that the disability levels between men and women are not different.

On the other hand, when comparing individuals who were diagnosed with COVID-19 by a doctor or laboratory test with those who did not have a diagnosis, significant differences were observed, as shown in Figure 3. The Mann-Whitney U test results indicate that individuals diagnosed with COVID-19 reported higher disability levels in the domains of cognition and community participation.

Given that the variability in disability may be explained by age and years of education, the Spearman correlation test was conducted between these variables and the WHODAS domains. As observed in

Table 2. Spearman correlation analysis between WHODAS domains and age and education.

WHODAS Domains	Age	Educational Years
Mobility	0.30 **	−0.19 **
Cognition	0.16 **	−0.12 **
Community participation	0.23 **	−0.15 **
Personal care	0.14 **	−0.13 **
Relationships	0.01	−0.10 **
Daily activities	0.21 **	−0.16 **
Total WHODAS	0.31 **	−0.27 **

[**] represents a significant level of <0.01, indicating that the associated values are statistically significant at the 99% level.

, age strongly influences different types of disability, especially those related to mobility. However, age does not have a significant relationship with disability concerning interpersonal relationships. Years of education show a negative relationship with disability scores, suggesting that individuals with lower education are more likely to develop high disability, or conversely, individuals with higher education tend to have fewer disability symptoms [see Table 2].

Due to the person’s main occupation being an indicator that may be related to disability domains, means were estimated to descriptively present disability levels for all occupations. In

Table 3. Descriptive analysis of disability domains by main occupation.

Main Occupation	n	d1	d2	d3	d4	d5	d6	Total WHODAS	Age
Farmer Cornfield and/or peasant	184	1.09	1.01	1.03	1.00	1.00	1.046	1.03	48.79
Mason	44	1.00	1.02	1.02	1.00	1.03	1.023	1.01	40.93
Housewife	317	1.11	1.04	1.05	1.02	1.01	1.068	1.05	43.46
Beekeeper	6	1.08	1.00	1.00	1.00	1.00	1.000	1.01	45.5
Craftsman	59	1.11	1.05	1.08	1.04	1.04	1.085	1.07	39.19
Salaried worker	85	1.01	1.00	1.00	1.00	1.00	1.000	1.00	32.43
Carpenter	1	1.00	1.00	1.00	1.00	1.00	1.000	1.00	53
Cook	5	1.00	1.00	1.00	1.00	1.00	1.000	1.00	32.4
Merchant	26	1.01	1.00	1.01	1.03	1.00	1.000	1.01	42.04
Electrician	5	1.00	1.00	1.00	1.00	1.00	1.000	1.00	32.4
Student	315	1.00	1.01	1.00	1.00	1.02	1.016	1.01	11.16
Blacksmith	6	1.00	1.08	1.08	1.00	1.16	1.083	1.06	34.33
Teacher	3	1.00	1.00	1.00	1.00	1.00	1.000	1.00	33
Domestic manufacturing	8	1.06	1.00	1.06	1.00	1.00	1.063	1.03	49.25
Waiter/Dishwasher	3	1.00	1.00	1.00	1.00	1.00	1.000	1.00	25.33
Retired	3	1.00	1.00	1.00	1.00	1.00	1.000	1.00	67
Day laborer	8	1.00	1.00	1.00	1.00	1.00	1.000	1.00	21.88
Plumber	5	1.10	1.00	1.00	1.00	1.00	1.000	1.01	35
Maquiladora industry worker	2	1.00	1.00	1.00	1.00	1.00	1.000	1.00	38
Domestic worker	13	1.00	1.00	1.00	1.00	1.00	1.000	1.00	28.92
Tricycle & motorcycle taxi driver	5	1.00	1.00	1.00	1.00	1.00	1.000	1.00	35.4
Hammock weaving	28	1.41	1.05	1.19	1.17	1.05	1.143	1.17	53.43
Crafts vendor	1	2.50	1.00	2.00	3.00	1.00	1.500	1.83	66
Shoemaker	8	1.06	1.00	1.00	1.00	1.00	1.000	1.01	42.38

Note: d1 is the mobility domain, d2 is cognition, d3 is community participation, d4 is personal care, d5 is relationships, and d6 is daily activities.

, there is consistency in disability scores for individuals engaged in hammock weaving and selling handicrafts. It is important to note that the main occupation is not the significant factor explaining disability, but rather age, as individuals engaged in hammock weaving have an average age of 53.43 years ±16.34, while the person involved in selling handicrafts had an age of 66 years.

One type of occupation that might be related to disability is working as a blacksmith. This main occupation was the only one with higher scores in the disability domains of cognition and interpersonal relations, despite having an average age of 34.33 ± 8.09 years.

4. Discussion

The results from the present research revealed relevant patterns about the perceived level of disability in rural population of Southeast Mexico, which affected different aspects of daily life of these individuals even after the COVID-19 pandemic was over. These results are similar to others reported from different human groups, and consistency was identified in the overall trend [22]. Our findings have substantial clinical implications by offering a detailed snapshot of disability perception in the studied population. The overall low prevalence of difficulties may suggest a relatively good level of functioning in daily life. However, specific attention should be directed to the mobility domain, where a higher average is observed. On the other hand, it is essential to consider study limitations, such as potential self-perception bias in responses. Additionally, the lack of comparison with control groups or specific reference data may limit the comprehensive interpretation of the results. For future research, it would be valuable to expand the analysis to similar populations and assess the stability of these patterns over time. Furthermore, exploring the relationship between WHODAS scores and other indicators of physical and mental health could enhance understanding of the underlying factors influencing disability perception in this specific population.

It is interesting to note that in the domain of community participation, women exhibit a slightly higher median than men. Although this difference is not statistically significant, it could suggest specific areas where women might perceive greater difficulties. Therefore, it is essential to consider contextual factors that may influence the perception of disability. Previous studies have emphasized the importance of considering sociocultural and contextual factors when interpreting gender differences in disability [23,24]. Cultural expectations, gender roles, and specific experiences can modulate how men and women report and experience disability. It is crucial to recognize the inherent limitations of the methodology used.

The subjective self-assessment of disability can be influenced by various factors, and the lack of an objective reference framework could impact the interpretation of results. For future research, it would be beneficial to delve more deeply into the reasons behind the subtle differences observed and consider the inclusion of additional measures addressing specific aspects of daily life and interpersonal relationships. Additionally, the incorporation of qualitative approaches could provide a deeper understanding of individual experiences. However, while the results do not indicate significant differences between men and women in the perception of disability, it is essential to recognize the complexity of this phenomenon. Apparent equality may mask subtle variations, and, therefore, it is crucial to address disability holistically, considering not only gender differences but also the individual and cultural contexts that shape these perceptions.

Previous studies have suggested that severe respiratory infections, such as those caused by COVID-19, may have long-term neurological effects and impact cognitive function [25,26]. The observed association in this study supports these previous findings and underscores the importance of considering the neuropsychological implications of COVID-19 infection in disability assessment. Similarly, the negative relationship in the domain of community participation may be influenced by the social consequences of the pandemic, such as physical distancing, mobility restrictions, and changes in community dynamics. This finding reflects the complexity of the impacts of COVID-19 beyond the physical realm and highlights the need for comprehensive interventions addressing both cognitive and social aspects. Our results have significant clinical implications by emphasizing the need for specialized follow-up for those diagnosed with COVID-19, even after apparent recovery from the illness. Healthcare attention should consider not only the physical effects of the infection but also potential consequences at the cognitive and social levels. We propose that for future research, it would be beneficial to conduct long-term follow-ups to better understand the evolution of these effects and assess the effectiveness of specific interventions. Furthermore, the inclusion of more detailed measures of cognitive function and community participation would allow for a more comprehensive analysis of these aspects.

The strong influence of age on mobility is a consistent finding in existing literature. Previous studies have emphasized that aging may be associated with changes in physical functionality, which could explain the observed significant relationship in the mobility domain [27,28]. This result highlights the importance of considering the impact of aging when designing interventions and public health policies aimed at improving mobility in older populations. However, the absence of a significant relationship between age and disability in interpersonal relationships is intriguing and may indicate that, despite aging, individuals maintain significant skills in this domain. This suggests that difficulties in interpersonal relationships may be more influenced by other factors, such as emotional or social aspects, which are not directly correlated with age.

On the other hand, the negative relationship between years of education and disability scores is a consistent result with existing literature, i.e., a higher level of education is associated with better health and lower disability [29]. Education can act as a social determinant of health by influencing access to information, resources, and healthy lifestyles. The fact that individuals with lower levels of education tend to have higher disability scores underscores the importance of addressing educational disparities as part of public health strategies. Interventions promoting education and health literacy can contribute to reducing disparities in disability perception. Future research should include longitudinal studies to examine associations over time and explore additional factors that may contribute to disability.

Regarding occupation, the observation of consistency in disability scores between individuals engaged in hammock weaving and handicraft vendors highlights an intriguing pattern concerning occupation. However, it is crucial to note that these results should be interpreted with caution, as the age of individuals in these occupations also significantly differs. The difference in the average age between those engaged in hammock weaving (53.43 years) and handicraft vendors (66 years) suggests that age may play a more significant role than the occupation itself in the perception of disability.

The variability in age could influence disability scores, as aging is commonly associated with changes in physical and cognitive functionality [30]. The occupation of blacksmithing presented higher scores in the disability domains of cognition and interpersonal relationships, despite the relatively young average age (34.33 years). These results deviate from some expectations and may indicate that the physical and cognitive demands associated with blacksmithing could have a significant impact on the health and well-being of individuals in this occupation. Contrasting these findings with previous research [31], there is a highlighted need for a more detailed exploration of occupational factors and their relationship with disability. Previous studies have suggested that certain occupations, especially those involving intense physical labor or exposure to occupational hazards, may be associated with an increased risk of disability [32] and that COVID-19 outcomes are deeply influenced by socioeconomic background and marginalization [33], indicating that the population studied in the present manuscript may have faced combined conditions for disability after COVID-19 pandemic. Future research could address these limitations by employing longitudinal designs and more advanced statistical analysis methods to assess causality and interactions among occupation, age, and disability.

Collectively, these results provide a robust foundation for understanding perceived disability in the studied population, highlighting potential areas of focus for interventions and public health policies. Emphasizing the importance of an equitable and personalized approach to disability care in the studied population.

This study provides substantial evidence of differences in the perception of disability between individuals diagnosed with COVID-19 and those without a diagnosis. These results underscore the importance of addressing the specific needs of those who have experienced the infection, considering both physical and cognitive as well as social aspects. This comprehensive understanding is essential to inform public health interventions and care strategies that address the complexities of COVID-19-associated disability, thereby contributing to improving quality of life and health equity.

Implications for Rehabilitation

Culturally Tailored Rehabilitation Programs: The study suggests a need for culturally sensitive rehabilitation programs tailored to the sociodemographic characteristics prevalent in Mayan communities. Recognizing and incorporating cultural nuances in rehabilitation strategies can enhance engagement and effectiveness.

Occupational Reintegration Strategies: Understanding the impact of occupational factors on disability within Mayan communities calls for targeted rehabilitation strategies focusing on occupational reintegration. Rehabilitating individuals within the context of their specific occupations can contribute to improved overall functionality.

Community-Based Interventions: The findings underscore the importance of community-based rehabilitation interventions. Developing rehabilitation initiatives that are embedded within the social fabric of Mayan communities can foster community support, making rehabilitation more accessible and effective.

Holistic Health Approaches: Given the complex interplay between sociodemographic factors and disability, rehabilitation efforts should adopt holistic health approaches. Integrating physical, mental, and social dimensions into rehabilitation programs can better address the multifaceted nature of disabilities in Mayan communities.

5. Conclusions

While occupation appears to play a role in the perception of disability, the influence of age should not be overlooked. These results highlight the complexity of interactions between occupational and demographic factors in determining perceived disability, underscoring the need for additional research to delve deeper into these aspects to inform more effective intervention strategies.