Disabilities

This study examined the association between formal sex education (FSE), sensory disability status, and contraceptive use among U.S. women. Women with disabilities face barriers to contraceptive decision-making, such as limited accessible FSE content and topics. Data were weighted and analyzed from the 2011–2019 National Survey of Family Growth among women 15–25 years of age. Multivariable logistic regression and moderation analysis examined the association between sensory disability status, contraceptive use during last sexual encounter, and FSE topics. Women with hearing loss or both hearing loss and vision loss were less likely to use contraceptives during last sexual encounter than women without sensory disability (hearing loss: adjusted odds ratio (aOR): 0.36; 95% confidence interval (CI): 0.14, 0.96; both: aOR: 0.28; CI: 0.08, 0.91). Exploratory moderation analysis showed women with vision loss who received FSE on birth control methods (aOR: 6.14; 95% CI: 1.70, 22.23) and on sexually transmitted infections (aOR: 28.24; 95% CI: 1.71, 46.63). The estimates were based on small numbers of individuals within each subgroup and wide confidence intervals, and thus should be interpreted with caution. The findings point to differences in contraceptive use according to sensory disability status, indicating future studies need larger sample sizes to better understand the role of FSE for women with sensory disability. Full article

The Quality Participation Framework proposes that repeated quality experiences foster continued quality participation (i.e., participation quantity over time). This study explored the relationship between the quality and quantity of participation in an exercise setting. Individuals (n = 17) with a physical disability engaged in Revved Up @ Home, a 10-week online community-based exercise program designed to foster quality participation. Using a mixed-methods sequential explanatory design situated in critical realism, participants completed quality experience global questionnaires at baseline and 10 weeks, and acute questionnaires following each exercise session. Participant attendance was retrieved from program records. In semi-structured interviews at 10 weeks, participants were shown graphs of results derived from the acute questionnaires and asked about their quality and quantity of participation during the program. Correlations quantified the relationship between quality and quantity of participation, and thematic analysis facilitated an exploration of the contextual relationship. Qualitative and quantitative findings were integrated, highlighting important relationships between belongingness and quantity, meaning and quantity, as well as between challenge and mastery. Findings provide preliminary evidence that repeated quality experiences foster quality participation, and detail relationships between the aspects of quality participation and between quantity and quality participation. Findings can be used to enhance quality participation and attendance among individuals with physical disabilities who attend community-based exercise programs. Full article

This study compared physical activity (PA) intensity during leisure and recreation between youth with chronic pain with and without (overweight, obesity) healthy weight. Thirty youth with chronic pain, 11–19 years old, completed the Children’s Assessment of Participation and Enjoyment (CAPE), Functional Disability Inventory (FDI), and a Demographic and Participation Questionnaire. Metabolic equivalent of task (MET) values for CAPE activities were estimated. Youth in both groups reported moderate perceived disability in physical functioning due to pain and mostly participated in leisure and recreation at a low PA intensity. Mann–Whitney U and t-tests indicated that the number of activities performed at high, moderate, and low MET intensity levels did not differ between the two groups (p > 0.05). Perceived disability in physical functioning due to pain was not related to PA intensity (p > 0.05). Youth reported that pain, anxiety/stress, and not having time limited their PA intensity. The findings suggest that multiple factors are potential barriers to PA participation and intensity during leisure and recreation activities. Engagement with youth is encouraged to identify preferred PA at moderate to high intensity and integrate them into interventions and daily routines to promote a physically active lifestyle and reduce disability in physical functioning due to pain. Full article

This case report describes the implementation of participation-based occupational therapy for children with physical disabilities and their siblings in two families. Case 1 was a girl with myelomeningocele spina bifida and her brother, and case 2 was a boy with cerebral palsy and his sister. Goals targeted joint participation in play. The Sibling Participation in Occupational Therapy (SPOT) approach adapted the Collaborative Process for Action Plans to Achieve Children’s Participation Goals in order to assess goal-related factors and develop actionable steps to achieve the goal. Corresponding interventions addressing performance skills differed across cases and related to all children’s ages, interests, and functional abilities. The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) measured sibling dyad’s achievement of their family’s goal, and participants completed an experiential questionnaire. Parent COPM ratings demonstrated a meaningful increase in performance and satisfaction, and the therapist and parent ratings of the GAS met or exceeded expected achievement. Parents and sibling dyads reported positive experiences in SPOT. The outcomes support the use of a participation-based approach inclusive of siblings that is consistent with family-centered practice to facilitate participation in meaningful joint sibling activities with families who have a child with a physical disability. Full article

The aim of this study was to explore the perceived relationship between inclusion and participation in social and physical activities for people with physical disabilities. In partnership with a local disability-focused non-profit organization, we completed semi-structured interviews with 12 individuals with physical disabilities. Interview transcripts were analysed using an inductive thematic approach considering the social–ecological model and quality participation framework for people with disabilities. We developed three themes to describe the relationship between inclusion and participation in social and physical activities: physical accessibility of spaces and places, advocates are needed to share knowledge, and social inclusion and social/physical activities influence each other. Participants discussed the facilitating role of social inclusion on physical and social activities and the bi-directional relationship between inclusion and community participation. Fostering social inclusion through increased accessibility, education, and awareness at the community or program level can facilitate full community participation for people with physical disabilities. Full article

Introduction: The change in environmental and social context during the COVID-19 pandemic affected daily activities of people with spinal cord injury (SCI), their interactions within the community, and, consequently, their social participation during the first wave of the pandemic. However, there is little information about the changes in social participation as the pandemic evolved in Canada. Objective: Our aim was to explore the change in the social participation of adults with SCI after the first two years of the COVID-19 pandemic in Canada. Methods: A follow-up from a previous study exploring the social participation of adults with SCI living during the first wave was conducted eight months later (second wave). Social participation was measured using the Assessment of Life Habits (LIFE-H 4.0) and Measure of Quality of the Environment (MQE) among 18 adults with SCI. Results: Participants reported increases between both waves of COVID-19 in some life habit categories, including mobility, personal care and health, nutrition, and recreation. New environmental factors were identified as facilitators, including the increased availability of businesses in the community. Conclusion: These findings indicate that people with SCI experienced greater realization and satisfaction with certain life habits. Although most barriers and facilitators showed little or no change between the two waves, the reduction in environmental barriers and the increase in facilitators may have contributed to improved social participation as the pandemic progressed. Full article

One of the greatest benefits of inclusion in general physical education (PE) is the opportunity for social interactions between students with and without disabilities. Unfortunately, interviews with students with disabilities who have participated in PE often find that social interactions with students without disabilities were limited. A model that promotes interaction between students with and without disabilities in PE is Special Olympics Unified Physical Education (UPE). In UPE, students with and without disabilities participate in activities together rather than the one-way focus on traditional peer tutoring. There have been anecdotal reports on the positive benefits of UPE for both students with and without disabilities. To date, there has been no published research on UPE. Additionally, some question how UPE has been implemented in schools, specifically questioning if UPE provided quality PE and whether students with disabilities were forced into UPE and denied opportunities to participate in general PE. The purpose of this qualitative study was to better understand how UPE was developed and implemented in select U.S. schools and the impact on social interactions between students with and without disabilities. Interviews with twelve teachers who were directly involved in their UPE programs revealed the following four major themes: (1) our students were not being served appropriately, (2) a mix of PE standards and Special Olympics programming, (3) UPE is a choice, and (4) our students improved in many ways. The discussion examined the results in relation to the criticisms of UPE and how UPE proved to be a positive alternative to limited social interactions in general PE. Full article

Accessing the built environment poses many challenges for people with disabilities, severely affecting their independence and quality of life. A panel of experts with a lived experience of disabilities co-designed a survey capturing the challenges in New Zealand’s public places. There were 319 survey respondents with impairments related to mobility (66.5%), vision (18.8%), hearing (5.0%), sensory processing and cognition (8.8%). They perceived sports stadiums as the least accessible venue, followed by bars, boutique shops and public toilets. The most accessible venues were supermarkets, libraries and shopping malls. The type of disability affected the main accessibility challenges. Significant outdoor barriers included uneven and cluttered paths, inadequate provision of curb cuts, seating and accessible parking spaces, and obscure wayfinding. Entrance barriers included heavy doors, complex access control, remote ramps and narrow, obscure entrances. Interior problems included cluttered paths and poor signage. The top priorities for improvement were simplifying layouts, keeping paths clear, and providing clear, inclusive signage, communication and assistance for people with varying impairments. Providing lower counters, better colour contrast, hearing loop facilities and better control of lighting and acoustics also improve accessibility. This research contributes novel experiential data from people with disabilities that is critical to achieving an inclusive built environment. Full article

Education about epilepsy plays a vital role in reducing stigma, improving seizure response, and preventing school dropout among affected learners. Despite this importance, there is a lack of a structured conceptual framework guiding epilepsy education in primary schools, where children’s foundational learning and social development take place. This study aims to develop a conceptual framework that integrates epilepsy education into the life skills curriculum to reduce epilepsy-related stigma from an early age. A qualitative multi-methods approach was employed during the empirical phase, which was conducted in two stages using an exploratory–descriptive design. Data were collected from teachers, life skills education advisors (LEAs), and learners to explore their views on incorporating epilepsy education into the life skills curriculum of primary schools. The findings informed the development of a conceptual framework guided by the Three-Legged Stool Model and Dickoff’s Practice-Oriented Theory. This educational framework is tailored for primary school settings and highlights the roles of learners and teachers in promoting self-esteem through knowledge acquisition, value formation, and skill development, all underpinned by the Ubuntu philosophy. Full article

Trauma often causes long-lasting functional impairment, but the extent varies across populations. This study investigated disability six months after moderate to severe injury and identified sociodemographic and early injury-related predictors, including estimated rehabilitation complexity. Further, we assessed the implementation of direct transfer from acute care in the trauma centre to specialised inpatient rehabilitation, bypassing local hospitals. In this prospective study 398 adults, treated from January 2020 to January 2021 at two Norwegian trauma centres, were included. Self-reported disability was measured using the 12-item World Health Organization Disability Assessment Schedule 2.0. Ordinal logistic regression was applied to identify predictors of the 6-month disability outcome. At follow-up, 22% reported no disability, 49% mild/moderate and 29% severe. In multivariable analyses, low education, comorbidities, number of injuries and higher estimated rehabilitation complexity at discharge from acute care were significantly associated with greater disability. Only 20% were transferred directly to specialised inpatient rehabilitation, while 17% went via local hospitals. Participants with orthopaedic injuries and women were less likely to be transferred directly. In summary, most participants experienced some disability at 6 months. Indirect pathways to specialised rehabilitation via local hospitals remained common. Understanding predictors of disability and optimising rehabilitation pathways may improve trauma rehabilitation outcomes, highlighting the need for guidelines that identify patients with high rehabilitation needs. Full article

Approximately one-third of stroke survivors live with aphasia, an acquired communication disorder that significantly impacts their ability to understand, speak, read, or write. This condition often leads to social isolation and a reduced quality of life. Financial institutions, as essential community services, present numerous communication barriers for people living with aphasia. This study aims to identify the barriers and facilitators influencing the communicative accessibility of financial institutions for people living with aphasia and to discuss solutions to optimize accessibility. A qualitative descriptive research design was employed, involving semi-structured interviews with people living with aphasia and questionnaires filled by employees from financial institutions. Data were analyzed using thematic analysis to identify key themes related to barriers and facilitators. People living with aphasia identified thirteen types of barriers and forty facilitators, related to physical environmental factors, conversational attitudes and service systems and policies. Financial institution employees highlighted the need for better training and awareness regarding aphasia. The study underscores the significant barriers people living with aphasia face in financial institutions and the potential facilitators that could enhance communicative accessibility. Implementing targeted training programs and standardizing accessibility policies are crucial steps towards improving service access for people living with aphasia. Full article

Disabled children often experience limited access to Family-Centred Care and social participation, while their families face significant caregiving responsibilities. Healthcare providers have a vital role in providing paediatric rehabilitation and support, yet access to and quality of services remain a key concern. To improve quality healthcare delivery, it is essential to understand stakeholder experiences of Family-Centred Care. Using an interpretive paradigm, semi-structured qualitative interviews and focus groups were conducted with paediatric healthcare service providers and service users, followed by reflexive thematic analysis. A key theme of ‘relationships enhance knowingness’ was identified. This theme highlights relationships as critical in meaningful service delivery and emphasises that mutual understanding, or knowingness, between service providers and service users is essential for success. Both service providers and service users identified subthemes related to ‘individual characteristics’ and ‘perceptions of families’, shaped by their differing positions within the care relationship. A distinct subtheme concerning ‘experiences of therapy’ was described by service users but was absent from service provider accounts. Fluctuating family capacity was identified as an influential factor affecting service engagement. A new service delivery model is presented to guide providers in delivering tailored, Family-Centred responsive Care. Full article

Background: Youth with intellectual disabilities are often marginalised and discriminated against regarding skills development and work opportunities as society seems to place high value on an individual’s intellect. Unemployment levels for youth with intellectual disabilities are significantly higher than youth in the general population, yet youth with intellectual disabilities can become valuable employees. This paper explores the untapped potential for youth with disabilities to access skill development opportunities through participation in sports organisations and events that enable them to become economically active. Methodology: A critical ethnographic approach was adopted as the research design. The sample included six youth with intellectual disabilities, five parents, two vocational trainers, two sports coaches, and two golf managers. Data was gathered through participant observations, semi structured interviews, and reflective journaling. Data was analysed using thematic analysis. Findings: The theme “Hidden treasures in a disabling environment” emerged, highlighting the untapped potential of youth with intellectual disabilities to engage in livelihood activities through participation in sports events. One subtheme was “Invisible and well-hidden resources” reflecting remote training centres leading to missed work opportunities. Research findings highlighted that youth with intellectual disabilities possessed marketable skills, alongside the discovery of substantial unexplored livelihood opportunities in the workforce of sports events. Full article

Persons with disabilities face barriers to accessing sexuality education. For those who identify as queer, these challenges are compounded by stigma, ableism, and heteronormativity, resulting in distinct and overlooked experiences. This study explored the sexuality education needs of persons with disabilities who identify as queer in Kenya—a neglected demographic—using a phenomenological approach. Data were collected through a focus group discussion with six participants and analyzed thematically. Three themes emerged: invisibility and erasure; unprepared institutions and constrained support networks; and agency and everyday resistance. Educational institutions often overlook the intersectional needs of persons with disabilities who identify as queer, leaving them without adequate tools to navigate relationships, sexuality, and rights. Support systems are often unprepared or unwilling to address these needs. Societal attitudes that desexualize disability and marginalize queerness intersect to produce compounded exclusion. Despite these challenges, participants demonstrated agency by using digital spaces and informal networks to resist exclusion. This calls for policy reforms that move beyond tokenism to address the lived realities of multiply marginalized groups. Policy reform means not only a legal or governmental shift but also a broader cultural and institutional process that creates space for recognition, protection, and participation. Full article

Background: Achieving meaningful community integration (engagement in meaningful activity, independent living, and social connectedness) after a traumatic brain injury (TBI) requires addressing persistent barriers limiting its fulfillment. This qualitative study explored the perceptions and experiences of community integration for individuals living with TBI in the community. Methods: Using semi-structured interviews, four focus groups of individuals with TBI were conducted. Data were analyzed using codebook thematic analysis. Findings: There were 13 participants between the ages of 25 and 64, who had acquired their injury at least three years earlier. Community integration was illustrated through three themes: (1) ‘Am I left on my own?’ explored the support systems after TBI, (2) ‘One size fits all’ described the response of society to TBI, and (3) ‘Adapting to a new normal’ highlighted responses to a changed reality. Conclusions: Individuals with TBI reported decreased community integration in multiple facets of life. Understanding the experiences of community integration after TBI can create room for future rehabilitation interventions that consider new abilities and adaptation to barriers. Full article

The present study focuses on investigating the contribution of puppetry as a pedagogical and psychosocial tool in special education, addressing the literature gap in the systematic documentation of the experiences of special education teachers, concerning its use in daily teaching practice. The main objective is to capture the way in which puppetry enhances the learning, social and therapeutic support of students with complex educational and psychosocial needs. The study employs a qualitative phenomenological approach, conducting semi-structured interviews with eleven special education teachers who integrate puppetry into their teaching. Qualitative data were analyzed using thematic analysis. The findings highlight that puppetry significantly enhances cognitive function, concentration, memory and language development, while promoting the active participation, cooperation, social inclusion and self-expression of students. In addition, the use of the puppet acts as a means of psycho-emotional empowerment, supporting positive behavior and helping students cope with stress and behavioral difficulties. Participants identified peer support, material adequacy and training as key factors for effective implementation, while conversely, a lack of resources and time is cited as a key obstacle. The integration of puppetry in everyday school life seems to ameliorate a more personalized, supportive and experiential learning environment, responding to the diverse and complex profiles of students attending special schools. Continuous training for teachers, along with strengthening the collaboration between the arts and special education, is essential for the effective use of puppetry in the classroom. Full article

Disability Certification is an instrument that can contribute to the identification of persons with disabilities who are potential beneficiaries of social protection programmes. In Colombia, the disability certification process was changed in 2020 to include a human rights perspective. However, little information exists on how far the process aligns with the recommendations made by the Convention on the Rights of Persons with Disabilities or to what extent it provides useful information for the operation of the country’s social protection system. This study aims to analyse how the changes implemented in 2020 have contributed to the identification and determination of persons with disabilities in social protection programmes in Colombia. This research uses an analytical-descriptive design, in which legal documents related to the social protection programme and disability certification were analysed. In addition, we conducted semi-structured interviews in Colombia with people with disabilities, professionals conducting the certification, and with key stakeholders, and we analysed the information using thematic analysis. Colombia changed its certification process in 2020, moving from a capacity-to-work assessment to a process of assessing functioning capacity and participation limitations following the International Classification of Functional Disability and Health. However, the new certification process has not provided an instrument to contribute to determining persons with disabilities who should be prioritised or receive social benefits in Colombia. The certification does not establish the support needs of people with disabilities, does not recommend reasonable adjustments to support their participation in society, and has not been used systematically in social protection programmes. Finally, individuals with disabilities commented that the disability certification is a process that does not open up opportunities to receive social benefits and social transfers, and in most cases, it is an expensive and lengthy process. Disability certification in Colombia is not an instrument that determines the needs of people with disabilities, nor the reasonable accommodations that they require in order to participate in society. Full article

The present study investigated the impact of a disability awareness program on the attitudes of university students at Al-Ahliyya Amman University towards people with disabilities. The study employed a randomized, two-group, pre- and post-test design. A total of 60 university students were randomly allocated to either the experimental or control group. The results of a survey showed that those in the experimental group, in comparison with the control group, exhibited a statistically significant increase in the favorability of their attitudes towards people with disabilities following the implementation of the program. Based on the results of this study, we recommend implementing disability awareness programs inside universities and subsequently evaluating their effectiveness in enhancing student attitudes and interactions with people with disabilities, which in turn could lead to a more inclusive society and improve the quality of life for people with disabilities by reducing social barriers and fostering greater understanding and acceptance. The limitations of this study include its restriction to a single university setting and its utilization of a rather small sample size. The study did not assess the long-term effects of the disability awareness program. Full article

About 8% of Ghanaians, including adolescents, have various types of disabilities. Although many legal and constitutional protections for people with disabilities, including adolescents, exist in Ghana, it is widely known that these persons face a variety of psychosocial issues. Several factors have been identified as contributing to the unremitting marginalisation of people with disabilities in general, but the extent to which these can be generalised to adolescents with disabilities is unknown. This study, therefore, sought to document the determinants, manifestations, and consequences of disability-related stigma among differently abled adolescents in three special schools in northern, middle, and southern Ghana. An exploratory descriptive qualitative design was used. Overall, 54 participants were purposively selected for a semi-structured interview and focus group discussions. Braun and Clarke’s procedure for thematic analysis was followed. The findings showed a variety of stigmatising experiences by adolescents with disabilities in their sociocultural context. More broadly, the cause of disability was linked to the ramifications of parental sins against the gods, being a descendant of river gods, and the consequences of bewitchment/curses by family members. Others included the perceived transmissibility of the disability and disability as a visible condition. Stigma manifested in the form of pejorative labelling, ableism, and social exclusion. The consequences of this stigma included negative psychological and emotional effects (i.e., depression, low self-esteem, and a lack of confidence) and suicidal ideation. There is an urgent need for stigma reduction interventions for adolescents with disabilities in Ghana as part of an effort to improve their wellbeing. Full article