Initial factor exploration of disability identity

Impairment and Disability Identity and Perceptions of Trust, Respect, and Fairness

Importance

Most studies use impaired functioning alone to specify populations with disabilities. However, some people with functional impairments do not identify as disabled. With functional status-based definitions, studies have shown disparate care quality for people with disabilities.

Objective

To examine whether impairment and disability identity have different associations with perceived health care experiences and explore factors associated with disability identification.

Design, Setting, and Participants

This cross-sectional study used a nationally representative survey of US adults conducted from April 20 through May 31, 2021, and analyzed between June 1 and August 31, 2022. Survey participants were 1822 English- or Spanish-speaking adults responding either online or via telephone.

Exposures

Using 8 survey questions, participants were grouped according to presence of impairment and disability identity.

Main Outcomes and Measures

Likert scale measures of trust, respect, and fairness (henceforth, procedural justice measures) were dichotomized. Sociodemographic characteristics and rates of procedural justice responses were compared across groups. Multivariable logistic regressions adjusting for baseline characteristics were performed to (1) estimate associations of impairment and disability identity with perceptions of procedural justice and (2) explore factors associated with disability identification. Analyses applied survey weights.

Results

Of 6126 individuals invited to participate, 1854 (30.3%) completed the survey. Thirty-two were excluded due to unreportable gender, for a final analytic sample of 1822 participants. Participants with impairments (n = 816; mean [SD] age, 48.1 [17.0] years; 51.2% women, 48.8% men) had worse perceptions on 7 of 10 procedural justice measures (crude) compared with those without impairments (n = 1006; mean [SD] age, 49.6 [18.1] years, 55.1% female, 44.9% male). Among respondents with impairments, those who did (n = 340) vs did not (n = 476) identify as disabled gave better ratings for clinician communication efforts (a lot of effort, 38.8% vs 31.0%) and having health goals understood (understood very or fairly well, 77.2% vs 70.1%) but gave worse ratings for respect (almost never felt inferior or talked down to, 66.1% vs 59.1%). Disability identification was associated with more reports of unfair treatment (31.0% vs 22.4%; adjusted odds ratio, 1.65; 95% CI, 1.12-2.42) and of being unafraid to ask questions or disagree (50.5% vs 40.1%; adjusted odds ratio, 1.51; 95% CI, 1.04-20.19). Income and employment were associated with disability identification.

Conclusions and Relevance

In this cross-sectional survey study of US adults, health care perceptions differed between groups defined by impairment status and disability identity. These findings suggest that, alongside functional measures, health systems should capture disability identity to better address disparities for people with impairments.

Disability acceptance as a moderator of the impacts of disability stigma on job satisfaction of people with disabilities in the workplace

BACKGROUND: Disability stigma is a significant risk factor that reduces job satisfaction. Based on the previous studies, the role of disability acceptance as a buffer to prevent the negative impact of stigma in the workplace is hypothesized. OBJECTIVE: This study examined the moderating effect of disability acceptance on the negative effects of disability stigma on job satisfaction of people with disabilities. METHODS: 164 participants working at the time of the survey completed questionnaires measuring disability stigma, disability acceptance, and job satisfaction. The associations among the three variables were examined using simple linear regression analyses. Hierarchical linear regression analysis was conducted to identify the moderating effect of disability acceptance after controlling disability type. RESULTS: Disability stigma (β=–0.17, p <  0.05) and disability acceptance (β=0.18, p <  0.05) were significantly associated with job satisfaction respectively. In the final model, disability acceptance moderated the relationship between disability stigma and job satisfaction (β=–0.16, p <  0.05). Specifically, the impacts of disability stigma on job satisfaction for participants with higher disability acceptance differed from those with lower acceptance. CONCLUSION: The current research suggests that disability acceptance plays a critical role for people with disabilities to cope with the negative impact of disability stigma. This result implies that disability acceptance should be an important focus of intervention to increase job satisfaction.