"We need a world we can operate in": Exploring the relationship between societal stigma and depression among wheelchair users

BACKGROUND

Stigma looms over the disability community.

OBJECTIVE OR HYPOTHESIS

The aim of this paper is to gain a deeper understanding of how societal stigma impacts depression among wheelchair users.

METHODS

Mixed research methods were used on a sample of sixty full-time wheelchair users (M age = 43.78, SD = 15.50) whose disability was either acquired (n = 32) or congenital (n = 28). Data was collected via an anonymous Qualtrics survey. Qualitative and quantitative content analyses were performed.

RESULTS

Three major themes were identified from the qualitative analysis, including pity, discomfort, and invisibility which demonstrated that our participants felt frequently stigmatized in public. Several participants noted how assumptions were made about their competence, intellect, ability, and the entire disability experience based on the physical representation of their wheelchair. The quantitative results demonstrated a positive correlation between The Major Depression Index and the Able Privilege Scale-Revised, a scale constructed to examine personal power and privilege in relation to society depending on disability type.

CONCLUSIONS

Wheelchair users feel stigmatized by members of society, which is associated with increased levels of depression and perceived pity, discomfort, and invisibility.

Types and factors affecting and impact of ableism among Asian children and youth with disabilities and their caregivers: a systematic review of quantitative studies

PURPOSE

Asian children and youth with disabilities often experience multiple barriers and discrimination in education, healthcare, and social settings, which influence their well-being, especially the transition to adulthood. This review aims to explore the types, factors affecting and impact of ableism on Asian children and youth with disabilities and their caregivers.

METHODS

We conducted a systematic review and a narrative synthesis whereby we searched the literature from six international databases, including Healthstar, Ovid Medline, Embase, PsycInfo, Scopus, and Web of Science.

RESULTS

Twenty-nine studies were included in the review, and three themes were identified that related to ableism: (1) types and rates of ableism (i.e., stigma, bullying and victimization, and discrimination and inequalities); (2) factors affecting ableism (i.e. sociodemographic factors, familial factors, and societal factors); and (3) impacts of ableism (i.e. mental health, family impacts, and societal impacts).

CONCLUSIONS

Our review highlights that ableism has various types and can be influenced by multiple factors, influencing social and health outcomes of Asian families with children and youth with disabilities. This review also emphasizes the importance of increasing the public's awareness regarding disabilities to reduce ableism among Asian families with children with disabilities.

More than just double discrimination: a scoping review of the experiences and impact of ableism and racism in employment

PURPOSE

Research has shed light on the employment barriers faced by individuals with disabilities, and by racialized people. The challenges faced by people belonging to both marginalized groups are less well-understood. The purpose of this scoping review was to examine existing research on labour market and workplace experiences of racialized people with disabilities, and to identify how ableism and racism intersect to shape employment experiences and outcomes.

METHODS

Seven international databases were searched, covering the period from 2000 to April 2022. Four reviewers independently conducted the screening, and data extraction and analysis were performed on 44 articles that met our inclusion criteria.

RESULTS

The findings highlighted rates of workplace ableism and racism (including discrimination allegations and perceived discrimination); types and forms of experiences arising from the intersection of ableism and racism (including unique individual stereotyping and systemic and institutional discrimination); and the role of other demographic variables. The intersection of ableism and racism impacted labour market outcomes, well-being in the workplace, and career/professional advancement.

CONCLUSIONS

Our review highlights the need for greater in-depth research focusing explicitly on the intersection of ableism and racism (and of other forms of discrimination), to better understand and address the barriers that racialized people with disabilities face in employment.IMPLICATIONS FOR REHABILITATIONThe experiences of racialized people with disabilities have been under explored, and clinicians and rehabilitation specialists should consider incorporating intersectionality into their practices to better understand and serve these populations.Ableism and racism do not operate in isolation, and clinicians and other professionals need to be aware that racialized people with disabilities may face unique challenges and barriers as a result.Service providers should aim to address gaps and inequities in services faced by racialized people with disabilities which may prevent them from finding and/or maintaining meaningful employment.

Creating an anti-ableist learning environment: Development of a novel disability-related microaggressions session for medical and dental students and mixed methods analysis of impact on learning and empowerment

BACKGROUND

Disability-related microaggressions are unique among microaggressions in the assumptions they reflect and the verbal and non-verbal forms they take. They impact patients and providers alike. Yet, medical and dental students are not routinely educated about disability-related microaggressions. A medical school student-faculty team harnessed Kern's six-step curriculum design process to co-produce a novel 90-min educational intervention centered on recognizing and responding to disability-related microaggressions. The session was piloted in February 2022 as a required element of the school's mandatory professional development training for first-year medical and dental students.

OBJECTIVE

This mixed-methods study examined session impact on student-reported learning pertinent to addressing and mitigating disability-related microaggressions.

METHODS

Voluntary surveys were distributed to all first-year students to capture pre-/post-session self-assessment of knowledge, skills, and comfort, as well as post-session reflection on lessons learned. Quantitative data was analyzed using summary statistics, unpaired t-tests, and Mann Whitney U tests; qualitative data was analyzed using a hybrid inductive-deductive approach.

RESULTS

Survey response rate was 61 % (100/164) pre-session and 25 % (41/164) post-session. Post-session, there was significantly increased student agreement with statements addressing microaggressions knowledge, comfort teaching others, and strategies to support disability-sensitive workplaces. Post-session narrative reflections revealed learning within five themes: nature of microaggressions, identifying microaggressions, preventing microaggressions, responding to microaggressions, and medical student empowerment. Ninety-three percent of post-session respondents (38/41) agreed the session empowered them to actively contribute to anti-ableist learning environments.

CONCLUSIONS

The pilot educational intervention provides a promising strategy to foster anti-ableism and advocacy among first-year medical/dental students. While limited by low response rate, small sample size, participant self-selection for survey participation, and unlinked individual pre- and post-session responses, mixed methods analysis suggests the session had a positive impact on student action-oriented knowledge and empowerment.

The shadow side of occupational therapy: Necropower, state racism and colonialism

BACKGROUND

In the Global North, advances in occupational therapy benefitted unduly from the oppression, disablement and suffering of thousands of people in the South (and beyond). To prevent the recurrence of these injustices, history must be unveiled and occupational therapists urged to come to terms with their own involvement and responsibility.

OBJECTIVE AND METHOD

Utilising Achille Mbembe's concept of necropolitics, this academic essay blends select historical and philosophical perspectives to explore occupational therapy's concealed role in manifestations of institutionalised violence.

RESULTS

By examining its roles in World War II and France's colonisation of Algeria, we make visible the development of occupational therapy's distinct 'shadow side'. In Nazi Germany's Euthanasia Programme, it became a tool for identifying which lives were deemed 'worthy of living' and which were not, which indirectly contributed to the killing of 200,000 disabled persons. Under France's colonial medical system, occupational therapy imposed Western standards that alienated and completely depersonalised Algerian patients.

CONCLUSION AND SIGNIFICANCE

Entrenched in a (bio)economy that has endured beyond these events, occupational therapists must exercise vigilance, remaining mindful of the potential to unintentionally overlook individuals labelled as 'unproductive'. This requires confronting the profession's assumptions of inherent 'goodness' and acknowledging and addressing its shadow side.

[Ableist obstetric violence against women with disabilities: An integrative literature review]

Women with disabilities face increased precarity throughout their lives, with one of the most affected areas being their sexual and reproductive health. The aim of this study was to identify and analyze the scientific literature on obstetric violence against women with disabilities. The search was conducted from August to October 2022 in five databases: PubMed, Web of Science, Dialnet, SciELO, and Scopus. A total of 194 articles were retrieved, and after applying selection criteria, ten articles were analyzed. Through thematic analysis, the dimension "ableist obstetric violence towards women with disabilities" emerged. Findings suggest that women with disabilities are marginalized during obstetric care, resulting in untimely attention and cascading interventions. At present, there is scarce literature addressing this phenomenon from a rights-based perspective. Urgent measures are needed to train healthcare teams on the provision of care to people with disabilities. Additionally, it is crucial to critically examine the relationship between healthcare personnel and institutions to women with disabilities within the framework of their sexual and reproductive rights.

Contemporary clinical conversations about stuttering: Neurodiversity and ableism

PURPOSE

To discuss issues about neurodiversity and ableism, and how they pertain to clinical management of stuttering, with particular reference to early childhood stuttering.

METHODS

During a webinar this year, the issue emerged of how concepts of neurodiversity and ableism apply to early childhood stuttering during the pre-school years. It became apparent that this topic elicited disparate views and would be of particular interest to students of speech-language pathology. Consequently, the leaders of that webinar continued the conversation by written dialogue for the purpose of placing it on record.

RESULTS

The discussants reached agreement on many points, but there was some diversity of viewpoint about how neurodiversity and ableism should apply to clinical practice with children who have recently begun to stutter.

Developing Disability-Focused Pre-Health and Health Professions Curricula

People with disabilities (PWD) comprise a significant part of the population yet experience some of the most profound health disparities. Among the greatest barriers to quality care are inadequate health professions education related to caring for PWD. Drawing upon the expertise of health professions educators in medicine, public health, nursing, social work, and physician assistant programs, this forum showcases innovative methods for teaching core disability skills and concepts grounded in disability studies and the health humanities. Each of the essays offers practical guidance for developing curricular interventions appropriate for students at various levels of training and familiarity with disability to be implemented in classroom discussions, case-based learning, lectures, panels, and clinical simulations across the full spectrum of pre-health and health professions education.

Leaving no one behind: successful ageing at the intersection of ageism and ableism

BACKGROUND

The concept of 'successful ageing' has been a prominent focus within the field of gerontology for several decades. However, despite the widespread attention paid to this concept, its intersectional implications have not been fully explored yet. This paper aims to address this gap by analyzing the potential ageist and ableist biases in the discourse of successful ageing through an intersectional lens.

METHOD

A critical feminist perspective is taken to examine the sensitivity of the discourse of successful ageing to diversity in societies. The paper analyzes how ageist and ableist biases can manifest in the ways we conceptualize ageing, drawing on examples in the context of mental health.

RESULTS

We argue that the conventional approach to successful ageing is limited in its ability to account for the experiences of people who have faced intersectional discrimination throughout their lives. Drawing on examples in the context of mental health, we explore among others the link between depression and disabilities. Furthermore, we shed light on the negative impact of ageist and ableist attitudes concerning the diagnosis and treatment of dementia.

DISCUSSION

We demonstrate how diversity is often overlooked in discussions of ageing well, and how ageist and ableist biases can manifest in the ways we conceptualize ageing. We argue that focusing solely on the health status as a means of achieving success fails to adequately counter ageism for all people. We further emphasize the role of structural factors, such as ageist attitudes, in shaping the experience of ageing and exacerbating health inequalities.

CONCLUSION

Overall, our findings emphasize the need for a more nuanced and inclusive understanding of ageing and therefore an intersectional approach to conceptions of ageing well that recognizes and addresses the biases and limitations of current discourses. Thereby, this paper offers valuable insights into the complex intersections between age and disabilities from a bioethical perspective, highlighting the need for a more inclusive and intersectional approach to ageing.

Exposing the disability-related hidden curriculum in case-based learning: A qualitative study

BACKGROUND

People with disabilities face significant health disparities. Studies show that healthcare professionals harbor negative attitudes towards disability, compromising the quality of care. These attitudes, in unwritten, unofficial, and even unintended ways can be passed from providers to learners in the medical education setting.

OBJECTIVE

Using a Critical Disability Studies (CDS) paradigm, the authors uncovered the disability-related hidden curriculum within Case-Based Learning (CBL) and proposed guidelines for promoting a disability-conscious medical education that resists ableism.

METHODS

The study team conducted a qualitative analysis of all CBL cases from the pre-clerkship curriculum (n = 53) at Sidney Kimmel Medical College. The authors employed a directed content analysis approach to develop a codebook based on case examination, literature review, and CDS concepts. Two researchers coded all cases and assessed intercoder reliability. The results informed the development of an explanatory model.

RESULTS

Only four of 53 cases overtly mentioned disability, none of which defined disability according to CDS. Coding did not identify content challenging stereotypical views of disability. Additionally, two cases included content fueling negative attitudes of disability.

CONCLUSION

By inadequately addressing disability from a CDS perspective, harmful assumptions of disability may go unchallenged, driving a hidden curriculum within CBL. This phenomenon leaves medical students ill-prepared to care for people with disabilities and creates physicians ill-equipped to teach the next generation. Since many health professions utilize CBL to educate students, these cases provide an untapped opportunity to resist ableism and better prepare students to address the negative attitudes driving health disparities experienced by people with disabilities.

Explicit and implicit: Ableism of disability professionals

BACKGROUND

People who work with disabled people or whose work is about disability - disability professionals - often have direct power over disabled people and can impact their lives immensely; they also have a role in creating and institutionalizing knowledge about disability.

OBJECTIVE

The aim of this study was to examine the explicit (conscious) and implicit (unconscious) disability attitudes of disability professionals.

METHODS

Between October 2021 and February 2023, disability professionals (n = 417) completed the Symbolic Ableism Scale (SAS) and the Disability Attitudes Implicit Association Test (DA-IAT). We had the following research questions: (1.) What are disability professionals' explicit attitudes towards disability? (2.) What are disability professionals' implicit attitudes towards disability? (3.) What is the relationship between disability professionals' explicit and implicit disability attitudes? and (4.) What sociodemographic factors correlate with disability professionals' explicit and implicit disability attitudes? We examined these questions using descriptive statistics, t-tests, a two-dimensional model of prejudice, and linear regression models.

RESULTS

In our sample, 77.24% of disability professionals preferred nondisabled people explicitly and 82.03% implicitly. Most commonly, disability professionals were symbolic ableists (37.8%). Race, political orientation, and job type correlated with disability professionals' explicit attitudes, while disability, gender, and job type correlated with their implicit attitudes.

CONCLUSIONS

Ableism cannot be eradicated until disability professionals look inward and rid themselves of negative attitudes; until that occurs, disability professionals will continue to do a disservice to the very people they have dedicated their careers to - disabled people.

Exploring the experiences of ableism among Asian children and youth with disabilities and their families: a systematic review of qualitative studies

PURPOSE

Asian children and youth with disabilities often experience multiple barriers, stigmas and discrimination within and outside their families; yet less is understood about their lived experiences. This systematic review explored the experiences of ableism among Asian children and youth with disabilities and their families.

METHODS

We conducted a systematic review of qualitative studies and a qualitative meta-synthesis. We searched six databases including Ovid Medline, Embase, PsychInfo, Healthstar, Web of Science, and Scopus.

RESULTS

Forty-two articles met our inclusion criteria involving 17 countries and regions over a 22-year period. The findings were synthesized into four themes: (1) individual- and family-level ableism (i.e., stigma, fears, concerns, stress and anxieties, physical abuse, bullying, reduced engagement in community activities); (2) institutional-level ableism (i.e., barriers to accessing and navigating supports, ableist attitudes among service providers, unavailable services); (3) societal-level ableism (i.e., cultural and religious stigma, social rejection, discrimination, environmental and policy barriers); and (4) coping strategies (i.e., self-care activities, supports from family, friends and people with similar conditions, religious beliefs).

CONCLUSIONS

Our results highlight the ableist experiences that Asian children and youth with disabilities and their caregivers often encounter and the strong need for further supports to address ableism using culturally responsive strategies.

Barriers and facilitators to obtaining accessible housing among children, youth and young adults with disabilities and their families: a scoping review

PURPOSE

Accessible housing is a fundamental human right and yet many children and youth with disabilities live in inaccessible, insecure, unaffordable and poor quality housing. The aim of our study was to understand the barriers and facilitators to obtaining accessible housing among children, youth and young adults with disabilities and their families.

METHODS

We conducted a scoping review involving seven international literature databases from 2000 to 2022 that identified 38 studies meeting our inclusion criteria.

RESULTS

The reviewed studies involved 10 countries over a 22-year period. Our review emphasized the following key trends: (1) barriers to obtaining accessible homes (i.e. common types of accessibility barriers, rates of inaccessible housing, factors affecting home accessibility), and negative impacts of inaccessible housing; and (2) rates and facilitators to obtaining accessible housing (i.e., common types of home modifications, enablers of home modifications) and positive impacts of accessible housing.

CONCLUSIONS

Our findings highlight the barriers and enablers of obtaining accessible housing among children, youth and young adults with disabilities and their families and the critical need to support them in securing appropriate housing.

Intellectual Humility: How Recognizing the Fallibility of Our Beliefs and Owning Our Limits May Create a Better Relationship Between the Physical Therapy Profession and Disability

Despite the many advancements over the history of the profession, physical therapy remains in a somewhat paradoxical relationship with disability. The physical therapist profession values disability as diversity but continues to focus on the normalization of body functions as the primary means to promote functionality in people with disability. This focus, consistent with a medicalized view of disability, may prevent physical therapists from empowering individuals with disability to explore alternative, yet effective, perceptual-motor strategies to achieve their functional goals. Additionally, recent research documents implicit, negative biases of physical therapists and physical therapist assistants toward people with disability, again consistent with the medicalized view that disability is the product of an imperfectly functioning body. Dominant underlying beliefs in any profession are often difficult to counter because they are so pervasive, and those beliefs can be reinforced and made stronger when challenged. The purpose of this Perspective article is to introduce physical therapists to a rising construct in psychology-intellectual humility-that may help to facilitate the profession's relationship with disability. Intellectual humility is predicated on recognizing the fallibility of one's beliefs and related practices. Intellectual humility is a promising construct for physical therapy to address the disability paradox and confront implicit attitudes that have served as the basis for many dominant ideas about disability. This Perspective synthesizes views and evidence from the behavioral and social sciences, philosophy, and critical disability studies to contribute to the ongoing evolution of the profession with respect to disability.

IMPACT

The development of enhanced intellectual humility in physical therapy may help to challenge long-held beliefs among physical therapists about disability-many of which are unnoticed, unquestioned, and difficult to counter.

Disability Justice and Anti-ableism for the Pediatric Clinician

The impact of ableism on health care, and specifically the health of people with disabilities, is not only underrecognized, but misunderstood at a foundational level due to socially acceptable denial of anti-disability bias. For the pediatrician that seeks to learn about the value of anti-ableist approaches to health care and how it can promote child health, this article reviews the relationship between medical jargon and anti-disability bias, and provides a primer on disability justice, the medical versus social models of disability, and other scholarly concepts related to anti-ableism. The authors provide narrative examples of disability bias in clinical scenarios, and the article concludes with actionable recommendations on anti-ableist language etiquette and clinical best practices. Although ableism is a societal issue, pediatricians have a responsibility to recognize and address ableism as a threat to child health.

Engineering Ableism: The Exclusion and Devaluation of Engineering Students and Professionals with Physical Disabilities and Chronic and Mental Illness

Background

The experiences of students and professionals with disabilities are routinely excluded from scholarly and policy debates about equity in engineering. Emergent research suggests that engineering is particularly ableist, yet systematic accounts of the possible exclusion and devaluation faced by engineers with disabilities are largely missing.

Purpose/Hypothesis

This paper asks, do engineers with disabilities have more negative interpersonal experiences in engineering classrooms and workplaces than those without disabilities? Utilizing a social relational model of disability, I hypothesize that engineers with physical disabilities and chronic and mental illness are more likely to experience exclusion and professional devaluation than their peers and, partly as a result, have lower persistence intentions.

Data/Methods

The paper uses survey data from 1,729 students enrolled in eight US engineering programs (ASEE Diversity and Inclusion Survey) and 8,321 US-employed engineers (STEM Inclusion Study Survey). Analyses use regression, mediation, and intersectional approaches.

Results

Consistent with expectations, engineering students and professionals with disabilities are less likely than their peers to experience social inclusion and professional respect at school and work. Students with disabilities are more likely to intend to leave their engineering programs and professionals with disabilities are more likely to have thought about leaving their engineering jobs compared to peers, and their greater risks of encountering interpersonal bias help account for these differences. Analyses also reveal intersectional variation by gender and race/ethnicity.

Conclusion

These results suggest that engineering harbors widespread ableism across education and work. The findings demand more scholarly attention to the social, cultural, and physical barriers that block people with disabilities from full and equal participation in engineering.

Ableism and Workplace Discrimination Among Youth and Young Adults with Disabilities: A Systematic Review

PURPOSE

Young people with disabilities are persistently under-employed and experience concerning rates of discrimination and ableism in looking for work and within the workplace. Focusing on youth is salient because rates of ableism are often higher among younger ages compared to older. The objective of this systematic review was to explore the experiences and impact of workplace discrimination and ableism among youth and young adults with disabilities.

METHODS

Systematic searches of seven databases from 2000 to 2021 were conducted. Four reviewers independently applied the inclusion criteria, extracted the data and rated the study quality.

RESULTS

Of the 39 studies meeting our inclusion criteria, they represented 516,281 participants across eight countries over a 20-year period. The findings highlight the rates of workplace ableism, factors affecting workplace ableism (i.e., type of disability, gender, education level, lack of employers' knowledge about disability), ableism in job searching and anticipated ableism. The review also noted the impact of workplace ableism, which included pay discrimination, lack of job supports and social exclusion, job turnover and unemployment, and discrimination allegations and charges.

CONCLUSIONS

Our findings reveal the stark prevalence of workplace ableism among youth and young adults with disabilities. There is an urgent need for further in-depth research to understand youth's lived experiences of ableism and the development of solutions to address it so they can be included in a meaningful and respectful way in the workplace.

Ableism among children and youth with acquired brain injury and their caregivers: a systematic review

PURPOSE

Children and youth with acquired brain injury (ABI) experience persistent discrimination and ableism. The purpose of this systematic review was to understand the experiences and impact of ableism among children and youth with ABI.

METHOD

Six international databases were systematically searched for articles from 2002-2022. Studies were screened independently by four researchers who performed the data extraction. Study quality was appraised using the Standard quality assessment criteria for evaluating primary research.

RESULTS

Of the 2085 studies identified in the search, 15 met the inclusion criteria, which involved 1442 children and youth with brain injuries or caregivers representing them. Studies in the review showed the following key trends: (1) incidence of ableism among children and youth with ABI; (2) experiences of ableism at the individual and institutional levels, (3) impact of ableism (i.e., mental health, social relationships, quality of life) and (4) coping strategies (i.e., resources, supports).

CONCLUSIONS

Our findings reveal the alarming incidence of ableism among youth with ABI. Therefore, there is a critical need for more research to explore youth's lived experiences of ableism, especially from their perspectives along with the co-development of solutions to help enhance their social inclusion and well-being.

Palliative Care Professionals' Perceptions and Communication About Sexual Expression of Older Adults at End of Life: How Biases Compromise Holistic Care

BACKGROUND AND OBJECTIVES

The sexuality of older people, which has historically been invisible, is increasingly represented and promoted in the media. However, the sexuality of the oldest older adults showing signs of frailty remains obscure and subject to ageist and ableist biases. Studies on sexual expression at the end of life have shown that sexuality and the need for support related to it remain important for many people.

RESEARCH DESIGN AND METHODS

This article examines the perceptions and attitudes of professionals regarding the sexuality of older adults in palliative care, based on an exploratory qualitative study. Participants were recruited from several palliative care teams working either in hospital or in home settings in Canada.

RESULTS

Professionals (n = 16) held two main views of sexuality: broad and holistic or narrow and genital-focused. Perceptions of sexuality in later life were either described as a continuation of or distinct from middle adulthood. No matter what views were held, most professionals did not discuss sexuality with their patients at the end of life.

DISCUSSION AND IMPLICATIONS

The lack of communication about sexuality may be largely due to professional's ageist, ableist, and heterosexist views regarding the sexuality of this population group. Results confirm the relevance of providing palliative care training about diverse sexual experiences and the importance of supporting older adults at the end of life with respect to their intimate and sexual needs. Such an approach is in line with the holistic vocation of palliative care.

The capability imperative: Theorizing ableism in medical education

Medical education programs profess commitments to justice, equity, and inclusion, seeking to diversify the profession and better serve patient populations. Although disability has more recently joined recognized categories of valued diversity, significant barriers remain for disabled learners in medicine. This paper develops the concept of the capability imperative, derived from a constructivist grounded theory study examining disability inclusion at four U.S. medical schools that analyzed technical standards policies and interviews with 19 disabled students and 27 school officials (faculty and administrators). Through three motifs (the selfless superhuman; the "real world" of medicine; and the malleable student), the capability imperative enforces the characteristics of a good physician, justifies institutional arrangements, and seeks to produce a learner who can conform to these expectations. Drawing on critical disability theories of ableism and crip theory, the paper argues that the capability imperative represents a context-specific manifestation of ableism that upholds a cultural logic of compulsory hyper-ablebodiedness and mindedness. This logic is antithetical to inclusive goals. Exploration of what constitutes a physician and whom this vision serves may help to shift the professional culture towards justice and unroot disabled peoples' ongoing marginalization in the medical profession.

Ever-changing but always constant: "Waves" of disability discrimination during the COVID-19 pandemic in the United States

The ongoing novel coronavirus 2019 (COVID-19) pandemic has had considerable effects on the disability community. As the pandemic has progressed and changed, the manifestations of these effects have differed, and yet the underlying causes-ableism including the devaluation of disabled lives-have remained consistent. In this commentary, we explore the impact of the pandemic on the disability community in the United States, conceptualizing four distinct but overlapping "waves" of discrimination: 1) healthcare rationing and missed opportunities for disability inclusion, 2) access to resources, supplies, and accommodations; 3) vaccine access; and 4) long COVID and disability identity. Throughout our discussion of these waves, we detail the discrimination faced by people with disabilities, the underlying ableism that perpetuates it, and the resilience shown by the disability community. We end with a call for combating systemic ableism in healthcare and public health systems.

Ableism within health care professions: a systematic review of the experiences and impact of discrimination against health care providers with disabilities

PURPOSE

People with disabilities experience concerning rates of ableism and are significantly under-represented within healthcare education and professions. Focusing on healthcare professions is important for enhancing the diversity and inclusion of equity-deserving groups within the workforce. The objective of this review was to explore the experiences and impact of workplace discrimination and ableism among healthcare providers and trainees with disabilities.

METHODS

Systematic searches of seven databases from 2000 to January 2022 were conducted. Five reviewers independently applied the inclusion criteria, extracted the data and rated the study quality.

RESULTS

48 studies met our inclusion criteria, representing 13,815 participants across six countries over a 21-year period. The findings highlighted rates and types of workplace ableism, which occurred at the institutional (i.e., inaccessible environments, physical barriers and unsupportive work environments) and individual level (i.e., negative attitudes, bullying, harassment). The impact of ableism on healthcare providers included difficulty disclosing due to fear of stigma, and effects on well-being and career development.

CONCLUSIONS

Our findings revealed a critical need for more research on the experiences of ableism amongst healthcare providers and the impact it has on their well-being. Further efforts should explore mechanisms for including and welcoming people with disabilities in healthcare professions.Implications for rehabilitationWorkplace ableism is prevalent in health care professions and could be discouraging people with disabilities from entering or completing health care education and training, leading to an under-representation of this equity-deserving group within health care.More efforts are needed to recruit, retain and support people with disabilities in the health care workforce.Health care providers who have a disability often experience workplace discrimination and inaccessible physical environments which can impact their health and well-being.Managers, senior leadership and health care organizations should advocate for improved social inclusion of employees with disabilities.

Unveiling ableism and disablism in assessment: a critical analysis of disabled students' experiences of assessment and assessment accommodations

This study examines the underlying mechanisms of ableism and disablism in the assessment of student learning in higher education. Globally, higher education institutions rely strongly on assessment accommodations (e.g., extra time in tests) to ensure disabled students' participation in assessment. This is also the case in Finland. Even though research on disabled students' experiences of assessment has repeatedly shown that both assessment and assessment accommodations cause barriers for disabled students' inclusion, critically oriented research on this topic has been scarce. In this study, the frameworks of ableism and disablism are used to unveil how assessment is predominantly designed for "the ideal, able student" and how disabled students are framed as "the Other" through assessment. This work is based on an analysis of 139 disabled students' experiences of assessment and assessment accommodations as collected through an open-ended, institution-wide survey at a Finnish university. The findings reveal the profound role of assessment in excluding and marginalizing disabled students as unfit to take part in the testing cultures of academia. The accommodation model is shown to hold disabled people responsible for their own exclusion. Disablism is identified in students' experiences of outright discrimination, such as teachers denying access to assessment accommodations when they are officially granted. This study offers a novel, critical means of discussing assessment from the viewpoints of diversity and inclusion. It also proposes future trajectories for anti-ableist assessment approaches that understand diversity as enriching, rather than obscuring, assessment.

Deconstructing Ableism in Health Care Settings Through Case-Based Learning

INTRODUCTION

Patients with disabilities face health disparities, and providers with disabilities confront professional roadblocks and institutional bias. Yet their experiences are often excluded from medical education, and few case studies address culturally humble care for those with disabilities.

METHODS

We created two 1-hour case-based modules on disability and ableism from patient and provider perspectives. Modules were piloted in June 2020 and presented at two conferences in April 2021. Modules included a prereading, introductory disability presentation, and facilitated case discussions. Sessions were evaluated with pre- and/or postsession surveys. Modules were rated on 5-point Likert scales for educational value, professional growth contribution, and interactive/engaging design.

RESULTS

Participants rated the patient and provider modules 4.5, 4.4, and 4.4 and 4.5, 4.4, and 4.5 for the three categories, respectively. Participants noted that the sessions were insightful and validating and improved their understanding of ableism and the importance of disability curricula. There were significant improvements in participants' perceptions of ability to discuss ableism's impacts, recognize barriers, identify resource/support gaps for trainees, and advocate. A total of 171 participants completed our modules, with survey response rates of 38% (60 out of 160) and 48% (77 out of 160) for one conference and a postsurvey response rate of 64% (seven out of 11) for the second.

DISCUSSION

Designed for health care trainees, providers, administration, and staff, our sessions introduced concepts of ableism, accommodation, and health care barriers. Our results suggest the modules can contribute to professional growth, understandings of ableism, and participants' disability advocacy tool kit.

Experiences of and resistance to multiple discrimination in health care settings among transmasculine people of color

Background

Research shows that transmasculine people experience discrimination based on their gender identity and/or expression (i.e., cissexism) while obtaining health care. However, studies examining the experience of other forms of discrimination in health care settings among diverse subgroups of transmasculine individuals, including those from minoritized racial/ethnic backgrounds, are very limited.

Methods

Guided by intersectionality, we designed a qualitative research study to explore how transmasculine people of color experience—and resist—multiple, intersecting forms of discrimination in health care settings. Guided by a purposive sampling strategy, we selected 19 transmasculine young adults of color aged 18–25 years to participate in 5 mini-focus groups conducted between February and May 2019 in Boston, MA. Focus group transcripts were analyzed using a template style approach to thematic analysis that involved both deductive and inductive coding using a codebook. Coded text fragments pertaining to participants’ experiences of health care discrimination were clustered into themes and sub-themes.

Results

Transmasculine people of color described experiencing notable challenges accessing physical and mental health care as a result of structural barriers to identifying health care providers with expertise in transgender health, finding providers who share one or more of their social positions and lived experiences, and accessing financial resources to cover high health care costs. Further, participants discussed anticipating and experiencing multiple forms of interpersonal discrimination—both independently and simultaneously—in health care settings, including cissexism, racism, weight-based discrimination, and ableism. Moreover, participants described the negative impact of anticipating and experiencing multiple interpersonal health care discrimination on their health care utilization, quality of care, and mental and physical health. Lastly, participants discussed using various strategies to resist the multiple, intersecting forms of discrimination they encounter in health care settings, including setting boundaries with health care providers, seeking care from competent providers with shared social positions, engaging in self-advocacy, drawing on peer support during health care visits, and obtaining health information through their social networks.

Discussion

Efforts are needed to address cissexism, racism, weight-based discrimination, ableism, and other intersecting forms of discrimination in clinical encounters, health care institutions and systems, and society in general to advance the health of transmasculine people of color and other multiply marginalized groups.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07729-5.

Which lives matter in reproductive biomedicine?

The most recent Black Lives Matter moment provides an important opportunity for consideration of the interlocking social and political systems that contribute to ongoing racism and racial inequality. What does this mean in the context of reproductive biomedicine? Which lives do reproductive biomedicine devalue and how? In this commentary, I address why reproductive biomedicine is an important site for reflection on race, and how the Reproductive Justice Movement calls on us to shift our thinking. I argue for the need to recognize the deep connections between reproductive biomedicine and eugenics, and then offer some examples of racialization in reproductive biomedicine through assisted reproductive technology. Finally, I consider what steps practitioners might take to be part of the change for which this Black Lives Matter moment calls.

Ableism at the Bedside: People with Intellectual Disabilities and COVID-19

People with intellectual and developmental disabilities have a higher risk of mortality from COVID-19 than the general population. Providers may assume that this is due to the burden of comorbidities for this population; however, the disparity in mortality persists even when controlling for comorbidities. We review the current policies and practices that may be contributing to this higher level of mortality. We contend that pervasive ableism among medical providers leads to a variation in the medical care options that are provided to people with intellectual disabilities and their families. Due to this bias, poor outcomes for people with intellectual disabilities may become a self-fulfilling prophecy. We make recommendations to address the modifiable factors that are contributing to the higher level of mortality for people with intellectual disabilities who are infected with COVID-19, provide strategies to combat ableism within the medical field, and discuss the unique role of the primary care physician as an advocate.

[Testimonial injustice against people with mental disorders in health care. A conceptual and ethical analysis]

Menschen mit psychischer Erkrankung sterben statistisch gesehen früher als die Allgemeinbevölkerung. Ein Grund hierfür ist, dass sie eine schlechtere somatische Gesundheitsversorgung erhalten. Wir argumentieren, dass ableistische Netzwerke sozialer Bedeutung zu einer Abwertung der epistemischen Kompetenz von Menschen mit psychischer Erkrankung führen. Diese Abwertung kann mit dem Konzept der testimonialen Ungerechtigkeit erfasst werden. Testimoniale Ungerechtigkeit bezeichnet das ungerechtfertigte Herabstufen der Glaubwürdigkeit einer*s Sprecher*in aufgrund eines Vorurteils gegen ihre*seine soziale Identität. Wir analysieren ethische und epistemische Folgen testimonialer Ungerechtigkeit als wichtige Ursachen der schlechteren Gesundheitsversorgung von Menschen mit psychischer Erkrankung. Testimoniale Ungerechtigkeit kann zu medizinischen Behandlungsfehlern führen und für Betroffene schwerwiegende gesundheitliche Folgen nach sich ziehen. Zudem kann sie zu einem Vertrauensverlust von Menschen mit psychischer Erkrankung in das Gesundheitssystem führen. Daher trägt testimoniale Ungerechtigkeit zur strukturellen Diskriminierung von Menschen mit psychischer Erkrankung bei. Vor diesem Hintergrund diskutieren wir, wie die somatische Gesundheitsversorgung unter ethischen Gesichtspunkten verbessert werden kann.

Social and Structural Determinants of Health: Exploring Occupational Therapy's Structural (In)competence

Background: In high-income countries, such as Canada, 50% of health outcomes are attributable to social determinants. Occupational opportunities are also structurally determined, yet these inequities are obscured by the White, Western assumptions and ableist neoliberal ideology in which the profession is deeply rooted. Purpose. To highlight the impact of structural injustices and other social determinants of health and occupation; explore the occupational therapy profession's structural competence; and build on existing knowledge to advance an agenda for action on injustice and inequity for the occupational therapy profession. Key issues. Occupational therapy's failure to prioritize education, research and action on systemic injustices and other social determinants of health and occupation reflects a lack of commitment to achieving the World Federation of Occupational Therapists' Minimal Standards. Implications. If occupational therapy is to advance knowledge and practices that address inequities in the social and structural determinants of health and occupation, we must strive towards structural competence.

Transing dementia: Rethinking compulsory biographical continuity through the theorization of cisism and cisnormativity

Using theoretical tools from trans studies and disability/crip studies, we reconceptualize the self in the context of dementia. We illustrate that most dementia discourse, scholarship and intervention emphasize a maintenance of the pre-dementia self. We argue that the compulsory biographical continuity needed to maintain the pre-dementia self is based on interlocking forms of ageism, ableism, and cogniticism, and interacts with what we call cisism (the oppressive system that discriminates against people on the basis of change) and its normative components, cisnormativity* and ciscognonormativity. After providing a critical genealogy of the term cisnormativity*, we resignify and redeploy this concept in the context of dementia, demonstrating how it is useful for critiquing compulsory biographical continuity. Following the verbs queering and cripping, we propose a transing of dementia that leads to a new conceptualization of the self that is fluid and changing, rather than one anchored in multiple oppressions.

Exploring experiences of ableism in academia: a constructivist inquiry

To understand the experiences of the disabled in academia, a fully accessible and inclusive workshop conference was held in March 2018. Grounded in critical disability studies within a constructivist inquiry analytical approach, this article provides a contextualisation of ableism in academia garnered through creative data generation. The nuanced experiences of disabled academics in higher education as well as their collective understandings of these experiences as constructed through normalisation and able-bodiedness are presented. We show that disabled academics are marginalised and othered in academic institutions; that the neoliberalisation of higher education has created productivity expectations, which contribute to the silencing of the disabled academics' perspectives and experiences due to constructions of normality and stigmatisation; and that it is important to enact policies, procedures, and practices that value disabled academics and bring about cultural and institutional changes in favour of equality and inclusion.

Perceptions of the International Symbol of Accessibility among nondisabled university students in Hong Kong

The present experimental study involved 346 university students without self-reported disability and investigated the perceived symbolic meanings of the International Symbol of Accessibility (ISA) along with its associations with stereotypes toward wheelchair users and the perceived inclusiveness of the social climate. Participants were randomized into four groups with exposure to either the ISA, Motion-symbol, Universal-Design-symbol, or all-symbols. The results showed that different symbols were associated with different patterns of perceived symbolic meanings. Exposure to the Universal-Design-symbol, which emphasizes equality (but not the Motion-symbol, which emphasizes autonomy), was significantly and indirectly associated with relatively lower stereotypes toward wheelchair users (and perceived less inclusive social climate) through associating the Universal-Design-symbol with relatively lower perceived symbolic meanings of "Passive" and "Labeling" (and "Passive") compared to exposure to the ISA. Recommendations for a contextual-dependent replacement of symbol, the methodology of implicit association tests, and the usage of symbols of access in cartography were discussed.

Disability and Ableism in Medicine: A Curriculum for Medical Students

INTRODUCTION

Individuals with disabilities (approximately 20% of the population) experience discrimination and health disparities. Medical school must equip students with expertise to care for patients with disabilities and to identify ableism. Yet, few schools provide curricula that offer a sociopolitical lens for understanding this topic. We developed a disability and ableism curriculum to address this gap.

METHODS

We developed a mandatory 2-hour session for first-year medical students at University of California San Francisco. Activities included: privilege awareness, student-led discussions, and intervention brainstorming for overcoming health care barriers/biases. The session was evaluated through pre/postsurveys, as well as a follow-up survey 1 year later.

RESULTS

In feedback collected during 2018 and 2019, students described the session as meaningful and relevant. Faculty facilitators reported that the session provoked powerful student-centered learning, leadership, and widespread participation. On average the students rated the session 4.6 on a 5-point scale. Pre- and postsession data analysis indicated significant increases in students' self-reported understanding of ableism (p < .001) and confidence in assessing barriers to care for patients with disability (p < .001). One year later, students reported that the session had influenced their conceptualization of providing care to patients with disabilities.

DISCUSSION

Through innovative and participatory activities, this small-group session introduced students to important topics such as ableism, the social model of disability, disability history and culture, and health disparities. Our work suggested that creating curricula to equip students with structural frameworks for understanding disability-a topic underrepresented in medical curricula-stimulated student interest and commitment.

"How can we make it work for you?" Enabling sporting assemblages for disabled young people

Disabled young people have lower levels of participation in community life than nondisabled peers across a number of domains, including sporting activities, with profound implications for health, wellbeing and life course opportunities. Playing sport is a defining feature of identity for many young people in Aotearoa/New Zealand. Participation in sporting activities provides opportunities to develop competencies, to have fun and to compete, while also providing a sense of inclusion and peer group belonging. However, despite policies promoting inclusion of disabled young people in school and club sport, ableist attitudes and practices still function to exclude individuals who do not fit able-bodied norms. Drawing on recent 'assemblage thinking' in health and cultural geography, this paper explores the material, social and affective dimensions of 'enabling' and 'disabling' sporting assemblages, drawing on interviews with 35 disabled young people (12-25 years), parents and key informants. Many reported instances of demoralising exclusion in mainstream sporting activities. Some turned to adaptive sporting codes, designed for inclusion. In our exploration of participants' embodied experiences of enabling and disabling assemblages we employ assemblage theory to examine how social, affective and material forces and processes converge to either enable or constrain participation in local sporting activities. We close with a brief assessment of the implications of our analysis for ongoing efforts to promote inclusion for disabled youth in physical activity.

Out on the streets - Crisis, opportunity and disabled people in the era of Covid-19: Reflections from the UK

Governments have responded to the Covid-19 crisis through various measures designed to reduce transmission and protect people judged to be at heightened risk. This paper explores the implications of such measures in the UK for disabled people, with a particular focus on measures designed to reduce and reshape the use of streets and public space. We divide UK measures into two broad categories. First, there are measures designed to reduce the use of streets and public spaces – e.g., rules requiring people to stay at home except in tightly prescribed circumstances and measures providing specific support (including food delivery and priority online shopping) for people designated as clinically extremely ‘vulnerable’. Second, there are measures designed to control the behaviour of people using streets and public space – e.g., rules on physical distancing and the use of face coverings. We explore the disability-related concerns associated with these types of measure. We also highlight the opportunities this crisis presents for embedding accessibility and inclusion more firmly into the fabric of our streets and call for renewed resistance to policies and practices shaped by ableist assumptions and attitudes.

Ableist Microaggressions and the Mental Health of Disabled Adults

Microaggressions perpetuate inequalities and stereotypes against people from marginalized communities. Research demonstrates that ongoing experiences of identity-related microaggressions can negatively impact mental health outcomes, increase somatic symptoms, and increase negative affect. This study explores the relationship between experiences of ableist microaggressions and mental health outcomes among disabled adults by using a quantitative cross-sectional survey of 311 U.S. adults who identify as disabled/having a disability, to examine the correlation between ableist microaggressions (using the AMS-65) and mental health (assessed by the MHI-18). Findings indicate that increased experiences ableist microaggressions are negatively correlated with positive mental health outcomes, and that the visibility of disabilities/impairments are correlated with experiencing ableist microaggressions. These findings can inform the work of counselors, therapists, social workers, and other human service professionals when supporting disabled individuals, recognizing that their mental health may be related to these common and often unintentional oppressive interactions.

The coin model of privilege and critical allyship: implications for health

Health inequities are widespread and persistent, and the root causes are social, political and economic as opposed to exclusively behavioural or genetic. A barrier to transformative change is the tendency to frame these inequities as unfair consequences of social structures that result in disadvantage, without also considering how these same structures give unearned advantage, or privilege, to others. Eclipsing privilege in discussions of health equity is a crucial shortcoming, because how one frames the problem sets the range of possible solutions that will follow. If inequity is framed exclusively as a problem facing people who are disadvantaged, then responses will only ever target the needs of these groups without redressing the social structures causing disadvantages. Furthermore, responses will ignore the complicity of the corollary groups who receive unearned and unfair advantage from these same structures. In other words, we are missing the bigger picture. In this conceptualization of health inequity, we have limited the potential for disruptive action to end these enduring patterns.

The goal of this article is to advance understanding and action on health inequities and the social determinants of health by introducing a framework for transformative change: the Coin Model of Privilege and Critical Allyship. First, I introduce the model, which explains how social structures produce both unearned advantage and disadvantage. The model embraces an intersectional approach to understand how systems of inequality, such as sexism, racism and ableism, interact with each other to produce complex patterns of privilege and oppression. Second, I describe principles for practicing critical allyship to guide the actions of people in positions of privilege for resisting the unjust structures that produce health inequities. The article is a call to action for all working in health to (1) recognize their positions of privilege, and (2) use this understanding to reorient their approach from saving unfortunate people to working in solidarity and collective action on systems of inequality.

The relationship between disability prejudice and medicaid home and community-based services spending

BACKGROUND

Medicaid is one of the most important health care safety nets for people with disabilities in the United States. Yet, from the beginning Medicaid only covered long-term services and supports (LTSS) through institutional care. In 1981 changes to Medicaid allowed states to provide home and community-based services (HCBS) instead so people with disabilities could receive LTSS in their own homes or in the community. As a result of these changes, there has been a significant decline in institutionalization of people with disabilities in favor of HCBS in the United States. However, the priority of HCBS can be impacted by ideas about community living and disability attitudes, among others. How these attitudes may trickle down to impact Medicaid funding decisions is unknown.

OBJECTIVE

The aim of this study was to examine the relationship between HCBS and disability prejudice in the United States.

METHODS

We used secondary data about state LTSS expenditures from across the nation in fiscal year (FY) 2015, as well as disability prejudice data (Disability Attitudes Implicit Association Test) from 325,000 people residing in all 50 states and the District of Columbia.

RESULTS

Findings revealed regardless of the state size or wealth, states with more disability prejudice direct less of their LTSS funding towards HCBS.

CONCLUSIONS

Biases and prejudice in disability policy decision-making are obstacles to equality of opportunity and full participation in society, as promised by civil rights.

Differences in Experiences of Discrimination in Accessing Social Services Among Transgender/Gender Nonconforming Individuals by (Dis)Ability

Transgender and gender nonconforming (GNC) individuals frequently experience discrimination and potentially a lack of respect from service providers, suggesting they have decreased access to professionals with cultural competency. Similarly, people with disabilities experience higher levels of discrimination in social services than their nondisabled counterparts. From an intersectional perspective, this study examines rates of discrimination in accessing social services faced by transgender and GNC people, comparing across ability. Data indicate that although transgender and GNC individuals of all abilities experience gender-based discrimination when accessing social services, those with disabilities experience higher levels of antitransgender discrimination in mental health centers, rape crisis centers, and domestic violence shelters.

Siblings of People with Disabilities' Explicit and Implicit Disability Attitude Divergence

Siblings of people with disabilities have more exposure to people with disabilities than most nondisabled people, uniquely positioning them toward disability, yet less is known about how this might impact their attitudes. This study examined siblings' disability attitudes by determining siblings' explicit and implicit disability bias, mapping their 2-dimensional prejudice, and examining theoretical variables that might be relevant to their attitudes. To do so, the Disability Attitudes Implicit Association Test, the Symbolic Ableism Scale, and survey questions were administered to 48 siblings. Findings revealed the majority of the siblings implicitly preferred nondisabled people, despite reporting low levels of explicit attitudes.