Pub Date : 2025-09-29DOI: 10.1016/j.dhjo.2025.101969
Rachel Liu-Galvin , Frank A. Orlando , Arch G. Mainous
Background
Disabilities are prevalent and linked to a wide variety of functional limitations, while inflammation, a key factor in chronic disease development and progression, is not a screening or treatment target and is therefore very rarely detected. Understanding the association between disabilities and inflammation is essential to address potential risks in this vulnerable population.
Objective
To determine whether individuals with disabilities are more likely to have elevated inflammation compared to those without.
Methods
In this cross-sectional study of a nationally representative sample of U.S. adults in the 2021–2023 National Health and Nutrition Examination Survey, survey-weighted logistic regression examined the associations between disabilities and high-sensitivity C-Reactive Protein (hs-CRP) levels. Adjusted models controlled for age, sex, race/ethnicity, poverty, health insurance, hypertension, diabetes, coronary heart disease, stroke, rheumatoid arthritis, and smoking.
Results
Individuals with disabilities had higher odds of hs-CRP >3 mg/L (adjusted OR: 1.46, 95 % CI: 1.21–1.76) and >10 mg/L (adjusted OR: 1.61, 95 % CI: 1.17–2.22) compared to those without disabilities. Physical disabilities were significantly associated with hs-CRP >3 mg/L (adjusted OR: 1.61, 95 % CI: 1.26–2.07) and >10 mg/L (adjusted OR: 1.94, 95 % CI: 1.47–2.55). Mental disabilities were associated with elevated hs-CRP in unadjusted but not adjusted models.
Conclusions
Disabilities, particularly physical disabilities, are associated with elevated inflammation, which may reflect underlying biological processes, reduced mobility, or cumulative health burden. The increased burden of systemic inflammation among individuals with disabilities supports consideration of hs-CRP as a potential marker for identifying elevated health risk in this population.
{"title":"Association of disability and inflammation: Potential risks to a vulnerable population","authors":"Rachel Liu-Galvin , Frank A. Orlando , Arch G. Mainous","doi":"10.1016/j.dhjo.2025.101969","DOIUrl":"10.1016/j.dhjo.2025.101969","url":null,"abstract":"<div><h3>Background</h3><div>Disabilities are prevalent and linked to a wide variety of functional limitations, while inflammation, a key factor in chronic disease development and progression, is not a screening or treatment target and is therefore very rarely detected. Understanding the association between disabilities and inflammation is essential to address potential risks in this vulnerable population.</div></div><div><h3>Objective</h3><div>To determine whether individuals with disabilities are more likely to have elevated inflammation compared to those without.</div></div><div><h3>Methods</h3><div>In this cross-sectional study of a nationally representative sample of U.S. adults in the 2021–2023 National Health and Nutrition Examination Survey, survey-weighted logistic regression examined the associations between disabilities and high-sensitivity C-Reactive Protein (hs-CRP) levels. Adjusted models controlled for age, sex, race/ethnicity, poverty, health insurance, hypertension, diabetes, coronary heart disease, stroke, rheumatoid arthritis, and smoking.</div></div><div><h3>Results</h3><div>Individuals with disabilities had higher odds of hs-CRP >3 mg/L (adjusted OR: 1.46, 95 % CI: 1.21–1.76) and >10 mg/L (adjusted OR: 1.61, 95 % CI: 1.17–2.22) compared to those without disabilities. Physical disabilities were significantly associated with hs-CRP >3 mg/L (adjusted OR: 1.61, 95 % CI: 1.26–2.07) and >10 mg/L (adjusted OR: 1.94, 95 % CI: 1.47–2.55). Mental disabilities were associated with elevated hs-CRP in unadjusted but not adjusted models.</div></div><div><h3>Conclusions</h3><div>Disabilities, particularly physical disabilities, are associated with elevated inflammation, which may reflect underlying biological processes, reduced mobility, or cumulative health burden. The increased burden of systemic inflammation among individuals with disabilities supports consideration of hs-CRP as a potential marker for identifying elevated health risk in this population.</div></div>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":"19 1","pages":"Article 101969"},"PeriodicalIF":3.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-25DOI: 10.1016/j.dhjo.2025.101968
Hugo Bessaguet, Charlotte Coeurdacier De Gesnes, Diana Rimaud, Bruno Fernandez, Pierre Flori, Philippe Berthelot, Marilyne Peyroche, Yann Boulon, Ahmed Adham, Pascal Giraux, Vincent Gautheron, Rodolphe Charles, Etienne Ojardias
Background: Disability is experienced by approximately 1.3 billion individuals worldwide. Therefore, people with disabilities (PWD) are part of every physician's patient base, regardless of specialty. Specific educational programs are needed, as medical students and physicians still report discomfort in taking histories, performing clinical examinations and making differential diagnoses when dealing with PWD.
Objective: We hypothesized that participation in a one-week disability awareness training, including theoretical sessions, practical workshops with PWD, and 3-day immersive training courses, would significantly improve the quantitative and qualitative outcomes of medical students toward PWD.
Methods: We conducted a monocentric prospective mixed-methods study targeting 3rd year medical students, using quantitative measurements through repeated synchronous surveys, evaluating disability attitudes in health care (DAHC) scores and performed qualitative explorations through individual semidirected interviews, evaluating students' feelings and attitudes toward PWD.
Results: A total of 218 students (mean age: 21.1 ± 1.4 years) were included in the study. While 60 % of the participants reported no prior working experience with PWD, there was a significant improvement in paired-DAHC scores 3 months after the training (+1.32, p = 0.003). Improvements were predominantly observed in comfort levels during interaction and in discriminatory attitudes. This practical experience was positively reported in the semidirected interviews, in which a facilitated transition from unfamiliarity to informed empathy and knowledge was reported.
Conclusions: The implementation of disability awareness trainings in compulsory medical curricula should be prioritized to improve future physician's skills and attitudes when caring for PWD.
{"title":"Does a one-week disability awareness training influence medical students attitudes? A French mixed-methods study.","authors":"Hugo Bessaguet, Charlotte Coeurdacier De Gesnes, Diana Rimaud, Bruno Fernandez, Pierre Flori, Philippe Berthelot, Marilyne Peyroche, Yann Boulon, Ahmed Adham, Pascal Giraux, Vincent Gautheron, Rodolphe Charles, Etienne Ojardias","doi":"10.1016/j.dhjo.2025.101968","DOIUrl":"https://doi.org/10.1016/j.dhjo.2025.101968","url":null,"abstract":"<p><strong>Background: </strong>Disability is experienced by approximately 1.3 billion individuals worldwide. Therefore, people with disabilities (PWD) are part of every physician's patient base, regardless of specialty. Specific educational programs are needed, as medical students and physicians still report discomfort in taking histories, performing clinical examinations and making differential diagnoses when dealing with PWD.</p><p><strong>Objective: </strong>We hypothesized that participation in a one-week disability awareness training, including theoretical sessions, practical workshops with PWD, and 3-day immersive training courses, would significantly improve the quantitative and qualitative outcomes of medical students toward PWD.</p><p><strong>Methods: </strong>We conducted a monocentric prospective mixed-methods study targeting 3rd year medical students, using quantitative measurements through repeated synchronous surveys, evaluating disability attitudes in health care (DAHC) scores and performed qualitative explorations through individual semidirected interviews, evaluating students' feelings and attitudes toward PWD.</p><p><strong>Results: </strong>A total of 218 students (mean age: 21.1 ± 1.4 years) were included in the study. While 60 % of the participants reported no prior working experience with PWD, there was a significant improvement in paired-DAHC scores 3 months after the training (+1.32, p = 0.003). Improvements were predominantly observed in comfort levels during interaction and in discriminatory attitudes. This practical experience was positively reported in the semidirected interviews, in which a facilitated transition from unfamiliarity to informed empathy and knowledge was reported.</p><p><strong>Conclusions: </strong>The implementation of disability awareness trainings in compulsory medical curricula should be prioritized to improve future physician's skills and attitudes when caring for PWD.</p>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":" ","pages":"101968"},"PeriodicalIF":3.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-16DOI: 10.1016/j.dhjo.2025.101967
Elisabeth L. Zeilinger , Theresa Wagner , Amelie Fuchs , Manon Schroeder , Nadine Brunevskaya , Jakob Pietschnig , Pavol Mikula , Matthias Unseld
Background
Colorectal cancer (CRC) screening is crucial for early detection, but people with intellectual and developmental disabilities (IDD) face significant healthcare disparities, including lower screening rates.
Objective
This study explores barriers and facilitators to CRC screening for individuals with IDD from the caregiver perspective.
Methods
Semi-structured interviews were conducted with 13 caregivers (eight women, mean age 45) of individuals with IDD in Austria and analyzed using thematic analysis. A modified version of the Bowel Cancer Awareness Measure (CAM) questionnaire was used to assess CRC-related healthcare literacy of the caregivers.
Results
The modified CAM revealed low CRC knowledge among caregivers, with gaps in symptom and risk factor recognition and low self-reported confidence in symptom detection. Four themes emerged from the interviews: (1) Improving access to inclusive healthcare, highlighting systemic healthcare challenges, inclusive environments, clinician expertise, and health education; (2) Managing IDD-specific challenges, including communication difficulties, reliance on routines, and comorbidities; (3) The critical role of caregiver support, focusing on the empowerment of people with IDD; and (4) Challenging stigma and bridging social gaps, addressing stereotypes and social segregation of people with IDD.
Conclusions
This study serves as a case study, illustrating how the exclusion of people with IDD from the design of preventive healthcare perpetuates inequities in CRC screening, and emphasizing the need for more inclusive systems and practices. Addressing these shortcomings requires improved knowledge and educational resources, disability-sensitive training for professionals, accessible healthcare environments and systemic efforts to promote autonomy and reduce stigma.
{"title":"Healthcare disparities in colorectal cancer prevention for people with intellectual and developmental disabilities: A caregiver perspective","authors":"Elisabeth L. Zeilinger , Theresa Wagner , Amelie Fuchs , Manon Schroeder , Nadine Brunevskaya , Jakob Pietschnig , Pavol Mikula , Matthias Unseld","doi":"10.1016/j.dhjo.2025.101967","DOIUrl":"10.1016/j.dhjo.2025.101967","url":null,"abstract":"<div><h3>Background</h3><div>Colorectal cancer (CRC) screening is crucial for early detection, but people with intellectual and developmental disabilities (IDD) face significant healthcare disparities, including lower screening rates.</div></div><div><h3>Objective</h3><div>This study explores barriers and facilitators to CRC screening for individuals with IDD from the caregiver perspective.</div></div><div><h3>Methods</h3><div>Semi-structured interviews were conducted with 13 caregivers (eight women, mean age 45) of individuals with IDD in Austria and analyzed using thematic analysis. A modified version of the Bowel Cancer Awareness Measure (CAM) questionnaire was used to assess CRC-related healthcare literacy of the caregivers.</div></div><div><h3>Results</h3><div>The modified CAM revealed low CRC knowledge among caregivers, with gaps in symptom and risk factor recognition and low self-reported confidence in symptom detection. Four themes emerged from the interviews: (1) <em>Improving access to inclusive healthcare</em>, highlighting systemic healthcare challenges, inclusive environments, clinician expertise, and health education; (2) <em>Managing IDD-specific challenges</em>, including communication difficulties, reliance on routines, and comorbidities; (3) <em>The critical role of caregiver</em> support, focusing on the empowerment of people with IDD; and (4) <em>Challenging stigma and bridging social gaps</em>, addressing stereotypes and social segregation of people with IDD.</div></div><div><h3>Conclusions</h3><div>This study serves as a case study, illustrating how the exclusion of people with IDD from the design of preventive healthcare perpetuates inequities in CRC screening, and emphasizing the need for more inclusive systems and practices. Addressing these shortcomings requires improved knowledge and educational resources, disability-sensitive training for professionals, accessible healthcare environments and systemic efforts to promote autonomy and reduce stigma.</div></div>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":"19 1","pages":"Article 101967"},"PeriodicalIF":3.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-13DOI: 10.1016/j.dhjo.2025.101966
Kirstin E. Yuzwa , Farah Bacchus-Misir , Siobhan Galeazzi-Stirling , Eva Cohen , Peter Athanasopoulos , Sander L. Hitzig , Christine L. Sheppard
Background
Housing is a critical social determinant of health and for individuals with accessibility needs, having a roof over one's head is not enough. For people requiring accessibility features to enter and exit their home, use the bathroom, or prepare meals, the absence of these features can limit social participation, increase reliance on caregivers, and negatively impact health, dignity, and safety.
Objective
This article presents a qualitative study with members from diverse key interest groups across the housing, disability, healthcare, and policy sectors to identify social and attitudinal barriers limiting accessible housing and home modifications options in Canada.
Methods
Semi-structured interviews and a demographic survey were conducted with 59 people. Participants included people with lived experience of disabilities and other end-users of accssible housing (i.e., family caregivers and people from the Deaf community), as well as cross-sectoral professionals with expertise in accessible housing. Inductive codebook thematic analysis was used to analyze the data.
Results
Four prevailing themes were identified from the data, including a lack of prioritization by policy makers and housing developers, cost-benefit appraisals of including accessibility features, discriminatory attitudes towards the aesthetics of accessibility and towards end-users, and underestimating of the need for preventative accessibility.
Conclusions
Attitudinal barriers are contributing to a lack of prioritization of accessibility in housing in Canada. To create a more inclusive housing landscape and improve public health, investments in accessible housing, policy advancement, and new regulatory measures are recommended.
{"title":"Social and attitudinal barriers to the provision of accessible housing in Canada: A qualitative study","authors":"Kirstin E. Yuzwa , Farah Bacchus-Misir , Siobhan Galeazzi-Stirling , Eva Cohen , Peter Athanasopoulos , Sander L. Hitzig , Christine L. Sheppard","doi":"10.1016/j.dhjo.2025.101966","DOIUrl":"10.1016/j.dhjo.2025.101966","url":null,"abstract":"<div><h3>Background</h3><div>Housing is a critical social determinant of health and for individuals with accessibility needs, having a roof over one's head is not enough. For people requiring accessibility features to enter and exit their home, use the bathroom, or prepare meals, the absence of these features can limit social participation, increase reliance on caregivers, and negatively impact health, dignity, and safety.</div></div><div><h3>Objective</h3><div>This article presents a qualitative study with members from diverse key interest groups across the housing, disability, healthcare, and policy sectors to identify social and attitudinal barriers limiting accessible housing and home modifications options in Canada.</div></div><div><h3>Methods</h3><div>Semi-structured interviews and a demographic survey were conducted with 59 people. Participants included people with lived experience of disabilities and other end-users of accssible housing (i.e., family caregivers and people from the Deaf community), as well as cross-sectoral professionals with expertise in accessible housing. Inductive codebook thematic analysis was used to analyze the data.</div></div><div><h3>Results</h3><div>Four prevailing themes were identified from the data, including a lack of prioritization by policy makers and housing developers, cost-benefit appraisals of including accessibility features, discriminatory attitudes towards the aesthetics of accessibility and towards end-users, and underestimating of the need for preventative accessibility.</div></div><div><h3>Conclusions</h3><div>Attitudinal barriers are contributing to a lack of prioritization of accessibility in housing in Canada. To create a more inclusive housing landscape and improve public health, investments in accessible housing, policy advancement, and new regulatory measures are recommended.</div></div>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":"19 1","pages":"Article 101966"},"PeriodicalIF":3.3,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: People with intellectual disabilities (ID) frequently experience poorer health and lower treatment coverage compared to those without ID, yet differences in hypertension prevalence and treatment coverage remain unclear.
Objective: To estimate the pooled prevalence ratio (PR) of hypertension and hypertension treatment coverage comparing adults with and without ID.
Methods: We searched MEDLINE, Embase, PsychINFO, Global Health and Global Index Medicus on June 6, 2024. We included observational and intervention studies that estimated the prevalence of hypertension and/or treatment coverage. The risk of bias was assessed using the Newcastle-Ottawa Scale tool. We undertook a random-effects meta-analysis to estimate the pooled PR with 95 % confidence intervals (CI). Sources of heterogeneity were explored through sensitivity and subgroup analyses, and meta-regression.
Results: 21 studies from 10 countries across three regions were included. The pooled PR were 0.71 (95 % CI: 0.47-1.05) for hypertension and 0.61 (95 % CI: 0.47-0.81) for hypertension treatment coverage. Only one study adjusted for age; most reported unadjusted estimates, making them prone to confounding. 14 studies were rated as high risk of bias. Subgroup analysis and meta-regression revealed variability in the methods used to diagnose ID, with sample size emerging as the primary source of variability in the effect estimates.
Conclusions: This systematic review showed that adults with ID have a similar prevalence of hypertension, but lower hypertension treatment coverage compared to those without disabilities. However, these results should be interpreted with caution due to the lack of adjustment for confounding in the association and variability in the diagnosis of ID.
背景：与无智力残疾者相比，智力残疾者经常经历较差的健康状况和较低的治疗覆盖率，但高血压患病率和治疗覆盖率的差异尚不清楚。目的：评估高血压合并患病率（PR）和高血压治疗覆盖率，比较患有和未患有高血压的成年人。方法：检索2024年6月6日的MEDLINE、Embase、PsychINFO、Global Health和Global Index Medicus。我们纳入了估计高血压患病率和/或治疗覆盖率的观察性和干预性研究。使用纽卡斯尔-渥太华量表工具评估偏倚风险。我们进行了随机效应荟萃分析，以95%置信区间（CI）估计合并PR。通过敏感性和亚组分析以及元回归来探索异质性的来源。结果：纳入了来自3个地区10个国家的21项研究。高血压的合并PR为0.71 (95% CI: 0.47-1.05)，高血压治疗覆盖率的合并PR为0.61 （95% CI: 0.47-0.81）。只有一项研究调整了年龄；大多数报告的是未经调整的估计，这使它们容易混淆。14项研究被评为高偏倚风险。亚组分析和元回归揭示了用于诊断ID的方法的可变性，样本量成为影响估计可变性的主要来源。结论：本系统综述显示，与无残疾的成年人相比，成年ID患者高血压患病率相似，但高血压治疗覆盖率较低。然而，这些结果应该谨慎解释，因为缺乏对相关性和ID诊断变异性的混淆调整。
{"title":"Hypertension prevalence and coverage and intellectual disability: a systematic review and meta-analysis.","authors":"Rodrigo Vargas-Fernández, Akram Hernández-Vásquez, Hannah Kuper","doi":"10.1016/j.dhjo.2025.101965","DOIUrl":"https://doi.org/10.1016/j.dhjo.2025.101965","url":null,"abstract":"<p><strong>Background: </strong>People with intellectual disabilities (ID) frequently experience poorer health and lower treatment coverage compared to those without ID, yet differences in hypertension prevalence and treatment coverage remain unclear.</p><p><strong>Objective: </strong>To estimate the pooled prevalence ratio (PR) of hypertension and hypertension treatment coverage comparing adults with and without ID.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, PsychINFO, Global Health and Global Index Medicus on June 6, 2024. We included observational and intervention studies that estimated the prevalence of hypertension and/or treatment coverage. The risk of bias was assessed using the Newcastle-Ottawa Scale tool. We undertook a random-effects meta-analysis to estimate the pooled PR with 95 % confidence intervals (CI). Sources of heterogeneity were explored through sensitivity and subgroup analyses, and meta-regression.</p><p><strong>Results: </strong>21 studies from 10 countries across three regions were included. The pooled PR were 0.71 (95 % CI: 0.47-1.05) for hypertension and 0.61 (95 % CI: 0.47-0.81) for hypertension treatment coverage. Only one study adjusted for age; most reported unadjusted estimates, making them prone to confounding. 14 studies were rated as high risk of bias. Subgroup analysis and meta-regression revealed variability in the methods used to diagnose ID, with sample size emerging as the primary source of variability in the effect estimates.</p><p><strong>Conclusions: </strong>This systematic review showed that adults with ID have a similar prevalence of hypertension, but lower hypertension treatment coverage compared to those without disabilities. However, these results should be interpreted with caution due to the lack of adjustment for confounding in the association and variability in the diagnosis of ID.</p>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":" ","pages":"101965"},"PeriodicalIF":3.3,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-07DOI: 10.1016/j.dhjo.2025.101962
Heejung Choi , GyeongAe Seomun , Jeongeun Song
Background
Parents of children with developmental disabilities (DD) experience ongoing uncertainty, which contributes to various physical and mental health challenges. However, studies mapping the factors influencing this uncertainty and its effects on other variables remain scarce.
Objective
This study aimed to analyze and synthesize existing evidence on the factors influencing uncertainty among parents of children with DD and its impact on parental outcomes.
Methods
A scoping review was conducted following Arksey and O'Malley's framework. Relevant studies were identified through a literature review conducted across five databases—Medline/PubMed, CINAHL, Cochrane Library, Embase, and APA PsycArticles—up to March 1, 2024. Studies with English abstracts were included without time restrictions.
Results
Eight studies involving 1986 participants were analyzed. The identified influencing factors were categorized into health condition-related factors (e.g., the severity of the child's condition), family and community resources (e.g., maternal education level, trust in healthcare professionals, and appraisal support), and appraisals of uncertainty as either a risk (e.g., caregiver burden and marital conflict) or an opportunity (e.g., adaptation, quality of life, parenting efficacy, sense of coherence, optimism, and self-help).
Conclusions
The findings of this study provide essential evidence for developing effective healthcare strategies to reduce parental uncertainty. By addressing these factors, the study aims to contribute to decreasing parental uncertainty and promoting the optimal development of children with DD.
{"title":"Factors associated with uncertainty in parents of children with developmental disabilities: A scoping review","authors":"Heejung Choi , GyeongAe Seomun , Jeongeun Song","doi":"10.1016/j.dhjo.2025.101962","DOIUrl":"10.1016/j.dhjo.2025.101962","url":null,"abstract":"<div><h3>Background</h3><div>Parents of children with developmental disabilities (DD) experience ongoing uncertainty, which contributes to various physical and mental health challenges. However, studies mapping the factors influencing this uncertainty and its effects on other variables remain scarce.</div></div><div><h3>Objective</h3><div>This study aimed to analyze and synthesize existing evidence on the factors influencing uncertainty among parents of children with DD and its impact on parental outcomes.</div></div><div><h3>Methods</h3><div>A scoping review was conducted following Arksey and O'Malley's framework. Relevant studies were identified through a literature review conducted across five databases—Medline/PubMed, CINAHL, Cochrane Library, Embase, and APA PsycArticles—up to March 1, 2024. Studies with English abstracts were included without time restrictions.</div></div><div><h3>Results</h3><div>Eight studies involving 1986 participants were analyzed. The identified influencing factors were categorized into health condition-related factors (e.g., the severity of the child's condition), family and community resources (e.g., maternal education level, trust in healthcare professionals, and appraisal support), and appraisals of uncertainty as either a risk (e.g., caregiver burden and marital conflict) or an opportunity (e.g., adaptation, quality of life, parenting efficacy, sense of coherence, optimism, and self-help).</div></div><div><h3>Conclusions</h3><div>The findings of this study provide essential evidence for developing effective healthcare strategies to reduce parental uncertainty. By addressing these factors, the study aims to contribute to decreasing parental uncertainty and promoting the optimal development of children with DD.</div></div>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":"19 1","pages":"Article 101962"},"PeriodicalIF":3.3,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There has been emerging evidence from country-level studies that disability prevalence tends to be lower in urban areas than in rural areas. However, such studies are difficult to compare as countries use different ways of categorizing rural and urban areas.
Objectives
We examine the association between disability measured through functional difficulties (seeing, hearing, walking, cognition, selfcare, communicating) and urban development measured through the satellite nightlight composite—an internationally comparable proxy for urban development.
Methods
We use Demographic and Health Survey data for 15 low- and middle-income countries (LMICs) with the Washington Group Short Set of questions on disability. This study uses multilevel random intercept models to estimate whether functional difficulties are negatively associated with village-level nightlight composite.
Results
While country level results vary, in the pooled sample, adults living in villages above the 80th percentile of nightlight activity have odds of reporting any functional difficulty that are 0.765 times those of adults in villages below the 80th percentile of nightlight (AOR = 0.765; 95 % CI = 0.717 to 0.816). The result is robust for each functional domain but the correlation is higher for hearing, cognition and communicating.
Conclusions
In 15 LMICs, adults in rural areas are significantly more likely to have functional difficulties compared to adults in urban areas. Research is needed on the factors that drive such a correlation, including poorer living conditions and access to services in rural areas, differential access to resources and environmental barriers in rural and urban areas and potential differences in rural-urban migration opportunities across functional difficulty status.
背景：从国家一级的研究中出现的新证据表明，城市地区的残疾患病率往往低于农村地区。然而，这些研究很难进行比较，因为各国使用不同的方法对农村和城市地区进行分类。目的：我们研究了通过功能障碍（视觉、听觉、行走、认知、自理、沟通）测量的残疾与通过卫星夜灯组合测量的城市发展之间的关系。卫星夜灯组合是城市发展的国际可比代理。方法：我们使用15个低收入和中等收入国家（LMICs）的人口和健康调查数据以及华盛顿小组关于残疾的短问题集。本研究使用多水平随机截距模型来估计功能困难是否与村庄水平的夜间灯光合成负相关。结果：虽然国家层面的结果有所不同，但在汇总样本中，生活在夜间灯光活动超过80百分位的村庄的成年人报告任何功能困难的几率是低于80百分位的村庄的成年人的0.765倍（AOR = 0.765; 95% CI = 0.717至0.816）。结果在各个功能领域都是鲁棒性的，但在听力、认知和交流方面的相关性更高。结论：在15个中低收入国家中，农村地区的成年人比城市地区的成年人更容易出现功能障碍。需要对推动这种相关性的因素进行研究，包括农村地区较差的生活条件和获得服务的机会，农村和城市地区获得资源和环境障碍的差异，以及不同功能困难状况的农村-城市移徙机会的潜在差异。
{"title":"Is disability prevalence higher in rural areas? Evidence from functional difficulty and nightlight data in 15 low- and middle-income countries","authors":"Katherine Theiss , Bradley Carpenter , Jill Hanass-Hancock , Sureshkumar Kamalakannan , Rachel J. Kulchar , G.V.S. Murthy , Monica Pinilla-Roncancio , Minerva Rivas Velarde , Shailaja Tetali , Sophie Mitra","doi":"10.1016/j.dhjo.2025.101964","DOIUrl":"10.1016/j.dhjo.2025.101964","url":null,"abstract":"<div><h3>Background</h3><div>There has been emerging evidence from country-level studies that disability prevalence tends to be lower in urban areas than in rural areas. However, such studies are difficult to compare as countries use different ways of categorizing rural and urban areas.</div></div><div><h3>Objectives</h3><div>We examine the association between disability measured through functional difficulties (seeing, hearing, walking, cognition, selfcare, communicating) and urban development measured through the satellite nightlight composite—an internationally comparable proxy for urban development.</div></div><div><h3>Methods</h3><div>We use Demographic and Health Survey data for 15 low- and middle-income countries (LMICs) with the Washington Group Short Set of questions on disability. This study uses multilevel random intercept models to estimate whether functional difficulties are negatively associated with village-level nightlight composite.</div></div><div><h3>Results</h3><div>While country level results vary, in the pooled sample, adults living in villages above the 80th percentile of nightlight activity have odds of reporting any functional difficulty that are 0.765 times those of adults in villages below the 80th percentile of nightlight (AOR = 0.765; 95 % CI = 0.717 to 0.816). The result is robust for each functional domain but the correlation is higher for hearing, cognition and communicating.</div></div><div><h3>Conclusions</h3><div>In 15 LMICs, adults in rural areas are significantly more likely to have functional difficulties compared to adults in urban areas. Research is needed on the factors that drive such a correlation, including poorer living conditions and access to services in rural areas, differential access to resources and environmental barriers in rural and urban areas and potential differences in rural-urban migration opportunities across functional difficulty status.</div></div>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":"19 1","pages":"Article 101964"},"PeriodicalIF":3.3,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-03DOI: 10.1016/S1936-6574(25)00172-4
{"title":"Author Information","authors":"","doi":"10.1016/S1936-6574(25)00172-4","DOIUrl":"10.1016/S1936-6574(25)00172-4","url":null,"abstract":"","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":"18 4","pages":"Article 101943"},"PeriodicalIF":3.3,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-02DOI: 10.1016/j.dhjo.2025.101963
Nathaniel Scherer , Ketmany Chanthakoummane , Anousin Homsana , Mark T. Carew , Latsamy Siengsounthone , Hannah Kuper , Bounhome Soukkhaphone , Lena Morgon Banks
Background
Children with disabilities are at increased risk of discrimination, contributing to exclusion from services and community life.
Objective
This study investigates the prevalence, predictors and consequences of reported discrimination against children with disabilities in Lao People's Democratic Republic (Lao PDR).
Methods
Data were collected in the baseline assessment for a non-randomised controlled trial of a cash-plus programme for children with disabilities in Xiengkhouang Province, Lao PDR. Assessment was conducted May to October 2023. Data on reported discrimination was collected using a tool based on a validated measure. Experience of discrimination in the past 30 days was classified into “any” and “frequent”. Children aged ≥8 years reported directly on their experiences of discrimination. Caregivers provided proxy response for children <8 years or for children ≥8 years who had severe difficulties communicating.
Results
405 children with disabilities aged ≤18 years were recruited. Prevalence of any reported discrimination in the past 30 days was 72.3%, and of frequent discrimination 28.4%. Reported discrimination was more common against children with cognitive disabilities (aRR: 1.55, 95% CI: 1.03-2.33), Hmong/Lu Mien children (aRR: 1.25, 95% CI: 1.10-1.41), and children without friends (aRR: 1.61, 95% CI: 1.16-2.23). Children experiencing frequent discrimination were substantially more likely to avoid others (aRR: 5.19, 95% CI: 3.48-7.74) and worry about how others act towards them (aRR: 4.05, 95% CI: 2.79-5.88).
Conclusions
Children with disabilities in Lao PDR experience high levels of discrimination. Action is needed to reduce disability-related stigma and discrimination in line with the United Nations Convention on the Rights of Persons with Disabilities.
{"title":"Prevalence, predictors and consequences of reported discrimination against children with disabilities in Lao PDR: a cross-sectional analysis in Xiengkhouang Province","authors":"Nathaniel Scherer , Ketmany Chanthakoummane , Anousin Homsana , Mark T. Carew , Latsamy Siengsounthone , Hannah Kuper , Bounhome Soukkhaphone , Lena Morgon Banks","doi":"10.1016/j.dhjo.2025.101963","DOIUrl":"10.1016/j.dhjo.2025.101963","url":null,"abstract":"<div><h3>Background</h3><div>Children with disabilities are at increased risk of discrimination, contributing to exclusion from services and community life.</div></div><div><h3>Objective</h3><div>This study investigates the prevalence, predictors and consequences of reported discrimination against children with disabilities in Lao People's Democratic Republic (Lao PDR).</div></div><div><h3>Methods</h3><div>Data were collected in the baseline assessment for a non-randomised controlled trial of a cash-plus programme for children with disabilities in Xiengkhouang Province, Lao PDR. Assessment was conducted May to October 2023. Data on reported discrimination was collected using a tool based on a validated measure. Experience of discrimination in the past 30 days was classified into “any” and “frequent”. Children aged ≥8 years reported directly on their experiences of discrimination. Caregivers provided proxy response for children <8 years or for children ≥8 years who had severe difficulties communicating.</div></div><div><h3>Results</h3><div>405 children with disabilities aged ≤18 years were recruited. Prevalence of any reported discrimination in the past 30 days was 72.3%, and of frequent discrimination 28.4%. Reported discrimination was more common against children with cognitive disabilities (aRR: 1.55, 95% CI: 1.03-2.33), Hmong/Lu Mien children (aRR: 1.25, 95% CI: 1.10-1.41), and children without friends (aRR: 1.61, 95% CI: 1.16-2.23). Children experiencing frequent discrimination were substantially more likely to avoid others (aRR: 5.19, 95% CI: 3.48-7.74) and worry about how others act towards them (aRR: 4.05, 95% CI: 2.79-5.88).</div></div><div><h3>Conclusions</h3><div>Children with disabilities in Lao PDR experience high levels of discrimination. Action is needed to reduce disability-related stigma and discrimination in line with the United Nations Convention on the Rights of Persons with Disabilities.</div></div>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":"19 1","pages":"Article 101963"},"PeriodicalIF":3.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Direct support professionals (DSPs) often play a critical role in supporting healthcare interactions for people with intellectual and developmental disabilities (IDD) but little is known about their experience supporting virtual healthcare.
Objective
This study explored utilization of virtual care and DSP experiences of supporting virtual care at four time points in Ontario, Canada.
Methods
DSPs in Ontario were invited to participate in an online survey in 2020 (n = 867), 2021 (n = 428), 2022 (n = 698) and 2023 (n = 603). This study focuses on the subset of questions related to DSP experience supporting virtual healthcare. Descriptive statistics were used to summarize quantitative data and content analysis was used to analyze open text responses.
Results
Over the four surveys, reported utilization of phone-based care was consistently higher (53–60 %) than video-based care (20–30 %). DSPs were more likely to provide positive feedback for video-based care compared with phone-based care, however, there was a decline in positive feedback for both over the four surveys. Though video-based care in particular was identified as valuable for patients who struggle to attend in-person appointments, ongoing challenges were reported including technical issues and poor communication quality.
Conclusions
Without the overwhelming concern of COVID transmission, for many patients, the benefits of virtual care may not outweigh the ongoing challenges. However, there appears to be a subset of people for whom virtual care can be critically important to support accessible care. DSPs require more training and resources to effectively support virtual healthcare visits.
{"title":"Direct support professional perspectives on the value of virtual healthcare for adults with intellectual and developmental disabilities: Trends over four years","authors":"Avra Selick , Sarah Ludmilla Bernier , Nicole Bobbette , Katharine Cardiff , Yona Lunsky","doi":"10.1016/j.dhjo.2025.101961","DOIUrl":"10.1016/j.dhjo.2025.101961","url":null,"abstract":"<div><h3>Background</h3><div>Direct support professionals (DSPs) often play a critical role in supporting healthcare interactions for people with intellectual and developmental disabilities (IDD) but little is known about their experience supporting virtual healthcare.</div></div><div><h3>Objective</h3><div>This study explored utilization of virtual care and DSP experiences of supporting virtual care at four time points in Ontario, Canada.</div></div><div><h3>Methods</h3><div>DSPs in Ontario were invited to participate in an online survey in 2020 (n = 867), 2021 (n = 428), 2022 (n = 698) and 2023 (n = 603). This study focuses on the subset of questions related to DSP experience supporting virtual healthcare. Descriptive statistics were used to summarize quantitative data and content analysis was used to analyze open text responses.</div></div><div><h3>Results</h3><div>Over the four surveys, reported utilization of phone-based care was consistently higher (53–60 %) than video-based care (20–30 %). DSPs were more likely to provide positive feedback for video-based care compared with phone-based care, however, there was a decline in positive feedback for both over the four surveys. Though video-based care in particular was identified as valuable for patients who struggle to attend in-person appointments, ongoing challenges were reported including technical issues and poor communication quality.</div></div><div><h3>Conclusions</h3><div>Without the overwhelming concern of COVID transmission, for many patients, the benefits of virtual care may not outweigh the ongoing challenges. However, there appears to be a subset of people for whom virtual care can be critically important to support accessible care. DSPs require more training and resources to effectively support virtual healthcare visits.</div></div>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":"19 1","pages":"Article 101961"},"PeriodicalIF":3.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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