Pub Date : 2026-01-01Epub Date: 2025-07-15DOI: 10.1016/j.dhjo.2025.101929
Ana Oña , Andrea Pacheco Barzallo , Jaime Toaquiza , Diana Pacheco Barzallo
This study assesses the environmental barriers faced by people with spinal cord injury (SCI) in Ecuador. Using cross-sectional data from the International Spinal Cord Injury Survey (InSCI), we analyzed responses from 510 participants across 23 provinces. We calculated the total environmental barrier index using the Nottwil Environmental Factor Inventory (NEFI) and applied regression analysis to identify key influencing factors. We also examined the severity of barriers by region, comparing rural and urban areas.
Our findings reveal significant disparities. Individuals with lower incomes, those with tetraplegia, and those without a partner reported higher levels of environmental barriers. Rural residents were disproportionately affected. While both urban and rural participants cited long-distance travel and limited public access as top barriers, finances ranked higher in urban settings, whereas home access was more critical in rural areas.
This is the first national study to map modifiable environmental barriers for people with SCI in Ecuador. The results point to clear spatial and economic inequalities, highlighting the need for targeted policies that improve public infrastructure to promote social inclusion.
{"title":"Environmental barriers to participation for people with spinal cord injury. The case of Ecuador","authors":"Ana Oña , Andrea Pacheco Barzallo , Jaime Toaquiza , Diana Pacheco Barzallo","doi":"10.1016/j.dhjo.2025.101929","DOIUrl":"10.1016/j.dhjo.2025.101929","url":null,"abstract":"<div><div>This study assesses the environmental barriers faced by people with spinal cord injury (SCI) in Ecuador. Using cross-sectional data from the International Spinal Cord Injury Survey (InSCI), we analyzed responses from 510 participants across 23 provinces. We calculated the total environmental barrier index using the Nottwil Environmental Factor Inventory (NEFI) and applied regression analysis to identify key influencing factors. We also examined the severity of barriers by region, comparing rural and urban areas.</div><div>Our findings reveal significant disparities. Individuals with lower incomes, those with tetraplegia, and those without a partner reported higher levels of environmental barriers. Rural residents were disproportionately affected. While both urban and rural participants cited long-distance travel and limited public access as top barriers, finances ranked higher in urban settings, whereas home access was more critical in rural areas.</div><div>This is the first national study to map modifiable environmental barriers for people with SCI in Ecuador. The results point to clear spatial and economic inequalities, highlighting the need for targeted policies that improve public infrastructure to promote social inclusion.</div></div>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":"19 1","pages":"Article 101929"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668808","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 : 2026-01-01Epub Date: 2025-07-22DOI: 10.1016/j.dhjo.2025.101931
Yana van der Meulen Rodgers , Lisa Schur , Flora M. Hammond , Renee Edwards , Jennifer Cohen , Douglas Kruse
Background
Many workers with disabilities face negative stereotypical attitudes, pay gaps, and a lack of respect in the workplace, contributing to substantially lower job satisfaction compared to people without disabilities. Work from home may help to increase job satisfaction for people with disabilities.
Objective
This study analyzes how different measures of job satisfaction vary between people with and without disabilities, and the extent to which working from home moderates the relationship between disability and job satisfaction.
Methods
We use multivariable regression analysis to examine if the ability to work from home moderates the relationship between disability and indicators related to job satisfaction. The dataset draws on a novel survey of healthcare professionals.
Results
Results show that people with disabilities have relatively greater turnover intentions, lower sense of organizational commitment and support, weaker perceptions of openness and inclusion in the workplace, and worse relations with management and coworkers. Regressions indicate that working from home helps to improve most perceptions of work experiences but does so more for people without disabilities than for people with disabilities.
Conclusions
The findings suggest that (a) some accommodations typically viewed as exceptions to meet the needs of people with disabilities have even greater benefits for the workforce at large and (b) because workers without disabilities also benefit from remote work, we cannot expect this accommodation to close job satisfaction gaps caused by inequities.
{"title":"Work from home and job Satisfaction: Differences by disability status among healthcare workers","authors":"Yana van der Meulen Rodgers , Lisa Schur , Flora M. Hammond , Renee Edwards , Jennifer Cohen , Douglas Kruse","doi":"10.1016/j.dhjo.2025.101931","DOIUrl":"10.1016/j.dhjo.2025.101931","url":null,"abstract":"<div><h3>Background</h3><div>Many workers with disabilities face negative stereotypical attitudes, pay gaps, and a lack of respect in the workplace, contributing to substantially lower job satisfaction compared to people without disabilities. Work from home may help to increase job satisfaction for people with disabilities.</div></div><div><h3>Objective</h3><div>This study analyzes how different measures of job satisfaction vary between people with and without disabilities, and the extent to which working from home moderates the relationship between disability and job satisfaction.</div></div><div><h3>Methods</h3><div>We use multivariable regression analysis to examine if the ability to work from home moderates the relationship between disability and indicators related to job satisfaction. The dataset draws on a novel survey of healthcare professionals.</div></div><div><h3>Results</h3><div>Results show that people with disabilities have relatively greater turnover intentions, lower sense of organizational commitment and support, weaker perceptions of openness and inclusion in the workplace, and worse relations with management and coworkers. Regressions indicate that working from home helps to improve most perceptions of work experiences but does so more for people without disabilities than for people with disabilities.</div></div><div><h3>Conclusions</h3><div>The findings suggest that (a) some accommodations typically viewed as exceptions to meet the needs of people with disabilities have even greater benefits for the workforce at large and (b) because workers without disabilities also benefit from remote work, we cannot expect this accommodation to close job satisfaction gaps caused by inequities.</div></div>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":"19 1","pages":"Article 101931"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144745667","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 : 2026-01-01Epub Date: 2025-06-20DOI: 10.1016/j.dhjo.2025.101919
Kristen P. Mark , Stella E. Mushy , Marguerite Puchner-Hardman , Lucy R. Mgopa , Gift G. Lukumay , B.R. Simon Rosser , Agnes F. Massawe , Dorkasi L. Mwakawanga , Victor Z. Chikwala , Emmanuel I. Sumari , Ally A. Lyimo , Gudrun Kilian , Maria E. Trent , Michael W. Ross , Charlotta Löfgren , Jennifer J. Connor , Rashid H. Mfinanga , Dickson A. Mkoka
Background
Tanzania has a sexual and reproductive health (SRH) crisis, a particularly vulnerable population of people with disabilities (PWD), and a need for healthcare providers trained in PWD-focused SRH care. However, SRH services are limited, and the inclusion of PWD in SRH efforts is rare in Tanzania. The current study examined the feasibility and acceptability of addressing this critical gap by training future healthcare professionals in SRH for PWD.
Objective
To determine the feasibility and acceptability of a PWD-focused SRH training to be delivered to healthcare students attending Muhimbili University of Health and Allied Science (MUHAS) in Dar es Salaam, Tanzania.
Methods
A mixed methods design via a survey taken by 409 medical, nursing, and midwifery student participants was employed to determine the feasibility and acceptability of a new curriculum focused on the SRH needs of PWD. Data were assessed using descriptive statistics and reflexive content analysis.
Results
Data indicate that 83.6% and 97.6% of medical, nursing, and midwifery students believe that an SRH training centered on the needs of PWD is feasible and acceptable, respectively. Moreover, findings indicated that 50.4% of medical, nursing, and midwifery students at MUHAS receive little to no training in SRH for PWD. Participants’ qualitative responses indicated that the training would improve the quality of life for PWD, address their vulnerability and healthcare neglect, and benefit society.
Conclusion
MUHAS students find a PWD-focused SRH training to be feasible, acceptable, and needed, presenting an opportunity for great impact.
{"title":"Needs assessment of training midwifery, nursing, and medical students in sexual and reproductive health care for people with disabilities in Tanzania","authors":"Kristen P. Mark , Stella E. Mushy , Marguerite Puchner-Hardman , Lucy R. Mgopa , Gift G. Lukumay , B.R. Simon Rosser , Agnes F. Massawe , Dorkasi L. Mwakawanga , Victor Z. Chikwala , Emmanuel I. Sumari , Ally A. Lyimo , Gudrun Kilian , Maria E. Trent , Michael W. Ross , Charlotta Löfgren , Jennifer J. Connor , Rashid H. Mfinanga , Dickson A. Mkoka","doi":"10.1016/j.dhjo.2025.101919","DOIUrl":"10.1016/j.dhjo.2025.101919","url":null,"abstract":"<div><h3>Background</h3><div>Tanzania has a sexual and reproductive health<span> (SRH) crisis, a particularly vulnerable population of people with disabilities (PWD), and a need for healthcare providers trained in PWD-focused SRH care. However, SRH services are limited, and the inclusion of PWD in SRH efforts is rare in Tanzania. The current study examined the feasibility and acceptability of addressing this critical gap by training future healthcare professionals in SRH for PWD.</span></div></div><div><h3>Objective</h3><div>To determine the feasibility and acceptability of a PWD-focused SRH training to be delivered to healthcare students attending Muhimbili University of Health and Allied Science (MUHAS) in Dar es Salaam, Tanzania.</div></div><div><h3>Methods</h3><div>A mixed methods design via a survey taken by 409 medical, nursing, and midwifery<span> student participants was employed to determine the feasibility and acceptability of a new curriculum focused on the SRH needs of PWD. Data were assessed using descriptive statistics and reflexive content analysis.</span></div></div><div><h3>Results</h3><div>Data indicate that 83.6% and 97.6% of medical, nursing, and midwifery students believe that an SRH training centered on the needs of PWD is feasible and acceptable, respectively. Moreover, findings indicated that 50.4% of medical, nursing, and midwifery students at MUHAS receive little to no training in SRH for PWD. Participants’ qualitative responses indicated that the training would improve the quality of life for PWD, address their vulnerability and healthcare neglect, and benefit society.</div></div><div><h3>Conclusion</h3><div>MUHAS students find a PWD-focused SRH training to be feasible, acceptable, and needed, presenting an opportunity for great impact.</div></div>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":"19 1","pages":"Article 101919"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486681","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 : 2025-12-23DOI: 10.1016/j.dhjo.2025.102023
Carli Friedman
Background: Direct support professionals (DSPs) play a key role in supporting the health and quality of life of people with intellectual and developmental disabilities (IDD). Despite the importance of their roles, the DSP workforce also represents a major threat to the health and quality of life of people with IDD due to the instability of the workforce, and the consequences of this instability.
Objective: We theorize and purport that the status, availability, and quality of the DSP workforce should be considered a social determinant of health of people with IDD. Thus, the aim of this study was to examine the relationship between DSP turnover, and people with IDD's health and social determinants of health-related outcomes.
Methods: We analyzed secondary Personal Outcome Measures (POM) data from 5457 people with IDD (January 2018 and December 2024) using descriptive statistics, binary logistic regressions, and negative binomial regression models.
Results: People with IDD who experienced DSP turnover were significantly less likely to have health outcomes present, and to receive person-centered health supports (odds ratios ranged from 0.50 to 0.77). People with IDD who experienced DSP turnover also had a 19.10 % decrease in other social determinants of health-related outcomes.
Conclusions: The harms of an unstable DSP workforce can be two-fold, in that it both directly negatively impacts people with IDD's health outcomes and health services, and it negatively impacts other areas of people with IDD's lives that also serve as social determinants of health, which also go on to hinder people with IDD's health.
{"title":"The direct support professional (DSP) workforce as a social determinant of health of people with intellectual and developmental disabilities.","authors":"Carli Friedman","doi":"10.1016/j.dhjo.2025.102023","DOIUrl":"https://doi.org/10.1016/j.dhjo.2025.102023","url":null,"abstract":"<p><strong>Background: </strong>Direct support professionals (DSPs) play a key role in supporting the health and quality of life of people with intellectual and developmental disabilities (IDD). Despite the importance of their roles, the DSP workforce also represents a major threat to the health and quality of life of people with IDD due to the instability of the workforce, and the consequences of this instability.</p><p><strong>Objective: </strong>We theorize and purport that the status, availability, and quality of the DSP workforce should be considered a social determinant of health of people with IDD. Thus, the aim of this study was to examine the relationship between DSP turnover, and people with IDD's health and social determinants of health-related outcomes.</p><p><strong>Methods: </strong>We analyzed secondary Personal Outcome Measures (POM) data from 5457 people with IDD (January 2018 and December 2024) using descriptive statistics, binary logistic regressions, and negative binomial regression models.</p><p><strong>Results: </strong>People with IDD who experienced DSP turnover were significantly less likely to have health outcomes present, and to receive person-centered health supports (odds ratios ranged from 0.50 to 0.77). People with IDD who experienced DSP turnover also had a 19.10 % decrease in other social determinants of health-related outcomes.</p><p><strong>Conclusions: </strong>The harms of an unstable DSP workforce can be two-fold, in that it both directly negatively impacts people with IDD's health outcomes and health services, and it negatively impacts other areas of people with IDD's lives that also serve as social determinants of health, which also go on to hinder people with IDD's health.</p>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":" ","pages":"102023"},"PeriodicalIF":3.3,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145901449","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 : 2025-12-22DOI: 10.1016/j.dhjo.2025.102021
Lucy C Campbell, Leslie Rydberg
Background: Disability-centric curricula in the education of health providers are often limited and highly variable across programs. It is unclear whether disability-centric content is tested in the licensure exams of health professions.
Objective: To evaluate the congruency of the licensure exams of eight health professions with the Core Competencies on Disability for Health Care Education.
Methods: We performed a cross-sectional analysis of publicly available official exam content outlines via key word search and manual mapping to identify the presence of Core Competencies.
Results: The median number of Core Competencies addressed by the content outlines was three (range 1-4). The most common Core Competency was Competency 2 (professionalism and patient-centered care; 8/8 exams), often in the context of using interpretive services or accessible forms of communication. No content outline addressed Competency 4 (teams and systems-based care), and only one addressed Competency 3 (legal obligations). The exams for physical therapy, occupational therapy, and clinical social work addressed the most competencies (4/6); the exam for physician assistants addressed the fewest (1/6). The median number of uses of the words "disabilit (y/ies)" and "disabl (ed/ing)" within content outlines was 1.5 (range: 0-11), with two outlines lacking any uses.
Conclusion: On average, health professions licensure exams, as proxied by their content outlines, addressed only half of the Core Competencies on Disability and often in a limited, specific manner. With the high and increasing prevalence of disability among American adults, health professions should strive to educate and assess their students using a disability-competent curriculum.
{"title":"Disability competencies in the licensure examinations of health professions.","authors":"Lucy C Campbell, Leslie Rydberg","doi":"10.1016/j.dhjo.2025.102021","DOIUrl":"https://doi.org/10.1016/j.dhjo.2025.102021","url":null,"abstract":"<p><strong>Background: </strong>Disability-centric curricula in the education of health providers are often limited and highly variable across programs. It is unclear whether disability-centric content is tested in the licensure exams of health professions.</p><p><strong>Objective: </strong>To evaluate the congruency of the licensure exams of eight health professions with the Core Competencies on Disability for Health Care Education.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis of publicly available official exam content outlines via key word search and manual mapping to identify the presence of Core Competencies.</p><p><strong>Results: </strong>The median number of Core Competencies addressed by the content outlines was three (range 1-4). The most common Core Competency was Competency 2 (professionalism and patient-centered care; 8/8 exams), often in the context of using interpretive services or accessible forms of communication. No content outline addressed Competency 4 (teams and systems-based care), and only one addressed Competency 3 (legal obligations). The exams for physical therapy, occupational therapy, and clinical social work addressed the most competencies (4/6); the exam for physician assistants addressed the fewest (1/6). The median number of uses of the words \"disabilit (y/ies)\" and \"disabl (ed/ing)\" within content outlines was 1.5 (range: 0-11), with two outlines lacking any uses.</p><p><strong>Conclusion: </strong>On average, health professions licensure exams, as proxied by their content outlines, addressed only half of the Core Competencies on Disability and often in a limited, specific manner. With the high and increasing prevalence of disability among American adults, health professions should strive to educate and assess their students using a disability-competent curriculum.</p>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":" ","pages":"102021"},"PeriodicalIF":3.3,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866068","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 : 2025-10-01Epub Date: 2025-05-13DOI: 10.1016/j.dhjo.2025.101849
Bryan R. Christ, Lucie Adams, Benjamin Ertman, Paul B. Perrin
Background
No research has yet determined exactly what accommodation needs are unmet for disabled students and how those needs being unmet predict psychosocial outcomes many years later.
Objective
To address this research gap, we seek to explore the potentially long-term associations of unmet educational accommodation needs and demographic characteristics with the mental health of adults with disabilities (n = 409).
Methods
To explore these associations, we use modern the machine learning technique of Random Forest feature importance.
Results
While 52.3 % of the sample reported having had one or more unmet accommodation needs while going to school, 57.2 % displayed current clinically elevated symptoms of depression and 48.4 % clinically elevated symptoms of anxiety. The machine learning approaches had 65.9 % and 60.0 % accuracy in correctly classifying clinically elevated depression and anxiety symptoms, respectively. For the models predicting clinically elevated depression symptoms using mean decrease in impurity (MDI) and permutation importance, unmet accommodation needs ranked fifth and fourth, respectively, in feature importance after age, disability severity, high school GPA, and individual income (for MDI). For the MDI model predicting clinically elevated anxiety symptoms, unmet academic accommodation ranked third in feature importance behind disability severity and age, while for permutation importance, unmet academic accommodation need ranked fourth behind age, urbanicity, and disability severity.
Conclusion
Unmet academic accommodations may result in reduced psychological adjustment and quality of life potentially many years into adulthood.
{"title":"Unmet educational accommodation needs and mental health outcomes in adults with disabilities: A machine learning approach","authors":"Bryan R. Christ, Lucie Adams, Benjamin Ertman, Paul B. Perrin","doi":"10.1016/j.dhjo.2025.101849","DOIUrl":"10.1016/j.dhjo.2025.101849","url":null,"abstract":"<div><h3>Background</h3><div>No research has yet determined exactly what accommodation needs are unmet for disabled students and how those needs being unmet predict psychosocial outcomes many years later.</div></div><div><h3>Objective</h3><div>To address this research gap, we seek to explore the potentially long-term associations of unmet educational accommodation needs and demographic characteristics with the mental health of adults with disabilities (n = 409).</div></div><div><h3>Methods</h3><div>To explore these associations, we use modern the machine learning technique of Random Forest feature importance.</div></div><div><h3>Results</h3><div>While 52.3 % of the sample reported having had one or more unmet accommodation needs while going to school, 57.2 % displayed current clinically elevated symptoms of depression and 48.4 % clinically elevated symptoms of anxiety. The machine learning approaches had 65.9 % and 60.0 % accuracy in correctly classifying clinically elevated depression and anxiety symptoms, respectively. For the models predicting clinically elevated depression symptoms using mean decrease in impurity (MDI) and permutation importance, unmet accommodation needs ranked fifth and fourth, respectively, in feature importance after age, disability severity<span>, high school GPA, and individual income (for MDI). For the MDI model predicting clinically elevated anxiety symptoms, unmet academic accommodation ranked third in feature importance behind disability severity and age, while for permutation importance, unmet academic accommodation need ranked fourth behind age, urbanicity, and disability severity.</span></div></div><div><h3>Conclusion</h3><div>Unmet academic accommodations may result in reduced psychological adjustment and quality of life potentially many years into adulthood.</div></div>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":"18 4","pages":"Article 101849"},"PeriodicalIF":3.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086607","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 : 2025-10-01Epub Date: 2025-05-14DOI: 10.1016/j.dhjo.2025.101854
Hye-Jin Kim , Bokyoung Choi , Eunhee Choi , Haesong Kim , Soong-Nang Jang , Jae-Young Lim , Kim Bulkeley , Jennifer Smith-Merry
Background
Integrated care addresses system fragmentation, especially for people with disabilities who require support across multiple domains. Most models focus on healthcare, overlooking social and environmental factors that hinder health management for people with disabilities. The International Classification of Functioning, Disability and Health (ICF)'s biopsychosocial approach integrates these broader factors, but its application in integrated care remains underexplored.
Objective
This scoping review aimed to explore the application of the ICF in research on integrated care, informed by the SELFIE framework, within the context of disability.
Methods
Following Joanna Briggs Institute's guidance and the PRISMA extension for scoping reviews, seven databases were searched from January 2011 to September 2023. Independent screening, selection, and data extraction were performed, with key findings related to integrated care identified deductively using the SELFIE framework.
Results
Twenty-six studies were included. These focused on populations with visual impairments, hearing loss, intellectual or developmental disabilities, spinal cord injuries, brain injuries, physical and learning disabilities, psychological impairment, and wheelchair users. Most studies applied the ICF as a conceptual framework rather than a coding system. Key elements of integrated care, such as holistic assessment, service delivery, leadership, governance, and workforce, were emphasized, while components like financing, technology, and research received limited attention.
Conclusions
Traditional integrated care models, focusing on disease management, fall short for people with disabilities, who have diverse, often cross-system needs and social barriers. This review highlights the importance of integrating the context of disability, with the ICF's biopsychosocial model playing a crucial role in addressing environmental factors impacting body functions, activities, and participation.
{"title":"Use of the International Classification of Functioning, Disability and Health (ICF) in integrated care for people with disabilities: A scoping review using the SELFIE framework","authors":"Hye-Jin Kim , Bokyoung Choi , Eunhee Choi , Haesong Kim , Soong-Nang Jang , Jae-Young Lim , Kim Bulkeley , Jennifer Smith-Merry","doi":"10.1016/j.dhjo.2025.101854","DOIUrl":"10.1016/j.dhjo.2025.101854","url":null,"abstract":"<div><h3>Background</h3><div>Integrated care addresses system fragmentation, especially for people with disabilities who require support across multiple domains. Most models focus on healthcare, overlooking social and environmental factors that hinder health management for people with disabilities. The International Classification of Functioning, Disability and Health (ICF)'s biopsychosocial approach integrates these broader factors, but its application in integrated care remains underexplored.</div></div><div><h3>Objective</h3><div>This scoping review aimed to explore the application of the ICF in research on integrated care, informed by the SELFIE framework, within the context of disability.</div></div><div><h3>Methods</h3><div>Following Joanna Briggs Institute's guidance and the PRISMA extension for scoping reviews, seven databases were searched from January 2011 to September 2023. Independent screening, selection, and data extraction were performed, with key findings related to integrated care identified deductively using the SELFIE framework.</div></div><div><h3>Results</h3><div>Twenty-six studies were included. These focused on populations with visual impairments, hearing loss, intellectual or developmental disabilities, spinal cord injuries, brain injuries, physical and learning disabilities, psychological impairment, and wheelchair users. Most studies applied the ICF as a conceptual framework rather than a coding system. Key elements of integrated care, such as holistic assessment, service delivery, leadership, governance, and workforce, were emphasized, while components like financing, technology, and research received limited attention.</div></div><div><h3>Conclusions</h3><div>Traditional integrated care models, focusing on disease management, fall short for people with disabilities, who have diverse, often cross-system needs and social barriers. This review highlights the importance of integrating the context of disability, with the ICF's biopsychosocial model playing a crucial role in addressing environmental factors impacting body functions, activities, and participation.</div></div>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":"18 4","pages":"Article 101854"},"PeriodicalIF":3.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120379","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 : 2025-10-01Epub 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":"2025-10-01","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 : 2025-10-01Epub Date: 2025-05-16DOI: 10.1016/j.dhjo.2025.101850
Jaekyeong Kwon
Background
Income helps low-income individuals reduce their reliance on transit and walking and increase car travel. People with disabilities might face challenges in improving their private vehicle access due to disability-related extra costs.
Objective
This study examines whether income has different impacts on travel mode choice based on disability status, disability type, and level of activity limitations.
Methods
This study used time diary data from the nationally representative American Time Use Survey to estimate the differences in income effects on the likelihood of using public transit, walking, and traveling in private vehicles as drivers or as passengers between working-age adults with and without disabilities. Confounding variables included socioeconomic, demographic, household, and geographic characteristics.
Results
Income was associated with a three-percentage-point (95 % CI: 0, 6) higher likelihood of using private vehicles as passengers for people with disabilities. In addition, people with vision disability were 10 percentage points (95 % CI: 4, 16) more likely to travel as passengers when they had more income. In contrast, people without disabilities were equally likely to travel as passengers regardless of income. Whereas people without disabilities were 10 percentage points (95 % CI: 8, 11) more likely to drive when they had more income, income was not associated with a higher likelihood of driving for people with activity-limiting disability.
Conclusions
Income effectively expands transportation options for people with disabilities beyond transit and walking. Personal care assistant programs with high reimbursement rates can ease the financial burden of people with disabilities who pay others to travel as passengers.
{"title":"Income effects on travel mode choices among people with and without disabilities: Operationalizing the capability approach","authors":"Jaekyeong Kwon","doi":"10.1016/j.dhjo.2025.101850","DOIUrl":"10.1016/j.dhjo.2025.101850","url":null,"abstract":"<div><h3>Background</h3><div>Income helps low-income individuals reduce their reliance on transit and walking and increase car travel. People with disabilities might face challenges in improving their private vehicle access due to disability-related extra costs.</div></div><div><h3>Objective</h3><div>This study examines whether income has different impacts on travel mode choice based on disability status, disability type, and level of activity limitations.</div></div><div><h3>Methods</h3><div>This study used time diary data from the nationally representative American Time Use Survey to estimate the differences in income effects on the likelihood of using public transit, walking, and traveling in private vehicles as drivers or as passengers between working-age adults with and without disabilities. Confounding variables included socioeconomic, demographic, household, and geographic characteristics.</div></div><div><h3>Results</h3><div>Income was associated with a three-percentage-point (95 % CI: 0, 6) higher likelihood of using private vehicles as passengers for people with disabilities. In addition, people with vision disability were 10 percentage points (95 % CI: 4, 16) more likely to travel as passengers when they had more income. In contrast, people without disabilities were equally likely to travel as passengers regardless of income. Whereas people without disabilities were 10 percentage points (95 % CI: 8, 11) more likely to drive when they had more income, income was not associated with a higher likelihood of driving for people with activity-limiting disability.</div></div><div><h3>Conclusions</h3><div>Income effectively expands transportation options for people with disabilities beyond transit and walking. Personal care assistant programs with high reimbursement rates can ease the financial burden of people with disabilities who pay others to travel as passengers.</div></div>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":"18 4","pages":"Article 101850"},"PeriodicalIF":3.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163378","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 : 2025-10-01Epub Date: 2025-05-14DOI: 10.1016/j.dhjo.2025.101851
Yi Yang , Nina Afshar , Joanna Butchart , Alex Sully , Rebecca J. Bergin , Anne Kavanagh , George Disney
Background
People with disability experience worse cancer outcomes than people without disability. One potential pathway is through low screening participation leading to delayed cancer diagnosis and late disease presentation.
Objective
To summarise and evaluate evidence quantifying disability-related inequalities in (1) cancer mortality, (2) fatality among cancer patients; and for cervical, breast, colorectal and lung cancers: (3) screening participation and (4) stage at diagnosis.
Methods
We searched MEDLINE, Embase, PsycInfo and Scopus up to November 2023 for studies that quantified disability-related inequalities in the four outcomes. Studies were evaluated using the Risk Of Bias In Non-randomized Studies - of Exposures tool.
Results
We found 73 eligible articles globally. People with disability had higher cancer mortality compared to those without. This inequality was most pronounced among people with intellectual disability. Evidence showed substantially higher fatality among cancer patients with disability compared to those without consistently across disability groups and cancer types. Screening uptake for breast, cervical and colorectal cancers was consistently lower for people with various disability types in multiple countries. Evidence regarding inequalities in stage at diagnosis for people with disability was limited and inconsistent. The main methodological challenges for future research are: complexity in defining disability, underestimation of inequalities due to over-adjustment of mediating factors, under-representation of people with severe disability in data, and reporting inequalities on relative scales only.
Conclusions
Existing evidence reinforces the need for high-quality cancer inequality research for this population, and a multi-pronged, inclusive approach to prioritise people with disability in the whole cancer control pathway.
{"title":"Cancer inequalities experienced by people with disability: a systematic review","authors":"Yi Yang , Nina Afshar , Joanna Butchart , Alex Sully , Rebecca J. Bergin , Anne Kavanagh , George Disney","doi":"10.1016/j.dhjo.2025.101851","DOIUrl":"10.1016/j.dhjo.2025.101851","url":null,"abstract":"<div><h3>Background</h3><div>People with disability experience worse cancer outcomes than people without disability. One potential pathway is through low screening participation leading to delayed cancer diagnosis and late disease presentation.</div></div><div><h3>Objective</h3><div>To summarise and evaluate evidence quantifying disability-related inequalities in (1) cancer mortality, (2) fatality among cancer patients; and for cervical, breast, colorectal and lung cancers: (3) screening participation and (4) stage at diagnosis.</div></div><div><h3>Methods</h3><div>We searched MEDLINE, Embase, PsycInfo and Scopus up to November 2023 for studies that quantified disability-related inequalities in the four outcomes. Studies were evaluated using the Risk Of Bias In Non-randomized Studies - of Exposures tool.</div></div><div><h3>Results</h3><div>We found 73 eligible articles globally. People with disability had higher cancer mortality compared to those without. This inequality was most pronounced among people with intellectual disability. Evidence showed substantially higher fatality among cancer patients with disability compared to those without consistently across disability groups and cancer types. Screening uptake for breast, cervical and colorectal cancers was consistently lower for people with various disability types in multiple countries. Evidence regarding inequalities in stage at diagnosis for people with disability was limited and inconsistent. The main methodological challenges for future research are: complexity in defining disability, underestimation of inequalities due to over-adjustment of mediating factors, under-representation of people with severe disability in data, and reporting inequalities on relative scales only.</div></div><div><h3>Conclusions</h3><div>Existing evidence reinforces the need for high-quality cancer inequality research for this population, and a multi-pronged, inclusive approach to prioritise people with disability in the whole cancer control pathway.</div></div>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":"18 4","pages":"Article 101851"},"PeriodicalIF":3.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121453","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号