Accessing the field: Disability and the research process

A mixed-methods study of women's birthplace preferences and decisions in England

PROBLEM

Choice has been a key aspect of maternity care policy in England since 1993, however a gap remains between the birthplaces women want and where they actually give birth.

BACKGROUND

The latest maternity care policy in England acknowledges that women are not being given 'real choice' in their care and often being told what to do. This is problematic since unfulfilled preferences have been linked to negative childbirth experiences.

AIM

To understand the factors affecting women's birthplace preferences and decisions, and why these might differ.

METHODS

A sequential mixed-methods study consisting of an online questionnaire (n=49) and follow-up interviews (n=14) with women who were either currently pregnant or had recently given birth in a metropolitan region in England.

FINDINGS

Most women in this study said that they would prefer to give birth in an alongside maternity unit because it offered a compromise between the risk of poor outcomes and risk of unnecessary medicalisation. However, the majority of women's preferences were medicalised at the point of decision-making as the minimisation of clinical risk was ultimately prioritised.

DISCUSSION

Women's preference for the alongside maternity unit demonstrates the growing popularity for this less medicalised, 'alternative' birthplace option. However pre-existing conditions, reproductive histories and experiential knowledge influence women's decision to give birth in the labour ward and suggests that minimising clinical risk is women's key priority.

CONCLUSION

Women navigate complex and competing discourses when forming childbirth preferences and making decisions, selectively considering different risks and knowledges to make the decisions right for them.

Perceived barriers and facilitators to good end of life care: Focusing on people with intellectual disabilities

BACKGROUND

People with intellectual disabilities are often left out of research on important topics. This exploratory study investigated their views on barriers and facilitators to accessing care at end of life, both at home and in a hospice setting.

METHOD

This qualitative study used reflexive thematic analysis. Two focus groups were held via Zoom with a total of four participants.

RESULTS

Three themes were produced: Unsettling Transitions, Maintaining Familiarity, and Respecting People's Wishes. Keeping things as unchanged as possible at end of life was highlighted as an ideal. Respecting people's wishes and education were highlighted as facilitators to good end of life care.

CONCLUSIONS

The themes identified in this study highlight the fears and wishes of this population with regards to receiving quality end of life care. Training for staff and families, as well as advanced care planning, could focus on enhancing facilitators and decreasing barriers for this population.

The impact of the COVID-19 pandemic on perceived publication pressure among academic researchers in Canada

The phenomenon of “publish-or-perish” in academia, spurred on by limited funding and academic positions, has led to increased competition and pressure on academics to publish. Publication pressure has been linked with multiple negative outcomes, including increased academic misconduct and researcher burnout. COVID-19 has disrupted research worldwide, leading to lost research time and increased anxiety amongst researchers. The objective of this study was to examine how COVID-19 has impacted perceived publication pressure amongst academic researchers in Canada. We used the revised Publication Pressure Questionnaire, in addition to Likert-type questions to discern respondents’ beliefs and concerns about the impact of COVID-19 on academic publishing. We found that publication pressure increased across academic researchers in Canada following the pandemic, with respondents reporting increased stress, increased pessimism, and decreased access to support related to publishing. Doctoral students reported the highest levels of stress and pessimism, while principal investigators had the most access to publication support. There were no significant differences in publication pressure reported between different research disciplines. Women and non-binary or genderfluid respondents reported higher stress and pessimism than men. We also identified differences in perceived publication pressure based on respondents’ publication frequency and other demographic factors, including disability and citizenship status. Overall, we document a snapshot of perceived publication pressure in Canada across researchers of different academic career stages and disciplines. This information can be used to guide the creation of researcher supports, as well as identify groups of researchers who may benefit from targeted resources.

Undergraduate Disabled Students as Knowledge Producers including Researchers: A Missed Topic in Academic Literature

Research experience is beneficial for undergraduate students for many reasons. For example, it is argued in academic literature and in reports produced by various organizations that engage with science, technology, engineering and math (STEM) education and science education that undergraduate research experience increases the graduation rate in STEM disciplines as well as the amount of students thinking about STEM careers. As such, being researchers should also be of benefit to undergraduate disabled students in all disciplines including STEM education. However, given that undergraduate disabled students encounter many problems within post-secondary education, including STEM education, undergraduate disabled students might encounter problems in becoming researchers. Policies are to be guided by knowledge and evidence. However, knowledge and evidence deficits exist in relation to the lived experience of disabled people. Undergraduate disabled students could decrease the knowledge deficit as researchers and knowledge producers. The numbers of disabled academic faculty are judged as being too low and efforts are under way to increase the number of disabled academics. Increasing the number of undergraduate disabled researchers might increase the available pool of disabled students that pursue an academic career. Given the important role research performed by undergraduate disabled students can play and given that many studies highlight problems for disabled students in post-secondary education in general, we used a scoping review approach to investigate the coverage of undergraduate disabled students as knowledge producers, including as researchers, in the academic literature. Using various search strategies, we obtained 1299 initial hits. However, only 15 had relevant content. No study investigated how undergraduate disabled students select their research topics or how they are enticed to pursue research projects outside of a course-based framework. No study looked at the linkage between being an undergraduate disabled researcher and career choices or using the obtained research skills on the undergraduate level in one’s role as a community member after graduation. Our findings suggest an opportunity for many fields, ranging from disability studies to STEM education, to generate more empirical data and conceptual work on the role of undergraduate disabled students as knowledge producers including as researchers. Such studies could help to increase the numbers of undergraduate disabled students as knowledge producers, including researchers, which in turn could help to increase (a) the number of disabled academics, (b) the number of disabled students who perform research in the community after graduation, (c) the degree success of disabled students and (d) the knowledge available on the social situation of disabled people.

The complexities of 'otherness': reflections on embodiment of a young White British woman engaged in cross-generation research involving older people in Indonesia

If interviews are to be considered embodied experiences, than the potential influence of the embodied researcher must be explored. A focus on specific attributes such as age or ethnicity belies the complex and negotiated space that both researcher and participant inhabit simultaneously. Drawing on empirical research with stroke survivors in an ethnically mixed area of Indonesia, this paper highlights the importance of considering embodiment as a specific methodological concern. Three specific interactions are described and analysed, illustrating the active nature of the embodied researcher in narrative production and development. The intersectionality of embodied features is evident, alongside their fluctuating influence in time and place. These interactions draw attention to the need to consider the researcher within the interview process and the subsequent analysis and presentation of narrative findings. The paper concludes with a reinforcement of the importance of ongoing and meaningful reflexivity in research, a need to consider the researcher as the other participant, and specifically a call to engage with and present the dynamic nature of embodiment.

Knowledge is power? The role of experiential knowledge in genetically 'risky' reproductive decisions

Knowledge of the condition being tested for is increasingly acknowledged as an important factor in prenatal testing and screening decisions. An analysis of the way in which family members living with an inheritable condition use and value this knowledge has much to add to debates about whether and how this type of knowledge could be made available to prospective parents facing screening decisions. This article reports on in-depth interviews (conducted between 2007 and 2009) with 61 people with a genetic condition, spinal muscular atrophy (SMA) in their family. Many participants reported that their intimate familial knowledge of SMA offered them valuable insights with which they could imagine future lives. Other participants, however, found themselves trapped between their experiential knowledge of SMA and their (often) competing responsibility to maintain the wellbeing of their family. Still, others established a hierarchy of knowledge to rank the authenticity of different family member's accounts of SMA in order to discredit or justify their decisions. This article highlights the way in which experiential knowledge of the condition being tested for cannot be unproblematically assumed to be a useful resource in the context of prenatal testing decisions and may actually constrain reproductive decisions.

Experiential knowledge of disability, impairment and illness: The reproductive decisions of families genetically at risk

As the capacities of Reproductive Genetic Technologies expand, would-be parents face an increasing number of reproductive decisions regarding testing and screening for different conditions. Several studies have acknowledged the role that 'experiential knowledge of disability' plays in arriving at decisions around the use of these technologies; however, there is a lack of clarity within this literature as to what constitutes 'experiential knowledge of disability' and an over-reliance on medical diagnoses as a shorthand to describe different types of experience. Drawing on both social model of disability theory and the literature on chronic illness, this article presents an analysis of data from an in-depth qualitative interview study with 64 people with an inheritable condition in their family, Spinal Muscular Atrophy, and reports their views around reproduction and Reproductive Genetic Technologies. An experiential typology is presented which demonstrates the way in which experiences of 'disability', 'embodied experiences of impairment' or 'embodied experiences of illness, death and bereavement' are strategically privileged in accounts of reproductive decisions, in order to validate reproductive decisions taken, and, specifically, justify use (or non-use) of Reproductive Genetic Technologies. By highlighting the experiential categories within which participants embedded their reproductive decisions, this article draws attention to the porous and collapsible nature of diagnostic categories in the context of reproductive decision-making and genetic risk, and suggests new ways of researching 'experiential knowledge of disability' within these contexts which are able to account for the various contours of the embodied lived reality of life with 'disability'.