Workplace accommodations for persons with physical disabilities: evidence synthesis of the peer-reviewed literature

The Job Demands and Accommodation Planning Tool (JDAPT): A Nine-Month Evaluation of Use, Changes in Self-efficacy, Presenteeism, and Absenteeism in Workers with Chronic and Episodic Disabilities

PURPOSE

Enhancing workplace communication and support processes to enable individuals living with disabilities to sustain employment and return to work is a priority for workers, employers, and community stakeholders. The objective of this study was to evaluate a new resource that addresses support challenges, the Job Demands and Accommodation Planning Tool (JDAPT), and assess its use, relevance, and outcomes over a nine-month follow-up period.

METHODS

Workers with physical and mental health/cognitive conditions causing limitations at work were recruited using purposive sampling. Online surveys were administered at baseline (prior to using the JDAPT), and at three and nine months post-baseline. Information was collected on demographics (e.g., age, gender) and work characteristics (e.g., job sector, organization size). Outcomes included assessing JDAPT use and relevance, and changes in self-efficacy, work productivity difficulties, employment concerns, difficulties with job demands, and absenteeism.

RESULTS

Baseline participants were 269 workers (66% women; mean age 41 years) of whom 188 (69.9%) completed all three waves of data collection. Many workers reported using JDAPT strategies at and outside of work, and held positive perceptions of the tool's usability, relevance, and helpfulness. There were significant improvements (Time 1-2; Time 1-3) in self-efficacy, perceived work productivity, and absenteeism with moderate to large effect sizes in self-efficacy and productivity (0.46 to 0.78). Findings were consistent across gender, age, health condition, and work context variables.

CONCLUSIONS

The JDAPT can enhance support provision and provide greater transparency and consistency to workplace disability practices, which is critical to creating more inclusive and accessible employment opportunities.

Who Requests and Receives Workplace Accommodations? An Intersectional Analysis

PURPOSE

This study investigates who requests workplace accommodations and who is more likely to have requests granted. We investigate the role of demographic characteristics and their intersection, including disability, gender, race/ethnicity, and age. We also consider the role of other personal and job-related factors.

METHODS

We use the data from the Current Population Survey (CPS) 2021 Disability Supplement to estimate the odds ratio of having requested workplace accommodations and having such request granted during the COVID-19 pandemic when the survey was conducted. In supplementary analyses, we explore the relationship between remote work and flexible scheduling and workplace accommodations, as well as possible trends using CPS 2019 Disability Supplement.

RESULTS

Our results indicate that Hispanics with disabilities are more likely than others to request workplace accommodations, but they are substantially less likely to be granted accommodations. Consistent with other studies, our paper also finds that people with disabilities, women, and older people are more likely to request accommodations than their respective counterparts. Other personal and job-related factors such as higher education, parenthood, being single, being a citizen, and working in management-related occupations are associated with higher likelihood of requesting workplace accommodations compared to their counterparts, while receiving accommodations is largely explained by occupational differences.

CONCLUSION

Our findings show that there are still disparities in the rates of workplace accommodation requests and provision for multiply marginalized groups, and as such, taking into account intersectional differences in addition and in relation to disability is important.

Facilitating inclusive education: Assessing faculty awareness and attitudes towards students with special educational needs at Qatar university

Introduction

An increasing number of students with special educational needs (SEN) are attending higher education institutions. Faculty members are key players in the implementation of inclusive policies, the success of which depends on their attitudes and awareness to help students with SEN.

Purpose

The aim of this study was to assess faculty attitudes toward SEN students and awareness of the support provided by the university for SEN students.

Methods

This was a cross-sectional study of Qatar University (QU) faculty conducted via an online survey. Demographic data such as gender, years of experience, and academic discipline were collected and associated with previous exposure to SEN students and survey responses using SPSS.

Results

Three hundred and thirty-one QU faculty responded out of 1107 registered faculty in 2022, a 30 % response rate. About a third of respondents did not know about available support services for SEN students, and only half of those with awareness of the services attended. After controlling for sociodemographic variables, previous contact with SEN students had a significant effect on attitudes, such that faculty with no previous contact with SEN students (M = 1.47, SD = 0.62) had higher positive attitudes towards SEN students relative to faculty with previous contact with SEN students (M = 1.31, SD = 0.47). However, faculty with contact with SEN students were more likely to report awareness of the availability of workshops and were more likely to be aware of assistive technology compared to being unsure, while those with no previous contact with SEN students were more uncertain about the availability of workshops and assistive technology.

Conclusion

The findings suggest a need for targeted interventions to improve faculty awareness of support services and attitudes towards students with SEN in higher education, highlighting the importance of professional development and training initiatives to promote inclusivity in the classroom. Faculty members need to be aware of existing support services for SEN students.

Understanding the Unmet Accommodation Needs of People Working with Mental or Cognitive Conditions: The Importance of Gender, Gendered Work, and Employment Factors

PURPOSE

Workplace support needs for women and men living with mental health conditions are not well understood. This study examined workplace accommodation and support needs among women and men with and without mental health or cognitive conditions and individual and workplace factors associated with having unmet needs.

METHODS

A cross-sectional survey of 3068 Canadian workers collected information on disability, gender, gendered occupations, job conditions, work contexts, and workplace accommodations. Multivariable logistic regression analyses examined gender- and disability-based differences in unmet needs for workplace flexibility, work modifications, and health benefits, and the association of work context (i.e., work schedule, job sector) and job conditions (i.e., precarious work) on the likelihood of unmet accommodation needs. The additive (i.e., super- or sub-additive) and multiplicative effects of disability, gender, and occupational gender distribution on the probability of unmet accommodation needs were also assessed.

RESULTS

The most common unmet workplace accommodation was work modifications reported by 35.9% of respondents with mental/cognitive disability and workplace flexibility reported by 19.6% of individuals without a mental/cognitive disability. Women, employees in female dominant occupations, and participants with mental/cognitive disabilities were more likely to report unmet needs compared with men, employees in non-female dominant occupations, and participants without disabilities but these findings were largely explained by differences in job conditions and work contexts. No interacting effects on the likelihood of reporting unmet needs for workplace accommodations were observed.

CONCLUSIONS

To support employee mental health, attention is needed to address work contexts and job conditions, especially for people working with mental/cognitive disabilities, women, and workers in female-dominated occupations where unmet accommodation needs are greatest.

Organisational Policies and Practices for the Inclusion of Vulnerable Workers: A Scoping Review of the Employer's Perspective

Purpose Current models of inclusive workplaces are primarily based on the perceptions of vulnerable workers, whereas attention for employer's perceptions is lacking. This scoping review addresses this issue by mapping the literature that covers employer's perceptions on the application and importance of organisational policies and practices aimed at the inclusion of vulnerable workers. Methods A literature search for qualitative and quantitative research articles was conducted in MEDLINE, Scopus, ProQuest, PsychInfo, Google Scholar and Web of Science. Studies were included when (a) they reported on practices aimed at the inclusion, participation, or rehabilitation of (b) workers with disabilities, a low education or migration background, or who were long-term unemployed, and (c) were based on samples of employers or their representatives. Results The search resulted in 3,134 articles. In total, 38 articles met the inclusion criteria of this study. We identified seven types of inclusive practices to stimulate the inclusion of vulnerable workers that employers applied and/or perceived as valuable: senior management commitment, recruitment and selection, performance management and development practices, job accommodations and redesign of work, supportive culture, external collaborations with other employers, and monitoring. Conclusions Our review identified seven categories of inclusive practices that pertain to all stages of the employee journey of vulnerable workers. These categories move beyond those reported in studies based on employee samples, for instance by highlighting the importance of monitoring and collaborations with other employers. Hence, our findings stress that insight into employers' perceptions about effective measures is crucial to increase labour market participation of vulnerable groups.

Examining the impact of reasonable accommodation appraisals on New Zealand managers' attitudes toward hiring people with disability

Purpose

Managers are responsible for implementing reasonable accommodation (RA) for people with disabilities (PwD). Yet, little is known about the extent to which managerial views of RA shape attitudes toward PwD. The study draws on conservation of resources (COR) and job demands and resources (JD-R) theories to examine the relationship between managerial views of RA availability and implementation ease on attitudes towards hiring PwD.

Design/methodology/approach

In total, 162 full-time managers at a large New Zealand (NZ) healthcare organisation completed an online survey. Moderated multiple regressions were conducted to test the main effects and interactions between perceptions of RA process and attitudes towards hiring PwD.

Findings

The study results indicate that line managers held positive attitudes towards hiring PwD when they viewed RA implementation as easy, particularity around the provision of flexible work arrangements.

Research limitations/implications

This study shows the importance of gaging managers' views of RA processes to understand their attitudes toward PwD and highlights potential linkages between managerial perspectives on RA, PwD experiences in the organisation and the effectiveness of disability support and inclusion initiatives.

Practical implications

RA availability from the organisation is insufficient to elicit positive managerial attitudes toward hiring PwD. Policies and procedures that reduce RA implementation complexity are expected to foster positive managerial attitudes toward PwD and improve employment outcomes for this employee group.

Originality/value

This study is the first to test how managerial attitudes towards hiring PwD are influenced by views of RA availability from the organisation and of RA implementation ease. It also provides a multidimensional measure that captures managerial views of RA availability from the organisation and RA implementation ease.

A "win-win" perspective on workplace accommodations: RETAIN Kentucky's self-advocacy guide to promote successful return to work and stay at work outcomes for workers with disabilities

BACKGROUND

Research has long documented the low cost and effectiveness of most workplace accommodations to enable qualified people with disabilities to seek, secure, and maintain employment.

OBJECTIVE AND METHOD

RETAIN Kentucky's return to work and stay at work intervention involves focused training for participants on requesting needed accommodations from their employers.

RESULTS

In this article, we describe the win-win approach to reasonable accommodations, which serves as the basis for helping Kentuckians with disabilities identify and request on-the-job supports to aid in their efforts to remain in the workforce.

CONCLUSIONS

Workers with disabilities are more likely to stay in the workforce and continue making valuable contributions to the national and global economies if they have effective accommodations and other employment supports available to them.

Workplace accommodations during the COVID-19 pandemic: A scoping review of the impacts and implications for people with disabilities

BACKGROUND

The COVID-19 pandemic has led to widespread changes in the way people work. Some of these changes represent the same kinds of work modifications or adjustments that have often been requested as workplace accommodations, and which may improve labour market and employment outcomes for people with disabilities.

OBJECTIVE

The aim of this scoping review was to examine the literature on workplace accommodations in the pandemic and their impacts and implications for people with disabilities.

METHODS

Following a search of six international databases, articles were selected by two reviewers, and data were abstracted in accordance with scoping review methodology. A thematic analysis was used to report the relevant findings.

RESULTS

Thirty-seven articles met the inclusion criteria, and three main themes were identified: positive impacts of pandemic-related workplace accommodations on people with disabilities (e.g., improved accessibility, reduced stigma around workplace accommodations, rapid implementation of workplace accommodations, opportunities for advocacy); negative impacts (e.g., worsened physical and mental health, new accommodation needs); and action needed and recommendations (e.g., revisit legislation and policy on accommodations, ensure representation of people with disabilities). Overall, our review identified a mixed assessment of the impacts of pandemic-related accommodations on people with disabilities. However, there was a broader consensus regarding the importance of learning from the experiences of the pandemic to improve workplace accommodation policies in the future.

CONCLUSIONS

The pandemic may present opportunities for improving workplace accommodation policies, but our review also highlights the need for more research examining how workplace changes due to the COVID-19 pandemic have impacted people with disabilities.

Employers’ Perceptions of Challenges and Strategies in Hiring, Retaining, and Promoting Employees With Physical Disabilities

Disability is a common component of human diversity, yet people with disabilities (PWD) are underrepresented in the workplace despite known benefits to PWD and companies alike. There is an urgent need to promote inclusion of PWD in the workplace. The purpose of this study was to explore employer-perceived challenges and strategies for employing, retaining, and promoting people with physical disabilities (PWPD) and to describe the policies, supports, and job accommodations they provide to PWPD. We administered a cross-sectional, online survey to employers in the Midwestern United States ( n = 53). Employers had an average of 8.5 years of experience in their job roles and represented diverse industries and company sizes. Employers provide a range of job accommodations; however, many reported lacking comprehensive disability policies such as training managers on how to support PWPD, providing employee resource groups for PWPD, and having a specific job accommodation fund. Major challenges reported by employers were related to lacking competencies in supporting employees with physical disabilities. However, employers endorsed the utility of strategies to address these challenges, including providing education and training and increasing buy-in from leadership. Study findings inform employers on ways to best support PWPD and improve diversity, equity, and inclusion in the workplace.

Conceptualizing disability accommodation device acceptance by workgroups through a sociomaterial lens

Purpose

The provision of accommodation devices is said to aid organizational inclusion of employees with a disability. However, devices that are meant to enable might only partially facilitate productivity, independence, and social inclusion if these devices are not accepted by the user's workgroup. The authors outline a conceptual model of accommodation device acceptance through a sociomaterial lens to suggest conditions influencing workgroup device acceptance.

Design/methodology/approach

To build the model, the authors draw upon the sociomateriality and disability literature to frame accommodation devices as experienced in ongoing interactions, representing the goals, feelings, and interpretations of specific workgroups. The authors also unpack attributes of devices—instrumentality, aesthetics, and symbolism—and propose how each of these can pattern social conduct to influence device acceptance. The authors then draw upon the disability literature to identify attributes of workgroups that can be expected to amplify or diminish the effect of device attributes on device acceptance in that workgroup.

Findings

The conceptualization, which the authors illustrate with examples particular to visual impairment, presents implications for who and what serves as a gatekeeper to accommodation device acceptance and thereby workgroup inclusion.

Originality/value

Prior research has focused on conditions under which devices are requested by users or made available by organizations, undergirded by the assumption that devices are well-specified once provided and that they operate relatively predictably when used in various workgroups. The authors focus instead on what happens after the device is provided and highlight the complex and dynamic interaction between an accommodation device and the workgroup, which influences device and user acceptance.

Changes in healthy and unhealthy working life expectancies among older working-age people in Finland, 2000-2017

Background

Raising the statutory retirement age has been a common policy response to population ageing, but health problems may restrict labour force participation in older ages. We examined the development of healthy and unhealthy working life expectancies in Finland from 2000 to 2017 using different measures of health problems.

Methods

Healthy and unhealthy working life expectancies were calculated for the age range 50–65 years using the Sullivan method. The health measures were limiting long-standing illness, self-rated health, mental health problems and self-assessed work ability.

Results

Healthy working life expectancy was highest when health was measured by work ability. From 2000 to 2017, working years in full ability between the ages 50–65 increased from 6.2 (95% confidence interval 5.9–6.4) to 8.2 (8.0–8.5). Healthy working life expectancy increased also when measured by the other indicators. Unhealthy working years also increased, except when health problems were measured by limiting long-standing illness. The share of years in work increased both within the healthy and the unhealthy years, the increase being larger or equally large for the latter. Within the healthy and unhealthy years measured by the other three indicators, the share of working years increased irrespective of whether work ability was full or limited, but the increase was larger for limited work ability.

Conclusions

In Finland, healthy working life expectancy has increased irrespective of how health is measured but also working with health problems has become more prevalent. The estimates for healthy working years are highest when a direct measure of work ability is used.

Inclusion of young people with disabilities in the future of work: forecasting workplace, labour market and community-based strategies through an online and accessible Delphi survey protocol

INTRODUCTION

The future of work is expected to transform the nature of work, create unique employment barriers for young people living with disabilities and disrupt pathways to better health. We present a Delphi survey protocol through which we aim to obtain future-oriented strategies that can improve the accessibility and inclusion of young people with disabilities in the future of work.

METHODS AND ANALYSIS

The Delphi survey will be conducted primarily online, over two rounds and in a format that is accessible to people living with disabilities. A diverse sample of subject matter experts (eg, policy makers, employment service providers, labour market experts) and participants with lived experience of a disability will be recruited using a purposive sampling strategy. All participants will be asked to complete both rounds of the Delphi survey. In the first round, open-ended questions will be asked about workplace, community-based or policy supports that can foster the inclusion of young people with disabilities in the labour market and that can also address specific future of work trends which span sociopolitical, economic, environmental and technological domains. In the second round of the survey, we will aim to build consensus; participants will be provided with a summary of specific strategies that correspond to the different future of work trends emerging from round one and will be asked to rank-order strategies according to their importance. Following the completion of the second round, consensus-based and future-focused recommendations will be generated that can support young people with disabilities in the world of work over the coming decades.

ETHICS AND DISSEMINATION

The study protocol has been cleared by the University of Toronto's research ethics board (#40727). The study will identify future-focused support strategies that will be shared with people living with disabilities, policy makers and disability employment service providers through an integrated knowledge transfer and exchange approach.

The Role of the Employer in Supporting Work Participation of Workers with Disabilities: A Systematic Literature Review Using an Interdisciplinary Approach

Purpose There is growing awareness that the employer plays an important role in preventing early labor market exit of workers with poor health. This systematic review aims to explore the employer characteristics associated with work participation of workers with disabilities. An interdisciplinary approach was used to capture relevant characteristics at all organizational levels. Methods To identify relevant longitudinal observational studies, a systematic literature search was conducted in PubMed, Web of Science, PsycINFO and EconLit. Three key concepts were central to the search: (a) employer characteristics, (b) work participation, including continued employment, return to work and long-term work disability, and (c) chronic diseases. Results The search strategy resulted in 4456 articles. In total 50 articles met the inclusion criteria. We found 14 determinants clustered in four domains: work accommodations, social support, organizational culture and company characteristics. On supervisor level, strong evidence was found for an association between work accommodations and continued employment and return to work. Moderate evidence was found for an association between social support and return to work. On higher organizational level, weak evidence was found for an association between organizational culture and return to work. Inconsistent evidence was found for an association between company characteristics and the three work outcomes. Conclusions Our review indicates the importance of different employer efforts for work participation of workers with disabilities. Workplace programs aimed at facilitating work accommodations and supervisor support can contribute to the prevention of early labor market exit of workers with poor health. Further research is needed on the influence of organizational culture and company characteristics on work participation.

Employment outcomes and experiences of people with seeing disability in Canada: An analysis of the Canadian Survey on Disability 2017

Background

Many individuals with disabilities face barriers to meaningful employment. Legislation has been put in place to ensure employment equity for individuals with disabilities in Canada. However, little is known about the employment profile and experiences of people with seeing disabilities.

Objectives

The objectives of our research study were to explore the employment rates of people with seeing disabilities in Canada, the factors associated with being employed, and supports and barriers that affect their work participation.

Methods

We used the nationally representative data from the Canadian Survey on Disability (CSD) 2017, collected by Statistics Canada. The CSD is a national cross-sectional survey of Canadians 15 years of age and above who face a functional limitation due to a health-related condition, representing more than 6 million (n = 6,246,640) Canadians. Our analyses focused on people who reported having a seeing disability. A subset of the complete dataset was created, focusing on individuals with a seeing disability. Weighted descriptive analyses were performed using SPSS. Multivariate logistic regression analyses were conducted for individuals between 25–64 years of age to identify predictors of employment.

Results

Out of the estimated 892,220 working-age adults (25–64 years) with a seeing disability who were represented by the survey, 54% were employed, 6% were unemployed and 40% were not in the labour force. Early onset of seeing disability (OR: 1.33; 95% CI: 1.32–1.35), less severe seeing disability (OR: 1.51; 95% CI: 1.49–1.53), education above high school (OR: 2.00; 95% CI: 1.97–2.02) and daily use of the internet (OR: 2.46; 95% CI: 2.41–2.51) were positively related with employment. The top three employment accommodations that were needed and were made available included: modified work hours (45%); work from home (38.5%) and a modified workstation (37%). The top three needed but least available accommodations were technical aids (14%), communication aids (22%) and a computer with specialized software or adaptation (27%). Overall, 26% reported that an accommodation was required but was not made available by the employer. While 75% of individuals with a seeing disability were out of the labour force due to their condition, the remaining identified barriers that prevented them from working which included (top 3): (i) too few jobs available (20%); (ii) inadequate training/experience (19%), (iii) past attempts at finding employment were unsuccessful (19%).

Conclusion

Adults with seeing disability in Canada experience lower labour force participation than the general population. Rigorous programs are required to assist them with the job search, job retraining and workplace accommodations. It is important for governments to improve efforts towards inclusive education and develop strategies that promote digital literacy of employees and job seekers with visual impairments. Although accessibility legislations have been put in place, programs should be established that provide accessibility solutions for various employers, enabling them to hire individuals with different abilities.

Case study on the effects of a disability inclusive mindset in a large biotechnology company

Purpose

Employers increasingly seek a competitive advantage through inclusive hiring practices and recruitment of persons with disabilities. Early research indicates when employers consider individuals for their strengths rather than solely for their needs, the organization prospers. However, details about how companies pursue a disability inclusive workplace and the effect of those efforts are poorly understood.

Design/methodology/approach

An inductive qualitative case study approach was utilized to understand one biotechnology corporation and their approach to recruiting, hiring, and retaining employees with disabilities. Individual and focus group interviews were conducted.

Findings

Results suggest that when the company lives its mission around wellness and inclusivity, they benefit from working with and learning from a range of perspectives, furthering their growth. Placing equal emphasis on hiring a diverse workforce and prioritizing supports and wellness practices lead to greater productivity and innovation.

Practical implications

This study illustrates how one company successfully recruits and hires persons with disabilities, resulting in benefits to their financial bottom line and to the organizational culture.

Originality/value

This paper offers insights for other companies intentionally hiring persons with disabilities, providing accommodations in the workplace, and creating an organizational culture where all employees feel valued and supported. These steps have a direct impact on employee engagement, productivity, and retention.

Job Accommodations, Return to Work and Job Retention of People with Physical Disabilities: A Systematic Review

Purpose We aimed to identify job accommodations that help persons with physical disabilities maintain or return to work and explore the barriers and facilitators that influence the provision and reception of job accommodations. Methods We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered in PROSPERO (CRD42019129645). The search strategy incorporated keywords describing physical disabilities, employer-approved job accommodations, and employment retention or return to work approaches. We searched MEDLINE, the Cochrane Library, Embase, CINAHL, PsycINFO, Web of Science, and ProQuest Theses and dissertations. Reviewers independently selected studies for inclusion. We used Hawker et al.'s method to assess study quality. Results We identified 2203 articles, of which 52 met inclusion criteria, developed a table of job accommodations commonly used by persons with physical disabilities, summarized the percentages of job accommodations used by persons with disabilities, synthesized evidence of the effectiveness of job accommodations, and identified the factors that influence job accommodation use. The most frequently reported accommodations were as follows: modification of job responsibilities, change of workplace policy, supportive personnel provision, flexible scheduling, and assistive technology. We summarized four types of facilitators and barriers that affect job accommodation use: employee-related factors, accommodation-related factors, job-related factors, and social workplace-related factors. Conclusion The absence of randomized controlled trials and prevalence of cross-sectional surveys provides inconclusive evidence regarding the effectiveness of specific job accommodations for people with particular functional limitations. Our system of categorizing job accommodations provides a guide to investigators seeking to evaluate the effectiveness of job accommodations using experimental methods.

Helpfulness of Workplace Accommodations in Maintaining Health and Work Ability in Older Employees with Poor Health in Germany

OBJECTIVE

Supporting employees with health impairments to stay at work through workplace accommodation is a well-researched topic. However, research on workplace accommodations for older employees is lacking.

METHODS

Cross-sectional data from the German lidA cohort study in 2018 focusing on older employees who reported poor health (n = 421) was analyzed. A multiple logistic regression analysis was conducted to asses a potential association between the accommodation type and perceived helpfulness of workplace accommodations in older employees with poor health.

RESULTS

Changes in working times (OR 6.59), in work tasks (OR 3.50) and in the workplace (OR 2.57) were perceived as most helpful.

CONCLUSION

The results indicate that workplace accommodations can be helpful in older employees with health impairments and that this is not by chance, but that the perceived effectiveness has determinants and can be influenced.

The role of workplace accommodations in explaining the disability employment gap in the UK

There has been limited theoretical and empirical research into the role of workplace accommodations in enabling workers with and without impairments to remain in work. This study used the International Classification of Functioning, Disability and Health (ICF) model to examine (a) whether workplace accommodations enable workers, particularly those with different impairments, to remain economically active; and (b) the predictors of the onset of work accommodations. Data from two waves of a large-scale longitudinal survey of disability in Great Britain, the Life Opportunities Survey (2009-2012) were analysed. 2307 workers with an impairment and 4308 workers without an impairment were followed up for a year. Work accommodations appear to enable workers with impairments to remain economically active, especially those with mental impairments. There was no difference in the employment rates of workers with and without mental impairments who had two or more work accommodations, in contrast to the 10% employment gap between workers with and without mental impairments who did not have any work accommodations. While there was no gender difference in the disability employment gap, barriers to employment related to caregiving were much greater for women compared to men. Moreover, only workers with incident pain impairments were associated with an increase in their work accommodations, not workers with incident mental impairments. Despite the evidence that workers with mental impairments could benefit considerably from workplace accommodations, they are less likely to have their workplace adjusted. The ICF model is particularly useful in analysing the role of work accommodations because it considers a much wider range of factors that are relevant not just to workers with different types of impairments, but are also relevant to the wider group of workers who use workplace accommodations.

Barriers to and facilitators of employment of persons with disabilities in low- and middle-income countries: A scoping review

BACKGROUND

Unemployment rates for persons with disabilities in low- and middle-income countries (LMICs) are high. This is despite the call to action by the United Nations Convention on the Rights of Persons with Disabilities and Sustainable Development Goals aimed at improving the economic well-being of the marginalised. To improve the employment outcomes of persons with disabilities in these countries, factors that facilitate and hinder employment should be explored.

OBJECTIVES

This study explored barriers to and facilitators of employment for persons with disabilities in LMICs through a scoping review.

METHODS

A search strategy included a systematic search of nine databases using specific keywords. The International Classification of Functioning, Disability and Health (ICF) framework was used as a conceptual framework and barriers and facilitators were reported according to the domains of the ICF. Articles published between 2008 and 2020 were reviewed using a predefined criteria.

RESULTS

Thirty-two studies were identified in the review. Factors were identified in all domains of the ICF: (1) body function and body structure (12; 39%); (2) activities and participation (13; 42%); (3) personal factors (23; 74%); (4) environmental factors (27; 84%).

CONCLUSION

Factors that hinder and facilitate the participation of persons with disabilities in LMICs were mainly found in the environment, with personal factors also influencing participation. The presence of negative attitudes and lack of services mainly in health and transport were major factors within the environment whilst personals factors included the lack of educational qualifications and skills. These results indicate the importance of consideration of contextual factors when developing intervention strategies aimed at facilitating the employment of persons with disabilities in LMICs.

Disability and sex/gender intersections in unmet workplace support needs: Findings from a large Canadian survey of workers

INTRODUCTION

Individual attributes including disability and sex/gender have the potential to intersect and determine the likelihood of unmet workplace support needs. Our study compares unmet workplace support needs between workers with and without a disability, and according to disability type and sex/gender differences.

METHODS

Workers with (n = 901) and without (n = 895) a disability were surveyed to examine their need and use of workplace supports including job accommodations, work modifications and health benefits. A multivariable logistic model was conducted to examine the relationship between disability status, disability type and sex/gender and unmet workplace support needs. The model included interaction terms between sex/gender × physical disability, sex/gender × nonphysical disability, and sex/gender × physical and nonphysical disability.

RESULTS

Among participants with a disability, 24% had a physical disability, 20% had a nonphysical disability (e.g., cognitive, mental/emotional or sensory disability) and 56% had both physical and nonphysical disability. Over half of the respondents were women (56%). Results from the multivariable model showed that nondisabled women were more likely to report unmet workplace support needs when compared to nondisabled men (odds ratio [OR] = 1.54, 95% confidence interval [CI], 1.13-2.10). Findings also showed an intersection between the number and type of disability and sex/gender; women with both a physical and nonphysical disability had the greatest likelihood of reporting unmet workplace support needs when compared to nondisabled men (OR = 2.73; 95% CI, 1.83-4.08).

CONCLUSIONS

Being a woman and having one or more disabilities can determine unmet workplace support needs. Strategies to address workplace support needs should consider the intersection between disability and sex/gender differences.

Facilitators of and barriers to return to work after mild traumatic brain injury: A thematic analysis

Individuals with mild traumatic brain injury (mTBI) may experience protracted symptoms affecting their ability to work. Several actors may facilitate or act as a barrier to a successful return to work (RTW). This qualitative study used semi-structured in-depth interviews with 22 adults with mTBI at 2-5 years post injury, targeting experiences of how different actors facilitated or acted as a barrier in the RTW process, and encompassed the mTBI trajectory from the acute phase to the post-acute phase. A thematic analysis with a hermeneutical phenomenological approach was used to analyse data. Three main themes emerged. (1) Worker-employer relationship: Workplace accommodations such as decreased working hours, modified working conditions, and support from co-workers were lacking. (2) The role of the general practitioner: The general practitioner was lacking treatment and referral opportunities and failed to provide the patient with relevant and individualized guidance. (3) Municipal case management: Participants perceived being met with distrust by social workers, follow-up assessments were too frequent, unnecessary, and did not target concussion, and rehabilitation was referred too late. Clinical practice guidelines to improve referral to relevant concussion rehabilitation in case of persistent symptoms are needed to inform clinicians, employers, and public institutions to facilitate a successful RTW.

Disabling organizational spaces: Exploring the processes through which spatial environments disable employees with impairments

Adopting a Lefebvrian perspective that draws attention to the connection between space and power, this study aims to contribute to the organizational literature by offering an in-depth understanding of the processes through which organizational spaces can disable employees with impairments and contribute to the unequal power relations between disabled and non-disabled employees. Based on 65 interviews, it shows how organizational spaces can disable employees with impairments through disabling productivity, social inclusion, independence, and physical comfort and safety. A first contribution this allows this study to make is identifying the different aspects involved in the production of ableist organizational spaces and the way they are connected to the relations of power between disabled and non-disabled employees. It shows how ableist organizational spaces are conceived in an ableist way, become dominated by ableist spatial practice and infuse lived experiences with ableism. Second, this study extends debates on disability in organizations by offering a spatial understanding of ableist notions of the ‘ideal employee’, the reproduction of ableist discourses, and embodied experiences of ableism in organizations. A third contribution this article makes is providing an understanding of the strategies employers and disabled employees use to (attempt to) manage ableist organizational spaces. It argues that as these strategies mainly aim to secure productive participation, they do not address, or can even contribute to, other disabling processes. In this way, they not only reproduce relations of power between employers and disabled employees but also do not fundamentally challenge those between disabled and non-disabled employees.

Health complaints and work experiences among adults with neurofibromatosis 1

BACKGROUND

Neurofibromatosis type 1 (NF1) is a rare genetic disorder with usually benign nerve tumours, skin problems, pain and cardiovascular problems among common complications.

AIMS

To examine work participation and experiences in relation to health complaints among adults with NF1.

METHODS

We conducted a cross-sectional self-reported survey among 142 persons with NF1 (mean age = 50.3 years, SD = 12.0; 62% females). We measured physical and social dimensions of work experiences with eight items from the third wave of the epidemiological survey 'Nord-Trøndelag Health Study' (HUNT3). We compared NF1 data to 27 036 HUNT3 controls. We measured health complaints with the 29-item Subjective Health Complaints Inventory (SHC; subscales musculoskeletal pain, pseudoneurology and gastrointestinal problems) and compared NF1 data to norms.

RESULTS

Compared to controls, significantly more persons with NF1 reported workplace bullying (13% versus 5%) and work as physically exhausting (74% versus 44%), whereas fewer reported work autonomy (64% versus 80%). Women with NF1 reported significantly more SHC than female norms (99% versus 86%). Men with NF1 reported significantly more pseudoneurology and gastrointestinal problems compared to male norms (76% versus 58%). SHC explained 9% of the variance in physical work experiences (β = -0.47; 95% CI -0.76 to -0.19) and 8% of the variance in social work experiences (β = 0.48; 95% CI 0.18-0.78).

CONCLUSION

Persons with NF1 experience more physical and social work problems, and both work domains were related to health complaints. Individualized assessment and information to co-workers and managers may represent ways to increase work participation among persons with NF1.

Perceived interpersonal and institutional discrimination among persons with disability in the U.S.: Do patterns differ by age?

RATIONALE

One-third of U.S. adults have an activity-limiting health condition and this proportion increases with age. However, it is unclear whether functional limitation renders one vulnerable to institutional and interpersonal discrimination, and whether this vulnerability differs over the life course. Stigma theories suggest disability would be more discrediting to younger persons relative to older adults, as it violates cultural norms and expectations regarding able-bodied working-age adults.

OBJECTIVE

We evaluate whether U.S. adults with functional impairment report higher levels of perceived interpersonal mistreatment and institutional discrimination relative to persons without impairment, and whether these patterns differ across age groups.

METHOD

We use data from the second wave of the National Survey of Midlife Development in the United States (MIDUS II), collected between 2004 and 2006 (n = 3931). We estimate OLS and logistic regression models to predict interpersonal and institutional discrimination, respectively.

RESULTS

Persons with impairment report more frequent encounters of disrespectful treatment, insults, and being treated as if they have a character flaw, and elevated odds of workplace- and service-related discrimination, net of sociodemographic, and physical and mental health characteristics. Effects are significantly larger among early (age 40-49) and late (age 50-64) midlife versus older (age 65+) adults.

CONCLUSIONS

We discuss implications for policy and practice, and underscore that stigmatization processes may further amplify health and socioeconomic disparities between those with versus without functional limitations.

Supporting the Transition into Employment: A Study of Canadian Young Adults Living with Disabilities

Objective To examine the job accommodation and benefit needs of young adults with disabilities as they transition into employment, and their perceived barriers to meeting support needs. Methods An online survey was conducted of 155 Canadian young adults with disabilities (mean age = 25.8 years). Respondents were either employed or seeking employment, and were asked about their need for health benefits, and soft (e.g., flexible scheduling) and hard accommodations (e.g., ergonomic interventions), and perceived accommodation barriers. Disability characteristics (e.g., disability type), demographic details and work context information were collected. Multivariable logistic analyses were conducted to examine the factors associated with a greater need for health benefits and hard and soft accommodations. Result Participants reported having a physical (79%), psychological (79%) or cognitive/learning disability (77%); 68% had > 1 disability. Over half (55%) were employed. Health benefits and soft accommodations were most needed by participants. Also, an average of six perceived accommodation barriers were indicated; difficulty with disability disclosure was most frequently reported. More perceived accommodation barriers were associated with a greater need for health benefits (OR 1.17, 95% CI 1.04-1.31) and soft accommodations (OR 1.13, 95% CI 1.01-1.27). A psychological disability was a associated with a greater need for health benefits (OR 2.91, 95% CI 1.09-7.43) and soft accommodations (OR 3.83, 95% CI 1.41-10.42). Discussion Employers can support the employment of young adults with disabilities through provision of extended health benefits and soft accommodations. Addressing accommodation barriers could minimize unmet workplace need, and improve employment outcomes for young adults with disabilities as they begin their career and across the life course.

Work-focused interventions that promote the labour market transition of young adults with chronic disabling health conditions: a systematic review

Objective

Young adulthood is an important transitional life phase where careers are established. Young adults with chronic disabling health conditions are underrepresented in the labour market. Our study aims to examine the effectiveness of work-focused interventions that support the labour market transition of young adults with chronic disabling health conditions; and to examine whether the effectiveness of work-focused interventions differ across work transition phase (eg, preparation, entry and sustaining work, employment advancement) and disability type.

Methods

A systematic review of articles published between January 1990 and July 2018 was conducted. Medline, EMBASE and PsycInfo were searched, and titles/abstracts and full texts of articles were reviewed for eligibility. Relevant articles were appraised for methodological quality. A best evidence synthesis was applied to medium-quality/high-quality studies to develop recommendations.

Results

5816 articles were identified; 10 articles were relevant and of moderate–high methodological quality. Six intervention categories were identified which focused on young adults with mental health or intellectual/learning disabilities (n=3) and addressed employment preparation (n=10) and/or work entry (n=9). No interventions addressed at-work issues or career advancement. Strong evidence existed for tailored supported employment (SE) interventions having a positive impact on preparation and entry into competitive employment. Also, moderate evidence existed for the positive impact of SE on preparation and entry into competitive employment for young adults with mental health conditions.

Conclusions

Tailored SE is recommended to foster preparation and entry into the labour market. Evidence-based interventions are needed to facilitate sustained work and career advancement of young adults living with different disabling health conditions.