1
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Meierer K, Borry P, Sanchini V. Appropriate inclusion of adult research participants with intellectual disability: an in-depth review of guidelines and policy statements. Account Res 2024; 31:259-280. [PMID: 36031953 DOI: 10.1080/08989621.2022.2119136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
The history of human-subject experimentation has shown the need for safeguards to protect participants from abuse. Balancing participant protection with adequate representation of the adult intellectual disability population in research presents an important challenge. Our study aimed to analyze guidance on the appropriate inclusion of adults with intellectual disability who are or are not able to consent to biomedical research participation. Terminology, consent and type of ethically acceptable research provisions relevant to adult participants with intellectual disability were comprehensively reviewed in a selection of 17 international and national ethical research guidelines and statements. Most guidelines and statements recommend that adult participants with intellectual disability who are unable to consent be included when it is not possible to conduct the same research with adults capable of independent decision-making, or when there is therapeutic benefit and only minimal risk. Instead of naming specific requirements, the Australian statement stands out by asserting the "individual right" to participate. Assent requirements for incapacitated adults are not explicitly mentioned in most documents reviewed. There appears to be room for further description of the importance of careful capacity assessments and solid assent requirements in ethical research guidance documentation to promote meaningful participation of adults with intellectual disability.
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Affiliation(s)
- Klara Meierer
- Faculty of Medicine and Health Sciences, Department of Psychiatry, McGill University, Montreal Quebec, Canada
| | - Pascal Borry
- Department of Public Health and Primary Care, Center for Biomedical Ethics and Law, Leuven, Belgium
| | - Virginia Sanchini
- Department of Public Health and Primary Care, Center for Biomedical Ethics and Law, Leuven, Belgium
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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2
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Haines D, Wright J. Thinking in Stories: Narrative Reasoning of an Occupational Therapist Supporting People with Profound Intellectual Disabilities' Engagement in Occupation. Occup Ther Health Care 2023; 37:177-196. [PMID: 34965831 DOI: 10.1080/07380577.2021.2022260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This article illustrates narrative reasoning using the findings from research into an occupational therapy intervention promoting changes in the ways a staff team facilitated meaningful engagement in occupation. Qualitative critical ethnographic case study research explored a single case over one year of an occupational therapist working with five people with profound intellectual disabilities and their support network. Data were collected using participant observation, interviews and document analysis. Illustrated by an ethnodramatic vignette, the findings demonstrate how the occupational therapist reasoned narratively by eliciting, telling and creating stories and how this supported individualization of her intervention to the specific context. Creation of a prospective story that the support network were invited to share, guided and propelled the intervention toward its hoped-for ending. Narrative reasoning was particularly apparent in opportunities to reflect aloud, supporting occupational therapists' need of opportunities for reflection through story-sharing and story-making. Case study and ethnographic research methodologies may be useful in further clinical reasoning research to better understand narrative reasoning.
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Affiliation(s)
- David Haines
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Jon Wright
- School of Sport and Health Sciences, University of Brighton, Brighton, UK.,Occupational Therapy, University of Brighton, Brighton, UK
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3
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Zamir A, Band-Winterstein T. "I Do Not Think She Will Understand, This is Not a Situation for a Girl Like Her:" Disenfranchised Grief Among Adults with Intellectual and Developmental Disabilities in the Ultra-orthodox Jewish Society. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221141941. [PMID: 36427817 DOI: 10.1177/00302228221141941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
This article examines the experience of aging ultra-Orthodox families alongside a person with intellectual and developmental disabilities (IDD) in relation to parents' illness and death, followed by grief. In-depth interviews were conducted with 14 family units. Each family unit included the person with IDD, a parent, and a sibling-a total of 43 participants. Three main themes emerged: A. The difficulty in confronting illness and dying of parents alongside a family member with IDD in an Ultra-Orthodox Context. B. Exclusion of the person with IDD from parents' memorial events. C. Religious ceremonies as a strategy for coping with mourning among persons with IDD. The discussion focuses on the concept of disenfranchised grief in a religious context and its impact on the family support system. Culturally sensitive therapeutic recommendations are made for professionals working with older ultra-Orthodox Jewish families alongside a person with IDD in the context of the subject.
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Affiliation(s)
- Alon Zamir
- The Minerva Center on Intersectionality in Aging (MCIA), University of Haifa, Haifa, Israel
- The Kibbutzim College of Education, Tel Aviv, Israel
- Depatment of Community Mentel Health, University of Haifa, Haifa, israel
| | - Tova Band-Winterstein
- The Minerva Center on Intersectionality in Aging (MCIA), University of Haifa, Haifa, Israel
- Department of Gerontology, University of Haifa, Haifa, Israel
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4
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Sellers A, Hudson S, Ledger J, Moorehouse C, Young C, Groeber I, Knight B, Mill J, Allard J, Shankar R. Designing genetic studies for people with intellectual disabilities: Practical lessons from a pilot study. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2022. [DOI: 10.1111/jppi.12445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | - Ian Groeber
- Cornwall Partnership NHS Foundation Trust Truro UK
| | - Bridget Knight
- NIHR Exeter Clinical Research Facility RD&E NHS Foundation Trust Exeter UK
- University of Exeter Medical School Exeter UK
| | | | - Jon Allard
- Cornwall Partnership NHS Foundation Trust Truro UK
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust Truro UK
- University of Exeter Medical School Exeter UK
- Cornwall Intellectual Disabilities Equitable Research (CIDER) University of Plymouth Medical School Truro UK
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5
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Helena T, Magnus T, Carin SN. People with intellectual disability and employment sustainability: A qualitative interview study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 36:78-86. [PMID: 36129123 PMCID: PMC10087293 DOI: 10.1111/jar.13036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Swedish employment rates are disproportionately low among people with intellectual disability and research on employment sustainability in this group is scarce. This study investigated employment sustainability among people with intellectual disability, with a focus on identifying facilitators. METHOD Fifteen persons with intellectual disability who were gainfully employed and had been so for at least 1 year during the last 3 years, and 10 representatives from their employers, were interviewed. RESULTS Five facilitators were identified: (1) having tried various types of work, (2) liking to be at work, (3) balance concerning expectations and adaptations, (4) mutual engagement and flexibility, and (5) wage subsidies. CONCLUSION Employment sustainability needs to be understood at individual as well as environmental and societal levels. In addition, both duration and progress should be considered regarding employment sustainability in this population.
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Affiliation(s)
- Taubner Helena
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Tideman Magnus
- School of Health and Welfare, Halmstad University, Halmstad, Sweden.,School of Allied Health, Human services and Sport, La Trobe University, Melbourne, Victoria, Australia
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6
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Mathan JJ, Simkin SK, Gokul A, McGhee CNJ. Down syndrome and the eye: ocular characteristics and ocular assessment. Surv Ophthalmol 2022; 67:1631-1646. [DOI: 10.1016/j.survophthal.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 01/20/2023]
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7
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Hole R, Schnellert L, Cantle G. Sex: What Is the Big Deal? Exploring Individuals' with Intellectual Disabilities Experiences with Sex Education. QUALITATIVE HEALTH RESEARCH 2022; 32:453-464. [PMID: 34923868 PMCID: PMC8796054 DOI: 10.1177/10497323211057090] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
This article offers perspectives shared by self-advocates in the first phase of a community-based participatory research project untaken to address barriers that individuals with intellectual disabilities face with respect to sexual health knowledge. Using descriptive qualitative methods, we interviewed 19 individuals with intellectual disability about their experiences and knowledge related to sexual health. The research question guiding this project was: What are self-advocates' with intellectual disabilities experiences learning about sexual health and sexuality? The findings highlight that participants faced barriers and lack of access to sexual health education, and while they learned about sexual health through formal sexual health education, frequently this knowledge came through lived experience. Finally, the findings underscore that participants knew what they wanted with respect to sexual health education and offered recommendations. The importance of accessible sexual health education for self-advocates that supports their rights and desires to express their sexuality and sexual agency is highlighted.
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Affiliation(s)
- Rachelle Hole
- UBC Okanagan School of Social Work, UBC Canadian Institute for Inclusion and Citizenship, Kelowna, BC, Canada
- Rachelle Hole, UBC Canadian Institute for Inclusion and Citizenship, ARTS/FHSD 1147 Research Road, 3333 University Way, Kelowna, BC V1V 1V7, Canada.
| | | | - Gloria Cantle
- UBC Okanagan School of Social Work, UBC Canadian Institute for Inclusion and Citizenship, Kelowna, BC, Canada
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8
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Fortune N, Madden RH, Clifton S. Health and Access to Health Services for People with Disability in Australia: Data and Data Gaps. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11705. [PMID: 34770219 PMCID: PMC8583158 DOI: 10.3390/ijerph182111705] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/17/2022]
Abstract
The right of people with disability to enjoyment of the highest attainable standard of health without discrimination on the basis of disability is enshrined in the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Among its obligations as a signatory to the CRPD, Australia is required to collect appropriate information, including statistical and research data, to inform development and implementation of policies to give effect to the Convention. In this commentary, we first describe how the International Classification of Functioning, Disability and Health (ICF) conceptual model of disability can be operationalised in statistical data collections, with a focus on how this is achieved in key Australian data sources such that people with disability can be identified as a population group. We then review existing statistical data on health and health service use for people with disability in Australia, highlighting data gaps and limitations. Finally, we outline priorities and considerations for improving data on health and access to health services for people with disability. As well as conceptual, practical, and ethical considerations, a key principle that must guide future disability data development is that people with disability and their representative organisations must be involved and participate fully in the development of disability data and statistics, and in their use.
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Affiliation(s)
- Nicola Fortune
- Centre for Disability Research and Policy, The University of Sydney, Susan Wakil Health Building, Western Ave., Camperdown, NSW 2050, Australia; (R.H.M.); (S.C.)
- Centre of Research Excellence in Disability and Health, University of Melbourne, 207 Bouverie Str., Carlton, VIC 3053, Australia
| | - Rosamond H. Madden
- Centre for Disability Research and Policy, The University of Sydney, Susan Wakil Health Building, Western Ave., Camperdown, NSW 2050, Australia; (R.H.M.); (S.C.)
| | - Shane Clifton
- Centre for Disability Research and Policy, The University of Sydney, Susan Wakil Health Building, Western Ave., Camperdown, NSW 2050, Australia; (R.H.M.); (S.C.)
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9
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Riggs NR, Hepburn SL, Pinks ME, Fidler DJ. A prevention science approach to promoting health and quality of life for individuals with intellectual and developmental disabilities. INFANT AND CHILD DEVELOPMENT 2021. [DOI: 10.1002/icd.2278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nathaniel R. Riggs
- Human Development and Family Studies Colorado State University Fort Collins Colorado USA
- Prevention Research Center Colorado State University Fort Collins Colorado USA
| | - Susan L. Hepburn
- Human Development and Family Studies Colorado State University Fort Collins Colorado USA
| | - Miranda E. Pinks
- Human Development and Family Studies Colorado State University Fort Collins Colorado USA
| | - Deborah J. Fidler
- Human Development and Family Studies Colorado State University Fort Collins Colorado USA
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10
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Dew A. Protocol Paper: Conducting Life History Interviews to Explore the Journeys of People with Disability from Syrian and Iraqi Refugee Backgrounds Settling in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157978. [PMID: 34360269 PMCID: PMC8345357 DOI: 10.3390/ijerph18157978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022]
Abstract
This paper outlines a research protocol to be undertaken with people with disability from Syrian and Iraqi refugee backgrounds settling in Australia. Since 2012, the numbers of people with disability arriving from these countries has increased with limited understanding about the impact of their refugee journeys on their settlement. The aim of this small-scale exploratory study is to learn about the journeys made by people with disability from Syrian and Iraqi refugee backgrounds from their countries of origin, through transit countries, to Australia in order to understand the impact of these journeys on inclusion and participation in Australian society. This participatory action research study employs a bilingual co-researcher with disability from a Syrian background to conduct life history interviews with up to five participants. Participants will recount their journeys with a focus on the impact of their disability on this experience. The study design is informed by BenEzer and Zetter’s 2014 seminal paper on the importance of the refugee journey to settlement. This study has the potential to foreground the voices and experiences of people with disability from refugee backgrounds who are often absent, silenced or excluded in research and, in so doing, hopefully impact Australian refugee policy.
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Affiliation(s)
- Angela Dew
- School of Health and Social Development, Institute of Health Transformation, Deakin University, Geelong 3211, Australia
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11
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Wheeler AC, Wylie A, Raspa M, Villagomez A, Miller K, Edwards A, DeRamus M, Appelbaum PS, Bailey DB. Decisional Capacity for Informed Consent in Males and Females with Fragile X Syndrome. J Autism Dev Disord 2020; 50:1725-1747. [PMID: 30825084 DOI: 10.1007/s10803-019-03930-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although informed consent is critical for all research, there is increased ethical responsibility as individuals with intellectual or developmental disabilities (IDD) become the focus of more clinical trials. This study examined decisional capacity for informed consent to clinical trials in individuals with fragile X syndrome (FXS). Participants were 152 adolescents and adults (80 males, 72 females) with FXS who completed a measure of decisional capacity and a comprehensive battery of neurocognitive and psychiatric measures. Females outperformed males on all aspects of decisional capacity. The ability to understand aspects of the clinical trial had the strongest association with the ability to appreciate and reason about the decision. Scaffolding improved understanding, suggesting researchers can take steps to improve decisional capacity and the informed consent process.
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Affiliation(s)
- Anne C Wheeler
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA.
| | - Amanda Wylie
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | - Melissa Raspa
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | - Adrienne Villagomez
- Children's Hospital Colorado, Anschutz Medical Campus, 13123 East 16th Avenue, Aurora, CO, 80045, USA.,Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, 101 Renee Lynne Court, Carrboro, NC, 27714, USA
| | - Kylee Miller
- Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.,Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, 101 Renee Lynne Court, Carrboro, NC, 27714, USA
| | - Anne Edwards
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | - Margaret DeRamus
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, 101 Renee Lynne Court, Carrboro, NC, 27714, USA
| | - Paul S Appelbaum
- Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Unit 122, New York, NY, 10032, USA
| | - Donald B Bailey
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
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12
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Wark S, MacPhail C, McKay K, Müeller A. Informed consent in a vulnerable population group: supporting individuals aging with intellectual disability to participate in developing their own health and support programs. AUST HEALTH REV 2019; 41:436-442. [PMID: 27537279 DOI: 10.1071/ah15235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 07/06/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to explore the use of complementary consent methodologies to support a potentially vulnerable group of people, namely those aging with intellectual disability, to provide personal input. It was premised on the view that processes to determine capacity for consent, appropriately modified to account for individual capabilities and current circumstances, could facilitate meaningful participation in the development of personal health care plans of people previously excluded from contributing. Methods The present descriptive case study research was undertaken in New South Wales, Australia. A seven-step process for determining capacity for consent was developed, and 10 participants aged between 54 and 73 years with lifelong intellectual disability and health comorbidities were involved. A variety of assistive communication tools was used to support individuals to demonstrate their capacity for giving informed consent. Results After being provided with tailored support mechanisms, seven participants were considered to meet all seven components for determining capacity for consent. Three participants were deemed not to have capacity to give consent regardless of the type of support provided. Conclusions Three critical factors for facilitating personal involvement in decision making for individuals with an intellectual disability were identified: (1) defining consent specifically for the target outcome; (2) outlining the criteria needed for consent to be obtained; and (3) using appropriately modified alternative communication mechanisms as necessary. What is known about the topic? Self-determination is one of the fundamental principles of human rights legislation around the world and, as such, it is considered desirable to have personal input by individuals into the development of their own health care plans. However, this is not always considered feasible if the person comes from a group in the community perceived to be vulnerable to exploitation and viewed as lacking capacity to give informed consent. This results in the use of proxy respondents, who may not accurately represent the desires and life aspirations of the individual. What does this paper add? This paper examines the development and implementation of a targeted program to support individuals aging with lifelong intellectual disability to demonstrate their capacity to provide informed consent. Specifically, it outlines how alternative communications methods, tailored to personal needs and capacity, can assist an individual to both understand and then confirm their understanding of consent in order to participate in developing health care plans. What are the implications for practitioners? People with intellectual disability are now living longer and are increasingly at risk of serious health conditions. The development of long-term health management plans has traditionally not included individuals with more complex needs and moderate intellectual disability, but the present study shows that members of this cohort can successfully understand and consent to participate in health care decision making. By proactively supporting this process, community and healthcare settings may be able to directly facilitate contribution from more individuals, therefore better meeting the goal of person-centred support.
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Affiliation(s)
- Stuart Wark
- School of Rural Medicine, University of New England, Armidale, NSW 2351, Australia. Email
| | - Catherine MacPhail
- School of Health, University of New England, Armidale, NSW 2351, Australia. Email
| | - Kathy McKay
- School of Education, University of New England, Armidale, NSW 2351, Australia. Email
| | - Arne Müeller
- School of Rural Medicine, University of New England, Armidale, NSW 2351, Australia. Email
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13
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Vazquez LM, Khanlou N, Davidson D, Aidarus F. Strategies to Promote the Inclusion of Young Adults With Developmental Disabilities in Community-Based Health Studies. QUALITATIVE HEALTH RESEARCH 2019; 29:958-971. [PMID: 30451071 DOI: 10.1177/1049732318808249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We discuss strategies to promote the inclusion of people with developmental disabilities (DDs) in qualitative community-based research studies. Strategies were applied in three projects conducted between 2012 and 2017 that addressed issues of socioeconomic challenges, discrimination, and exclusion of children and young adults with developmental disabilities (YADD). Strategies included partnership with community organizations; inclusion of YADD, family caregivers (FCs), and service providers in advisory committees (ACs); and strategies to accommodate YADD. As part of our contribution, we discuss issues of invisibility and exclusion of individuals with DDs who have "low" functioning capacities. There is a need to review studies sampling inclusion criteria as they may constitute a barrier for participation. Preference for sampling "high" functioning individuals may reinforce exclusion in research, and replicate broader patterns of socioeconomic exclusion of individuals with disabilities. Our discussion of inclusive research is informed by critical disability studies and the underlying principle "nothing about us without us."
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14
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Beighton C, Victor C, Carey IM, Hosking F, DeWilde S, Cook DG, Manners P, Harris T. 'I'm sure we made it a better study…': Experiences of adults with intellectual disabilities and parent carers of patient and public involvement in a health research study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2019; 23:78-96. [PMID: 28812949 PMCID: PMC6383106 DOI: 10.1177/1744629517723485] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/06/2017] [Indexed: 05/26/2023]
Abstract
Patient and public involvement is considered integral to health research in the United Kingdom; however, studies documenting the involvement of adults with intellectual disabilities and parent carers in health research studies are scarce. Through group interviews, this study explored the perspectives and experiences of a group of adults with intellectual disabilities and a group of parent carers about their collaborative/participatory involvement in a 3-year study which explored the effectiveness of annual health checks for adults with intellectual disabilities. Thematic analysis identified five key themes consistent across both groups; authenticity of participation, working together, generating new outcome measures, dissemination of findings and involvement in future research. Although reported anecdotally rather than originating from the analysis, increased self-confidence is also discussed. The groups' unique perspectives led to insights not previously considered by the research team which led to important recommendations to inform healthcare practice.
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Affiliation(s)
- Carole Beighton
- Carole Beighton, Population Health Research
Institute, St Georges University of London, London SW17 ORE, UK.
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15
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Haines D, Wright J, Comerasamy H. Occupational Therapy Empowering Support Workers to Change How They Support People with Profound Intellectual and Multiple Disabilities to Engage in Activity. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2018. [DOI: 10.1111/jppi.12257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- David Haines
- University of Brighton, Eastbourne; United Kingdom of Great Britain and Northern Ireland
| | - Jonathan Wright
- University of Brighton, Eastbourne; United Kingdom of Great Britain and Northern Ireland
| | - Huguette Comerasamy
- University of Brighton, Eastbourne; United Kingdom of Great Britain and Northern Ireland
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16
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Stoffelen JMT, Schaafsma D, Kok G, Curfs LMG. Women Who Love: An Explorative Study on Experiences of Lesbian and Bisexual Women with a Mild Intellectual Disability in The Netherlands. SEXUALITY AND DISABILITY 2018; 36:249-264. [PMID: 30220750 PMCID: PMC6132951 DOI: 10.1007/s11195-018-9519-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Empirical research that addresses sexual orientation in people with an intellectual disability (ID) is limited, and very little is known regarding the personal experiences of lesbian and bisexual women with ID. This study set out to answer the question: What are the experiences of lesbian and bisexual women with a mild intellectual disability in the Netherlands? Ten lesbian and bisexual women (average age of 33 years) with a mild intellectual disability took part in our study comprising of semi-structured interviews. Participants reported that they had found it hard to talk to others about sensitive subjects such as their sexuality, and had been left to figure out information regarding their sexual orientation without support or guidance. Our results point to a lack of information, sexual education and role models when it comes to lesbian sex and women with an intellectual disability. Social contact was often limited, and participants experienced difficulties finding a partner. Furthermore, participants often had to cope with mental health problems and had struggled with loneliness, depression and addiction. Last but not least, our participants reported that they had been discriminated against. Coming out (revealing your sexual orientation) is not easy when you have an intellectual disability. To enable women with ID who have lesbian or bisexual feelings to understand and secure their sexual rights in their daily lives is important. Therefore, it is necessary to provide support in the following domains: sexual education and training, social contact and assertiveness.
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Affiliation(s)
- J. M. T. Stoffelen
- Governor Kremers Centre, Maastricht University, Maastricht, The Netherlands
- Psychology and Neuroscience, Work and Social Psychology, Applied Social Psychology, Maastricht University, Maastricht, The Netherlands
- Zorgbelang Gelderland-Utrecht, Arnhem, The Netherlands
| | - D. Schaafsma
- Governor Kremers Centre, Maastricht University, Maastricht, The Netherlands
- Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - G. Kok
- Governor Kremers Centre, Maastricht University, Maastricht, The Netherlands
- Psychology and Neuroscience, Work and Social Psychology, Applied Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - L. M. G. Curfs
- Governor Kremers Centre, Maastricht University, Maastricht, The Netherlands
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17
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Chalghoumi H, Cobigo V, Dignard C, Gauthier-Beaupré A, Jutai JW, Lachapelle Y, Lake J, Mcheimech R, Perrin M. Information Privacy for Technology Users With Intellectual and Developmental Disabilities: Why Does It Matter? ETHICS & BEHAVIOR 2017. [DOI: 10.1080/10508422.2017.1393340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Terband H, Coppens-Hofman MC, Reffeltrath M, Maassen BAM. Effectiveness of speech therapy in adults with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31:236-248. [DOI: 10.1111/jar.12384] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Hayo Terband
- Utrecht Institute of Linguistics - OTS; Utrecht University; Utrecht The Netherlands
- Department of Medical Psychology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
- Centre for Language and Cognition (CLCG); Faculty of Arts, University of Groningen; Groningen The Netherlands
| | - Marjolein C. Coppens-Hofman
- Department of Medical Psychology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
- Nijmegen Centre for Evidence-Based Practice (NCEBP); Nijmegen The Netherlands
| | - Maaike Reffeltrath
- Department of Medical Psychology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Ben A. M. Maassen
- Centre for Language and Cognition (CLCG); Faculty of Arts, University of Groningen; Groningen The Netherlands
- Research School of Behavioural and Cognitive Neurosciences (BCN); University Medical Center Groningen; Groningen The Netherlands
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Haines D. Ethical considerations in qualitative case study research recruiting participants with profound intellectual disabilities. RESEARCH ETHICS 2017. [DOI: 10.1177/1747016117711971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Drawing on the author’s experience carrying out qualitative research in the field of occupational therapy with people with intellectual disabilities, this article explores ethical issues inherent in ethnographic and case study research, where study designs can evolve over time. Such qualitative methodologies can enable deep understanding of research topics, but detailed description of methods and of the range of potential experiences participants may have is necessary to ensure that they are fully informed and ethics committees satisfied. Thorough consideration is required of ethical issues related to topic relevance and design, recruitment, collection of data and portrayal of participants in the eventual case report. The article illustrates a way in which research of this type can be explained and justified, including how recruitment can be achieved of participants likely to lack capacity to consent to participation themselves.
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Roffee JA, Waling A. Resolving ethical challenges when researching with minority and vulnerable populations: LGBTIQ victims of violence, harassment and bullying. RESEARCH ETHICS 2016. [DOI: 10.1177/1747016116658693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article provides an analysis of the issues and ethical challenges faced in a study with LGBTIQ student participants concerning their experiences of violence, harassment and bullying in tertiary settings. The authors detail the ethical challenges behind the development of the project, and around conducting research with a minority and vulnerable population. The article illustrates how the utilization of feminist and queer theory has impacted the process of conducting ethical research, including approaches to recruitment and participant autonomy. The dilemmas of confidentiality within a self-labelled and easily identifiable population are resolved. Further, unexpected challenges and risks to participant safety created through adherence to institutional ethical research frameworks are rectified. Importantly, the authors seek to avoid revictimization of participants and to instead empower students in their responses to violence, harassment and bullying that they may have experienced. The authors point to utilization of theoretical foundations and continual reflexive improvement as elements of best practice for those seeking to research minority populations, and in projects marked by the participation of those deemed vulnerable and high-risk.
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McDonald KE, Conroy NE, Kim CI, LoBraico EJ, Prather EM, Olick RS. Is Safety in the Eye of the Beholder? Safeguards in Research With Adults With Intellectual Disability. J Empir Res Hum Res Ethics 2016; 11:424-438. [PMID: 27307420 DOI: 10.1177/1556264616651182] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Human subjects research has a core commitment to participant well-being. This obligation is accentuated for once exploited populations such as adults with intellectual disability. Yet we know little about the public's views on appropriate safeguards for this population. We surveyed adults with intellectual disability, family members and friends, disability service providers, researchers, and Institutional Review Board (IRB) members to compare views on safeguards. We found many points of convergence of views, particularly for decision-making and participation. One trend is that adults with intellectual disability perceive greater safety in being engaged directly in recruitment, and recruitment by specific individuals. Researchers and IRB members need to consider community views to facilitate the safe and respectful inclusion of adults with intellectual disability.
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Affiliation(s)
| | | | | | | | | | - Robert S Olick
- 2 SUNY Upstate Medical University, Syracuse, New York City, USA
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Bertelli MO, Bianco A, Piva Merli M, Scuticchio D, Lassi S, Lorenzoni L, Carbone Viviani D, Brown I. Psychometric Properties of the Italian Adaptation of a Quality of Life Instrument as Applied to Adults With Intellectual and Developmental Disabilities. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2016. [DOI: 10.1111/jppi.12158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Marco O. Bertelli
- CREA (Research and Clinical Centre) of Fondazione San Sebastiano; Florence Italy
| | - Annamaria Bianco
- CREA (Research and Clinical Centre) of Fondazione San Sebastiano; Florence Italy
| | - Micaela Piva Merli
- CREA (Research and Clinical Centre) of Fondazione San Sebastiano; Florence Italy
- DSNP (Department of NeuroPsychiatric Sciences); University of Florence; Florence Italy
| | - Daniela Scuticchio
- CREA (Research and Clinical Centre) of Fondazione San Sebastiano; Florence Italy
| | - Stefano Lassi
- Fondazione Opera Diocesana Assistenza Firenze ONLUS; Florence Italy
| | | | | | - Ivan Brown
- Faculty of Social Work, University of Toronto; Canada
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Gibbons HM, Owen R, Heller T. Perceptions of Health and Healthcare of People With Intellectual and Developmental Disabilities in Medicaid Managed Care. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2016; 54:94-105. [PMID: 27028251 DOI: 10.1352/1934-9556-54.2.94] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study examined perceptions of health and healthcare of people with intellectual and developmental disabilities (IDD) receiving Medicaid Managed Care. Exploratory, semistructured interviews were conducted with 23 participants. Findings indicate that participants generally expressed being in good health and defined good health as (a) absence of pain, disease, and symptoms; (b) adherence to or not requiring treatment; (c) physical self-care; (d) mental or spiritual self-care; and (e) ability to perform the activities one wants to do. Participants conceptualized healthcare as (a) ensuring needs are met through access to services, (b) obtaining quality services, (c) navigating the healthcare system successfully, and (d) receiving humanizing healthcare. This study has implications for improving healthcare and communications between people with IDD and healthcare providers.
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Affiliation(s)
- Hailee M Gibbons
- Hailee Marie Gibbons, Disability and Human Development, University of Illinois at Chicago, IL USA
| | - Randall Owen
- Randall Owen, Disability and Human Development, University of Illinois at Chicago, IL USA; and
| | - Tamar Heller
- Tamar Heller, Disability and Human Development, University of Illinois at Chicago, IL USA
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24
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Goldsmith L, Skirton H. Research involving people with a learning disability – methodological challenges and ethical considerations. J Res Nurs 2015. [DOI: 10.1177/1744987115591867] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aims of the original study referred to in this paper were to explore the information needs of people with learning disabilities with respect to consent for genomic tests, and to identify ways of facilitating informed consent for such tests. In this research methods review paper, we consider the ethical issues involved in recruitment for our study and describe the process of recruiting vulnerable participants via gatekeepers. We discuss the ethical issues under the themes ‘freedom from coercion’, ‘disclosure of information’ and ‘competence’. In conclusion, we acknowledge the paradox that exists in learning disability research: the importance of protecting members of a vulnerable group against the need to include people with a learning disability in order to gather the best possible evidence. However, a focus on wider inclusion will result in a more robust body of knowledge concerning the health and welfare of people with learning disabilities.
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Affiliation(s)
- Lesley Goldsmith
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, UK
| | - Heather Skirton
- Faculty of Health and Human Sciences, University of Plymouth, UK
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Bredemeier J, Agranonik M, Perez TS, Fleck MPDA. Brazilian version of the Quality of Care Scale: the perspective of people with disabilities. Rev Saude Publica 2015; 48:583-93. [PMID: 25210817 PMCID: PMC4181102 DOI: 10.1590/s0034-8910.2014048005056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 02/10/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze evidence of the validity and reliability of a Brazilian Portuguese version of the Quality of Care Scale from the perspective of people with physical and intellectual disabilities. METHODS There were 162 people with physical disabilities and 156 with intellectual disabilities from Porto Alegre and metropolitan region, who participated in the study in 2008. Classical psychometrics was used to independently analyze the two samples. Hypotheses for evidence of criterion validity (concurrent type) were tested with the Mann-Whitney test for non-normal distributions. Principal components analysis was used to explore factorial models. Evidence of reliability was calculated with Cronbach alpha for the scales and subscales. Test-retest reliability was analyzed for individuals with intellectual disabilities through intra-class correlation coefficient and the Willcoxon test. RESULTS The principal components in the group with physical disabilities replicated the original model presented as a solution to the international project data. Evidence of discriminant validity and test-retest reliability was found. CONCLUSIONS The transcultural factor model found within the international sample project seems appropriate for the samples investigated in this study, especially the physical disabilities group. Depression, pain, satisfaction with life and disability may play a mediating role in the evaluation of quality of care. Additional research is needed to add to evidence of the validity of the instruments.
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Affiliation(s)
| | - Marilyn Agranonik
- Faculdade de Engenharia, Universidade do Vale do Sinos, São Leopoldo, RS, Brasil
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Taua C, Neville C, Hepworth J. Research participation by people with intellectual disability and mental health issues: an examination of the processes of consent. Int J Ment Health Nurs 2014; 23:513-24. [PMID: 24891249 DOI: 10.1111/inm.12079] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Balancing the demands of research and ethics is always challenging, and even more so when recruiting vulnerable groups. Within the context of current legislation and international human rights declarations, it is strongly advocated that research can and must be undertaken with all recipients of health-care services. Research in the field of intellectual disability presents particular challenges in regards to consenting processes. This paper is a reflective overview and analysis of the complex processes undertaken, and events that occurred in gaining informed consent from people with intellectual disability to participate in a study exploring their experiences of being an inpatient in mental health hospitals within Aotearoa/New Zealand. A framework based on capacity, information, and voluntariness is presented, with excerpts from the field provided to explore consenting processes. The practical implications of the processes utilized are then discussed in order to stimulate debate regarding clearer and enhanced methods of gaining informed consent from people with intellectual disability.
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Affiliation(s)
- Chris Taua
- School of Nursing and Midwifery, The University of Queensland, Brisbane, Queensland, Australia
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Affiliation(s)
- B S Chavan
- Department of Psychiatry, Government Medical College and Hospital, Regional Institute for the Mentally Handicap, Chandigarh, India
| | - Abhijit R Rozatkar
- Department of Psychiatry, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Haryana, India
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McDonald KE, Raymaker DM. Paradigm shifts in disability and health: toward more ethical public health research. Am J Public Health 2013; 103:2165-73. [PMID: 24134380 DOI: 10.2105/ajph.2013.301286] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Disability is often considered a health outcome disproportionately experienced by minority groups. It is also possible to view people with disabilities as a minority group that itself experiences health disparities. Calls to reduce these disparities necessitate the inclusion of people with developmental disabilities in research, although resulting ethical issues can thwart scientific progress. Using disability rights principles can help address ethical challenges and promote safe, respectful public health research. Examples include applying human rights frameworks, providing accommodations, attending to power, countering legacies of deficits-based models of disability, and transforming access to science more broadly. Collectively, these strategies can encourage broader engagement in safe, respectful, inclusive public health research aimed at promoting the health and well-being of people with developmental disabilities.
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Affiliation(s)
- Katherine E McDonald
- Katherine E. McDonald is with the Department of Public Health, Food Studies, and Nutrition and the Burton Blatt Institute, Syracuse University, Syracuse, NY. Dora M. Raymaker is with the Academic Autistic Spectrum Partnership in Research and Education and the Systems Science Program, Portland State University, Portland, OR
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Horner-Johnson W, Bailey D. Assessing Understanding and Obtaining Consent from Adults with Intellectual Disabilities for a Health Promotion Study. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2013; 10. [PMID: 24223054 DOI: 10.1111/jppi.12048] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
People with intellectual disabilities are often excluded from research, in part because they may be perceived as lacking capacity to provide informed consent. A requirement of informed decision making about research participation is ability to understand the study description and disclosures presented during the consent process. The authors' aims were to determine the extent to which study participants with intellectual disabilities were able to answer questions about key aspects of study disclosures, identify ways in which people who provided appropriate answers for all of the questions differed from those who had difficulty with one or more of the questions, and examine patterns of responses to see if certain issues were more difficult to understand than others. The authors piloted a short set of questions to assess the extent to which adults with intellectual disabilities were able to answer questions about key aspects of a health promotion study. More than half of study participants correctly answered all of the questions. For those not able to answer all questions, identifying potential risks of being in the study proved the most challenging. The findings indicate that many people with intellectual disabilities likely can provide their own consent to participate in low risk studies.
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Affiliation(s)
- Willi Horner-Johnson
- Institute on Development & Disability Oregon Health & Science University Portland, Oregon, USA
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Stoffelen J, Kok G, Hospers H, Curfs LMG. Homosexuality among people with a mild intellectual disability: an explorative study on the lived experiences of homosexual people in the Netherlands with a mild intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2013; 57:257-67. [PMID: 23379862 DOI: 10.1111/j.1365-2788.2011.01532.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Empirical research on homosexuality among people with an intellectual disability (ID) is limited and, to date, very little is known regarding the personal experiences of gay and lesbian people with an ID. This study set out to answer the question: What are the lived experiences of a specific cohort of homosexual people with an intellectual disability living in the Netherlands? METHOD To answer this question, a qualitative study was performed in which 21 people with a mild ID were interviewed via semi-structured interviews. In this study, 19 participants were men and two were women (average age = 40.5 years). RESULTS Participants reported positive and negative experiences, and talked about their gay or lesbian identity. Almost half of the participants (n = 10) reported that they had experienced sexual abuse including partner violence (n = 6). Additionally, they indicated that there was a lack of support for homosexual people with an ID. CONCLUSION Specific problems impact the lives of homosexual people with ID, namely the high prevalence of negative sexual experiences, the lack of support, training and sex education, and their search for a suitable partner.
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Affiliation(s)
- J Stoffelen
- Maastricht University, Maastricht, the Netherlands Governor Kremers Center, Maastricht University, Maastricht, the Netherlands.
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McDonald KE, Kidney CA, Patka M. 'You need to let your voice be heard': research participants' views on research. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2013; 57:216-25. [PMID: 22292970 DOI: 10.1111/j.1365-2788.2011.01527.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Persons with intellectual and developmental disabilities have had regrettably few opportunities to voice their opinions on aspects of research with which they have had direct experience. Understanding and responding to these views can contribute to policies and practices that increasingly treat people as they desire to be treated. METHODS We conducted individual interviews and focus groups with 16 adults with intellectual and developmental disabilities to examine their perspectives on participating in research. RESULTS Our analysis indicates that adults with intellectual and developmental disabilities want to engage in research to improve their quality of life and to have greater access to a worthwhile activity through more active participation. Our results also highlight trust as a critical ingredient in the success of research with this group. CONCLUSIONS Our findings suggest that despite ethical challenges, researchers can and should pursue research that has the potential to improve the lives of persons with intellectual and developmental disabilities. Such research is more likely to be both ethical and successful if researchers pay attention to enhancing autonomy and person-centredness, while at the same time engendering participant trust.
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Affiliation(s)
- K E McDonald
- Department of Public Health, Food Studies and Nutrition and the Burton Blatt Institute, Syracuse University, Syracuse, NY 13244, USA.
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Marshall Z. Navigating risks and professional roles: research with lesbian, gay, bisexual, trans, and queer young people with intellectual disabilities. J Empir Res Hum Res Ethics 2013; 7:20-33. [PMID: 23086045 DOI: 10.1525/jer.2012.7.4.20] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We examine ethical issues that emerged during a community-based participatory research (CBPR) study in Toronto, Canada, exploring sexual health attitudes and practices among lesbian, gay, bisexual, trans, queer, and questioning (LGBTQ) young people (ages 17-26) labeled with intellectual disabilities. These ethical concerns included: (1) managing the risk of coercion, (2) consent to participate in the study, (3) issues of confidentiality and disclosure, (4) balancing beneficence with self-determination, and (5) role conflict for researcher-practitioners who participate in CBPR projects. Incorporating critical disability perspectives and a heightened awareness of professional role conflict into CBPR practices has the potential to foster development of more inclusive and accessible sexual health initiatives and research environments.
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d'Abrera JC, Holland AJ, Landt J, Stocks-Gee G, Zaman SH. A neuroimaging proof of principle study of Down's syndrome and dementia: ethical and methodological challenges in intrusive research. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2013; 57:105-118. [PMID: 22044507 DOI: 10.1111/j.1365-2788.2011.01495.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Research into specific illnesses and the development of new treatments may only become possible as new technologies become available. When used for research, such technologies may best be described as 'intrusive', in that they require a considerable willingness and commitment on the part of the participants. This has increasingly been the case for brain disorders and illnesses where novel neuroimaging techniques, often combined with clinical and psychological assessments, have the potential to result in new understanding. People with intellectual disabilities (ID) have a history of under-representation as participants in research using such technologies and are therefore at risk of not receiving equal access to state-of-the-art treatments. We propose that 'intrusive' biomedical research is both possible and ethical in ID, and explore some of the methodological challenges by reference to a recent proof of principle study that used a relatively new ligand-based brain scanning technique in a group of volunteers with Down's syndrome. METHODS Five overlapping stages of the study methodology were identified and evaluated for their acceptability to volunteers with mild to moderate ID through discussion, reflection, and analysis of structured feedback in the context of key policy documents, ethical guidelines and relevant legislation. RESULTS Identification of key ethical and methodological challenges from reflective practice and participant feedback facilitated the emergence of strategies that permitted continual refinement of the study design. Important areas considered included (1) being clear about the purpose and scientific justification for the study; (2) reconciling the potential risks and benefits with relevant ethical guidelines and legislation; (3) identifying and implementing effective recruitment strategies; (4) optimising and assessing capacity to consent; and (5) making the 'intrusive' procedures as acceptable as possible to people with ID. CONCLUSION We were able to demonstrate that a proof of principle study incorporating a novel brain scanning technique in a group of volunteers with ID was feasible, safe and well tolerated, despite the vulnerabilities of the study cohort and the intrusive nature of the research. We consider the study within an ethical and historical discourse about the principles that define current 'best practice' in ID research and propose a number of key recommendations for making intrusive research acceptable in people with ID.
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Affiliation(s)
- J C d'Abrera
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Iacono T, Carling-Jenkins R. The human rights context for ethical requirements for involving people with intellectual disability in medical research. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:1122-32. [PMID: 23106755 DOI: 10.1111/j.1365-2788.2012.01617.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND The history of ethical guidelines addresses protection of human rights in the face of violations. Examples of such violations in research involving people with intellectual disabilities (ID) abound. We explore this history in an effort to understand the apparently stringent criteria for the inclusion of people with ID in research, and differences between medical and other research within a single jurisdiction. METHOD The history of the Helsinki Declaration and informed consent within medical research, and high-profile examples of ethical misconduct involving people with ID and other groups are reviewed. The UN Convention on the Rights of Persons with Disabilities is then examined for its research implications. This background is used to examine a current anomaly within an Australian context for the inclusion of people with ID without decisional capacity in medical versus other types of research. RESULTS Ethical guidelines have often failed to protect the human rights of people with ID and other vulnerable groups. Contrasting requirements within an Australian jurisdiction for medical and other research would seem to have originated in early deference to medical authority for making decisions on behalf of patients. CONCLUSIONS Stringent ethical requirements are likely to continue to challenge researchers in ID. A human rights perspective provides a framework for engaging both researchers and vulnerable participant groups.
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Affiliation(s)
- T Iacono
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia.
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McDonald K, Patka M. “There is No Black or White”: Scientific Community Views on Ethics in Intellectual and Developmental Disability Research. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2012. [DOI: 10.1111/j.1741-1130.2012.00348.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Mazna Patka
- Portland State University; Portland; Oregon; USA
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McDonald KE. "We want respect": adults with intellectual and developmental disabilities address respect in research. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2012; 117:263-74. [PMID: 22809073 DOI: 10.1352/1944-7558-117.4.263] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Respect is central to ethical guidelines for research. The scientific community has long debated, and at times disagreed on, how to demonstrate respect in research with adults with intellectual and developmental disabilities. To illuminate the voices of those most affected, the author studies the views of adults with intellectual and developmental disabilities on respect in research. Findings are consistent with disability rights' ideas and indicate that adults with intellectual and developmental disabilities have much to contribute to the discussion, that they value participating, and that they agree with calls to focus on human rights and dignity. Notably, participants spoke at lengths about the nature of interactions between researchers and participants. Implications are discussed, including how to infuse research standards with community-supported values and preferences.
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Affiliation(s)
- Katherine Elizabeth McDonald
- Public Health, Food Studies, and Nutrition and the Burton Blatt Institute, Syracuse University, Syracuse, NY 13244, USA.
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Cohen L, Brown RI. Mapping Future Research in Disabilities-Research Initiatives in Intellectual Disabilities in India: Report of a National Interdisciplinary Meeting. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2012. [DOI: 10.1111/j.1741-1130.2012.00339.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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McDonald KE, Kidney CA. What Is Right? Ethics in Intellectual Disabilities Research. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2012. [DOI: 10.1111/j.1741-1130.2011.00319.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Swaine J, Parish SL, Luken K, Atkins L. Recruitment and consent of women with intellectual disabilities in a randomised control trial of a health promotion intervention. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2011; 55:474-483. [PMID: 21385259 DOI: 10.1111/j.1365-2788.2011.01399.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND The need for evidence-based health promotion interventions for women with intellectual and developmental disabilities is critical. However, significant barriers impede them from participating in research, including those related to recruitment and obtaining informed consent. METHODS This study describes a procedure for the recruitment and consent of women with intellectual disabilities into a community-based, multi-site randomised controlled trial. RESULTS Of 269 women who participated in information sessions, 203 (75%) enrolled in the study. While women with and without legal guardians consented at the same approximate rates (83% and 85%, respectively), those with legal guardians enrolled at significantly lower rates (61%) because of lower rates (74%) of guardian consent. CONCLUSIONS It is possible to recruit community-dwelling women with intellectual disabilities into randomised controlled trials at relatively high participation rates. Recruiting women who have guardians poses additional challenges for researchers.
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Affiliation(s)
- J Swaine
- School of Social Work, UNC Chapel Hill, Chapel Hill, NC, USA
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Veenstra MY, Walsh PN, van Schrojenstein Lantman-de Valk HMJ, Haveman MJ, Linehan C, Kerr MP, Weber G, Salvador-Carulla L, Carmen-Cara A, Azema B, Buono S, Germanavicius A, Tossebro J, Maatta T, van Hove G, Moravec D. Sampling and ethical issues in a multicenter study on health of people with intellectual disabilities. J Clin Epidemiol 2010; 63:1091-100. [PMID: 20304607 DOI: 10.1016/j.jclinepi.2009.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 11/25/2009] [Accepted: 12/20/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To study health inequalities in persons with intellectual disabilities, representative and unbiased samples are needed. Little is known about sample recruitment in this vulnerable group. This study aimed to determine differences in ethical procedures and sample recruitment in a multicenter research on health of persons with intellectual disabilities. Study questions regarded the practical sampling procedure, how ethical consent was obtained in each country, and which person gave informed consent for each study participant. STUDY DESIGN AND SETTING Exploratory, as part of a multicenter study, in 14 European countries. After developing identical guidelines for all countries, partners collected data on health indicators by orally interviewing 1,269 persons with intellectual disabilities. Subsequently, semistructured interviews were carried out with partners and researchers. RESULTS Identification of sufficient study participants proved feasible. Sampling frames differed from nationally estimated proportions of persons with intellectual disabilities living with families or in residential settings. Sometimes, people with intellectual disabilities were hard to trace. Consent procedures and legal representation varied broadly. Nonresponse data proved unavailable. CONCLUSION To build representative unbiased samples of vulnerable groups with limited academic capacities, international consensus on respectful consent procedures and tailored patient information is necessary.
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Affiliation(s)
- Marja Y Veenstra
- Department of General Practice, CAPHRI Care and Public Health Research Institute, University of Maastricht
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McDonald KE, Kidney CA, Nelms SL, Parker MR, Kimmel A, Keys CB. Including Adults With Intellectual Disabilities in Research: Scientists' Perceptions of Risks and Protections. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2009. [DOI: 10.1111/j.1741-1130.2009.00225.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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O'Reilly M, Armstrong N, Dixon-Woods M. Subject positions in research ethics committee letters: a discursive analysis. ACTA ACUST UNITED AC 2009. [DOI: 10.1258/ce.2009.009027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ethical review of applications to conduct research projects continues to be a focus of scrutiny and controversy. We argue that attention to the actual practices of ethical review has the potential to inform debate. We explore how research ethics committees (RECs) establish their position and authority through the texts they use in their correspondence with applicants. Using a discursive analysis applied to 260 letters, we identify four positions of particular interest: RECs positioned as disinterested and responsible; as representing the interests of potential participants; as facilitating ethically sound, high-quality research; and as engaged in dialogue. These positions are used strategically to deflect criticism or complaint. This analysis has implications for reducing contestation between researchers and RECs, suggesting that more dialogic rather than hierarchical approaches to positioning might be helpful.
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Affiliation(s)
- Michelle O'Reilly
- Department of Health Sciences, University of Leicester, Adrian Building, University Road, Leicester LE1 7RH, UK
| | - Natalie Armstrong
- Department of Health Sciences, University of Leicester, Adrian Building, University Road, Leicester LE1 7RH, UK
| | - Mary Dixon-Woods
- Department of Health Sciences, University of Leicester, Adrian Building, University Road, Leicester LE1 7RH, UK
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Cook T, Inglis P. Making our Own Decisions: Researching the Process of ‘Being Informed’ with People with Learning Difficulties. RESEARCH ETHICS REVIEW 2009. [DOI: 10.1177/174701610900500204] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Historically people with learning difficulties1 have been either included in research without their consent or excluded from research that affects their treatment and care. Over the last 20 years, however, it has been recognised that to exclude the voice of people with learning difficulties (and other so called vulnerable groups) in research that reflects their lived experiences challenges our notion of ethical practice. Cognitive ability has traditionally been one of the key factors in determining ability to consent. This paper identifies, through work with a group of men with learning difficulties, the impact of different ways of presenting information to prospective participants on their ability to understand key issues in relation to participation in research and hence their ability to give informed consent2.
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Affiliation(s)
- Tina Cook
- School of Health Community and Education Studies, Northumbria University, Newcastle upon Tyne, UK
| | - Pamela Inglis
- School of Health Community and Education Studies, Northumbria University, Newcastle upon Tyne, UK
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Boxall K, Ralph S. Research ethics and the use of visual images in research with people with intellectual disability. JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2009; 34:45-54. [PMID: 19234978 DOI: 10.1080/13668250802688306] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The aim of this paper is to encourage debate about the use of creative visual approaches in intellectual disability research and discussion about Internet publication of photographs. Image-based research with people with intellectual disability is explored within the contexts of tighter ethical regulation of social research, increased interest in the use of visual methodologies, and rapid escalation in the numbers of digital images posted on the World Wide Web. Concern is raised about the possibility that tighter ethical regulation of social research, combined with the multitude of ethical issues raised by the use of image-based approaches may be discouraging the use of creative visual approaches in intellectual disability research. Inclusion in research through the use of accessible research methods is also an ethical issue, particularly in relation to those people who have hitherto been underrepresented in research. Visual approaches which have the potential to include people with profound and multiple intellectual disabilities are also discussed.
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Affiliation(s)
- Kathy Boxall
- Department of Sociological Studies, University of Sheffield, Sheffield, UK.
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McDonald KE, Keys CB, Henry DB. Gatekeepers of Science: Attitudes Toward the Research Participation of Adults With Intellectual Disability. ACTA ACUST UNITED AC 2008; 113:466-78. [DOI: 10.1352/2008.113:466-478] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AbstractResearchers and Institutional Review Board (IRB) members' attitudes influence scientific knowledge about individuals with intellectual disability. We recruited 260 intellectual disability researchers and IRB members to develop a measure of attitudes toward the research participation of adults with intellectual disability, the Participation in Research Attitude Scale. Findings suggest three conceptual domains: Opportunity and Choice, Help in Decision Making, and Beneficence. We also examined individual differences in attitudes and the relationships between general and specific attitudes. In general, intellectual disability researchers and those with closer relationships to individuals with disabilities had attitudes consistent with disability-rights principles. Some dimensions of global attitudes toward adults with intellectual disability predicted more specific attitudes toward their research participation. Implications are discussed.
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McDonald KE, Keys CB. How the powerful decide: access to research participation by those at the margins. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2008; 42:79-93. [PMID: 18584318 DOI: 10.1007/s10464-008-9192-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
How do those in power decide to include and exclude those at the margins from community life? We used simulated review of research vignettes to examine how researchers and members of Institutional Review Boards make decisions concerning the research participation of adults with and without intellectual disabilities. Results indicate that decision-makers are influenced by the disability status of the sample, characteristics of the research in which they are engaged, and their attitudes toward the research participation of adults with intellectual disabilities as well as their own relationship to the research process. For example, decision-makers may create situations that limit the self-determination of adults with intellectual disabilities and adults without disabilities within the research context, particularly when the research poses some risk of harm to participants. Implications for theory, action and research are explored.
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Affiliation(s)
- Katherine E McDonald
- Department of Psychology, Portland State University, P.O. Box 751, Portland, OR 97207-0751, USA.
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Remaining Open to Quantitative, Qualitative, and Mixed‐Method Designs: An Unscientific Compromise, or Good Research Practice? ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s0074-7750(07)35005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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48
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Hubert J, Hollins S. Ethnographic Research in Closed Institutions: Ethical Issues. RESEARCH ETHICS 2007. [DOI: 10.1177/174701610700300405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper discusses a number of ethical issues that arise in the context of ethnographic research with people with severe intellectual disabilities and mental health problems living in closed institutions. These very vulnerable people have tended to live emotionally and physically deprived lives in segregated and bleak environments, and because they cannot communicate through speech, and often have seriously challenging behaviour, they have tended to become socially and physically isolated from society. Most research with people who do not communicate verbally has been quantitative, or conducted through informal and formal carers. Ethnographic research, on the other hand, involves spending long periods of participant observation with people in their ‘natural’ settings, providing intensely qualitative material, in order to present data as far as possible from each individual's perspective. Such research provides rich and emotionally powerful material which is often distressing and even shocking. This raises a number of ethical issues in relation to the conduct of such research, including questions regarding consent – who can give consent for someone who does not have the capacity to give consent themselves? The ethics of publication of such research are also discussed. This paper outlines the reasons why such research, and its publication, is vital for the futures of institutionalized men and women with severe intellectual disabilities.
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Affiliation(s)
- Jane Hubert
- Division of Mental Health, St George's, University of London, Cranmer Terrace, London SW17 0RE
| | - Sheila Hollins
- Division of Mental Health, St George's, University of London, Cranmer Terrace, London SW17 0RE. London, UK
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Iacono T. Ethical challenges and complexities of including people with intellectual disability as participants in research. JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2006; 31:173-9; discussion 180-91. [PMID: 16954097 DOI: 10.1080/13668250600876392] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Teresa Iacono
- Centre for Developmental Disability Health Victoria, Monash University, Australia.
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Lai R, Elliott D, Ouellette-Kuntz H. Attitudes of Research Ethics Committee Members Toward Individuals with Intellectual Disabilities: The Need for More Research. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2006. [DOI: 10.1111/j.1741-1130.2006.00062.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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