The added value of inclusive research

What makes life better or worse: Quality of life according to people with intellectual disabilities

BACKGROUND

People with intellectual disabilities are rarely involved in research on quality of life. The study sought to answer the question: what do people with intellectual disabilities believe improves or hinders their quality of life?

METHOD

Using an inclusive, accessible research design, 18 participants met in small groups to answer the study's question using their choice of arts-based media. Participants completed the analysis collaboratively, identifying key themes among their responses.

RESULTS

The participants concluded that supports, well-being, hobbies, and activities contribute to quality of life. Lack of accessibility, assumptions, negative behaviours, stress, and negative people (staff, roommates, people in general) were identified as detractors of quality of life.

CONCLUSIONS

To continue to make progress in improving the quality of life of individuals with intellectual disabilities, the voice of those with intellectual disabilities is key. The results suggest key areas of focus to make these improvements.

Research About Us, With Us: An Inclusive Research Case Study

Inclusive research combines the expertise of academically trained researchers with the lived experience of individuals with disabilities to render results that are more accessible, accountable, and meaningful to the disability community. In this case study, adults with intellectual and developmental disabilities (IDD) contributed as co-researchers to a series of studies on mental health of adults with intellectual disability. The research model, specific engagement strategies, and lessons learned are shared. Feedback from members of the research team suggests that including adults with IDD as co-researchers benefited investigators, co-researchers with IDD, and project outcomes. Our case study emphasizes the valuable contributions of research partners with IDD and provides a model that may be adapted and utilized by researchers to enhance their practice.

Designing the Food and Lifestyle Information Program (FLIP) culinary nutrition intervention for adults with mild-to-moderate intellectual disability

BACKGROUND

People with intellectual disability have diverse needs and experience higher rates of diet-related chronic disease such as type 2 diabetes compared to people without disability. However, they are infrequently included in development and implementation of interventions to address diet-related chronic disease. The present study describes the process to plan, develop and refine the Food and Lifestyle Information Program (FLIP) culinary nutrition intervention for adults with mild-to-moderate intellectual disability.

METHODS

The project was initiated by a disability service provider and was guided by the Cook-Ed™ model and inclusive research principles. Initially the disability service provider and academic research team members co-designed pre-program consultation and pilot studies, and draft program resources. Pre-program consultation explored paid disability support worker (n = 10) perceptions of cooking and food skills, nutrition priorities and optimal program format, which guided further program drafting. Program resources and pilot study design were further developed and refined with co-researchers with lived experience of intellectual disability who attended a pre-pilot and then pilot study sessions as remunerated co-facilitators.

RESULTS

Key characteristics of the FLIP intervention arising from pre-program consultation included providing cooking task instruction in small steps, enabling participant choice in program activities, promoting an inclusive and social atmosphere, and providing paper-based resources.

CONCLUSIONS

FLIP intervention co-design was enabled through ongoing input from the disability service provider and people with lived experience of intellectual disability. Evaluation of FLIP feasibility, acceptability and preliminary effectiveness to improve diet-related health is underway.

Reflections on How What We Say, Do, and Acknowledge as Intellectual and Developmental Disability Researchers Matters

This article highlights reflections by the author on the importance of considering what we say, do and acknowledge in intellectual and developmental disability research. The goal is to advance thinking that can lead to personal and collective change in our approaches to truly share power and elevate the expertise of people with lived experience with intellectual and developmental disabilities in the movement for equity, inclusion, and disability justice. Implications for inclusive research, policy, and practice are discussed as is the need to engage in personal reflection and build new partnerships for collective change.

Cervical screening participation and access facilitators and barriers for people with intellectual disability: a systematic review and meta-analysis

Background

The World Health Organisation's vision of eliminating cervical cancer as a public health problem is achievable, but elimination must be achieved equitably, including for people with intellectual disability. A better understanding of cervical screening within the context of the lives of people with intellectual disability is needed. This study systematically reviewed research on the rates of cervical screening participation among people with intellectual disability, and facilitators and barriers that affect participation.

Method

Six electronic databases were systematically searched: MEDLINE, CINAHL, Scopus, PsycINFO, Embase and Pro-Quest Central Social Sciences Collection. Empirical studies published between 1986 and 2023, in English language peer-reviewed journals were eligible for inclusion. Further articles were identified through forward and backward citation tracking, and hand-searching the index lists of two key journals. Two authors screened the studies, extracted the data and collated study outcomes using a standardised software program. A meta-analysis was performed using the DerSimonian and Laird method to estimate pooled effect sizes in prevalence rates and odds ratios (ORs). The socio-ecological model (SEM) was used as a framework to thematically analyse facilitators and barriers impacting participation in cervical screening.

Results

Sixty-three articles met the inclusion criteria. Of these, 42 reported on rates of cervical screening participation and 24 reported on facilitators or barriers to cervical screening for people with intellectual disability. Overall, the studies reported a screening prevalence of 35% (95% CI: 26% to 45%), indicating that just over a third of people with intellectual disability have had cervical screening. The pooled odds ratio of 0.30 (95% CI: 0.23 to 0.41) indicated that people with intellectual disability are significantly less likely to have a cervical screening test compared with people without intellectual disability. Most studies examined individual and interpersonal factors impacting cervical screening. These included: (i) fear and anxiety among people with intellectual disability, (ii) misassumptions preventing screening participation, (iii) the role of support people, (iv) the need for education, (v) accessible information, and time to prepare for screening, (vi) patient-provider communication including challenges obtaining informed consent, and (vii) healthcare provider lack of confidence.

Conclusion

Future research, policy and practice efforts must address barriers to cervical screening participation among people with intellectual disability and ensure these efforts are co-produced and community-led. This is critical to ensuring equity in global and local efforts to eliminate cervical cancer.

Self-Determination Research: Current and Future Directions

This article summarizes the history, current status, and future directions of self-determination research across the globe, with a focus on applications to the education of students with intellectual and developmental disabilities and their transition from school to adult life. Research on the development, implementation, and outcomes of self-determination assessments and interventions is explored. Causal Agency Theory, a theoretical framework for understanding the development of self-determination as a psychological construct, is reviewed, along with research on the importance of self-determination for inclusion, psychological growth, and overall well-being. Specific approaches, models, and perspectives for addressing the support needs of students with intellectual and developmental disabilities, particularly during transitions, are discussed. Assessment and intervention aligned with Causal Agency Theory, including the Self-Determination Inventory and the Self-Determined Learning Model of Instruction, are introduced. Future directions and emerging areas of research are summarized, including issues related to cultural validity, integration of strengths-based approaches, emerging technologies, and systemic changes in schools and communities.

Co-design knowledge mobilization tools for universal accessibility in municipalities

Introduction

Modern research teams are re-evaluating conventional methods with the aim of improving the usefulness of knowledge for users, focusing on the role of knowledge users in shaping innovation. In disability field, encouraging participatory research inherently involves diverse perspectives and inclusion, which aligns with the principles of universal accessibility. By actively involving individuals with various backgrounds, abilities, and needs in the research process, we can better understand and address the challenges faced in adopting universal accessibility. This approach ensures that solutions are more comprehensive, inclusive, and effectively cater to the needs of all individuals, fostering a more equitable and accessible environment for everyone. Despite municipal organizations mandating universal accessibility action plans, they lack tools for efficient implementation. The aim of this study was to develop knowledge mobilization tools tailored to a specific municipal context in Quebec, Canada, to facilitate the implementation of universal accessibility measures by municipal employees.

Methods

The co-design process employed in this study was organized into four distinct stages, following the Morales model: (1) Exploration (2) Co-Design (3) Validation (4) Development.

Results

Stages one and two highlighted the employees' lack of awareness about universal accessibility issues and their need to have more information and resources about how universal accessibility is encountered in their work. A steering committee co-designed three video vignettes about universal accessibility, the city's action plan and measures included in it.

Discussion

The co-design approach used in this study allowed us to observe the non-linear nature of partnership research with an organization as complex as a municipality. Our study shows significant advantages of collaboration between the municipal sector and research.

Sustainable Employability of People with Limited Capability for Work: The Participatory Development and Validation of a Questionnaire

PURPOSE

Understanding sustainable employability (SE) of people with limited capability for work (LCW) due to physical or mental disability is crucial for the sustainable participation of this target group. Therefore, adequate measurement instruments for SE are needed. This study aims to validate a questionnaire to measure SE among people with LCW using a participatory approach, including person-job fit (PJ fit) and work-related sense of coherence (Work-SoC).

METHODS

Existing scales for the main concepts were tested and adapted for face validity via cognitive interviews (n = 6), with the involvement of a co-researcher with LCW in the research team. Next, the questionnaire was administered among people with LCW (n = 248) to assess its factor structure (Confirmatory Factor Analysis) and reliability (Cronbach's alpha).

RESULTS

Analysis of the cognitive interviews identified problems with clarity and readability of items, instructions and response categories of used (existing) scales. The main adjustments concerned the shortening of text length, the usage of familiar language and examples, and the addition of an introduction game. Most of the adapted SE indicator scales showed an overall good fit and acceptable-to-good internal reliability. The overall SE model had an overall good fit, and excluding 'internal employability' further improved this fit. PJ fit and Work-SoC had an acceptable/good model fit and internal consistency.

CONCLUSION

The participatory validation process resulted in a validated and comprehensive questionnaire to measure SE, PJ fit and Work-SoC among people with LCW, which enables research into the development of their SE. This questionnaire can be utilised to contribute to a more inclusive labour market.

Appropriate inclusion of adult research participants with intellectual disability: an in-depth review of guidelines and policy statements

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.

Facilitators and challenges in partnership research aimed at improving social inclusion of persons with disabilities

PURPOSE

To identify partnership research challenges and facilitators, as experienced by members of the Inclusive Society (IS) initiative.

MATERIALS AND METHODS

A case study was conducted on all partnership research projects conducted between 2017 and 2019 under the IS initiative through surveys, interviews with the IS community, logbooks, and focus group. Thematic analysis and descriptive analysis were undertaken.

RESULTS

To work effectively with a diversity of stakeholders, winning conditions must be created for the project from the outset. These include determining the team functioning, project objectives, the expectations of each party, and agreeing on a realistic action plan. Project implementation with concern for sustained stakeholder commitment, good working relationships, and achieving project objectives requires organizational planning that favours partner involvement, shared leadership, agreed methods for communicating, conflict resolution methods, recognition of each participant's expertise, and creating a climate of trust. Upon concluding a partnership research project, it is essential to devote time to implement project results in local environments and to ascertain their usefulness to partners.

IS partnership research challenges and facilitators are similar to those identified in past research. Despite this knowledge, challenges persist. Future research could explore tools and practices from other domain to overcome partnership research challenges.

Researching belonging in the context of research with people with intellectual disabilities: A systematic review of inclusive approaches

BACKGROUND

In disability studies belonging is emerging as a promising area of study. Inclusive research, based as it is on lived experience perspectives, is likely to provide salient insights into belonging in the lives of people with intellectual disabilities.

METHOD

A systematic review utilising four databases and five leading journals in the field of intellectual disabilities was used. Content analysis and a deductive synthesis of the extracted data was undertaken.

RESULTS

A high level of confluence was found between the findings of the included studies and key themes of belonging identified in the wider literature. Beyond this, studies utilising inclusive research approaches have contributed novel findings about belonging in the lives of people with intellectual disabilities.

CONCLUSIONS

Inclusive research approaches to belonging may provide innovative and responsive frameworks to support people to develop a sense of being connected and "at home" in themselves and in their communities.

Developing and evaluating a toolkit of strategies to support remote inclusive research teams

Research teams must collaborate with people with intellectual and developmental disabilities to identify effective and inclusive responses to the COVID-19 pandemic and other public health emergencies. Collaborating remotely requires telecommunication and other technologies. We designed and evaluated a digital "Toolkit for Remote Inclusive Research" to provide research teams with evidence-informed strategies to make remote research accessible to and inclusive of people with intellectual and developmental disabilities. First, we completed a rapid scoping review to identify technology used by people with intellectual and developmental disabilities on collaborative research teams. Second, we designed a digital toolkit featuring 23 strategies identified in the review. Third, six inclusive researchers evaluated the toolkit. We illustrate how our team used these evidence-informed strategies during the past year to develop this and other tools to support inclusive research.

What do we not know (yet) about recovery colleges? A study protocol on their (cost-)effectiveness, mechanisms of action, fidelity and positioning

BACKGROUND

Recovery Colleges (RCs) have spread across the globe as a new way of supporting people with mental vulnerabilities in their recovery journey. RCs focus on 'learning' rather than 'curing' and in that line facilitate a transition from being a passive, dependent patient/client to an active, empowered student learning to live life, despite vulnerabilities. Peer support and co-creation are central in RCs, as peers learn from each other by sharing personal experiences with mental vulnerabilities in an accessible, inspiring and stimulating atmosphere. The implementation of RCs is highly encouraged internationally, and as a result RCs and related self-help initiatives increasingly emerge. However, high-quality research on RCs is scarce and there is a call for thorough investigation of (cost-)effectiveness, mechanisms of action, cross-border fidelity and positioning of RCs. In response, this research project aims to fill these gaps.

METHODS

This research project entails (1) a prospective quasi-experimental effectiveness study and economic evaluation, (2) a multifaceted qualitative study to elaborate on the mechanisms of action of RCs for those involved (3) a study to develop a (Dutch) Fidelity Measure of Recovery Colleges, and (4) an organisational case study to describe the positioning of RCs in relation to other mental health care services and community-based initiatives. Following the ideals of co-creation and empowerment in RCs we conduct this research project in co-creation with RC students from Enik Recovery College in Utrecht, the Netherlands.

DISCUSSION

This research project will lead to one of the first longitudinal controlled quantitative evaluations of both cost-effectiveness and effectiveness of RC attendance in a broad sense (beyond attending courses alone). Moreover, we will gather data on a micro level (i.e., impact on RC students), meso level (i.e., organisational fidelity) and macro level (i.e., positioning in the care and support domain), capturing all important perspectives when scrutinizing the impact of complex systems. Finally, we will demonstrate the validity and value of embracing experiential knowledge in science as a complementary source of information, leading to a more profound understanding of what is researched.

TRIAL REGISTRATION

The prospective quasi-experimental study has been pre-registered at clinicaltrails.gov (#NCT05620212).

A call to action for more disability-inclusive health policy and systems research

To date, the exclusion of people with disability participating in research has limited the evidence base informing health system strengthening policy and practice more generally, and addressing disability-related inequalities in access to health services and better health outcomes more particularly. Given that more than 1 billion people, or 16% of the world's population, have a disability, we may fail to respond to the needs of a large proportion of the population unless we are purposeful with inclusion. Our research in this area indicates that online qualitative methods can be effective in engaging under-represented groups and are essential to ensure their input into health policy and systems research. This has important implications for researchers whose responsibility it is to make all health research disability inclusive, for ethical and methodological reasons, so they do not perpetuate the under-representation of people with disability in health policy and systems research. Our paper puts forward several recommendations to facilitate more people with disability participating in health policy and systems research. By critically reflecting on a health system strengthening research project, in which we purposefully aimed to support the participation of people with disability, we identify lessons learnt and issues to consider when planning and conducting accessible research. We also propose a set of actions for moving the agenda forward.

Advancing inclusive research with people with profound and multiple learning disabilities through a sensory-dialogical approach

People with profound and multiple learning disabilities are often excluded from the processes of knowledge production and face barriers to inclusion in research due to cognitive and communicative challenges. Inclusive research-even when intending to be inclusive-tends to operate within criteria that exclude people with profound and multiple learning disabilities. The aim of this article is to provide a state-of-the-art review of the topic of inclusive research involving people with profound disabilities and thereby challenge traditional assumptions of inclusive research. The review presents themes that will inform a discussion on how to challenge the criteria in ways that make it possible to understand inclusive research for people who communicate in unconventional ways. We argue that a fruitful way of rethinking inclusive research is by applying a sensory-dialogical approach that privileges the dialogical and sensory foundations of the research. We suggest this might be a way to understand inclusive research that regards the person's communicative and cognitive distinctiveness.

Recognising Basic Health Literacy Capabilities: An Explorative Study on the Relevance of Health-Related Information in the Support of People with Profound Intellectual and Multiple Disabilities

Background: People with profound intellectual disabilities represent a vulnerable and heterogeneous population whose health-related needs and questions often remain unheard. One reason for this is that they are usually unable to participate in verbal communication. However, there is also a lack of suitable approaches to communicate health-related information to them according to their capabilities. The research presented in this paper addresses this gap. Methods: Following grounded theory methodology, we used a multimethod approach. Based on a theoretical analysis, a Delphi study (n = 14) was conducted as a starting point to map the research field. In a second step, these findings were incorporated into an online survey targeting disability care professionals (n = 111). Three field studies supplemented the data, encompassing a variety of ethnographic methods. Results: People with PIMD have basic health-related capabilities that can improve their health literacy. Nevertheless, their support environments have to take over many health literacy-related requirements by proxy or substitution. One of the most important tasks is to engage health information in an individualised way. Conclusions: The findings underline the importance of focusing on more basic capabilities and intersubjective approaches in health literacy research and practice, especially regarding new perspectives on the inclusion of previously marginalised populations (such as people with PIMD).

Peer researchers' experiences of a co-produced research project on supported decision-making

BACKGROUND

Making decisions about your own life is a key aspect of independence, freedom, human rights and social justice. There are disabled people who, without support, would be assessed as incapable of making certain decisions but with the appropriate support are capable of making those decisions and so to not provide that support infringes their rights, undermines their autonomy and reinforces their exclusion from society. However, there is limited research evidence available about disabled people's experiences of the range of approaches provided to support decision-making. This article will explore the experiences of four peer researchers who co-produced a research project on how people have, or have not been, supported to make their own decisions. Two of the peer researchers have experience of mental health problems and two are people with an intellectual disability. The article refers to peer research because its subject matter is the relevant lived experience of people. Peer research is therefore an approach within the broader areas of participatory research and co-production.

METHODS

The peer researchers interviewed 21 people with mental health problems and 20 people with an intellectual disability to gain an in-depth understanding of their experiences and preferences for how decision-making should be supported. Peer researcher experiences at each stage of the study from design to analysis were explored using data collected from the peer researchers via blogs written at early stages of the study, discussions at team meetings as the fieldwork progressed and at a final workshop at the end of the study which gave the peer researchers the opportunity to focus on their overall reflections of being a peer researcher. The article also discusses motivations to undertake the peer research role, the process of co-production and the challenges negotiated during the study.

RESULTS

The peer researchers reported a number of positive effects of being involved in the research project which included improvements in skills and self-confidence.

CONCLUSION

The peer researchers' involvement challenged assumptions about the inability of people with an intellectual disability and/or mental health problems to participate proactively in a research project whilst also highlighting the importance of training for all team members.

'Getting our voices heard in research: a review of peer researcher's roles and experiences on a qualitative study of adult safeguarding policy

BACKGROUND

Historically, disabled people have been marginalised in research that traditionally adopted a medical model perspective. Since the 1970's, there has been a shift from research on disabled people to research with disabled people with a strong emphasis on co-produced participatory research. Co-production involves disabled people working with academics to produce research and outcomes which are informed by the end user. This paper reflects on the role and experiences of peer researchers in co-producing a recent UK-wide research project called 'Getting our Voices Heard'. This project sought to identify the best approaches for people with a learning disability and their supporting organisations to influence adult safeguarding policies, across the four jurisdictions of the UK.

METHODS

A co-produced participatory design was used to address the project aims; achieved through the establishment of a collaborative research team comprising academic researchers, key stakeholders and six peer researchers, each of whom had a learning disability. Semi-structured interviews were completed with senior policy makers. Following this, in each of the four Nations, an organisational case-study was completed (four in total). Organisations were purposively sampled to identify one organisation in each country which was recognised as being successful in influencing adult safeguarding policy. Data were gathered through focus groups discussions and semi-structured interviews with key stakeholders. Findings were developed into an Impact Strategy and Action Plan. Co-production methods were used throughout.

RESULTS

Six individuals with a learning disability were recruited and trained to work as peer researchers, involved at key stages of the project, working alongside a wider research team. The role and experiences of the peer researchers in the context of policy are presented. Peer researchers provided largely positive first-hand accounts of their experiences. The importance of collaboration, the invaluable role of Learning Disability support organisations, and the need for additional time and resources to facilitate co-production, was noted.

CONCLUSION

Whilst peer researchers were positive about their experiences, some success in promoting co-produced research and areas for improvement were evident. Collaboration at all stages would have been strengthened with research funding which enabled involvement of all team members in all research activities.

Inclusive Research and Intellectual Disabilities: Moving Forward on a Road Less Well-Travelled

In reflecting on the title of the special issue: Inclusive Research: A road less or more well-travelled, this paper reviews the strengths of inclusive research that have augmented the global knowledge about the lives of people with intellectual disabilities across the lifespan. The successes of inclusive research are outlined with the respective ongoing individual challenges discussed. Authors will draw upon their own experiences of inclusive research, together with the seminal and current literature, as well as the dialogue between them. The conclusions of the article are in the form of recommendations aimed at increasing the traffic on the road of inclusive research through: 1. expanding its purpose and parameters across all forms of disability research; 2. developing systems for sustaining inclusive research as a funded model; 3. creating capacity to enable people with intellectual disabilities to be employed as researchers directing research projects; and 4. establishing bridges and crossroads with policy and practice through its findings.

Lessons Learned From Research Collaboration Among People With and Without Developmental Disabilities

Research related to the developmental disability (DD) community should include collaboration with individuals with DD. Unfortunately, people with DD are infrequently involved in research projects in meaningful ways, and there is little guidance about how to collaborate equitably with researchers with DD. The purpose of this article is to share lessons learned from a collaborative research study among researchers with and without DD using both qualitative and quantitative methods to develop and examine the effectiveness of a civic engagement intervention for transition-aged youth with disabilities. It includes how our research team compensated researchers with DD, clarified team member roles, leveraged the expertise of researchers with DD in using both qualitative and quantitative methods, and integrated technology throughout the research process.

Opening the door to university health research: recommendations for increasing accessibility for individuals with intellectual disability

BACKGROUND

Advances in health equity rely on representation of diverse groups in population health research samples. Despite progress in the diversification of research samples, continued expansion to include systematically excluded groups is needed to address health inequities. One such group that is infrequently represented in population health research are adults with intellectual disability. Individuals with intellectual disability experience pervasive health disparities. Representation in population health research is crucial to determine the root causes of inequity, understand the health of diverse populations, and address health disparities. The purpose of this paper was to develop recommendations for researchers to increase the accessibility of university health research and to support the inclusion of adults with intellectual disability as participants in health research.

METHODS

A comprehensive literature review, consultation with the university ethics review board, and review of United States federal regulations was completed to identify barriers to research participation for individuals with intellectual disability. A collaborative stakeholder working group developed recommendations and products to increase the accessibility of university research for participants with intellectual disability.

RESULTS

Eleven key barriers to research participation were identified including gaps in researchers' knowledge, lack of trust, accessibility and communication challenges, and systematic exclusion among others. Together the stakeholder working group compiled seven general recommendations for university health researchers to guide inclusion efforts. Recommendations included: 1) address the knowledge gap, 2) build community partnerships, 3) use plain language, 4) simplify consent and assent processes, 5) establish research capacity to consent, 6) offer universal supports and accommodations, and 7) practice accessible dissemination. In addition, four products were created as part of the stakeholder working group to be shared with researchers to support the inclusion of participants with intellectual disability. 1) Supports I Need Checklist, 2) Plain language glossary of health and research terms, 3) Understanding Consent and Assent in Plain Language, 4) Easy-Read Paper Template.

CONCLUSION

Community members and individuals with intellectual disability want to be included in research and are eager to engage as research participants. It is the responsibility of the researcher to open the door to university health research. The recommendations discussed in this paper could increase accessibility for a broader range of research participants and, in particular, promote the inclusion of individuals with intellectual disability to advance health equity in population health research.

Opening the door to university health research: recommendations for increasing accessibility for individuals with intellectual disability

BACKGROUND

Advances in health equity rely on representation of diverse groups in population health research samples. Despite progress in the diversification of research samples, continued expansion to include systematically excluded groups is needed to address health inequities. One such group that is infrequently represented in population health research are adults with intellectual disability. Individuals with intellectual disability experience pervasive health disparities. Representation in population health research is crucial to determine the root causes of inequity, understand the health of diverse populations, and address health disparities. The purpose of this paper was to develop recommendations for researchers to increase the accessibility of university health research and to support the inclusion of adults with intellectual disability as participants in health research.

METHODS

A comprehensive literature review, consultation with the university ethics review board, and review of United States federal regulations was completed to identify barriers to research participation for individuals with intellectual disability. A collaborative stakeholder working group developed recommendations and products to increase the accessibility of university research for participants with intellectual disability.

RESULTS

Eleven key barriers to research participation were identified including gaps in researchers' knowledge, lack of trust, accessibility and communication challenges, and systematic exclusion among others. Together the stakeholder working group compiled seven general recommendations for university health researchers to guide inclusion efforts. Recommendations included: 1) address the knowledge gap, 2) build community partnerships, 3) use plain language, 4) simplify consent and assent processes, 5) establish research capacity to consent, 6) offer universal supports and accommodations, and 7) practice accessible dissemination. In addition, four products were created as part of the stakeholder working group to be shared with researchers to support the inclusion of participants with intellectual disability. 1) Supports I Need Checklist, 2) Plain language glossary of health and research terms, 3) Understanding Consent and Assent in Plain Language, 4) Easy-Read Paper Template.

CONCLUSION

Community members and individuals with intellectual disability want to be included in research and are eager to engage as research participants. It is the responsibility of the researcher to open the door to university health research. The recommendations discussed in this paper could increase accessibility for a broader range of research participants and, in particular, promote the inclusion of individuals with intellectual disability to advance health equity in population health research.

Sex Education for Students with an Intellectual Disability: Teachers’ Experiences and Perspectives

Background: Sex education assists students in the development of a healthy sexual identity and relationships. However, students with an intellectual disability tend to receive less holistic sex education as compared to students without a disability. In this inclusive study, we explored the perspectives of 10 high school teachers through interviews and focus groups on how students with an intellectual disability are informed about sexual relationships and prepared for their future life living with as much autonomy as possible, including living with a partner and becoming parents. Method: The interviews and focus groups were analysed using the inductive content analysis. Results: Data analysis revealed three themes: (a) sex education; (b) self-determination and self-advocacy skills; and (c) teachers’ concerns. Conclusions: Several recommendations are discussed. These include incorporating sexuality education-related goals in an Individualised Learning Plan (ILP); teachers adopting a rights-based approach and focusing on students’ self-determination, agency, and rights regarding sex education; and providing schools with necessary resources to teach sex education.

Participatory curriculum development for health and independent living for disabled people: a qualitative study of participant experiences

Participatory curriculum development is an approach that draws on participatory research philosophy by engaging members of intended audiences in the curriculum development process. This is a fairly new approach to curriculum development, which has seldom been applied in health promotion and, to our knowledge, has not previously been used to develop curriculum with disabled people. In this project, participatory curriculum development was used to both develop a new curriculum and revise an existing curriculum for in-person, web-based delivery. We engaged in this process with Center for Independent Living staff members, twelve of whom we interviewed post-engagement. We assessed the development process for equitable engagement and sharing of power and identified three relevant main themes: learning, collaborating, and empowering. Our project partners engaged collaboratively in project development and believed the curriculums would empower their intended end-users. However, they desired greater sharing of power during the process to create an equitable experience.

Relationships of People with Intellectual Disabilities in Times of Pandemic: An Inclusive Study

(1) Background: Since 2012, our Inclusive Research Team has developed several studies on various topics that interest the co-researchers with intellectual disabilities. In 2021, throughout the COVID-19 pandemic, the co-researchers decided to investigate the impact of the pandemic on the relationships of people with intellectual disabilities. The aim of this article is to disseminate how this inclusive study was developed and to explain its results; (2) Methods: Co-researchers and academic researchers met six times to make different decisions: decide on the research topic; discuss the topic; prepare an interview script for people with intellectual disabilities; analyse the data obtained; and decide how to disseminate the results of the research. The co-researchers interviewed 10 people with intellectual disabilities and participated as facilitators in 3 focus groups; (3) Results: During the pandemic, digital devices have enabled people with intellectual disabilities to maintain their social relationships. However, the lack of access or support in using them, as well as the restrictions imposed on people with intellectual disabilities living in institutions, have presented significant barriers to maintaining their social relationships; (4) Conclusions: This article shows the difficulties people with intellectual disabilities face in maintaining successful social relationships in times of pandemic, and how we undertook research in an inclusive, virtual manner.

On the Road Together: Issues Observed in the Process of a Research Duo Working Together in a Long-Term and Intense Collaboration in an Inclusive Research Project

Inclusive research practices can lead to progress towards an inclusive society. With this study, we aimed to gain insight into dilemmas and catalysing processes within the long-term collaboration of an inclusive research duo: one non-academic researcher who lives with the label of intellectual disabilities and visual impairment, and one academic researcher. Both researchers kept personal diaries about their collaboration process. Inductive thematic analysis, individually and as a group of authors, was employed. Our findings reveal six necessary conditions for diversity-sensitive work in inclusive research: (a) experiencing belonging within the research group, (b) empowering people in a team through growing self-awareness and competence-building, (c) having room for reflection and searching for various ways of communication, (d) sharing power and ownership of research processes, (e) having enough time to foster the above conditions, and (f) joining in a mutual engagement in accommodating vulnerability in dialogue and collaborative work. Awareness of stigma-related issues and the risk of tokenism is also required.

A Closer Look at the Quest for an Inclusive Research Project: ‘I Had No Experience with Scientific Research, and then the Ball of Cooperation Started Rolling’

The original adage of the movement of people with disabilities ‘Nothing about us without us’ is fortunately more and more adopted in the research world. There is, for example, increasing recognition of the importance and value of actively involving people with intellectual disabilities in research projects on topics that are relevant to them. In a current doctoral research project, a co-researcher with an intellectual disability was recruited to work together with the doctoral researcher. Now that this project is nearing completion, it is time to look at some aspects of their collaboration and see what we can learn from this process. In several (joint) meetings, the researchers reflected on their personal experiences with working and researching together. Our reflections are presented using three overarching themes: preparations for the collaboration, collaborating as a complex process, and conducting research together. The discussion focuses on what can be inferred from these personal experiences with regard to the following three topics: how inclusive research can be organised best, the possible benefits of the collaboration for the researchers involved, and the possible impact of the collaboration on the quality of the research.

Reflections on Working Together in an Inclusive Research Team

The funding of a research project working with local governments and people with intellectual disabilities led to the establishment of an inclusive research team within a university faculty. The core team consisted of four people, including a design researcher, an architect, a disability advocate and a community researcher/self-advocate. Though there are ample attention and resources devoted to the front-facing parts of a university being visibly inclusive—mostly from a physical access perspective or focussed on the student experience—less attention has been directed to what it means to develop and support inclusive research and aligned work opportunities for people with intellectual disabilities within a university campus. For this reason, the paper explores what it was like for our team that included non-traditional academics and people with intellectual disabilities to work at a university in a design school (not a disability-related research centre). We employ a process of collaborative autoethnography to reflect on how different team members took the lead across different parts of the study. We conclude with a set of tips for the development of more inclusive research teams within university settings.

Being an Inclusive Researcher in a National Consultation Exercise—A Case Study

This paper presents a case study of the Inclusive Research Network (IRN), an inclusive research group founded by the Centre for Disability Studies, contributing to a National Disability Research Agenda (NDRA) setting project. IRN members with ID carried out their own consultations with disability stakeholders. This paper sets out the experiences of the IRN members in facilitating focus groups as part of phase 2 of the NDRA project. As this project took place during the COVID-19 pandemic and state lockdowns, this paper also provides a reflection on new ways of carrying out research and provides an insight into the process for other groups seeking to engage in inclusive research of this nature in a challenging and changing environment. IRN members showed great interest in being involved in the project, and their motivations aligned with the project’s objectives. Facilitating the focus groups on Zoom took some preparation and posed accessibility challenges but enabled a more diverse group of people to attend. IRN members with ID improved their online facilitation skills and confidence but concluded that they preferred working face to face. IRN members overcame the challenges presented by online focus groups, and their involvement added value to the NDRA project. Researchers are encouraged to continue practicing inclusive research in times of remote working and virtual interaction and to share their experiences for mutual learning.

Doing Research Inclusively: Understanding What It Means to Do Research with and Alongside People with Profound Intellectual Disabilities

Positive developments in inclusion in line with ‘Nothing about us without us’ have rarely extended to people with profound intellectual disabilities. Advances in inclusive research are in danger of leaving this group (and their families and allies) on the outside, with researchers relying on proxies at best, or more often omitting this group as ‘too difficult’ to include in the research process at all. This paper argues that finding a way for people with profound intellectual disabilities to belong in inclusive research is important. Using examples, small stories and photographs, it explores and illustrates potential ways to research with and alongside those with profound intellectual disabilities that celebrate different kinds of agency and personhood and that support relational autonomy. The paper concludes that rather than starting from how inclusive research is currently conceived, the starting point should be a deep knowledge of people with profound intellectual and multiple disabilities. The way forward is likely to be an inclusive research culture that can accommodate ‘being with’ as core to its research approach. This will enable the voices of people with profound intellectual disabilities to inform the research in creating intersubjective knowledge together.

Inclusive Research and the Use of Visual, Creative and Narrative Strategies in Spain

In recent decades, there have been many works on inclusive research that provide a clear framework on its meaning and the implications it entails. They also highlight the importance of addressing outstanding challenges, among others, to inquire after research strategies that respond to the diversity of situations in which people with intellectual disabilities find themselves. This article presents a research project carried out in Spain over a period of eighteen months by a team of researchers with and without intellectual disabilities. Specifically, we explore how the construction of enabling relationships, both dialogic and horizontal, requires giving greater emphasis to visual and creative methodological strategies, such as photographs, image-theatre, body-mapping, murals or visual presentations. The findings reported by the researchers and co-researchers have encouraged us to review some methodological premises such as our role as researchers or the type of relationships we establish. They also demonstrate the value of using a variety of collaborative enquiry strategies that recognise the agency of all researchers.

Using immersive virtual reality with autistic pupils: moving towards greater inclusion and co-participation through ethical practices

Purpose

The potential of head mounted displays based virtual reality (HMD-based VR) for autistic groups has been well documented. However, the deployment and application of this technology, especially in schools, has been extremely limited. One of the main criticisms in this field has been the lack of involvement from practitioners in research on educational approaches for autistic populations and the gap between research and practice in real-life settings.

Design/methodology/approach

This conceptual article focuses on our research in a UK-based special needs school that sought to examine the effects and potential use of VR-HMDs, while seeking to establish best practices for safe and ethical application using this technology. This draws upon ethical and participatory research guidance, including British Educational Research Association and Autism Participatory Research.

Findings

The authors make recommendations on planning and implementing a participatory, safe and ethical approach to researching the use of VR-HMDs in special needs schools and engaging with the priorities of autistic children and young people and their teachers.

Originality/value

This conceptual article provides an initial first consideration of ways we can better include autistic people and their views in research that is with and about them. The value in this will mean we are able to better support autistic groups moving ahead using VR HMD-based technologies. Without this paradigm shift and including autistic people (and their stakeholders) the field might continue to build initiatives around medical-based models of disabilities rather that what the community need/want.

How Being a Researcher Impacted My Life

Doing research can help people to learn about a lot of different topics. For example, researchers can learn how to work in a group, collect and analyze data, how to make accessible materials, and get to know their own strengths. In this paper, a researcher shares what she learned while working on two research projects about young adults with intellectual/developmental disabilities and co-occurring mental health conditions. The first project was peer mentoring. In this project, we focused on individual needs for someone who may be struggling with mental health. The second project was about workplace disclosure. In this project, we tried to find out if young adults disclose their mental health conditions at work and in job interviews. We explain how we did the projects, how the researcher learned to do research, and what made it easy to learn. We also share about the impact of doing research on the researcher’s personal life. Finally, we share why doing inclusive research is important and how to help researchers with disabilities feel like they are valued members of the research team.

Experiences of Inclusive Action and Social Design Research with Social Workers and People with Intellectual Disabilities

In this study, we report on a two-year experience of inclusive participative action and social design research consisting of intensive collaboration between social workers, people with intellectual disabilities and researchers. Action research and design research are attunable and lend themselves to an inclusive approach aimed at knowledge development and change in practice. Social workers and people with intellectual disabilities were involved in a community of development. They became owners of the subject matter and the answers and solutions they designed. We conclude that an inclusive approach lends itself well to combining or even merging action research and social design research. Inclusive participative action and social design research cannot be standardized since it contains a particularly emergent process. Hence, it requires flexibility and creativity in finding ways to create an inclusive process of co-creation.

Supporting Remote Survey Data Analysis by Co-researchers with Learning Disabilities through Inclusive and Creative Practices and Data Science Approaches

Through a process of robust co-design, we created a bespoke accessible survey platform to explore the role of co-researchers with learning disabilities (LDs) in research design and analysis. A team of co-researchers used this system to create an online survey to challenge public understanding of LDs [3]. Here, we describe and evaluate the process of remotely co-analyzing the survey data across 30 meetings in a research team consisting of academics and non-academics with diverse abilities amid new COVID-19 lockdown challenges. Based on survey data with >1,500 responses, we first co-analyzed demographics using graphs and art & design approaches. Next, co-researchers co-analyzed the output of machine learning-based structural topic modelling (STM) applied to open-ended text responses. We derived an efficient five-steps STM co-analysis process for creative, inclusive, and critical engagement of data by co-researchers. Co-researchers observed that by trying to understand and impact public opinion, their own perspectives also changed.

When people matter: The ethics of qualitative research in the health and social sciences

When research involves people, ethics are fundamental. In the health and social sciences, when qualitative methodologies are used, in addition to ensuring an ethical process approved by the ethics review board, it is also necessary to guarantee an ethical practice capable of responding adequately to the complex questions and dilemmas which arise as the study progresses. This theoretical article analyses some of the most sensitive issues involved in qualitative research and discusses the following questions: (a) How should ethics be approached when working with vulnerable groups? (b) Is informed consent enough? (c) Should we rethink anonymity? (d) What is the difference between confidentiality and anonymity? (e) What exactly do we mean by relational ethics? (f) How can we avoid hurting people, yet remain honest? In the conclusions, we discuss some basic aspects for ensuring ethical studies. This paper, therefore, may be of interest to all health and social researchers concerned about ensuring that their studies comply with ethical principles which recognise, protect and respect participants' rights.

"They don't think I can cope, because I have got a learning disability…": Experiences of stigma in the lives of parents with learning disabilities

BACKGROUND

Parents with learning disabilities report facing a widely held 'presumption of incompetence', placing them under pressure to prove their parenting competence. In collaboration with a learning disability theatre company, an inclusive research methodology explored experiences of parenting with learning disabilities, with a specific focus on the operation of stigma in parents' lives.

METHOD

Interviews with 17 mothers and 5 fathers who self-identified as having learning disabilities were co-facilitated by learning-disabled co-researchers, and analysed using thematic analysis, with input from people with learning disabilities.

RESULTS

Thematic analysis generated four key themes; (1) positions of powerlessness, (2) assumptions of incompetence, (3) challenging assumptions and proving competence and (4) claiming power.

CONCLUSION

Parents reported experiencing stigma and disempowerment within their networks, yet continued to embrace their valued parental identity and drew strength from involvement with self-advocacy organisations. The research informed arts-based performance pieces and resources aimed at training professionals and raising public awareness.

Successful strategies for including adults with intellectual disabilities in research studies that use interpretative phenomenological analysis

BACKGROUND

Adults with intellectual disabilities are not often asked to participate in health research. This may be because researchers perceive them as unable to participate meaningfully with or without significant support and anticipate difficulty in obtaining ethical approval because of issues concerning consent and mental capacity. This means that the voices of adults with intellectual disabilities are often missing from health research and their experiences and views are unexplored.

AIM

To share successful strategies for accessing, recruiting and collecting data from a purposive sample of adults with intellectual disabilities from a study that used interpretative phenomenological analysis (IPA).

DISCUSSION

IPA is a person-centred, flexible and creative approach to research. Meaningful collaboration with people with intellectual disabilities, their families, carers, advocacy group managers, specialists in intellectual disability services and research supervisors was vital to the success of the study. The authors share practical strategies for including people with intellectual disabilities, from the perspective of a novice researcher who is an outsider to the field of intellectual disability.

CONCLUSION

It is important to include people with intellectual disabilities in healthcare research. This article presents a framework to support researchers outside the specialist field of intellectual disabilities in achieving this.

IMPLICATIONS FOR PRACTICE

Personal views and perceptions of healthcare are important if health services are to meet individual needs. Adults with intellectual disabilities often receive poor healthcare and have poorer outcomes. This will be perpetuated without their input into research. People with intellectual disabilities can make valuable contributions to the evidence base.

How people with intellectual and developmental disabilities on collaborative research teams use technology: A rapid scoping review

BACKGROUND

We conducted a rapid scoping review to identify how inclusive research teams use technology during the research process that could support remote collaboration during public health emergencies like the COVID-19 pandemic.

METHOD

We searched three databases and conducted a hand search. Two independent reviewers screened 1498 abstracts and titles for inclusion criteria; 81 full text articles were further reviewed; 47 were included. We extracted information about each type of technology, categorised technology used during the research process, and documented described accommodations.

RESULTS

We identified 47 articles and 94 examples of technologies used by people with intellectual and developmental disabilities throughout the research process: team formation and team function (38), data collection (19), data analysis (17) and dissemination (20).

CONCLUSIONS

Technology use by team members with intellectual and developmental disabilities demonstrates promise for remote research collaborations during public health and climate emergencies and teams with members living in diverse locations.

Inclusive approaches to developing content valid patient-reported outcome measure response scales for youth with intellectual/developmental disabilities

BACKGROUND

Patient-reported outcome measures (PROMs) are increasingly used in health care to evaluate service quality and client progress. Response scales are a critical component of PROM content validity and must be designed to be relevant and comprehensible by users.

METHODS

In collaboration with eight youth co-researchers with intellectual/developmental disabilities ages 14-21, we used an iterative, three-stage approach to develop and select a response scale for the PEDI-PRO. Stages: 1) inclusive development of response scale options; 2) Collecting data about response scale options during focus groups with youth with intellectual/ developmental disabilities (n = 62); and 3) Analysing data to refine response options.

RESULTS

Through two cycles of the three-stage process, the inclusive research approach led to the development of a content valid response scale that describes functional performance of everyday activities ("very easy," "a little easy," "a little hard").

CONCLUSION

An inclusive research approach can support the development of content valid PROM scales. We identified four broad strategies that supported youth co-researchers to engage in this response scale development process: universal design for learning, use of lived experiences, breaking down tasks, and peer support. Researchers may adopt and/or adapt the accessible inclusive research approaches described in this manuscript for measurement development and other research projects.

"We Copy to Join in, to Not Be Lonely": Adolescents in Special Education Reflect on Using Dramatic Imitation in Group Dramatherapy to Enhance Relational Connection and Belonging

This paper focuses on doctoral research which explored relationships and interpersonal learning through group dramatherapy and creative interviewing with adolescents in special education. A constructivist grounded theory study, positioning adolescents with intellectual/developmental disabilities as experts of their own relational experiences, revealed a tendency to “copy others.” The final grounded theory presented “copying” as a tool which participants consciously employed “to play with,” “learn from,” and “join in with” others. Commonly experiencing social ostracism, participants reflected awareness of their tendency to “copy others” being underpinned by a need to belong. Belonging was therefore expressed as the ultimate therapeutic experience participants wished to have. Participant responses which link dramatic imitation to a self-identified tendency “to copy,” are discussed with regard to how imitation provides an accessible point of dramatic entry from which adolescents in special education begin to explore new ways of being and inter-relating. Recommendations for how dramatherapists might centralize imitative aspects of the dramatic process to achieve therapeutic intent when working alongside adolescents in special education are discussed with specific focus on creating a space of belonging.

Note on type: Participant quotes extracted from the data are included throughout this article. In order to highlight participant’s contributions quotes are italicized and presented within speech marks.

Building a research team and selecting a research topic within the process of an inclusive research project in Spain

BACKGROUND

In this paper, we illustrate the extent to which building an inclusive research team and the selection of a research topic, based on a collaborative group approach, constitute key elements of inclusive research.

METHOD

The selection and analysis of activities and methodological strategies, extracted from the recordings of the research meetings, offer clues about the creation of collaborative and deliberative research spaces.

RESULTS

Some of the elements that reaffirm the inclusive nature of this research are as follows: contributions by all members of the research team receive equal recognition, the particular interests of all of those involved are taken into account and research strategies that are supported in different languages encourage the participation of all researchers.

CONCLUSIONS

We need to review our practices in order to identify the added value of this type of work and move towards research training proposals that promote the research ownership of people with intellectual disabilities.

Awareness of Sexual Rights and Empowerment: Quantitative and Qualitative Evaluation of a Sexual Health Intervention for Adults with Intellectual Disability

Young people with intellectual disability (ID) rarely have opportunities to form intimate relationships or receive long-term interventions promoting their sexual health and awareness of sexual rights. To promote sexual health in adults with ID in Taiwan, we utilized intervention research and inclusive research to introduce three interventions that involved adults with ID, their parents, and service workers. This paper primarily evaluates the outcomes of a two-year intervention to promote sexual and reproductive health knowledge/positive attitudes and quality of life for adults with ID. A non-equivalent multiple-groups with replications design was used to gather data from 87 adults with ID. In-depth interviews and focus groups were used to collect the experiences and perspectives of adults with ID, service workers and parents. Although the experimental groups did not show a strong quantitative increase in sexual knowledge and sexual attitudes, the qualitative data indicated that the dialogues with and among the participants transformed their perceptions of sexual needs from being sexual problems to being sexual rights, which was empowering for adults with ID. Involving parents and service workers in the intervention and facilitating dialogue between these groups are essential to transform sexual problems of adults with ID into sexual rights.

Belonging through sport participation for young adults with intellectual and developmental disabilities: A scoping review

BACKGROUND

Research suggests that sport facilitates belonging for diverse athletes. This scoping review characterizes literature on sport participation and belonging for young adults with intellectual and developmental disabilities.

MATERIALS AND METHODS

A search of five databases identified 17,497 articles. Selected articles (N = 39) underwent data extraction and analysis guided by a theoretical framework of belonging, outlining four processes through which belonging is experienced by individuals with intellectual and developmental disabilities.

RESULTS

Articles originated from developed countries and in the context of Special Olympics (N = 17). Studies commonly used qualitative interviews with proxy respondents. While all studies described at least one belonging process, only 11 studies applied the term "belonging," and no study defined the construct.

CONCLUSION

Belonging is not well-conceptualized in sports literature for athletes with intellectual and developmental disabilities. Understanding belonging through sport participation for this population may inform sport-based policies and programming.