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Whalen Smith CN, Havercamp SM, Tosun L, Shetterly S, Munir A, Kennedy W, Feldner HA, Herrman D, Sloane BM, Weinstein FH. Training an Anti-Ableist Physical Therapist Workforce: Critical Perspectives of Health Care Education That Contribute to Health Inequities for People With Disabilities. Phys Ther 2024; 104:pzae092. [PMID: 39001711 DOI: 10.1093/ptj/pzae092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 03/22/2024] [Accepted: 07/11/2024] [Indexed: 07/15/2024]
Abstract
Americans with disabilities represent the largest historically underserved and marginalized health disparity population in the United States. This perspective piece will raise the awareness of physical therapist faculty and clinicians on gaps in health care provider knowledge about disability and provide actionable strategies, frameworks, and resources available to improve disability competence to make changes in clinical education and practice. In this perspective piece, 3 contributions are made. First, health disparities experienced by Americans with disabilities as a result of health care providers' biased assumptions about disability and lack of disability competence are described through an in-depth illustration of lived experiences of people with disabilities. Second, a discussion of disability competence in physical therapist education is provided. Finally, critical and evidence-based insights and actionable frameworks and resources to address disability competence training gaps and to promote anti-ableist practice are provided.
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Affiliation(s)
- Cara N Whalen Smith
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Susan M Havercamp
- Nisonger Center, The Ohio State University, College of Medicine, Columbus, Ohio, USA
| | - Leyla Tosun
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Samantha Shetterly
- Physical Therapy, Human Movement, and Rehabilitation Sciences, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Armin Munir
- Physical Therapy, Human Movement, and Rehabilitation Sciences, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Winston Kennedy
- Physical Therapy, Human Movement, and Rehabilitation Sciences, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Heather A Feldner
- Department of Rehabilitation Medicine, Disability Studies Program, Center for Research and Education on Accessible Technology and Experiences (CREATE), University of Washington, Seattle, Washington, USA
| | - Deana Herrman
- Doctor of Physical Therapy Program, College of Health and Human Sciences, Northern Illinois University, DeKalb, Illinois, USA
| | - Bethany M Sloane
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
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Herrman D, Pechak CM, Berg K, Magasi S. Instructing to Impact: Exploration of Doctor of Physical Therapy Education Instruction of Social Determinants of Health and Health Equity for People With Disabilities. Phys Ther 2024; 104:pzae070. [PMID: 38738784 DOI: 10.1093/ptj/pzae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 12/21/2023] [Accepted: 05/06/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE The aim of this study was to explore the instruction of social determinants of health (SDOH) for people with disabilities (PWD) in doctor of physical therapy (DPT) education programs. METHODS A sequential mixed methods study informed by a five-member disability community advisory panel was conducted. Qualitative semi-structured interviews with educators (n = 10) across 4 DPT programs in the Midwest were conducted and analyzed thematically. The qualitative findings formed the basis of the quantitative phase. An online survey was conducted with faculty of DPT programs in the United States (n = 254) with the most knowledge of instruction of SDOH and health equity for PWD (n = 74; 29% response rate). Quantitative data were analyzed with descriptive statistics and triangulated with qualitative data. RESULTS SDOH for PWD is an emerging component of instruction in DPT curricula. Five themes included: emerging instruction of SDOH for PWD; conceptual frameworks informing instruction; instructional strategies; barriers to integration of SDOH for PWD; and facilitators to integration of SDOH for PWD. Quantitative analysis revealed that 71 respondents (95.9%) included disability in health equity discussions primarily focused on health care access. Limited time (n = 49; 66.2%) was the most frequently reported barrier, and educator interest in disability health equity was the most frequently reported facilitator (n = 62; 83.7%) to inclusion of the SDOH for PWD in health equity discussions. CONCLUSION Opportunities exist in DPT curricula to build on instructional strategies, integrate SDOH frameworks, and amplify facilitators to integration of SDOH for PWD. IMPACT To meet the needs of the 67 million Americans living with disabilities, students must have the knowledge and skills to address the complex needs of this historically marginalized population. Understanding the DPT education landscape around SDOH for PWD can guide DPT educators to more fully prepare their students to recognize and ameliorate health disparities faced by PWD.
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Affiliation(s)
- Deana Herrman
- College of Health and Human Sciences, Northern Illinois University, DeKalb, Illinois, USA
| | - Celia M Pechak
- Doctor of Physical Therapy Program, The University of Texas at El Paso, El Paso, Texas, USA
| | - Kristin Berg
- Department of Disability and Human Development, University of Illinois-Chicago, Chicago, Illinois, USA
| | - Susan Magasi
- Department of Occupational Therapy, University of Illinois-Chicago, Chicago, Illinois, USA
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Spong J, Iacono T, Weise J, Trollor J, Spong L, Lenten T. Preparedness and training needs of a regional public mental health service to support people with intellectual disability. Aust J Rural Health 2024; 32:724-739. [PMID: 38715521 DOI: 10.1111/ajr.13130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/12/2024] [Accepted: 04/22/2024] [Indexed: 08/29/2024] Open
Abstract
OBJECTIVE To explore the preparedness and training needs of a regional public mental health workforce to support people with intellectual disability and mental ill health. SETTING AND PARTICIPANTS Staff from a regional public mental health service in Victoria, Australia. DESIGN A mixed-methods design comprised a survey, interviews and a focus group to collect data about staff attitudes, confidence, education and professional development regarding supporting people with intellectual disability and mental ill health. Descriptive and thematic analyses were used. RESULTS Data from 31 survey respondents, seven interviews and one focus group were analysed. Survey descriptive analyses showed participants believed treating people with intellectual disability was part of their role but reported areas of low confidence along with insufficient education and training in intellectual disability mental health. Thematic analyses from interviews showed that underpinning confidence, education and training were the themes (1) need for flexibility, such as having more time and (2) solutions but with challenges, such as limited opportunity to upskill and availability of experts. A need for collaborative problem-solving where staff share skills and information to work towards person-centred solutions was a key theme from the focus group analysis. CONCLUSION Professional development in intellectual disability mental health is required for the regional public mental health workforce but needs to account for the challenges experienced and reflect how teams function. Exploration of described preparedness offered a possible learning approach informed by workforce members. Collaborative learning approaches to supporting people with intellectual disability and mental ill health are suggested.
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Affiliation(s)
- Jo Spong
- Living with Disability Research Centre, La Trobe University, Bendigo, Victoria, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Teresa Iacono
- Living with Disability Research Centre, La Trobe University, Bendigo, Victoria, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Janelle Weise
- Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Julian Trollor
- Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Lisa Spong
- Bendigo Health Mental Health Services, Bendigo Health, Bendigo, Victoria, Australia
| | - Tim Lenten
- Bendigo Health Mental Health Services, Bendigo Health, Bendigo, Victoria, Australia
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Yanes T, Nathan V, Wallingford C, Faragher R, Nankervis K, Jacobs C, Vassos M, Boyle F, Carroll A, Smith S, McInerney-Leo A. Australasian genetic counselors' attitudes toward disability and prenatal testing: Findings from a cross-sectional survey. J Genet Couns 2024; 33:822-833. [PMID: 37735951 DOI: 10.1002/jgc4.1788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023]
Abstract
Diagnostic genetic testing and non-invasive prenatal testing (NIPT) for conditions associated with disability are becoming increasingly available to consumers. This genetic information can be used in the disability setting to inform factors such as prognosis, management, and reproductive decision-making. Genetic counselors (GCs) play an important role in the provision of genetic testing and NIPT, and their attitudes toward disability can influence how genetic information is communicated and shape patients' responses. This study aimed to evaluate and describe Australasian GCs' experience with and attitudes toward disabilities to identify potential biases and training needs. A cross-sectional survey was distributed to 400 GCs registered with the Human Genetics Society of Australasia. Of the 106 respondents (participation rate: 26%), a significantly greater proportion were more comfortable interacting with individuals with physical disability as compared to intellectual disability (p < 0.001). GCs with personal experiences with disabilities reported significantly greater comfort interacting with people with intellectual disability than those without experience (p = 0.012). Qualitative analysis revealed discomfort was less reflective of bias than inexperience and apprehension about communicating disrespectfully. GCs believed people with disabilities experience discrimination and that having a disability could make a person stronger, wiser, and more motivated. Most GCs viewed prenatal testing for disabilities positively as it allowed for decisions regarding continuing the pregnancy and/or provided opportunity to prepare. Challenges identified for prenatal counseling included negative societal attitudes and the low visibility of disability. GCs felt that 'personal beliefs' was the primary factor influencing the decision to terminate a pregnancy affected by disability. These findings highlight important education and training needs for GCs to improve preparedness and comfort when communicating with people with a disability.
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Affiliation(s)
- Tatiane Yanes
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Vaishnavi Nathan
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Courtney Wallingford
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Rhonda Faragher
- School of Education, The University of Queensland, Brisbane, Queensland, Australia
| | - Karen Nankervis
- School of Education, The University of Queensland, Brisbane, Queensland, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Maria Vassos
- School of Education, The University of Queensland, Brisbane, Queensland, Australia
| | - Fran Boyle
- Institute for Social Science Research, The University of Queensland, Queensland, Australia
| | - Annemaree Carroll
- School of Education, The University of Queensland, Brisbane, Queensland, Australia
| | - Simon Smith
- Institute for Social Science Research, The University of Queensland, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
- ARC Centre of Excellence for the Digital Child, The University of Queensland, Brisbane, Queensland, Australia
| | - Aideen McInerney-Leo
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
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Pillen H, Attrill S, Fisher A, Forte S, Brebner C, Robinson S. Educating for supported decision making and shared decision making: a scoping review of educational design and outcomes for education and training interventions. Disabil Rehabil 2024:1-12. [PMID: 38591714 DOI: 10.1080/09638288.2024.2337099] [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: 02/16/2023] [Accepted: 03/24/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE To characterise existing knowledge about the design and learning outcomes of education and training programs for supported or shared decision making. MATERIALS AND METHODS A scoping review was performed to identify academic and grey literature, published between January 2006 and February 2022, that reported on the design and/or learning outcomes of supported or shared decision making education or training programs. Eligible literature was mapped across domains of educational design and Kirkpatrick's hierarchy of learning effectiveness, and then qualitatively synthesised using cross-case analysis. RESULTS A total of 33 articles were identified (n = 7 for supported decision making and n = 26 for shared decision making) that provided education or training to supporters of persons with mental illness or substance use disorders (n = 14), dementia or neurocognitive disorders (n = 6), cognitive disability (n = 5), mixed populations (n = 1), and those receiving end-of-life care (n = 7). In their design, most programs sought specific changes in practice (behaviour) via experiential learning. Reported educational outcomes also focused on supporter behaviour, with limited evidence for how changes in learner attitudes, skills, or knowledge might be contributing to changes in supporter behaviour. CONCLUSIONS Future education and training would benefit from a closer engagement with theories of teaching and learning, particularly those oriented towards co-design.
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Affiliation(s)
- Heath Pillen
- School of Allied Health Science and Practice, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Stacie Attrill
- School of Allied Health Science and Practice, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Alinka Fisher
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Sabrina Forte
- Council for Intellectual Disability, Surry Hills, Australia
| | - Chris Brebner
- Office of the Deputy Vice-Chancellor, Flinders University, Adelaide, Australia
| | - Sally Robinson
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Richardson CG. The Underutilization of Mental Health Care Services in the Lives of People with Blindness or Visual Impairment: A Literature Review on Rehabilitation Factors Toward Provision. Clin Ophthalmol 2024; 18:953-980. [PMID: 38566829 PMCID: PMC10986414 DOI: 10.2147/opth.s442430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Roughly 3 million adult Americans have a visual impairment or blindness, and over 4 million adults aged 40 and older. Despite data demonstrating an elevated prevalence of mental health symptoms in people with BVI, this population remains largely untreated. Given that people with BVI often interface with multiple systems of rehabilitative care that are designed to improve quality of life, the relatively low rates of initiation of mental health care services are particularly alarming. In this review, the systematic processes of mental health care services across pertinent rehabilitation groups are identified and critically examined. Patients and Methods A comprehensive literature review was conducted. The literature review utilized a critical systems typology, whereby relevant literature was selected, reviewed, and analyzed intra and extra organizationally. In addition, a thorough discussion of disability-related factors was provided, lending a socio-political lens to the problem. Results Considerable data indicates that short-term mental health care services for people with BVI are ineffective treatment methods, albeit primarily employed in health-rehabilitative processes. Multiple studies offered data indicating the presence of diverse and entangled mental health issues relative to vocational rehabilitation services, mobility tool utility, and emotional reactions to vision loss. Many studies suggested that disability identity work be integrated into health-rehabilitative processes for people with BVI. Conclusion To improve the utility of mental health care services for people with BVI, a reenergization of the mental health care needs of this population must occur. A critical podcast or forum focused on educating listeners about the health-rehabilitation factors that influence the provision of mental health care services can aid to improve future mental health policy and practice for people with BVI. Disability scholars need to advance research on integrating critical theories in work with people with BVI and accelerate qualitative, community-based methods to enhance understanding of this population and their unique mental health needs.
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Chiang JL, Kim D, Siu C, White B, Zhu M, Switzer-McIntyre S, Gibson BE. What is 'disability'? Exploring the conceptions of internationally educated learners in a Canadian physical therapy bridging program. Physiother Theory Pract 2024; 40:276-287. [PMID: 35980247 DOI: 10.1080/09593985.2022.2113942] [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] [Received: 02/11/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Physiotherapists' understanding of disability has direct relevance for their practices and work with disabled people. PURPOSE To explore how physiotherapists from diverse backgrounds, cultures and social locations conceptualize disability. Understanding their conceptualizations will provide insight to determine future directions regarding disability education, in healthcare education, to optimize the quality of care and life for individuals with disabilities. METHODS Six internationally educated physiotherapists enrolled in a Canadian physical therapy bridging program were interviewed and data were analyzed for themes. RESULTS Participants' conceptualizations of disability were complex and a dynamic process that reflected what was 'thinkable' in relation to experience, such as with social location and in personal, professional and educational domains. This primary theme was reflected in three subthemes: 1) Professional PT acculturation shaped disability conceptualization in particular ways; 2) Medical model as the dominant way of thinking; and 3) Social model thinking was more feasible in resource rich contexts. CONCLUSION These results reinforce the benefits of a wide exposure to different ways of conceptualizing and addressing disability within PT education to counter the dominance of the medical model and reinforce the importance of advocacy and allyship with disabled people.
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Affiliation(s)
- Jessica L Chiang
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Diane Kim
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carissa Siu
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Blaire White
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Megan Zhu
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sharon Switzer-McIntyre
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Barbara E Gibson
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Azizatunnisa L, Rotenberg S, Shakespeare T, Singh S, Smythe T. Health-worker education for disability inclusion in health. Lancet 2024; 403:11-13. [PMID: 38048789 DOI: 10.1016/s0140-6736(23)02707-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/30/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Luthfi Azizatunnisa
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Sara Rotenberg
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Tom Shakespeare
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Satendra Singh
- University College of Medical Sciences, University of Delhi, Delhi, India
| | - Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; Department of Health and Rehabilitation Sciences, Stellenbosch University, South Africa
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Vuković A, Jovanović OS, Vranješević J, Popovac A, Perić T, Marković D. Using role play to develop positive attitudes toward people with disabilities among dental students: An exploratory pilot study. SPECIAL CARE IN DENTISTRY 2023; 43:806-814. [PMID: 36572954 DOI: 10.1111/scd.12816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 07/26/2022] [Accepted: 12/10/2022] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Comprehensive and interprofessional undergraduate teaching and training in special care dentistry (SCD) could influence future dentists' attitudes towards patients with disabilities. The aim of the study was to assess the influence of role play as part of SCD training on the attitudes of undergraduates towards patients with disabilities. METHOD The students attending the SCD module during the autumn semester of 2019 comprised our target population. A quasi-experimental design was used to compare the attitudinal scores between three groups of students exposed to different modalities of SCD teaching: group 1 - didactic teaching (N = 92), group 2 - didactic teaching and clinical training in the dental treatment of children or elderly patients with disabilities (N = 142), group 3 - theoretical teaching and clinical training, accompanied by role play sessions featuring persons with disabilities (N = 20). The contact rate was 100%. The outcomes of the intervention were measured using the altruism scale, which forms part of the International Association for Disability and Oral Health (iADH) Toolbox for measuring attitudes and intended behaviors towards persons with disabilities. RESULTS The analysis revealed the two-factor structure of the nine-item altruism scale. The first factor was described as the acceptance of oral health care as a universal human right, while the second was the perception of the contribution of marginalised groups, including people with disabilities, to the community. The students participating in the role play scored higher on both factors in comparison to those attending other modes of SCD training. CONCLUSION The presented findings suggested role play as a powerful tool in fostering positive attitudes towards persons with disabilities in the education of dental students and highlighted the importance of multidisciplinary training.
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Affiliation(s)
- Ana Vuković
- School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | | | | | | | - Tamara Perić
- School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Dejan Marković
- School of Dental Medicine, University of Belgrade, Belgrade, Serbia
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Towson G, Daley S, Banerjee S. Intellectual disabilities teaching for medical students: a scoping review. BMC MEDICAL EDUCATION 2023; 23:818. [PMID: 37915002 PMCID: PMC10621142 DOI: 10.1186/s12909-023-04766-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND People with intellectual disabilities are a marginalized group whose health experiences and outcomes are poor. Lack of skill and knowledge in the healthcare workforce is a contributing factor. In England, there is a new legislative requirement for mandatory intellectual disability training to be given to the existing healthcare workforce, including doctors. There is a lack of evidence about effective models of educational delivery of such training in medical schools. We undertook a scoping review to assess the range of intellectual disabilities educational interventions and their effectiveness. METHODS We included any study from 1980 onwards which reported an educational intervention on intellectual disability, or intellectual disability and autism, for medical students from any year group. Databases searched included PUBMED, ERIC, Scopus and Web of Science as well as searches of grey literature and hand searching two journals (Medical Education and Journal of Learning Disabilities). 2,020 records were extracted, with 1,992 excluded from initial screening, and a further 12 excluded from full-text review, leaving 16 studies for inclusion. Data was extracted, quality assessed, and findings collated using narrative analysis. RESULTS We found a variety of intervention types: classroom-based teaching, simulation, placement, home visits, and panel discussions. There was substantial variation in content. Most studies involved lived experience input. Across studies, interventions had different learning outcomes which made it difficult to assess effectiveness. Overall study quality was poor, with high use of non-validated measures, making further assessment of effectiveness problematic. CONCLUSIONS There is a need for more consistency in intervention design, and higher quality evaluation of teaching in this area. Our review has drawn attention to the variety in teaching on this topic area and further research should focus on updating this review as curriculum changes are implemented over time.
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Affiliation(s)
- Georgia Towson
- Brighton and Sussex Medical School, Centre for Dementia Studies, University of Sussex, Trafford Building, Room 101, Falmer, BN1 9RY, UK
| | - Stephanie Daley
- Brighton and Sussex Medical School, Centre for Dementia Studies, University of Sussex, Trafford Building, Room 101, Falmer, BN1 9RY, UK.
| | - Sube Banerjee
- Faculty of Medicine and Health Sciences, University of Nottinham, Nottingham, UK
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11
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Mheta D, Sibiya MN, Nkosi PB. Experiences of Women with Disabilities in Accessing Maternal Healthcare Services: A South African Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6966. [PMID: 37947524 PMCID: PMC10647398 DOI: 10.3390/ijerph20216966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
Access to maternal healthcare services is a challenge in most low- and middle-income countries. South Africa is one of the countries striving to improve the accessibility of maternal healthcare services. Although South Africa has put some interventions in place to improve the accessibility of maternal healthcare services, vulnerable women including women with disabilities are still facing numerous challenges when trying to access these services. The aim of this study was to explore the experiences of women with disabilities in the province of KwaZulu-Natal in South Africa in accessing public maternal healthcare services. The objectives of this study were to describe the experiences of women with disabilities in accessing maternal healthcare services during pregnancy, childbirth and post-partum care; explore the inhibitors of access to maternal healthcare services for women with disabilities; and explore the facilitators of access to maternal healthcare services for women with disabilities. Twelve women with disabilities (four with physical impairments, four with hearing impairments and four with visual impairments) were interviewed for this study. Data were transcribed verbatim and analysed utilising the Framework of Assessing Access to Maternal Healthcare Services by Peters et al., 2008. Our study found that narrow passages and information in inaccessible formats were a challenge for women with visual impairments. Women with hearing impairments faced communication difficulties due to the lack of sign language interpreters in most facilities. Moreover, healthcare professionals displayed unfavourable attitudes toward women with hearing impairments, and these women were often overlooked when seeking help. The women with physical impairments encountered inaccessible buildings, narrow passages, small consultation rooms and equipment that is not adjustable, such as beds and scales.
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Affiliation(s)
- Doreen Mheta
- Faculty of Health Sciences, Durban University of Technology, Durban 4000, South Africa;
| | - Maureen Nokuthula Sibiya
- Division of Research, Innovation and Engagement, Mangosuthu University of Technology, Durban 4031, South Africa;
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Sabatello M, Diggs-Yang G, Santiago A, Easter C, Jacoby Morris K, Hollister BM, Hahn M, Baker K, McCormick A, Greene-Moton E, Daulton C, Goto G. The need for an intersectionality framework in precision medicine research. Am J Hum Genet 2023; 110:1609-1615. [PMID: 37802041 PMCID: PMC10577071 DOI: 10.1016/j.ajhg.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 10/08/2023] Open
Abstract
Precision medicine research has seen growing efforts to increase participation of communities that have been historically underrepresented in biomedical research. Marginalized racial and ethnic communities have received particular attention, toward the goal of improving the generalizability of scientific knowledge and promoting health equity. Against this backdrop, research has highlighted three key issues that could impede the promise of precision medicine research: issues surrounding (dis)trust and representation, challenges in translational efforts to improve health outcomes, and the need for responsive community engagement. Existing efforts to address these challenges have predominantly centered on single-dimensional demographic criteria such as race, ethnicity, or sex, while overlooking how these and additional variables, such as disability, gender identity, and socioeconomic factors, can confound and jointly impact research participation. We argue that increasing cohort diversity and the responsiveness of precision medicine research studies to community needs requires an approach that transcends conventional boundaries and embraces a more nuanced, multi-layered, and intersectional framework for data collection, analyses, and implementation. We draw attention to gaps in existing work, highlight how overlapping layers of marginalization might shape and substantiate one another and affect the precision-medicine research cycle, and put forth strategies to facilitate equitable advantages from precision-medicine research to diverse participants and internally heterogeneous communities.
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Affiliation(s)
- Maya Sabatello
- Center for Precision Medicine and Genomics, Department of Medicine, New York, NY, USA; Division of Ethics, Department of Medical Humanities and Ethics, New York, NY, USA.
| | - Gregory Diggs-Yang
- Stacey Nicholas Office of Access and Inclusion, University of California Irvine, Irvine, CA, USA
| | - Alicia Santiago
- Division of Research on Learning, STEM Education Directorate, National Science Foundation, Alexandria, VA, USA
| | - Carla Easter
- Smithsonian National Museum of Natural History, Washington, DC, USA
| | - Kim Jacoby Morris
- Air Force Office of Scientific Research, Air Force Research Laboratory, Arlington, VA, USA
| | - Brittany M Hollister
- University of Florida Genetics Institute, University of Florida, Gainesville, FL, USA
| | - Michael Hahn
- All of Us Research Program, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Ella Greene-Moton
- Community-Based Organization Partners (CBOP) and Community Ethics Review Board (CERB), Flint, MI, USA
| | - Christina Daulton
- Training, Diversity, and Health Equity Office, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Greta Goto
- Alaska Center for Climate Assessment and Policy, University of Alaska Fairbanks, Anchorage, AK, USA
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Edwards AP, Nash AJ. Transformative care for people with disabilities: Empowering senior nursing students with competency based clinical education-A qualitative study of the impact. NURSE EDUCATION TODAY 2023; 126:105822. [PMID: 37182275 DOI: 10.1016/j.nedt.2023.105822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 03/27/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND People with disabilities (PWD) constitute 26 % of the U.S. population yet no nursing schools have compulsory clinical education specific to PWD. Inadequate education and negative attitudes lead to lack of preparedness for working with PWD. To meet the needs of this highly underserved population, nursing students need training and experience in the care of PWD. OBJECTIVE The objective of this paper is to report three themes from the qualitative evaluation of two immersive clinical experiences with PWD for undergraduate nursing students designed to evaluate competencies for working with PWD. DESIGN Curriculum evaluation using qualitative methods. METHODOLOGY During and after the clinical experience, qualitative data (reflection papers, debriefing responses, and group interviews) were collected with a volunteer sample of senior nursing student participants of the clinical experiences with PWD. Thematic analysis was used to identify changes in students' attitudes, perceived competence, and motivation for working with PWD. FINDINGS Three major themes are reported in this paper: A positive shift in perspective of PWD (attitudes), impact of the experience on students' practice with PWD (comfort, confidence, awareness and motivation), and revelations from the experience (attitudes and resource awareness). CONCLUSIONS A comprehensive immersive clinical experience caring for PWD provides a real-world laboratory with important experiential learning activities that help students acquire and apply knowledge about the healthcare needs of PWD. Reflection activities facilitate synthesis of that knowledge. Results from this study suggest that this clinical experience can transform students' attitudes toward PWD, enhance their clinical skills, and motivate them to consider a nursing career with this highly under-served population.
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Affiliation(s)
- Allison P Edwards
- Department of Undergraduate Studies, Cizik School of Nursing, The University of Texas Health Science Center Houston, 6901 Bertner Ave., Ste. 716, Houston, TX 77030, United States of America.
| | - Angela J Nash
- Department of Graduate Studies, Cizik School of Nursing, The University of Texas Health Science Center Houston, 6901 Bertner Ave., Ste. 630, Houston, TX 77030, United States of America.
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Han N, Park SY, Bang JB. Pharmacy Students' Attitudes Toward Persons With Disabilities and Perceptions of Right to Self-Determination. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:ajpe9109. [PMID: 36347542 PMCID: PMC10159025 DOI: 10.5688/ajpe9109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/24/2022] [Indexed: 05/03/2023]
Abstract
Objective. As the number of persons with disabilities increases, pharmacists are responsible for providing optimal pharmaceutical care services to more patients in this population. The purpose of this study was to assess pharmacy students' perceptions of the right of persons with disabilities to self-determination and to identify factors that affect pharmacists' attitudes and perceptions.Methods. A survey of 370 pharmacy students was conducted. The revised Korean versions of the Scale of Attitudes Towards Disabled Persons (SADP) and the Attitudes Toward Disabled Persons Form O (ATDP-O) were used to measure attitudes toward persons with disabilities. Pharmacy students' perception of the right of persons with disabilities to self-determination was measured in 2 subdomains developed by education and ethics experts: absoluteness of right and social support.Results. Responses from 363 pharmacy students were included in the analysis. We found that the more contact students had with persons with disabilities in the past, the more positive attitudes they had toward this patient group. In addition, students' understanding of self-determination and positive attitudes toward persons with disabilities were determined to be statistically significant factors affecting pharmacy students' perceptions of both the absoluteness of right of persons with disabilities and the level of social support that should be given to this patient group.Conclusion. Since experience relating to people with disabilities is associated with pharmacy students' positive perceptions about the right of persons with disabilities to self-determination, education and activities are needed in the pharmacy curriculum to ensure students have experiences with this patient group.
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Affiliation(s)
- Nayoung Han
- Jeju National University, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Jeju Special Self-Governing Province, Republic of Korea
| | - So-Youn Park
- Kyung Hee University School of Medicine, Department of Medical Education and Medical Humanities, Seoul, Republic of Korea
| | - Jae Beum Bang
- Kyung Hee University School of Dentistry, Department of Dental Education, Seoul, Republic of Korea
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15
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Reporting Down syndrome on the death certificate for Alzheimer disease/unspecified dementia deaths. PLoS One 2023; 18:e0281763. [PMID: 36780546 PMCID: PMC9925077 DOI: 10.1371/journal.pone.0281763] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/31/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Death certificates are crucial for understanding population health trends including the burden of disease mortality. Accurate reporting of causes of death on these records is necessary in order to implement adequate public health policies and fund disease research. While there is evidence that Alzheimer disease and unspecified dementia are prevalent among people with Down syndrome, a 2014 Centers for Disease Control and Prevention (CDC) rule change instructing that Down syndrome should be reported as the underlying cause of death in instances when death occurred from Alzheimer disease or unspecified dementia threatens the accuracy and the utility of death certificates for this population. METHODS This study used 15 years (2005-2019) of US death certificate data for adults with and without Down syndrome. We compare the mortality burden due to Alzheimer disease and unspecified dementia prior to and after amending death certificates that report Down syndrome as the underlying cause of death. RESULTS When analyzing death certificates without addressing the reporting of Down syndrome as the underlying cause of death, rates of death due to Alzheimer disease and dementia ranked as the third leading cause of death for both adults with and without Down syndrome. After amending death certificates that reported Down syndrome as the underlying cause of death, Alzheimer disease and dementia were the leading cause of death among those with Down syndrome, occurring 2.7 times more in adults with compared to without Down syndrome. CONCLUSION The findings of this study highlight the importance of accurate mortality data for studying and addressing population health trends. The current practice of reporting Down syndrome as the underlying cause of death rather than the disease responsible for death needs to be reconsidered and modified. If not, people with Down syndrome may be further marginalized within dementia related support and research.
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Are They the Same for All People? Nurses' Knowledge about the Basic Human Needs of People with Disabilities. Behav Sci (Basel) 2023; 13:bs13010068. [PMID: 36661640 PMCID: PMC9854844 DOI: 10.3390/bs13010068] [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: 12/02/2022] [Revised: 01/01/2023] [Accepted: 01/10/2023] [Indexed: 01/14/2023] Open
Abstract
Nursing care involves a continuous interaction between nurses and people with disabilities. This has created a need for assessment tools that measure nurses' knowledge about the basic human needs of people with disabilities. The aim of this cross-sectional study was to develop a Knowledge of Basic Human Needs Scale and investigate nurses' levels of knowledge about the basic human needs of people with disabilities and their association with nurses' education. Data were analyzed using principal component analysis to test the construct validity and to identify factors using principal varimax rotation. The reliability estimate was based on Cronbach's alpha coefficient. Linear regression models were used to assess the association between knowledge about basic human needs and predictors. Factor analysis extracted eight factors, explaining 66.3% of the total variance. The sampling adequacy, criterion validity, and internal consistency were satisfactory. The nurses' levels of education was associated with their knowledge about the basic human needs of people with disabilities. The questionnaire constitutes a valuable contribution to improving nurses' knowledge and practice, as well as the quality of healthcare, and it provides a contribution to improving the quality of life for people with disabilities.
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Maternal healthcare for women with physical disabilities in Northern Vietnam: perspectives of healthcare providers. Disabil Health J 2023; 16:101439. [PMID: 36739186 DOI: 10.1016/j.dhjo.2023.101439] [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: 04/20/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Pregnancy among women with physical disabilities is common around the world; however, there are limited qualitative studies that explore the perspectives of healthcare providers toward pregnant women with disabilities outside of the Global North. OBJECTIVE This article explores perspectives and experiences of maternal healthcare providers in the delivery of services to women with physical disabilities in Northern Vietnam. METHODS Semi-structured interviews were conducted with 14 healthcare providers who worked in public and/or private healthcare North Vietnamese facilities where maternal services were provided. Data were thematically analyzed. RESULTS The participants included six males and eight females. Ten were obstetricians/gynecologists, one was a doctor specializing in obstetric imaging diagnosis, three were midwives, and one was a midwife/assistant doctor. Four themes were identified. In the first theme, providers attached provisos to the right to motherhood including the view that the women were limited to one child and should undergo prenatal screenings for fetal abnormalities. In the second theme, the providers reported that disability was not incorporated into their education; this led to half of them lacking confidence in providing appropriate maternal healthcare services for women with physical disabilities. The third theme found that although women with physical disabilities were considered as a priority group, decisions around who was seen before others or provided with fee discount/exemption were left in the hands of staff. The fourth theme identified that some providers overlooked their needs for physical accessibility and independence. CONCLUSION This study shows that maternal healthcare providers in Vietnam discounted the needs of women with physical disabilities. The needs of women with disabilities should be included in the training of maternal healthcare providers in Vietnam.
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Balkaran R, Perry M, Maharaj A, Rajhbeharrysingh A, Virtanen JI. Evaluation of a special needs dental workshop for health professionals and students in Trinidad and Tobago. FRONTIERS IN ORAL HEALTH 2022; 3:951165. [PMID: 36561727 PMCID: PMC9766665 DOI: 10.3389/froh.2022.951165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022] Open
Abstract
Aims This study aimed to evaluate a special needs dental workshop for dentists, allied dental health professionals and students in Trinidad and Tobago. Methods This feedback study conducted in 2019-2020, included two surveys, one at the time of the workshop and a second survey one year after it. The first survey utilized an anonymous self-administered questionnaire enquiring about the reason for attendance, profession/education, demographics, and difficulties faced in treating patients with special needs. The follow-up study used an online survey tool assessing the workshop and queried comments/suggestions. The Chi-square test served for statistical analysis. Results Of the 176 attendees 131 participated (response: 74.4%). The majority (81.5%) were females. Most attendees were dental students (50.3%) or dentists (38.9%). Knowledge acquisition (73.1%) and professional development (14.2%) were the main motives for attendance while communication (31.8%) and non-compliance (34.5%) were the main problems faced in treating patients with special needs. The follow-up evaluation (post-workshop) (response: 72.5%) showed that most participants (90.5%) assessed the workshop as positive; 80% reported an increase in their knowledge and 64.2% perceived a need for further education. Conclusion These findings suggest a considerable demand for special needs dental services and continuing education and show that workshops can actively affect patient care.
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Affiliation(s)
- Ramaa Balkaran
- School of Dentistry, The University of the West Indies St. Augustine, St. Augustine, Trinidad and Tobago,Institute of Dentistry, University of Turku, Turku, Finland
| | - Maureen Perry
- Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa Arizona, United States
| | - Anushka Maharaj
- School of Dentistry, The University of the West Indies St. Augustine, St. Augustine, Trinidad and Tobago
| | - Amrita Rajhbeharrysingh
- School of Dentistry, The University of the West Indies St. Augustine, St. Augustine, Trinidad and Tobago
| | - Jorma I. Virtanen
- Institute of Dentistry, University of Turku, Turku, Finland,Faculty of Medicine, University of Bergen, Bergen, Norway,Correspondence: Jorma Virtanen
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Landes SD, Stevens JD, Turk MA. Postmortem Diagnostic Overshadowing: Reporting Cerebral Palsy on Death Certificates. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2022; 63:525-542. [PMID: 35266426 PMCID: PMC9989907 DOI: 10.1177/00221465221078313] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Postmortem diagnostic overshadowing-defined as inaccurately reporting a disability as the underlying cause of death-occurs for over half of adults with cerebral palsy. This practice obscures cause of death trends, reducing the effectiveness of efforts to reduce premature mortality among this marginalized health population. Using data from the National Vital Statistics System 2005 to 2017 U.S. Multiple Cause of Death files (N = 29,996), we identify factors (sociodemographic characteristics, aspects of the context and processing of death, and comorbidities) associated with the inaccurate reporting of cerebral palsy as the underlying cause of death. Results suggest that inaccurate reporting is associated with heightened contexts of clinical uncertainty, the false equivalence of disability and health, and potential racial-ethnic bias. Ending postmortem diagnostic overshadowing will require training on disability and health for those certifying death certificates and efforts to redress ableist death certification policies.
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Abdelnasser N, Abdel Aziz SAE, El-Gamal SMA. Effect of nursing guidelines on first-year nursing students' knowledge and reported practice towards sensory impairments among the elderly. BMC Geriatr 2022; 22:883. [PMID: 36411407 PMCID: PMC9677672 DOI: 10.1186/s12877-022-03524-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 10/10/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Sensory impairments are common among older adults. These impairments have consequences on activities of daily living and communication with others. Such impairments for the elderly remain a significant public health issue globally. This study aimed to assess effect of nursing guidelines on first-year nursing students' knowledge and reported practice towards sensory impairment among the elderly. METHOD A Pre- and post-test research design was utilized in this study to assess first year nursing students' knowledge and reported practice towards sensory impairments among the elderly. It was carried out at faculties of nursing affiliated with three universities with a purposive sample (n = 531) of the first-year nursing students. The study was conducted in four phases: Pre-intervention assessment, nursing guidelines development, nursing guidelines implementation, and post-test after one month. The pre- and post-tests were conducted online and included three parts to collect the required data about students' socio-demographic data, students' knowledge about the five senses and changes in these senses among the elderly, and the students' reported practice for coping with changes in these senses among elderly. Student t-tests and an ANOVA test were used to compare means. For qualitative data, comparison was done using chi-square. Pearson correlation coefficient was used for detecting the relations between continuous variables of the study. RESULTS There are statistically significant differences between the studied subjects means score knowledge and reported practice about the five senses among elderly people in the pre- and the post-tests (P = 0.001). At pre-test the total score mean of students' knowledge was 24.25 while at post-test became 28.16. At pre-test the total score mean of students' reported practice was 38.40 while at post-test became 44.43. There is a relationship between students' knowledge and their reported practice at both pre-test and post-test with P value = 0.001. CONCLUSION The levels of the first-year nursing students' knowledge and reported practice of the studied sample towards sensory impairment among the elderly were improved after implementation of the nursing guidelines. So, it is recommended that these nursing guidelines could be embedded within the undergraduate curriculum. Raising students' awareness through providing lectures, and workshops on sensory impairment among elderly and how to deal with them, and train students on how to communicate with sensory impairment among the elderly.
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Affiliation(s)
- Nadia Abdelnasser
- grid.412707.70000 0004 0621 7833Faculty of Nursing, Department of Gerontological Nursing, South Valley University, Qena, 83523 Egypt
| | - Saieda Abd Elhameed Abdel Aziz
- grid.252487.e0000 0000 8632 679XFaculty of Nursing, Department of Gerontological Nursing, Assiut University, Assuit, 71515 Egypt
| | - Sara Mohamed Ahmed El-Gamal
- grid.412258.80000 0000 9477 7793Faculty of Nursing, Department of Community Health Nursing, Tanta University, Gharbia Governorate, Tanta, 6632110 Egypt
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21
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Bannink Mbazzi F, Kawesa ES. 'Impairments of the brain': Global South perspectives on childhood neurodevelopmental disability. Dev Med Child Neurol 2022; 64:1193-1201. [PMID: 35524350 PMCID: PMC9545297 DOI: 10.1111/dmcn.15253] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 01/05/2023]
Abstract
The word 'disability' does not exist in most African languages. There are words for impairments that describe the 'missing' or affected body parts, but no specific words to characterize, for instance, neurodevelopmental conditions. In this narrative review we focus on the different interpretations of neurodevelopmental conditions in Uganda and discuss the importance of cultural concepts and the intersectionality of family-centred care, poverty, and neocolonialism when working with children with 'impairments of the brain'. We suggest that these concepts should be taken into consideration in health care service provision and public health awareness campaigns, and the need to rethink how disabled children can be included in a 'global' health approach. We explain how applying biomedical categories used in the Global North to diagnose children is only ethical if this information will benefit the child and is accompanied by supportive actions that are relevant to the child and family setting. We argue for the enhancement of community-based structures of belonging and interdependence that are already in place and strengthening of family and community networks to continue the care and co-responsibility for children with 'impairments of the brain'. WHAT THIS PAPER ADDS: Cultural concepts, family-centred care, poverty, and neocolonialism are key in defining disability in the Global South. Diagnosis of a neurodevelopmental condition should be accompanied by supportive actions relevant to the child's setting. Interventions need to build on family and community-based structures of belonging and interdependence. Health care services and public health awareness campaigns should be made culturally relevant.
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Affiliation(s)
- Femke Bannink Mbazzi
- Social Aspects of HealthMedical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine, Uganda Research UnitEntebbeUganda,Faculty of Psychology and Educational SciencesGhent UniversityGhentBelgium,Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
| | - Elizabeth S. Kawesa
- Social Aspects of HealthMedical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine, Uganda Research UnitEntebbeUganda
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Dassah E, Aldersey HM, McColl MA, Davison C. Health care providers’ and persons with disabilities’ recommendations for improving access to primary health care services in rural northern Ghana: A qualitative study. PLoS One 2022; 17:e0274163. [PMID: 36112654 PMCID: PMC9481012 DOI: 10.1371/journal.pone.0274163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 08/23/2022] [Indexed: 11/25/2022] Open
Abstract
In Ghana, many persons with physical disabilities are members of populations who face health disparities including physical, structural, knowledge, attitudinal and financial barriers to various health care services compared to those without disabilities. However, there is limited evidence on how to improve access to primary health care services for persons with physical disabilities. This study aimed to understand persons with physical disabilities’ experiences and health care providers’ perspectives for improving access to primary health care for persons with disabilities in rural Ghana. We used a qualitative approach and interviewed 33 persons with physical disabilities and health care providers, and thematically analysed data from in-depth interviews. We identified 4 major themes. According to the participants, health care could be more accessible by: i) Making it more affordable; ii) Increasing the availability of providers and services; iii) Providing more education about system navigation; and iv) Improving access to disability friendly health facilities and equipment. Participants’ recommendations were nested in the areas of policy and practice modifications. Policy makers need to consider supporting persons with physical disabilities who cannot afford non-medical services (i.e., cost of transportation). In terms of practice, the provision of education and training related to physical disability issues should be extended to both clinical and nonclinical health workers for better client centered care. There is an urgent need for policy makers and relevant key stakeholders to include persons with physical disabilities in designing and implementing policies and programs to ensure that they are meeting their needs.
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Affiliation(s)
- Ebenezer Dassah
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- * E-mail:
| | - Heather M. Aldersey
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Mary Ann McColl
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Colleen Davison
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
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Feldner HA, Evans HD, Chamblin K, Ellis LM, Harniss MK, Lee D, Woiak J. Infusing disability equity within rehabilitation education and practice: A qualitative study of lived experiences of ableism, allyship, and healthcare partnership. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:947592. [PMID: 36188899 PMCID: PMC9397845 DOI: 10.3389/fresc.2022.947592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/13/2022] [Indexed: 11/21/2022]
Abstract
Background Addressing issues of diversity, equity, and inclusion (DEI) has become central in implementing inclusive and socially responsible rehabilitation education and clinical practice. Yet, the constructs of disability and d/Deaf identity and culture, as well as ableism and allyship are often overlooked. Or, these concepts are approached using outdated philosophical perspectives that pathologize disability and fail to prioritize the lived experiences, expertise, intersectionality, and self-identified needs of people with disabilities. A Critical Disability Studies (CDS) framework may provide a background for better understanding and responding to these issues through allyship. Purpose This study employed a CDS framework to understand the lived experiences of ableism and allyship from faculty, staff, and students on University of Washington (UW) campuses who identify as d/Deaf, disabled/with a disability, or as having a chronic health condition. Methods During 2020–2021, we conducted in-depth, semi-structured interviews and focus groups with 22 diverse undergraduate and graduate students, faculty, and staff with disabilities, one third who also identified as people of color. Encounters were audio-recorded, transcribed verbatim, and coded using constant comparison until themes emerged. Results Four major themes that emerged from the data are: (1) Ever-present ableism in healthcare, (2) Ableism at the intersections, (3) COVID: Surfacing ableism and expanding access, and (4) Disability allyship and healthcare partnership building. Experiences of ableism and allyship were identified at individual, group/unit, and institutional/systemic levels, though participants reported significantly fewer instances of allyship compared to experiences of ableism. Participants identified intersections between disability and other marginalized identities and juxtaposed the benefits of widespread adoption of many access-increasing practices and technologies due to the COVID-19 pandemic, while also highlighting ways in which the pandemic created new obstacles to inclusion. Conclusions This analysis provides insights into ways of implementing inclusive practices in rehabilitation education, practice, and beyond. Rehabilitation students, faculty, and staff may not be aware of how ableism affects their disabled peers or underpins their professional education. It is important to cultivate opportunities within professional education and clinical training to explicitly address our collective role in creating inclusive and accessible academic and healthcare experiences for our diverse community post COVID-19. Drawing on a CDS framework, the research team devised the mnemonic TRAC, which includes Training, Recognition and Representation, Attendance and Action, and Calling to account as strategic guidelines for operationalizing such opportunities.
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Affiliation(s)
- Heather A. Feldner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
- Disability Studies Program, University of Washington, Seattle, WA, United States
- Center for Research and Education on Accessible Technology and Experiences (CREATE), University of Washington, Seattle, WA, United States
- *Correspondence: Heather A. Feldner
| | - Heather D. Evans
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
- Disability Studies Program, University of Washington, Seattle, WA, United States
| | - Katherine Chamblin
- Disability Studies Program, University of Washington, Seattle, WA, United States
| | - Lesley M. Ellis
- The Disability and Deaf Cultural Center, University of Washington, Seattle, WA, United States
| | - Mark K. Harniss
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
- Disability Studies Program, University of Washington, Seattle, WA, United States
| | - Danbi Lee
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
- Disability Studies Program, University of Washington, Seattle, WA, United States
| | - Joanne Woiak
- Disability Studies Program, University of Washington, Seattle, WA, United States
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Vermaak C, Ferreira S, Terblanche E, Derman W. Physical activity promotion in persons with spinal cord injuries: Barriers and facilitators in low-resource communities. Afr J Disabil 2022; 11:988. [PMID: 35812772 PMCID: PMC9257716 DOI: 10.4102/ajod.v11i0.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background A spinal cord injury is a devastating and life-changing event that presents the affected individual with multiple challenges throughout life. Physical activity can help mitigate some of these challenges; however, in low-resource communities where opportunities for physical activity are scarce, these challenges are often exacerbated and multiple. Objective This study aimed to identify the barriers and facilitators to physical activity, specifically in individuals with spinal cord injuries, in low-resourced communities. Methods A total of 57 adults (> 20 years) with a spinal cord injury living in the Western Cape, South Africa completed the self-developed research questionnaire. Results A total of 289 barriers and 290 facilitators were reported. The most frequently reported barriers were lack of transport (n = 35), impairment type (n = 32), lack of trained volunteers and appropriate programmes (n = 19 each) and lack of information received from therapists following discharge (n = 10). The most frequently reported facilitators were support from family (n = 38), the ‘enjoyment’ of physical activity and the fact that ‘it made me feel good’ (n = 37); safe and accessible facilities were reported by 25 participants and 12 participants reported that higher-quality programmes and better-trained staff would help them to be more physically active. Conclusion Individuals with a spinal cord injury face many barriers in being physically active. Yet it is evident that people with spinal cord injuries in low-resourced communities are eager to participate and improve their health and physical function. However, this will only realise if practitioners reduce the barriers to access, provide relevant training to staff and volunteers, educate their patients about the importance of physical activity post discharge, and create tailored programmes in safe and accessible community facilities.
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Affiliation(s)
- Candace Vermaak
- Division of Biokinetics, Department of Sport Science, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Suzanne Ferreira
- Institute of Sport and Exercise Medicine, Department of Sport Science, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elmarie Terblanche
- Division of Sport Science, Department of Sport Science, Faculty of Medicine and Health Sciences, Stellenbosch University, cape Town, South Africa
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Department of Sport Science, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
- International Olympic Committee Research Center, Cape Town, South Africa
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Khouderchah C, Eijansantos E, Bindman J, Henson L. Impact of a 10-week disability elective on health professions students' attitudes towards disabled persons. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:773-778. [PMID: 35809908 DOI: 10.1016/j.cptl.2022.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 02/25/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND PURPOSE Disability is overlooked in health provider training despite the growing number of patients and providers with a disability. In-depth training on delivering outstanding care is provided as part of training for health professions, however little guidance is provided on how to interact with patients with disabilities. EDUCATIONAL ACTIVITY AND SETTING Students enrolled in a 10-week interdisciplinary elective at the University of California, San Francisco were asked to participate in the study. Students who consented to participate completed a pre-intervention assessment that incorporated the Interaction with Disabled Persons Scale (IDP) and Marlowe-Crowne Social Desirability Scale Short Form C (MC). At the conclusion of the elective, participating students retook both surveys as part of a post-intervention assessment. FINDINGS There was a significant difference in IDP score and non-significant difference in MC score following the elective. There was a positive but non-significant correlation between the paired results for the IDP and MC surveys. SUMMARY Following completion of a 10-week disability awareness curriculum, there was a significant improvement in health professions students' perceptions towards persons with disabilities.
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Affiliation(s)
- Christy Khouderchah
- 1st-year Pharmacy Resident, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, United States.
| | - Emily Eijansantos
- 4th-year Medical Student, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, United States.
| | - Jay Bindman
- 4th-year Medical Student, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, United States.
| | - Laurence Henson
- Resident Physician, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, United States.
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Cahú FGDM, Miranda FES, Apostolico MR, Germani ACCG, Pina-Oliveira AA. Health promotion competencies: focus on users of The Beach Without Barriers project. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022275.23842021en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Carrying out university extension actions on beaches represents an innovative opportunity to promote the health of people with disabilities or reduced mobility. This article aims to analyze the understanding of users of the Beach Without Barriers (PSB, Praia sem Barreiras) Project about the Health Promotion practices developed by undergraduate students in the health area. Qualitative, descriptive and exploratory study, based on interviews with ten PSB users in Recife, Pernambuco, Brazil. A thematic analysis of content was carried out anchored on Developing Competencies and Professional Standards for Health Promotion Capacity Building in Europe. Six empirical categories emerged: Dedication of students working in the PSB, Technical qualification of students in the PSB, Emotion during contact with the sea, Mental health improvement, User guidance to students as future professionals and Opinions about the PSB. The qualification of students as agents of change in the local reality, effective communication and strategic partnerships were demonstrated. Actions that transcend bodily limitations and assess the participants’ health needs should be valued in undergraduate school.
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Cahú FGDM, Miranda FES, Apostolico MR, Germani ACCG, Pina-Oliveira AA. Health promotion competencies: focus on users of The Beach Without Barriers project. CIENCIA & SAUDE COLETIVA 2022; 27:1773-1780. [PMID: 35544807 DOI: 10.1590/1413-81232022275.23842021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 11/27/2021] [Indexed: 11/21/2022] Open
Abstract
Carrying out university extension actions on beaches represents an innovative opportunity to promote the health of people with disabilities or reduced mobility. This article aims to analyze the understanding of users of the Beach Without Barriers (PSB, Praia sem Barreiras) Project about the Health Promotion practices developed by undergraduate students in the health area. Qualitative, descriptive and exploratory study, based on interviews with ten PSB users in Recife, Pernambuco, Brazil. A thematic analysis of content was carried out anchored on Developing Competencies and Professional Standards for Health Promotion Capacity Building in Europe. Six empirical categories emerged: Dedication of students working in the PSB, Technical qualification of students in the PSB, Emotion during contact with the sea, Mental health improvement, User guidance to students as future professionals and Opinions about the PSB. The qualification of students as agents of change in the local reality, effective communication and strategic partnerships were demonstrated. Actions that transcend bodily limitations and assess the participants' health needs should be valued in undergraduate school.
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Affiliation(s)
- Fabiana Gonçalves de Mello Cahú
- Departamento de Saúde, Centro Universitário Maurício de Nassau. R. Dr. Osvaldo Lima 130, Bloco E, Derby. 52010-180 Recife PE Brasil.
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Resciniti NV, Hong Y, McDermott S. Factors contributing to antihypertensive medication adherence among adults with intellectual and developmental disability. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022; 26:137-148. [PMID: 33140659 DOI: 10.1177/1744629520961958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Adults with intellectual or developmental disabilities often have hypertension and mental illness, and are prescribed medications for treatment. This study examined psychotropic medication adherence as a mediator between the association of residence type and antihypertensive medication adherence for adults with intellectual or developmental disabilities. We used Medicaid data of adults with intellectual or developmental disabilities who had hypertension and prescribed antihypertensive medication (N = 1,201) to measure the direct effect, indirect effect, and total effect of residence type (home vs. supervised setting) and antihypertensive medication adherence, with a mediator of psychotropic medication adherence. The indirect effect of psychotropic medication adherence on antihypertensive medication adherence was 1.26 (OR = 1.26, CI: 1.08-1.52), holding residency constant. The direct effect of residential type on antihypertensive medication adherence was 3.75 (OR = 3.75, CI: 1.61-8.75). This association may be due to some features of having a mental illness or maybe the result of being prescribed more than one medication.
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People with Arthritis-Disability and Provider Experiences With Chronic Opioid Therapy: A Qualitative Inquiry. Disabil Health J 2022; 15:101294. [DOI: 10.1016/j.dhjo.2022.101294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 01/21/2022] [Accepted: 01/31/2022] [Indexed: 01/01/2023]
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Su CJ, Cyr PEP. Accessible Medical Education & TIC: Increasing Equitable Care for Disabled Patients. HARVARD PUBLIC HEALTH REVIEW (CAMBRIDGE, MASS.) 2022; 44:https://hphr.org/edition-44-su/. [PMID: 36176338 PMCID: PMC9518008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
An estimated 1 in 4 U.S. adults has a disability, and this number continues to increase. Disabled individuals face significant healthcare inequities, including but not limited to inaccessibility and mistreatment. Our current healthcare system is ill-equipped to provide equitable care to this population. There is a lack of accessibility in healthcare environments, lack of accessible medical training to enable disabled people to become healthcare providers serving their own community, and lack of thorough medical education that encompasses care for disabled patients. Furthermore, the increased risk of trauma, as well as increased risk of medical trauma specifically, endured by disabled people puts them at greater risk of long-lasting adverse effects. In this commentary, we analyze three key areas: 1) the current state of healthcare for disabled patients, 2) disability in medical education & physician workforce, and 3) the relationship between trauma and disability. We argue that the road to more equitable care for disabled patients involves changes to medical education that address all three of these areas. Medical training should expose trainees to disability early and throughout their training, should be made more accessible to support disabled physicians, and finally, should be trauma-informed in a manner that explicitly includes caring for disabled patients and their other intersecting identities.
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Rotenberg S, Gatta DR, Wahedi A, Loo R, McFadden E, Ryan S. Disability Training for Health Workers: A Global Evidence Synthesis. Disabil Health J 2022; 15:101260. [DOI: 10.1016/j.dhjo.2021.101260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/16/2021] [Accepted: 12/03/2021] [Indexed: 11/03/2022]
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Amir N, Smith L, Valentine AM, Mitra M, Parish SL, Moore Simas TA. Clinician perspectives on the need for training on caring for pregnant women with intellectual and developmental disabilities. Disabil Health J 2021; 15:101262. [PMID: 35031269 PMCID: PMC8983509 DOI: 10.1016/j.dhjo.2021.101262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/27/2021] [Accepted: 12/12/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Women with intellectual and developmental disabilities (IDDs) experience disparities in obstetric care access and quality, in addition to communication gaps with healthcare providers. Many obstetric providers are untrained and uneducated about critical aspects of providing care to persons with IDDs. OBJECTIVE The study was conducted to describe obstetric clinicians' training experiences related to providing obstetric care to women with IDDs, to assess the perceived need for formalized training, and to identify recommendations for training content. METHODS This study involved qualitative individual interviews (n = 9) and one focus group (n = 8) with obstetric clinicians who self-reported experience caring for women with IDDs during pregnancy. Descriptive coding and content analysis techniques were used to develop an iterative codebook related to education and training; codes were applied to the data. Coded data were analyzed for larger themes and relationships. RESULTS Analysis revealed three main themes: 1. Need for obstetric training and education: No participant reported receiving any training in caring for pregnant women with IDDs. Participants expressed a need for formal education. 2. Recommendations for formal training: Participants noted the need for training during residency and beyond, and all healthcare staff members should be included in training. 3. Training outcomes should increase knowledge, enhance attitudes, and develop practical skills related to care for pregnant women with IDDs. CONCLUSION Results indicate a need for systematic training efforts regarding obstetric care for women with IDDs. Improved training and education may decrease health inequities and improve the quality of care, and thus pregnancy outcomes, for women with IDDs. LEVEL OF EVIDENCE VI.
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Affiliation(s)
- Nili Amir
- University of Connecticut Medical School, Department of Obstetrics and Gynecology, 200 Academic Way, Farmington, CT 06032, USA; University of Masachusetts Chan Medical School, 55 Lake Ave North Worcester, MA 01605, USA.
| | - Lauren Smith
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, USA
| | - Anne M Valentine
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, USA
| | - Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, USA
| | - Susan L Parish
- Virginia Commonwealth University, College of Health Professions, 900 E. Leigh Street, Box 980233 Richmond, VA 23298, USA
| | - Tiffany A Moore Simas
- University of Massachusetts Chan Medical School/UMass Memorial Health Care Department of Obstetrics and Gynecology, Pediatrics, Psychiatry, and Population and Quantitative Health Sciences Memorial Campus, 119 Belmont Street, Jaquith Building Floor 2, Worcester, MA 01605, USA
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Khan M, Brown HK, Lunsky Y, Welsh K, Havercamp SM, Proulx L, Tarasoff LA. A Socio-Ecological Approach to Understanding the Perinatal Care Experiences of People with Intellectual and/or Developmental Disabilities in Ontario, Canada. Womens Health Issues 2021; 31:550-559. [PMID: 34556400 PMCID: PMC8595790 DOI: 10.1016/j.whi.2021.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Accessible and quality care during the perinatal period is critical for optimal maternal and neonatal health. Using the socio-ecological model, the purpose of this study was to explore barriers and facilitators that shape the perinatal care experiences of people with intellectual and/or developmental disabilities (IDD). METHODS Semi-structured interviews were conducted with 10 individuals with IDD in Ontario, Canada, who had given birth within the past 5 years. Interviews focused on care experiences before, during, and after pregnancy. Data were analyzed using a directed content analysis approach, and the socio-ecological model guided analysis. RESULTS Barriers at the societal (e.g., cultural norms of motherhood), policy/institutional (e.g., child protection policies and practices), interpersonal (e.g., inadequate formal and informal support), and intrapersonal levels (e.g., internalized stigma) contributed to participants having negative perinatal care experiences. Conversely, we identified facilitators on the interpersonal level (e.g., positive interactions with perinatal care providers and familial and social service supports) as positively shaping participants' perinatal care experiences. CONCLUSIONS Findings reveal that the perinatal care experiences of people with IDD are shaped by several interrelated factors that largely stem from societal-level barriers, such as dominant (stigmatizing) discourses of disability. To improve the perinatal care experiences of people with IDD, there is a need for interventions at multiple levels. These include the development of policies to support perinatal care for diverse populations and training care providers to enact policies at the institutional and interpersonal levels.
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Affiliation(s)
- Momina Khan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hilary K Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada.
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kate Welsh
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | | | - Laurie Proulx
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Lesley A Tarasoff
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada; Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Project Inclusive Genetics: Exploring the impact of patient-centered counseling training on physical disability bias in the prenatal setting. PLoS One 2021; 16:e0255722. [PMID: 34352009 PMCID: PMC8341652 DOI: 10.1371/journal.pone.0255722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 07/22/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE There is robust research examining the negative impact of racial and socioeconomic implicit bias on healthcare provider clinical decision-making. However, other under-studied important biases are likely to impact clinical care as well. The goal of this study was to explore the presence of bias against people with physical disability among a heterogeneous group of healthcare workers and trainees and to evaluate the effect of implicit association testing and an educational module on this bias. METHOD The study was composed of a one-hour web-based survey and educational module. The survey included an explicit disability bias assessment, disability Implicit Association Tests (IATs), demographic collection, and pre- and post- module clinical vignettes of prenatal patient scenarios. In addition to providing counseling to hypothetical patients, participants also indicated their personal preferences on genetic testing and termination. The educational module focused on the principles of patient-centered counseling. RESULTS The collected data reflects responses from 335 participants. Within this sample, there were both explicit and implicit biases towards individuals with physical disabilities. Prior to the IAT and educational module, when respondents were tasked with providing genetic testing recommendations, implicit biases and personal preferences for genetic testing and termination influenced respondents' clinical recommendations. Importantly, having previous professional experience with individuals with disabilities diminished biased clinical recommendations prior to the intervention. In response to the IAT and educational intervention, the effect of implicit bias and personal preferences on clinical recommendations decreased. CONCLUSIONS This study demonstrates how bias against a marginalized group exists within the medical community and that personal opinions can impact clinical counseling. Importantly, our findings suggest that there are strategies that can be easily implemented into curricula to address disability bias, including formal educational interventions and the addition of professional experiences into healthcare professional training programs.
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Masuku KP, Moroe N, van der Merwe D. 'The world is not only for hearing people - It's for all people': The experiences of women who are deaf or hard of hearing in accessing healthcare services in Johannesburg, South Africa. Afr J Disabil 2021; 10:800. [PMID: 34395202 PMCID: PMC8335767 DOI: 10.4102/ajod.v10i0.800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/26/2021] [Indexed: 11/01/2022] Open
Abstract
Background Despite legal and adopted frameworks purporting access to healthcare and rehabilitation services, which are both a human right and key to developmental issues, women who are deaf and/or hard of hearing (HoH) are still excluded and experience barriers when accessing healthcare services. Largely, this is attributed to communication barriers between healthcare professionals and women who are deaf and/or HoH. There have been limited research studies carried out on women with invisible disabilities, such as deafness, especially amongst African women. Objectives This study sought to gain insights into the communication experiences of women who are deaf or HoH when accessing public healthcare services in hospitals in Johannesburg. Methods A qualitative research study employing semi-structured interviews with 10 African women who are deaf and/or HoH residing in Johannesburg, South Africa and attending government healthcare facilities was conducted. Participants were purposively selected. Data were analysed using thematic analysis. Results Data revealed the following themes: communication barriers resulting in compromised quality of care and infringement on participants' right to confidentiality; accommodation that is not accommodative and negative attitudes of healthcare professionals. Conclusion The findings of this study confirm the alienating, exclusion, marginalisation, discrimination, invisibility, lack of independence and autonomy of women who are deaf and/or HoH when accessing healthcare services. Therefore, this study argues for a need for the conscientisation of healthcare professionals on communication needs of persons who are deaf and/or HoH. This has implications for the implementation of training programmes that will address communication, reasonable accommodation and attitudes of healthcare professionals.
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Affiliation(s)
- Khetsiwe P Masuku
- Department of Speech Pathology, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
| | - Nomfundo Moroe
- Department of Audiology, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
| | - Danielle van der Merwe
- Department of Speech Pathology and Audiology, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
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Edwards AP, Hekel BE. Appraisal of disability attitudes and curriculum of nursing students: a literature review. Int J Nurs Educ Scholarsh 2021; 18:ijnes-2021-0029. [PMID: 34260832 DOI: 10.1515/ijnes-2021-0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/30/2021] [Indexed: 12/15/2022]
Abstract
Worldwide, more than one billion people live with a disability (World Health Organization. (2011). World report on disability. Retrieved from https://www.who.int/disabilities/world_report/2011/report/en/). People with a disability (PWD) have unmet needs with the delivery of health care, secondary to nursing student's negative attitudes, knowledge, and skill deficits. This integrative literature review evaluated nursing student's education and attitudes towards PWD. Deficient education, attitudes, knowledge, and skills are addressed. Combined search terms utilized included: healthcare students; healthcare education; nursing students; clinical experience; clinical rotation; attitude of health care students; and exposure to PWD. Thirty articles were analyzed with common themes identified. Educational methods that produced improved attitudes, knowledge and skills included standardized patients with disabilities; phenomenological approaches; curriculum enhancement; empathy exercises and clinical experiences (Anderson, E. S., Ford, J., & Thorpe, L. (2011). Learning to listen: Improving students' communication with disabled people. Medical Teacher, 33(1), 44-52. doi: 10.3109/0142159X.2010.498491; Castro, S. S., Rowe, M., Andrade, L. F., & Cyrino, E. G. (2018). Developing competencies among health professions students related to the care of people with disabilities: A pilot study. Interface: Comunicacao, Saude, Educacao, 22(65), 551-563. doi: 10.1590/1807-57622016.0684; Hensel, D., Malinowski, C., & Watts, P. A. (2015). Implementing a pediatric camp clinical for pre-licensure education. Nursing Education Perspectives, 36(1), 60-61. doi: 10.5480/12-871.1; Levett-Jones, T., Lapkin, S., Govind, N., Pich, J., Hoffman, K., Jeong, S. Y., . . . Everson, N. (2017). Measuring the impact of a 'point of view' disability simulation on nursing students' empathy using the comprehensive state empathy scale. Nurse Education Today, 59, 75-81. doi: 10.1016/j.nedt.2017.09.007; Smith, P., Ooms, A., & Marks-Maran, D. (2016). Active involvement of learning disabilities service users in the development and delivery of a teaching session to pre-registration nurses: Students' perspectives. Nurse Education in Practice, 16(1), 111-118. doi: 10.1016/j.nepr.2015.09.010). Nursing schools must incorporate disability education to fully realize its impact and eliminate barriers to transform care.
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Affiliation(s)
- Allison P Edwards
- Department of Undergraduate Studies, Cizik School of Nursing at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Barbara E Hekel
- Department of Undergraduate Studies, Cizik School of Nursing at The University of Texas Health Science Center at Houston, Houston, TX, USA
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Holler R, Chemla I, Maeir A. Disability Orientation of Occupational Therapy Practitioners in Physical Rehabilitation Settings: Tension Between Medical and Social Models in Theory and Practice. Am J Occup Ther 2021; 75:12518. [PMID: 34780606 DOI: 10.5014/ajot.2021.042986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE To date, little is known about the extent to which occupational therapy practitioners have adopted the core insights of disability studies. OBJECTIVE To examine the degree to which occupational therapy practitioners endorse the medical model of disability versus the social model of disability in theory and in practice. DESIGN Cross-sectional study. SETTING Physical rehabilitation facilities, ranging from hospital to community settings. PARTICIPANTS One hundred two Israeli occupational therapy practitioners. Outcomes and Measures: The Orientation toward Disability Scale, constructed for this study, has two dimensions that distinguish between the medical and social models of disability: locus of intervention (the person or environment) and client involvement (extent to which the practitioner fosters the client's autonomy in the rehabilitation process). Each dimension addresses both theoretical and practical endorsements. RESULTS Greater support for the social model of disability was mostly evident in the client involvement dimension, whereas support for the medical model of disability was mostly evident in the locus of intervention dimension. Over both dimensions, the medical model of disability was significantly more endorsed in practice than in theory. Work setting and prior exposure to the social model of disability were found to affect practitioners' disability orientation. CONCLUSIONS AND RELEVANCE Occupational therapy practitioners working in physical rehabilitation are still relatively far from fully adopting the critical insights of the social model of disability. This finding is especially relevant when their actual practice, rather than their theoretical views, is considered and when rehabilitation takes place in out-of-home settings. What This Article Adds: This study offers unique insight into the disability orientation of occupational therapy practitioners, showing a need for more training programs to expose students to the social model of disability. These programs should use critical discussions of the challenges that this model presents to the profession and barriers to implementing it in practice.
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Affiliation(s)
- Roni Holler
- Roni Holler, PhD, is Senior Lecturer, Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel;
| | - Idit Chemla
- Idit Chemla, MScOT, is Graduate Student, School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adina Maeir
- Adina Maeir, PhD, is Associate Professor, School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Use of Standardized and Non-Standardized Tools for Measuring the Risk of Falls and Independence in Clinical Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063226. [PMID: 33804715 PMCID: PMC8004039 DOI: 10.3390/ijerph18063226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 01/20/2023]
Abstract
(1) Background: The use of standardized tools is regarded as the basis for an evidence-based assessment. The tools enable monitoring of complex events and the effectiveness of adopted interventions. Some healthcare facilities use standardized tools such as the Morse Fall Scale, but many use non-standardized tools created based on patient needs. Our study question was, why are non-standardized tools used when standardized tools are more beneficial and can be statistically evaluated and compared to other results; (2) Methods: We used a quantitative, non-standardized questionnaire to survey 1200 nurses, which was representative sample for the entire Czech Republic. All questionnaires were assessed in two phases (a) the frequency evaluation and descriptive analysis, and (b) hypotheses testing and correlation analyses; (3) Results: We found that the Conley Scale, Barthel test, and IADL test were preferred by many nurses. Furthermore, we found that nurses using standardized assessment scales noticed risk factors significantly more frequently but regarded the increased complexity of care to be psychologically demanding. (4) Conclusions: In patients with physical disabilities, both types of tools (internal non-standardized and standardized) are used to assess the risk of falls and independence; nurses generally welcomed the increase use of standardized tools in their facilities.
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Associations between Disability and Infertility among U.S. Reproductive-Aged Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063202. [PMID: 33808812 PMCID: PMC8003727 DOI: 10.3390/ijerph18063202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 12/22/2022]
Abstract
We aim to evaluate the association between self-reported disabilities and infertility and whether disabilities are associated with decreased likelihood of seeking infertility-related care. This US nationally representative cross-sectional analysis includes 3789 non-pregnant women aged 18–49 years without history of hysterectomy or oophorectomy (NHANES, 2013–2018). Disabilities and infertility were both self-reported in personal interviews with trained interviewers. Logistic regression models estimated the adjusted odds ratio (aOR) and 95% confidence intervals for the association between disabilities and infertility and related care seeking. Models adjusted for potential confounders and complex probability sampling. Compared to women without disabilities, women with disabilities (WWD) had higher odds of infertility (aOR: 1.78 (1.31–2.40)). Similar findings were observed for sensory (2.32 (1.52–3.52)) and cognitive disabilities (1.77 (1.28–2.44)). Among women with infertility, WWD were less likely to seek infertility-related care (0.68 (0.32–1.44)) but these estimates were not statistically significant. WWD have increased odds of reporting infertility, and if affected, are less likely to visit a health care provider for this condition. While more research is needed to understand reproductive health issues and needs among WWD, it is important to push for more equitable policies and practices to address the health needs of this underserved population.
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Dambal A, Gururaj H, Aithal KR, Kalasuramath Dharwad M, Sherkhane R, Siddanagoudra S, Kanabur DR, Ahmed Mulla S. Delivering disability competencies of MCI's revised competency based curriculum at a medical university in North Karnataka. Med J Armed Forces India 2021; 77:S65-S72. [PMID: 33612934 PMCID: PMC7873704 DOI: 10.1016/j.mjafi.2020.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/31/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND India has ratified with the United Nations Convention on the Rights of Persons with Disabilities and has passed the Rights of People with Disabilities Act in 2016. There is need for training healthcare professionals in disability competencies as people with disabilities are many and marginalized. Disability competencies were introduced in the foundation course of revised competency based medical curriculum for Indian medical graduates by the Medical Council of India (MCI) just prior to the rollout of the programme. We intend describing our center's experience in implementing the same. METHODS FC 4.5.1 TO 4.5.8 of MCI foundation course guidelines were resource material. Eight faculty members participated. Setting was the lecture theatre. The suggested and actual teaching learning methods are compared for each competency. Notes made from delivering disability competencies, photographs, videos and reflections from students were source of data. RESULTS We used sensitizing lectures of 15 min each for FC 4.5.1, 4.5.2 and 4.5.4 [cognitive] with interesting set induction, student narratives of family members with disability, buzz groups for interaction and self-directed learning activity using mobile phones. We facilitated FC 4.5.3 and 4.5.5 [skill/affective domain] demonstrating unacceptable and acceptable disability etiquettes using standardized patients and role play. We conducted a forum theatre of the oppressed for FC 4.5.6. We introduced our learners to universal design in our campus for teaching 4.5.7. As a part of the principle of inclusivity we involved two staff members with motor disabilities for delivering FC 4.5.8 in an interview. We assessed the learners using written reflections and obtained feedback on a rating scale.
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Affiliation(s)
- Archana Dambal
- Professor (General Medicine) & Curriculum Committee Member, SDMCMS&H, Sattur, Dharwad, India
| | | | - Kiran R. Aithal
- Professor & Head (General Medicine), SDMCMS&H, Sattur, Dharwad, India
| | | | - Radhika Sherkhane
- Professor & Head (Pharmacology) & Coordinator, Medical Education Unit, SDMCMS&H, Sattur, Dharwad, India
| | - Savitri Siddanagoudra
- Professor (Physiology) & Curriculum Committee Member, SDMCMS&H, Sattur, Dharwad, India
| | - Deepak R. Kanabur
- Professor (Physiology) & Curriculum Committee Member, SDMCMS&H, Sattur, Dharwad, India
| | - Sameer Ahmed Mulla
- Associate Professor (General Surgery) & Curriculum Committee Member, SDMCMS&H, Sattur, Dharwad, India
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Rotoli J, Backster A, Sapp RW, Austin ZA, Francois C, Gurditta K, Mirus C, McClure Poffenberger C. Emergency Medicine Resident Education on Caring for Patients With Disabilities: A Call to Action. AEM EDUCATION AND TRAINING 2020; 4:450-462. [PMID: 33150294 PMCID: PMC7592824 DOI: 10.1002/aet2.10453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 05/07/2023]
Abstract
People with disabilities constitute a marginalized population who experience significant health care disparities resulting from structural, socioeconomic, and attitudinal barriers to accessing health care. It has been reported that education on the care of marginalized groups helps to improve awareness, patient-provider rapport, and patient satisfaction. Yet, emergency medicine (EM) residency education on care for people with disabilities may be lacking. The goal of this paper is to review the current state of health care for patients with disabilities, review the current state of undergraduate and graduate medical education on the care of patients with disabilities, and provide suggestions for an improved EM residency curriculum that includes education on the care for patients with disabilities.
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ÖZKAN F, USLU N, ZİNCİR H. Zihinsel engelli çocuklar için yapılan uygulamaların hemşirelik öğrencilerinin tutumlarına etkisi. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.715000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Crane JM, Strickler JG, Lash AT, Macerollo A, Prokup JA, Rich KA, Robinson AC, Whalen Smith CN, Havercamp SM. Getting comfortable with disability: The short- and long-term effects of a clinical encounter. Disabil Health J 2020; 14:100993. [PMID: 33012692 DOI: 10.1016/j.dhjo.2020.100993] [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] [Received: 04/24/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Physicians report discomfort when interacting with patients with disabilities, which can negatively impact the quality of healthcare they provide. OBJECTIVE/HYPOTHESIS An intervention structured around a formative clinical encounter was assessed for its effectiveness in changing comfort towards treating patients with disabilities. It was predicted that this encounter would have a positive short- and long-term impact on medical students. METHOD During the 2017-2018 academic year, 169 third-year medical students conducted a patient encounter with a person who had a disability. Students met individually with the "patient" and completed a brief social and medical history as if they were meeting a new patient to establish care. A measure of perceived comfort caring for patients with disabilities was administered to students before and after the encounter. One year after the patient encounter, 59 students were surveyed about their satisfaction and the impact of the patient encounter. RESULTS The impact of encountering people with disabilities in a clinical setting was positive, with statistically significant improvements across all items on the measure of perceived comfort. Students were highly satisfied with the experience and anticipated feeling more confident, more comfortable, less awkward, and more skilled and efficacious when encountering a person with a disability in their future practice. A thematic analysis of the one year follow-up data suggest that students valued the encounter and desired more content on disability throughout their education. CONCLUSIONS Medical education should include dedicated exposure to persons with disabilities and a simulated patient experience allowing for a safe environment to gain skills and confidence.
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Affiliation(s)
- Jill M Crane
- Ohio State University Nisonger Center, 1581 Dodd Drive, Columbus, OH, 43210, United States.
| | - Jesse G Strickler
- Ohio State University Nisonger Center, 1581 Dodd Drive, Columbus, OH, 43210, United States.
| | - A Todd Lash
- The Ohio State University Wexner Medical Center, United States.
| | | | | | - Kelly A Rich
- Ohio State University Nisonger Center, 1581 Dodd Drive, Columbus, OH, 43210, United States.
| | - Ann C Robinson
- Ohio State University Nisonger Center, 1581 Dodd Drive, Columbus, OH, 43210, United States.
| | | | - Susan M Havercamp
- Ohio State University Nisonger Center, 1581 Dodd Drive, Columbus, OH, 43210, United States.
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Havercamp SM, Barnhart WR, Robinson AC, Whalen Smith CN. What should we teach about disability? National consensus on disability competencies for health care education. Disabil Health J 2020; 14:100989. [PMID: 32952097 DOI: 10.1016/j.dhjo.2020.100989] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Health care providers are unprepared to meet the health needs of patients who have disabilities. Disability training is needed, yet there is little agreement about what should be taught. OBJECTIVE Establish a national consensus on what healthcare providers across disciplines need to know to provide quality care to patients with all types of disabilities (e.g., mobility, sensory, developmental, mental health). METHODS People with disabilities, disability advocates, family members of people with disabilities, disability and health professionals, and inter-disciplinary health educators systematically evaluated and provided feedback on a draft set of disability competencies. Based on this feedback, competencies were iteratively refined. RESULTS After two waves of feedback, six competencies, 49 sub-competencies, and 10 principles and values emerged that addressed topics such as respect, person-centered care, and awareness of physical, attitudinal, and communication health care barriers. An overwhelming majority (89%) agreed or strongly agreed that the disability competencies reflected the core understandings needed to provide quality care for patients with disabilities, were relevant across disability types (85%), and across health care disciplines (96%). Averaging evaluative feedback across competencies, participants reported that the competencies were important (98%) and clear (96%). CONCLUSIONS This consensus on what to teach is an important milestone in preparing a disability competent health care workforce. Future directions for research, training, and policy are discussed. When disability is included in health care education, the health care workforce will be prepared to deliver accessible, patient-centered, quality health care to patients with disabilities.
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Flynn S, Hastings RP, Gillespie D, McNamara R, Randell E. Trainer and support staff's experiences of engaging with the Who's Challenging Who? challenging behaviour training course. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2020; 24:367-380. [PMID: 30606072 DOI: 10.1177/1744629518821789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The Who's Challenging Who? (WCW) training is coproduced and delivered by people with intellectual disabilities (IDs), and it aims to improve staff empathy for people with challenging behaviour (CB). This study qualitatively describes trainees' and trainers' experiences of the WCW. METHODS Semi-structured interviews were undertaken with managers (n = 7), support staff (n = 6) and the WCW trainers (n = 4; three had IDs). Interviews were transcribed verbatim and analysed using thematic analysis. RESULTS Two cross-cutting themes were drawn from the data: (1) valued roles of the trainers, whereby trainers and trainees benefited from the training being coproduced and delivered by people with IDs, and (2) beyond the training, within which trainees reported that they were engaging in increased reflection about their past and current practice. CONCLUSIONS Being trained by people with IDs and CB appears to be a useful method, which can lead to perspective taking and reflection about supporting people with IDs and CB.
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Green TC, Donovan E, Klug B, Case P, Baird J, Burstein D, Tapper A, Walley AY, Bratberg J. Revisiting pharmacy-based naloxone with pharmacists and naloxone consumers in 2 states: 2017 perspectives and evolving approaches. J Am Pharm Assoc (2003) 2020; 60:740-749. [PMID: 32334964 PMCID: PMC10948012 DOI: 10.1016/j.japh.2020.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 02/21/2020] [Accepted: 03/06/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Pharmacies provide accessible sources of naloxone to caregivers, patients taking opioids, and individuals using drugs. While laws permit expanded pharmacy naloxone access, prior work identified barriers like concerns about stigma of addiction and time constraints that inhibit scale-up. We sought to examine similarities and differences in experiences obtaining naloxone at the pharmacy over a 1-year period in 2 states, and to explore reactions from people with opioid use disorder, patients taking opioids for chronic pain, caregivers of opioid users, and pharmacists to communication tools and patient outreach materials designed to improve naloxone uptake. DESIGN Eight focus groups (FGs) held December 2016 to April 2017 in Massachusetts and Rhode Island. SETTING AND PARTICIPANTS Participants were recruited from pharmacies, health clinics, and community organizations; pharmacists were recruited from professional organizations and pharmacy colleges. OUTCOME MEASURES The FGs were led by trained qualitative researchers using a topic guide and prototypes designed for input. Five analysts applied a coding scheme to transcripts. Thematic analysis involved synthesis of coded data and connections between themes, with comparisons across groups and to first-year findings. RESULTS A total of 56 individuals participated: patients taking opioids for chronic pain (n = 13), people with opioid use disorders (n = 15), caregivers (n = 13), and pharmacists (n = 16). Fear of future consequences and stigma in the pharmacy was a prominent theme from the previous year. Four new themes emerged: experience providing pharmacy naloxone, clinician-pharmacist-partnered approaches, naloxone coprescription, and fentanyl as motivator for pharmacy naloxone. Prototypes for prompting consumers about naloxone availability, materials facilitating naloxone conversations, and posters designed to address stigma were well received. CONCLUSIONS Experiences dispensing naloxone are quickly evolving, and a greater diversity of patients are obtaining pharmacy naloxone. Persistent stigma-related concerns underscore the need for tools to help pharmacists offer naloxone, facilitate patient requests, and provide reassurance when getting naloxone.
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Affiliation(s)
- Traci C. Green
- Department of Emergency Medicine, The Warren Alpert School of Medicine, Brown University, 55 Claverick St. 2 Floor, Providence, RI 02903, United States
- Boston Medical Center Injury Prevention Center, Boston Medical School, Department of Emergency Medicine, 771 Albany St, Boston, MA, 02118, United States
| | | | - Brittany Klug
- Boston Medical Center Injury Prevention Center, Boston Medical School, Department of Emergency Medicine, 771 Albany St, Boston, MA, 02118, United States
| | - Patricia Case
- Northeastern University, Institute on Urban Health Research and Policy, Bouve College of Health Sciences,360 Huntington Ave, Boston, MA 02115, United States
| | - Janette Baird
- Department of Emergency Medicine, The Warren Alpert School of Medicine, Brown University, 55 Claverick St. 2 Floor, Providence, RI 02903, United States
| | - Dina Burstein
- Department of Emergency Medicine, The Warren Alpert School of Medicine, Brown University, 55 Claverick St. 2 Floor, Providence, RI 02903, United States
| | - Abigail Tapper
- Boston Medical Center Injury Prevention Center, Boston Medical School, Department of Emergency Medicine, 771 Albany St, Boston, MA, 02118, United States
| | - Alexander Y. Walley
- Boston Medical Center, Boston Medical School, Department of Internal Medicine, 801 Massachusetts Ave, Boston, MA, 02118, United States
| | - Jeffrey Bratberg
- University of Rhode Island College of Pharmacy, 7 Greenhouse Road, Kingston, RI 02881, United States
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Peiris-John R, Jain NR, Hogan A, Ameratunga S. Educating health science students about disability: Teachers' perspectives on curricular gaps. Disabil Health J 2020; 14:100985. [PMID: 32878740 DOI: 10.1016/j.dhjo.2020.100985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/30/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND People living with disabilities are significantly more likely than their peers to find health professionals' skills and facilities inadequate. The 66th World Health Assembly called for better health care for people with disabilities including more inclusive health services and a stronger focus on professional training. OBJECTIVE To explore how teachers at a New Zealand university perceived the need, approaches, and systemic challenges to enhance disability education for health professionals in training. METHODS Qualitative analysis of interviews with 11 key informants teaching in population health, medicine, nursing, pharmacy, and optometry training programmes. Transcribed interview recordings were analysed using a general inductive approach. RESULTS The participants described a range of teaching approaches that they used to increase disability awareness among their students. However, these were largely ad hoc individually driven initiatives reflecting personal interests. Participants identified a critical need to develop and implement a systematic, integrated approach to enhance disability education particularly from a social justice perspective among students in health disciplines. Engaging people with lived experience of disability in teaching and course design, and senior administrative commitment were identified as necessary to address current gaps in education. CONCLUSIONS In order to develop a health professional workforce competent to respond to the needs of people with disabilities, greater attention is required at a strategic level to enhance the profile of disability education in health curricula. Meaningful engagement of people with disability and senior leadership commitment are critical components that can enable effective progression of this agenda.
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Affiliation(s)
| | - Neera R Jain
- Faculty of Education and Social Work, University of Auckland, New Zealand
| | - Amy Hogan
- Faculty of Medical & Health Sciences, University of Auckland, New Zealand
| | - Shanthi Ameratunga
- Faculty of Medical & Health Sciences, University of Auckland, New Zealand; Counties Manukau Health - Population Health Directorate, South Auckland, New Zealand
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Lundälv J, Ehrlington H, Johansen A. Disability awareness arena in Sweden: voices of learning toward community facilities, universal design and disability perspective. FACILITIES 2020. [DOI: 10.1108/f-12-2019-0135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study is to describe knowledge, awareness and experience of different employees in a Swedish municipality (City of Gothenburg) concerning the disability perspective, accessibility and universal design in practice.
Design/methodology/approach
This study is based on an online survey. A total of 119 different employees responded to the survey. The data was analyzed from a mixed-method approach, using descriptive statistics and textual analysis. The study also included personal interviews with 19 employees in the City of Gothenburg.
Findings
A total of 521 employees in the City of Gothenburg participated in disability awareness exercises (DAE) at the Disability Awareness Arena to gain greater knowledge and insight on disability perspectives in different environments and services. Of these, 119 people representing different professions in soft and hard services and companies participated in the survey; and 19 people participated in personal interviews. The study showed that a vast majority of them were very satisfied and they have developed and practiced their new knowledge and attitude toward disability and accessibility.
Research limitations/implications
One limitation in this study is that it has investigated the experiences and effects of the DAE 6–12 months after its implementation. Therefore, it is not possible to analyze long-term effects that the DAE can have in practice.
Originality/value
To the best of the authors’ knowledge, no prior study of these issues has been conducted in Sweden. This study is deemed to have significant social benefit because of the steadily increasing demand for disability simulations, awareness of disability perspective and accessibility in municipality settings. No other study has addressed the importance of the DAE in these perspectives. DAE is defined in this article as a unique concept for promoting the usage of the disability perspective in the everyday workplace.
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Health care access and the Americans with Disabilities Act: A mixed methods study. Disabil Health J 2020; 14:100967. [PMID: 32768336 DOI: 10.1016/j.dhjo.2020.100967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 06/07/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Americans with Disabilities Act (ADA) requires that health care entities provide full and equal access to people with disabilities. However, results of previous studies have indicated that the ADA has been largely ineffective at creating systemic change in the delivery of health care. OBJECTIVE The objective of this study was to examine the current barriers to health care access experienced by people with disabilities under Titles II and III of the ADA. METHODS This study utilized a mixed methods multiphase design. In phase one, a survey and focus groups were conducted with individuals with disabilities who experienced barriers to health care access. In phase two, key informant interviews were conducted with individuals who had a role in ensuring equal access to health care for people with disabilities. RESULTS In the current context of health care reform, people with disabilities continue to experience multiple barriers to health care access under Titles II and III of the ADA. However, a notable result is that several provisions of the Patient Protection and Affordable Care Act (ACA) have likely bolstered existing directives implementing requirements for health care access under the ADA. CONCLUSIONS The results of this study provide additional support for a comprehensive examination of both the national standards for accessible health care and the enforcement of laws that prohibit discrimination on the basis of disability.
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VanPuymbrouck L, Friedman C, Feldner H. Explicit and implicit disability attitudes of healthcare providers. Rehabil Psychol 2020; 65:101-112. [PMID: 32105109 PMCID: PMC9534792 DOI: 10.1037/rep0000317] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
PURPOSE/OBJECTIVE Health care providers' attitudes of marginalized groups can be key factors that contribute to health care access and outcome disparities because of their influence on patient encounters as well as clinical decision-making. Despite a growing body of knowledge linking disparate health outcomes to providers' clinical decision making, less research has focused on providers' attitudes about disability. The aim of this study was to examine providers' explicit and implicit disability attitudes, interactions between their attitudes, and correlates of explicit and implicit bias. Research Method/Design: We analyzed secondary data from 25,006 health care providers about their disability attitudes. In addition to analyzing people's explicit and implicit attitudes (Disability Attitudes Implicit Association Test), we used Son Hing, Chung-Yan, Hamilton, & Zanna's (2008) model of two-dimensional prejudice to compare provider's explicit and implicit attitudes. Finally, we used linear regression models to examine correlates of providers' explicit and implicit attitudes. RESULTS While on average, provider's explicit attitudes (M = 4.41) indicated little prejudice, their implicit attitudes (M = 0.54) revealed they moderately preferred nondisabled people-they were aversive ableists. Correlates of providers' explicit and implicit attitudes also included age, gender, political orientation, and having relationships with disability (friends, family, and being a person with disability). CONCLUSIONS/IMPLICATIONS This study revealed that despite a majority of providers self-reporting not being biased against people with disabilities, implicitly, the overwhelming majority were biased. This study's findings can be used to better understand how provider disability bias can contribute to inequitable health care access and health outcomes for people with disabilities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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