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

Caregivers' perspectives of community acceptance before and after surgical treatment for their child's disability

In Tanzania, about 600 000 youth between 5 and 24 years old have a disability. Individuals with disabilities face numerous obstacles due to social stigma. The aim of this formative evaluation is to assess how caregivers of children with correctable disabilities (e.g., cleft lip/palate, club foot, and burn scar contractures) in Tanzania perceive their community's acceptance of their child before and after surgical treatment. Semi-structured interviews were conducted with 80 caregivers of children with disabilities treated at Kafika House in Arusha, Tanzania. The constant comparative method identified themes regarding the caregivers' feelings on their child's functional abilities and experiences of stigma in their community. Caregiver perceptions of stigma before and after surgical treatment were categorized and quantified as 'positive', 'neutral' and 'negative'. Thematic analysis of the 80 interviews resulted in five major themes: (1) stigma and acceptance (pre-treatment) and (2) post-treatment; (3) functional abilities (pre-treatment) and (4) post-treatment; and (5) emotional impact (pre- and post-treatment). These themes indicate caregivers and their children experience a range of emotional impacts before and after treatment, more severe stigma before treatment, and overall better social, emotional and functional status after treatment. Frequency analysis of caregiver experiences indicated that stigma experienced by children and their families decreased from 75% before surgical treatment to 2.5% after surgery. Surgical intervention and rehabilitation of physical disabilities mitigated experiences of social stigma for both children and their caregivers. Findings support the need for expanded treatment of correctable disabilities, larger investments in community-based rehabilitation programmes and further interventions to support stigmatized parents and their children.

A Qualitative, Small-Sample Study of Employment Challenges for People with Disabilities in Saudi Arabia

Many people live with disabilities and many countries worldwide are acting to provide people with disabilities opportunities to find and sustain gainful employment. Notwithstanding, people with disabilities still do not have the same access to employment as their counterparts without disabilities. Although some research has investigated these issues in Western countries, very little research has investigated these issues in the Middle East, in general, and in Saudi Arabia, in particular. The aim of the present study is to gain an initial understanding of the employment experiences of people with disabilities and prospective employers of people with disabilities in Saudi Arabia. We identify several potential obstacles preventing people with disabilities from securing and maintaining gainful employment in Saudi Arabia. We secured qualitative data from semi-structured interviews with five prospective employers and five individuals with disabilities in Saudi Arabia. We focused on identifying barriers to employment. The impact of demographic factors such as age, gender, and education on employment opportunities was also examined. The results suggest several practical conclusions and recommendations relating to improving and enhancing opportunities for employment for people with disabilities in Saudi Arabia.

Vocational skill training programs for persons with intellectual disability (PID) and trainers' perspective during and post vocational skill training

Background

Employment is one of the primary goals of persons with intellectual disabilities (PID). Employment can lead to positive psychosocial and economic benefits for people with ID, but people with disabilities are not afforded this opportunity to contribute to society through work due to multiple challenges, as well as the transition from vocational skill training to getting employed for PID is more challenging.

Materials and Methods

Seven vocational skill trainers were chosen from the seven vocational skill training centres offering skill training for PID and located in urban Bengaluru were selected using a purposive sampling design for this study. The trainers were interviewed to understand their perspectives on challenges during and post vocational training for PID.

Results

Training offered to PID in several vocational centres ranged from unskilled to semi-skilled. A range of barriers including gaps in awareness and knowledge of the various training programs for PID challenges associated with their transition after training, unique challenges in placing the trained PID into external organizations, stigma, and attitudinal barriers associated with disability are described to be influencing the skill training of PID and their subsequent employment.

Conclusion

Skill training offered for PID across the centres with significant challenges while providing the training and supporting their transition into the community for employment. The challenges of the PID need to be studied at a broader level through including all the stakeholders.

Factors influencing employment among people with spinal cord injury in South Africa

PURPOSE

The unemployment rate post spinal cord injury (SCI) in South Africa is high with limited knowledge of environmental factors outside the health services, especially in an unevenly developed resource setting like South Africa, affecting the employment rate in people with SCI. Our purpose was to investigate factors associated with employment in people with SCI in South Africa.

METHODS

Two hundred persons with SCI participated in a cross-sectional survey design. This study formed part of the International Spinal Cord Injury Community Survey. Subsections of the questionnaire responses were used as explanatory variables to predict employment after SCI using logistic regression analysis.

RESULTS

The response rate of the study was 54%. Of the 200 participants included, 61% reported being employed before SCI onset whereas only 25% reported being engaged in paid work at the time of this study. The logistic regression model showed not requiring physical assistance in the home environment (p = 0.016), the number of education years before SCI (p = 0.007), household income (p < 0.001), having worked before SCI onset (p = 0.041), and environmental factors (p = 0.029) to be factors associated with employment after SCI.

CONCLUSION

The finding suggests multiple factors influence the employment rate, advocating for interdisciplinary rehabilitation approaches and social development interventions to address meaningful occupations in persons with SCI in South Africa.Implications for rehabilitationRehabilitation programs should be adapted and tailored to enhance physical independence.Public policies regarding environmental factors such as access to reliable transport, assistive devices, and public places for wheelchair users are important and could potentially support individuals with spinal cord injury (SCI) becoming employed/re-employed.For successful social/community/civic reintegration for individuals with SCI an intersectional collaboration (i.e., between policymakers, health professionals, and the labor market) needs to be considered to improve the employment opportunities post-SCI.

The impact of disability-related deprivation on employment opportunity at the neighborhood level: does family socioeconomic status matter?

Introduction

Difficulties in attaining employment significantly contribute to socioeconomic poverty among individuals with disabilities. However, our understanding of how socioeconomic deprivation experienced by individuals and families with disabilities influences employment opportunities remains incomplete. This study aims to explore the relationship between index of disability-related multiple deprivation (IDMD) and employment opportunities (EMPO), while also investigating the role of family socioeconomic status (FSES) in shaping this relation.

Methods

This study explores the heterogeneous effects of IDMD, FSES, and the interaction between IDMD*FSES on EMPO among four disabled population groups categorized by IDMD and FSES.

Results

Results reveal that IDMD has a significant negative impact on EMPO, suggesting that persons with disabilities are confronted with a poverty trap resulting from the relationship between IDMD and EMPO. Furthermore, FSES demonstrates an effective moderating role in the IDMD-EMPO relationship, with the greatest impact observed among disabled population groups characterized by high IDMD and low FSES.

Discussion

The findings suggest that family-level support is crucial for vulnerable groups of disabled individuals to overcome the poverty trap, surpassing the reliance on individual-level assistance alone. This study supports a paradigm shift in comprehending disability-related deprivation by acknowledging its association with families, thereby presenting opportunities to enhance the welfare of people with disabilities.

The Sustainable Development Goals: A framework for addressing participation of persons with complex communication needs in South Africa

BACKGROUND

Participation in society is the cornerstone to living a meaningful, connected, and healthy life. Persons with complex communication needs, however, often have restricted opportunities to participate in everyday contexts and situations. Reasons for this include societal attitudinal barriers, as well as limited knowledge and skills about augmentative and alternative communication (AAC) to enhance participation. Enhancing participation of persons with complex communication needs requires a holistic and multi-faceted approach. The 17 Sustainable Development Goals (SDGs) with their disability-inclusive agenda provide an impetus for shaping the approach of the Centre for Augmentative and Alternative Communication (CAAC) in enhancing participation of persons with complex communication needs in South Africa.

PURPOSE

This paper aims to provide a reflective description and application of the work conducted by the CAAC in addressing the SDGs in South Africa.

RESULT

Research and training conducted by the CAAC is shown to be aligned to five SDGs, namely zero hunger (SDG 2), good health and well-being (SDG 3), quality education (SDG 4), decent work and economic growth (SDG 8) and peace, justice, and strong institutions (SDG 16), with a focus on reaching these goals in order to benefit persons with complex communication needs.

CONCLUSION

The paper demonstrates that, despite some gains in addressing the SDGs, research and clinical practice still needs to be on these and the remaining SDGs. Furthermore, there is a need to also find ways to integrate the SDGs to ensure participation of persons with complex communication needs in major life activities and society.

Mapping frameworks and approaches to measuring the quality of transition support services for young people with intellectual and developmental disabilities

Transition to adulthood for young people with intellectual disabilities and developmental disabilities (IDD) has been given significant attention in research, policy development and practice. The aim of this paper was to explore how a recently developed theoretical outcomes-based framework for measuring the quality of services for people with disabilities could potentially be useful in conceptualizing and supporting successful transition to adulthood. The theoretical discussion draws on both the scoping review and template analysis that was used to develop the Service Quality Framework and on a separate study synthesizing expert completed country templates and literature review which included models of and research on successful transition to adulthood. Synthesis identified that using a quality of life outcomes focused framework of Service Quality could be mapped onto and extend current thinking on what is seen as successful transition to adulthood by putting the focus on successful transition as people with IDD moving towards having similar opportunities and quality of life as other adults without disabilities living in the same community/society. Implications of a more wide-ranging definition and holistic view for both practice and future research are discussed.

Access to Services from Persons with Disabilities in Afghanistan: Is Community Based Rehabilitation Making a Difference?

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), ratified in 2006, states that the achievement of equal rights, empowerment, and social inclusion of people with disabilities requires comprehensive rehabilitation services involving educational, social, economic, and medical interventions, all dimensions of the World Health Organization Community based rehabilitation (CBR) matrix. CBR programs aim at achieving those goals. In the present study, we investigated whether a large scale CBR program is improving access to multiple services (namely physical therapy, assistive technology, education, employment, advocacy, and community awareness) and providing satisfactions (by measuring the reduction in unmet needs) of Afghans with disabilities. We enrolled in the study 1861 newly recruited CBR participants with disabilities from 169 villages between July 2012 and December 2013, and 1132 controls screened with disabilities randomly selected with a two-stage process within 6000 households from 100 villages in the same provinces as the CBR but outside its catchment area. Using propensity score matching (PSM) and difference in difference analysis, we estimated the differences in accessing services. There were statistically significant differences between participants and controls on the access of available services between the baseline and endline. Using PSM we also found that needs were more often met among CBR participants compared to the controls. Our study indicates that a CBR program may be an effective way to provide services for persons with disabilities even in a conflict context such as Afghanistan. It contributes to addressing the longstanding question whether CBR can actually improve the rehabilitation of persons with disabilities.

Legislation on Disability and Employment: To What Extent Are Employment Rights Guaranteed for Persons with Disabilities?

Although the Convention on the Rights of Persons with Disabilities guarantees the right to employment and most countries in Latin America have signed and ratified the Convention, a large proportion of the population with disabilities still does not participate in the labour market. (1) Objective: The objective of this research was to understand how legislation in seven Latin American countries (Bolivia, Costa Rica, Chile, Colombia, Ecuador, Mexico, and Peru) has defined and enabled the inclusion of people with disabilities in the labour market. (2) Methods: We conducted a thematic analysis of the content of 34 documents and generated two thematic networks that summarise the results of the thematic analysis and represent the general relationships between the categories of analysis in each country. Using this information, we analysed the differences between countries and the advance in their legislation to fulfil the recommendations made by the Convention. (3) Results: Although all countries have enacted legislation promoting the employment rights of persons with disabilities, six of the seven countries (except Chile) have applied a medical perspective to the definition of disability in their labour legislation, thus imposing a barrier to the labour-market inclusion of this population and perpetuating the association of disability with lack of capacity to work.