The Employment Quality of Persons with Disabilities: Findings from a National Survey.

PURPOSE: Labour market integration is a widely accepted strategy for promoting the social and economic inclusion of persons with disabilities. But what kinds of jobs do persons with disabilities obtain following their integration into the labour market? In this study, we use a novel survey of workers to describe and compare the employment quality of persons with and without disabilities in Canada. METHODS: We administered an online, cross-sectional survey to a heterogeneous sample of workers in Canada (n = 2,794). We collected data on sixteen different employment conditions (e.g., temporary contract, job security, flexible work schedule, job lock, skill match, training opportunities, and union membership). We used latent class cluster analysis to construct a novel typology of employment quality describing four distinct 'types' of employment: standard, portfolio, instrumental, and precarious. We examined associations between disability status, disability type, and employment quality. RESULTS: Persons with disabilities reported consistently lower employment quality than their counterparts without disabilities. Persons with disabilities were nearly twice as likely to report low-quality employment in the form of either instrumental (i.e., secure but trapped) or precarious (i.e., insecure and unrewarding) employment. This gap in employment quality was particularly pronounced for those who reported living with both a physical and mental/cognitive condition. CONCLUSION: There are widespread inequalities in the employment quality of persons with and without disabilities in Canada. Policies and programs aiming to improve the labour market situation of persons with disabilities should emphasize the importance of high-quality employment as a key facet of social and economic inclusion.

A qualitative exploration of how gender and relationship shape family caregivers' experiences across the Alzheimer's disease trajectory.

Caregiving experiences are not static. They change across the disease trajectory and care continuum. However, it is not clear how caregiver gender or relationship type is related to evolving caregiver experiences over time. This qualitative study informed by constructivist grounded theory and framework analysis explored the experiences over time of men and women who were adult children and spousal caregivers to persons with Alzheimer's disease. Forty spousal (10 husbands and 10 wives) and adult children (10 sons and 10 daughters) caregivers to persons with Alzheimer's disease were interviewed using a semi-structured interview guide. Our findings suggest the experiences of caregiving, examined through a gender and relationship type lens, are complex and variable. The caregiving experience was not related to gender or relationship type alone, but often to a combination of the two. For instance, spousal caregivers did not immediately accept the diagnosis, with wives being more optimistic than husbands about a slow progression of the disease. Adult children caregivers were concerned about the ways the caregiving role would impact their personal and career obligations and sought ways to mitigate the changes to their daily lives. Sons and husband caregivers largely utilized home and community health services to assist with personal care tasks, whereas daughters and wives utilized the same services to allow them to complete other caregiving tasks (e.g., housekeeping). Recognition of the complex inter-relationships among gender and relationship type on caregiving experiences supports the need for family-centered interventions. This article also extends sex and gender research as it highlights that an in-depth understanding of the caregiving experience cannot be understood by gender alone and relationship type must also be considered.

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

OBJECTIVE: Young adulthood is an important transitional life phase where careers are established. Young adults with chronic disabling health conditions are underrepresented in the labour market. Our study aims to examine the effectiveness of work-focused interventions that support the labour market transition of young adults with chronic disabling health conditions; and to examine whether the effectiveness of work-focused interventions differ across work transition phase (eg, preparation, entry and sustaining work, employment advancement) and disability type. METHODS: A systematic review of articles published between January 1990 and July 2018 was conducted. Medline, EMBASE and PsycInfo were searched, and titles/abstracts and full texts of articles were reviewed for eligibility. Relevant articles were appraised for methodological quality. A best evidence synthesis was applied to medium-quality/high-quality studies to develop recommendations. RESULTS: 5816 articles were identified; 10 articles were relevant and of moderate-high methodological quality. Six intervention categories were identified which focused on young adults with mental health or intellectual/learning disabilities (n=3) and addressed employment preparation (n=10) and/or work entry (n=9). No interventions addressed at-work issues or career advancement. Strong evidence existed for tailored supported employment (SE) interventions having a positive impact on preparation and entry into competitive employment. Also, moderate evidence existed for the positive impact of SE on preparation and entry into competitive employment for young adults with mental health conditions. CONCLUSIONS: Tailored SE is recommended to foster preparation and entry into the labour market. Evidence-based interventions are needed to facilitate sustained work and career advancement of young adults living with different disabling health conditions.

Perceived personal importance of exercise and fears of re-injury: a longitudinal study of psychological factors related to activity after anterior cruciate ligament reconstruction.

BACKGROUND: Psychological perceptions are increasingly being recognized as important to recovery and rehabilitation post-surgery. This research longitudinally examined perceptions of the personal importance of exercise and fears of re-injury over a three-year period post anterior cruciate ligament (ACL) reconstruction. Stability and change in psychological perceptions was examined, as well as the association of perceptions with time spent in different types of physical activity, including walking, household activities, and lower and higher risk for knee injury activities. METHODS: Participants were athletes, 18-40 years old, who underwent ACL reconstruction for first-time ACL injuries. They were recruited from a tertiary care centre in Toronto, Canada. Participants completed interviewer-administered questionnaires pre-surgery and at years one, two and three, postoperatively. Questions assessed demographics, pain, functional limitations, perceived personal importance of exercise, fear of re-injury and physical activities (i.e., walking; household activities; lower risk for knee injury activities; higher risk for knee injury activities). Analyses included fixed-effect longitudinal modeling to examine the association of a fear of re-injury and perceived personal importance of exercise and changes in these perceptions with the total hours spent in the different categories of physical activities, controlling for other factors. RESULTS: Baseline participants were 77 men and 44 women (mean age = 27.6 years; SD = 6.2). At year three, 78.5% of participants remained in the study with complete data. Fears of re-injury decreased over time while personal importance of exercise remained relatively stable. Time spent in walking and household activities did not significantly change with ACL injury or surgery. Time spent in lower and higher risk of knee injury physical activity did not return to pre-injury levels at three years, post-surgery. Greater time spent in higher risk of knee injury activities was predicted by decreases in fears of re-injury and by greater personal importance of exercise. CONCLUSIONS: This study highlights not only fears of re-injury, which has been documented in previous studies, but also the perceived personal importance of exercise in predicting activity levels following ACL reconstructive surgery. The findings can help in developing interventions to aid individuals make decisions about physical activities post knee injury and surgery.

For better or worse? Changing shift schedules and the risk of work injury among men and women.

OBJECTIVES: The aim of this study was to examine the risk of work injury associated with changes in shift schedules and identify whether work injury risks differ between men and women. METHODS: Longitudinal panels from the Survey of Labor and Income Dynamics were used to describe work schedule patterns over a 6-year period among a representative sample of Canadian workers (N=19 131). Cox regression was used to estimate the risk of work injury among workers who (i) switched from regular day to nonstandard shifts, (ii) switched from nonstandard to day shifts and (iii) remained in nonstandard shifts, compared with (iv) those who worked regular day shifts only. Gender differences were examined in separate stratified analyses. Adjustments were made for potential respondent and occupational confounders. RESULTS: Increased injury risk was observed among those who: switched from day to nonstandard shifts [hazard ratio (HR) 2.60, 95% confidence interval (95% CI) 1.79-3.77], switched from nonstandard to days (HR 2.36, 95% CI 1.62-3.49), and worked nonstandard shifts only (HR 1.44, 95% CI 1.23-1.70). For women, work injury risk was higher among those who switched shifts (days to nonstandard HR 3.10, 95% CI 1.76-5.46; nonstandard to days HR 2.31, 95% CI 1.36-3.91), or worked nonstandard shifts only (HR 1.85, 95% CI 1.44-2.37) compared to day schedules. However, for men the risk of injury was elevated only among those who switched shifts (days to nonstandard HR 2.18, 95% CI 1.35-3.51; nonstandard to days HR 2.38, 95% CI 1.41-3.95). The only significant difference between men and women were among nonstandard shift workers. CONCLUSIONS: Our results suggest that changing shift types may increase work injury risk among men and women, and that the risk remains increased among women who work nonstandard shifts for a prolonged period of time. This highlights the need for awareness and implementation of health and safety programs when workers initially change shift schedules and on a regular basis to maintain worker health.