Negotiating legitimacy and belonging: Disabled students' and practitioners' experience.

INTRODUCTION: People with disabilities are underrepresented in health professions education and practice. Barriers for inclusion include stigma, disabling discourses, discriminatory programme design and oppressive interactions. Current understandings of this topic remain descriptive and fragmented. Existing research often includes only one profession, excludes particular types of disability and focuses on one aspect of the career journey. To expand understanding, we examined the recurrent forms of social relations that underlie the participation of disabled individuals in learning and practice contexts across five health professions. METHOD: We analysed 124 interviews with 56 disabled health practitioners and students. Participants were interviewed up to three times over 1.5 years. Using constructivist grounded theory, authors used a staged analytic approach that resulted in higher level conceptual categories that advance interpretations of social processes. Finally, the authors compared and integrated findings among students and practitioners. RESULTS: Participants experience challenges to their sense of legitimacy and belonging as health providers. They describe tensions within the health education and practice between the commitment to inclusion and the day-to-day realities experienced by disabled participants. We identified six distinct, but related, conditions underlying these tensions: (i) validity and transparency of competencies' evaluation; (ii) the social and physical contexts; (iii) integration of inclusive practices; (iv) boundaries between personal and professional identities; (v) vulnerability to authority figures; and (vi) dynamic person-level factors. DISCUSSION: If we are to commit to health practitioners and students with disabilities experiencing an overall sense of legitimacy and belonging, priority needs to be given to system-level practices and policies to support inclusion. Attention to the day-to-day marginalisation of students and practitioners with disabilities in the health professions is also needed. Additionally, inclusive and transparent delineation of competency requirements is needed. Finally, educational actions are needed to increase understanding of disability in the health professions, with particular attention to promoting social relations that foster collective responsibility for supporting inclusion.

Social support experiences of students and clinicians with disabilities in health professions.

Social support is vital in promoting the health, well-being, and performance of students and clinicians in health professions. Health settings' demanding and competitive nature imposes unique challenges on students and clinicians with disabilities. This paper aims to explore the trajectories and experiences of social support interactions amongst students and clinicians with disabilities in health professions. In a qualitative longitudinal study, 124 in-depth semi-structured interviews were conducted with 27 health students and 29 health clinicians with disabilities. Data analysis was informed by grounded theory as an adapted analytic approach involving constant comparisons. A few main characteristics of social support and trajectories in which social support is negotiated emerged from the data: (1) The need to be accepted and not questioned when asking for support, (2) Support interactions that do not heighten otherness, (3) Failure to acknowledge the challenges, (4) Interactions that support the process of disclosure (5) Interactions that allow mobilization of social support without strain or an extra effort. These findings have important implications for designing more supportive health professions, educational programs, and workplaces for people living with disabilities.

Resilience practices among a broad spectrum of individuals with physical disabilities during the COVID-19 pandemic: A qualitative photo elicitation study.

This community-based study explored resilience practices among people living with physical disabilities (i.e., stroke, spinal cord injury, and other physical disabilities) during the COVID-19 pandemic. In this photo elicitation study, during 1:1 interviews, participants shared and described photos that reflected their pandemic-related experiences. Data were analyzed thematically to identify resilience-related practices. Our analysis revealed three themes: (1) reflecting on the importance of family, friends, and community (e.g., recalling past memories and strengthening existing connections); (2) engaging in social and recreational activities (e.g., experiencing the outdoors and gardening); and (3) reframing personal contexts and social environment (e.g., adjusting to new social norms and overcoming physical barriers to navigating safely during the pandemic). The resilience that participants identified encompassed not only individual strategies but also family and community supports. Resilience can be fostered through community initiatives that support more equitable responses to health emergencies for people with disabilities.

Disabled healthcare professionals' diverse, embodied, and socially embedded experiences.

Disabled people are underrepresented within healthcare professions, although their participation has potential benefits for them personally, and for broader society. Disabled peoples' participation in healthcare professions is limited by assumptions about disability. Little research explores how healthcare professions can be organized to support disabled peoples' employment. Within a critical realist paradigm influenced by grounded theory, this study used interviews to explore the experiences of 56 disabled healthcare clinicians and students, and advance a conceptual taxonomy of disability experience within healthcare professions. Participants describe their experiences of disability in the healthcare professional context in terms of characteristics and dimensions of disability-how characteristics interact with factors within healthcare training and practice environments. We profile two particularly salient dimensions of the disability experience: visibility and onset of disability. These are developed to describe complexity and specificity of the experiences of individuals negotiating the healthcare context. Among participants there is extensive heterogeneity related to the experience of disability in healthcare professional contexts. Despite some having similar disability characteristics, no two individuals experience the same combination of characteristics and dimensions of disability. Given the complexity of experiences for disabled healthcare professionals/students, a taxonomy for conceptualizing this experience is presented. Readers are encouraged to consider the taxonomy through which they might conceptualize individual, embodied, and socially embedded experiences of disabled healthcare professionals and students. Stakeholders involved in healthcare professions and education should consider this shift in perspective, with a view to increasing access of disabled people to health professional practice.

"I Can Understand Where They're Coming From": How Clinicians' Disability Experiences Shape Their Interaction With Clients.

Students and clinicians with disabilities are underrepresented in the academic health programs and professional clinical settings. Disability studies foregrounds the unique ways of knowing and being that clinicians with disabilities can offer. Based on a larger grounded theory study of the experiences of students and clinicians with disabilities, this article examines the role that clinicians' abilities to draw on their personal experiences of living with a disability have on their interactions with clients. The analysis of semistructured interviews with 55 students and clinicians with disabilities from different fields contributes to the development of a theory of epistemic connection. The theory is informed by the following three themes: (a) building rapport through understanding, (b) from understanding to advocacy and creative approaches, and (c) between professionalism and disability. The findings emphasize not only the importance of diversifying the health care workforce but also incorporating disability epistemology into the health care culture.

Correlates of self-reported Wheelchair Skills Test Questionnaire scores of new users of mobility scooters: a cross-sectional study.

OBJECTIVES: To describe the subjective reported scooter-skill scores of new mobility scooter users and to identify significant correlations with other characteristics and measures. MATERIALS AND METHODS: This was a single-centre study using a cross-sectional design. Participants (N = 22) completed the Wheelchair Skills Test-Questionnaire (WST-Q) Version 4.3 for scooter users. It measures the users' perceived capacity (what the user can do), performance (what the user actually does), and confidence (or self-efficacy). Their scooter skills were also rated objectively with the Wheelchair Skills Test (WST). They completed standardised measures of cognition, hearing, vision, life space mobility, visual attention and task switching, and confidence negotiating the social environment using their scooters. RESULTS: Mean total WST-Q capacity scores were 83% and performance scores were 25%. WST-Q capacity scores had significant positive correlations with WST-Q performance (r = 0.321) and confidence scores (r = 0.787), WST capacity scores (r = 0.488), and confidence negotiating the social environment (WheelCon) (r = 0.463). WST-Q capacity scores were significantly negatively correlated with Trail Making B scores (r = -0.591) and age (r = -0.531). CONCLUSIONS: The correlations between WST-Q scores and other variables are similar to those found in other studies among users of scooters and other mobility devices. The gap between capacity and performance scores highlights the needs for additional skills training in this population of novice scooter users.IMPLICATIONS FOR REHABILITATIONIn implementing scooter training for new scooter users, attention should be paid to building community-based skills for navigating both the physical and the social environment.Scooter users' age and their driving capabilities need to be taken into account when developing and delivering the training.

Qualitative experiences of new motorised mobility scooter users relevant to their scooter skills: a secondary analysis.

OBJECTIVE: To explore the experiences of new motorised mobility scooter users from the perspectives of the assessment and training of scooter skills. DESIGN: Descriptive secondary analysis of qualitative data. SETTING: Community. PARTICIPANTS: 20 New users of motorised mobility scooters. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Directed qualitative analysis of up to four semi-structured interviews over the course of the first year of scooter use, to identify themes and sub-themes that could inform recommendations regarding assessment and training protocols. RESULTS: We identified two themes. The first related to potential new content. As one example of the sub-themes, there were many excerpts that dealt with the use of skills in various combinations and permutations that were used to carry out activities during everyday life and participate in society. These excerpts suggested the importance of training skills in combination to facilitate skill transfer (or generalizability). The second theme is related to enhancements of existing content. As one example of the sub-themes, there were several excerpts that dealt with scooter security. These excerpts led to the recommendation that removing and inserting the scooter key should be added to the assessment criteria for the "turns power on and off" skill of the Wheelchair Skills Test (WST) and its questionnaire version (WST-Q). CONCLUSIONS: The experiences of scooter users over the first year of receiving a scooter appear to be relevant to the assessment and training of scooter skills and suggest themes for further study. Clinical trial registration number: NCT02696213 IMPLICATIONS FOR REHABILITATIONThe experiences of new scooter users are highly relevant to the assessment and training of scooter skills.These experiences suggest both potential new content and enhancements of existing content to the Wheelchair Skills Program Manual.

Quality of Physical Activity Participation Among Adults with Disabilities Through Pandemic Restriction.

Background. Physical activity (PA) is essential for maintaining well-being in adults with disabilities. This population experienced reduced PA during the COVID-19 pandemic; yet, the impact on quality of PA participation remains unclear. Purpose. This secondary analysis explored how pandemic restrictions impacted six experiential dimensions of quality of PA participation among adults with disabilities. Methods. An exploratory sequential mixed-methods design, including semi-structured interviews (n = 10) and self-reported surveys (n = 61), was conducted in May-2020 and February-2021. Quality of PA participation was measured using the Measure of Experiential Aspects of Participation (MeEAP). Participants included community-dwelling adults over 19 years of age (mean 59.2 ± 14.0 years) living with stroke, spinal cord injury, or other physical disabilities. Findings. Directed content analysis identified three themes related to adjusting PA participation for restrictions, motivation barriers, and valuing social support. These themes highlighted five factors, such as resilience, as potential quantitative predictors of quality of PA participation. While paired correlations with MeEAP scores were observed, these factors were not statistically predictive in multiple regression analysis (adjusted R2 = -0.14, F(10,50) = 0.92, p = .53). Implications. The interplay between Meaning, Autonomy, Engagement, and Belongingness dimensions of quality of PA participation was complex, with an emphasized role for mental health, in adults with disabilities.

"Dirty looks": A critical phenomenology of motorized mobility scooter use.

The use of motorized mobility scooters has become increasingly prevalent. Drawing on the critical-phenomenology and disability-studies literature, this study explored the embodied nature of scooter use among 20 new scooter users. The analysis revealed four themes: 1) Navigating the social environment and being (un)seen presented a paradox of how hypervisibility and invisibility can both exist; 2) Transitioning to scooter use revealed the affective component of becoming a scooter user despite the underlying desire to avoid unwanted attention; 3) Experiencing accessibility challenges en route and at destinations demonstrated that the inconsistency in accessibility along different routes unavoidably makes disability more visible; 4) Strategic and personalized use of devices for mobility illustrated how reliance on other mobility devices (e.g. canes and walkers) can be used as a strategy to circumvent the barriers and lessen the visibility of disability. The lifeworlds of "lived relation", "lived body", "lived space", and "lived things" encapsulated the multi-faceted experiences of new scooter users. The critical phenomenology of scooter use emphasized the need for creative strategies to address the physical and attitudinal barriers as well as scooter design-related concerns.

Organizations' Strategies to Improve Implementation of Universal Accessibility Principles: Protocol for a Scoping Review.

BACKGROUND: Since the publication of the Convention on the Rights of Persons with Disabilities, several countries have adopted laws, policies, and action plans to improve the universal accessibility of environments to improve inclusion and social participation of all citizens. Different organizations are involved in the application of these measures. OBJECTIVE: The aim of this study is to identify strategies that are contextually appropriate and provide guidelines for organizations to promote successful implementation of universal accessibility. METHODS: We will conduct a scoping review identifying implementation strategies of universal accessibility measures in local organizations using the Arksey and O'Malley framework. We will search in Medline, CINHAL, Urban Studies Abstracts, ABI Inform, and Social Sciences Full Text from 2006 until today, following the adoption of the Convention on the Rights of Persons with Disabilities. Two reviewers will independently select studies for inclusion and will extract the data. A descriptive and thematic analysis of the characteristics of the identified implementation strategies will be performed. RESULTS: Implementation strategies will be summarized in tables. They will then be linked to various constructs and domains listed in the Theoretical Domain Framework to identify barriers and facilitators of organizations' uptake of evidence-based strategies of implementation. CONCLUSIONS: We will tabulate the characteristics of the included studies and the outcomes of implementation strategies in them. The results of this scoping review are expected to help the research community in various fields, local organizations, and stakeholders to identify better ways to improve implementation strategies of universal accessibility practices. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/33641.

Pilot study of a training program to enhance transformational leadership in Spinal Cord Injury Peer Mentors.

STUDY DESIGN: Experimental, pragmatic design. OBJECTIVES: (1) To determine the effects of a transformational leadership (TFL) training program on spinal cord injury (SCI) peer mentors and their mentees; (2) To document characteristics of mentorship within a community-based SCI peer mentor program. METHODS: In total 23 SCI peer mentors (70% male; M age = 47.4 ± 12.1) were randomly allocated to an Experimental or Control condition. Experimental condition mentors received a half-day TFL workshop and bi-weekly emailed information on using TFL in SCI peer mentorship. Sixteen SCI mentees (50% male; M age = 49.1 ± 12.9) enrolled in the study and 9 completed measures of self-efficacy and their mentors' use of TFL and supportiveness at 3 and 6-months. Mentors completed monthly reports of mentorship activities. SETTING: Community-based peer mentorship program in British Columbia, Canada. RESULTS: There were no between-groups differences in mentee self-efficacy, mentor use of TFL or mentor supportiveness. In the Experimental condition only, total mentorship time and sessions were positively correlated with mentors' use of TFL and supportiveness. Mentorship occurred in-person, by phone, text, and email and mentors discussed an average of 11 topics. CONCLUSIONS: The intervention did not increase SCI peer mentors' use of TFL relative to a Control condition. Nevertheless, there may be merit in coaching SCI peer mentors to use TFL given the positive correlations between mentorship time and sessions, TFL use, and perceived supportiveness of the mentor. Although inherently challenging, research involving community-based SCI peer mentorship programs provides opportunities for scientists and community organizations to extend knowledge of peer mentorship beyond the context of hospital-based programs. SPONSORSHIP: Research supported by a SSHRC Partnership Development Grant.