Considerations when asking about "disability" in disability inclusive research.

PURPOSE: There are several ways to include "disability" in research studies, which can be confusing or overwhelming for researchers, community members, and students. The aim of this paper is to share conceptualizations of disability and how to ask about "disability" in research studies. The paper provides a general introduction and brief analysis of the methodological approaches which can be used. METHODS: We used reviews of the literature and extensive discussions to identify key articles, books, websites, and reports that provide guidance and examples of asking about disability in research. RESULTS: Four primary approaches to asking study participants about disability were identified. For each of these, we provide background information, key points about the ways to use the approach including tools that have been developed, and example studies. A comparison table provides a high-level overview of similarities and differences in approaches. Other approaches and tools were also identified and are briefly described. CONCLUSION: Researchers involved in disability and rehabilitation research should be aware that there is not one best or singular way to ask about disability when conducting research. The approach or approaches chosen for a particular study need to match the purpose of the study. It is important that researchers take time to carefully consider their options and choose the best fit for their study.

There are several different ways to ask about disability and functioning when conducting research that aims to include a disability component or focus.Researchers need to carefully select the best option(s) for their study.Whenever possible, researchers should use more than one approach and should allow for more than one type of disability or impairment to be selected.Researchers often require training to understand how to include disability in research.Allow adequate time and resources for training research team members so that the tools are implemented correctly.

Using Twitter to Understand the Effects of the Cameroon Anglophone Crisis on Social Determinants of Health.

Insufficient opportunities to collect data on public health exist in armed conflict regions. Increased use of social media during war and conflict has allowed for data collection in situations where information is usually difficult to obtain. In this study, Twitter, a public social media platform, was used as a source of data and information to gain insight into how the Cameroon Anglophone Crisis impacts public health in the population. Our findings revealed that Twitter was being used to share information and call for action. Analysis of tweets revealed 8 distinct themes, which illustrated the impact of the crisis on the social determinants of health: neglect from government related to the social determinants of health; education; loss of employment; increased poverty; housing and homelessness; social exclusion and oppression; women and gender inequality; and health services. This study provides insight into the significant impact on public health in Cameroon caused by the Anglophone Crisis, and demonstrates the potential benefits of social media for gathering information about public health in crisis situations.

A report on the development of COVID-19 guidelines for rehabilitation professionals in African settings.

COVID-19 is the disease caused by SARS-CoV-2, one of a large family of coronaviruses. Severe forms of the disease can lead to respiratory failure with multiple organ failure necessitating rehabilitation in both acute and long-term care. With the increasing prevalence of COVID-19 and rehabilitation needs, the African Rehabilitation Network (AFRENET) produced a guidance document to assist in reducing variation in clinical practice among rehabilitation professionals in the Africa Region. This report outlines the process of the guideline development.

Looking Back to Move Forward: Canadian Occupational Therapy In Public Health, 1914-2019.

BACKGROUND.: Decades of literature demonstrate that occupational therapy is well-suited to collaborate with public health due to overlapping views of health. However, there has been little collaboration between these professions with few examinations of why they remain distinct. PURPOSE.: This study examines historical events that have led to the present-day separation of occupational therapy and public health. METHOD.: This narrative review and thematic analysis of the scholarly, archival, and grey literature was conducted to examine the development of both fields. FINDINGS.: Fifty texts were analyzed revealing four themes: the influence of structural and social forces; professional, societal, and institutional hindrances; potential for a shared vision; and next steps for integration. These themes highlight historical barriers to collaboration and provide evidence that occupational therapy could benefit public health. IMPLICATIONS.: Collaboration between occupational therapy and public health has many potential benefits, however new approaches to bridge the divide are needed to advance collaboration.

Investigating the provision of occupational therapy services: A case study.

BACKGROUND.: The World Health Organization has identified occupational therapists as integral human resources on health care teams, yet in many contexts, occupational therapy services are not adequately provided. One example is occupational therapy in mental health care in Saskatchewan. PURPOSE.: This study aimed to uncover what is known about the case of occupational therapy in the context of mental health services in Saskatchewan. METHOD.: An instrumental case study design was employed, applying a critical interpretive approach and thematic analysis to examine 40 publicly available documents. FINDINGS.: Three main themes (with subthemes) were identified: access (representation, funding, rural communities), awareness (comprehension, value, collaboration), and advocacy (leadership, education). IMPLICATIONS.: This study illuminates how restricted access to, limited awareness of, and ineffective advocacy for occupational therapy impacts mental health services in Saskatchewan and provides a replicable process for other contexts where occupational therapy is underrepresented.

Patient Experience in Health Professions Curriculum Development.

To enhance student learning, many health profession programs are embracing involvement of patients in their curricula, yet little is known about the impact of such an experience on patients. OBJECTIVE: To understand the experiences of patients who contributed to the creation of a Verbatim Reader's Theater used in health professions curriculum. METHODS: A semi-structured interview was conducted with a focus group of 3 patients who participated in curriculum development. The interview was recorded, transcribed verbatim, and analyzed for themes using van Manen approach to hermeneutic phenomenology. RESULTS: Five themes emerged: (1) contextualizing contribution, (2) addressing expectations, (3) changing health-care service delivery, (4) sharing common experiences, and (5) coordinating participation. CONCLUSION: Patients had a positive experience contributing to curriculum development and found meaning in sharing their lived experience to shape the values of future clinicians. Strategies to promote continued success in partnership between patients and health professional curriculum developers include clear communication about the project's direction and early discussion of patient role and expectations.

Mapping of pain curricula across health professions programs at the University of Toronto.

BACKGROUND: There is a growing societal need for health professional competency in pain care. The University of Toronto Centre for the Study of Pain-Interfaculty Pain Curriculum (UTCSP-IPC) has been offered since 2002. Content and process have been updated annually. In addition, participating health professions programs have advanced their pain teaching. A curricular scan was needed to creatively and constructively advance the UTCSP-IPC. AIM: The aim of this study was to map curricular pain content in participating health professions programs onto the UTCSP-IPC content as a first step to further curriculum design. METHODS: UTCSP-IPC committee members and faculty representatives from six health profession programs completed a 27-item online survey in this collaborative action study. Descriptive statistics were completed in Microsoft Excel. RESULTS: The UTCSP-IPC provided an average of 43.3% (range 32%-62%) of total pain content teaching hours to participating health professions students and a range of 8% to 100% of total opioid-related teaching hours. Curricular overlaps and gaps in pain content were identified and will be used to update and inform the iterative design of the UTCSP-IPC. Ninety-three percent of participating health professions faculty indicated that the interprofessional focus on pain care in the UTCSP-IPC was important. CONCLUSION: This study highlighted the value of the UTCSP and areas of curricular refinement to ensure continued relevance in relationship to pain content within the six participating health professions programs. Mapping a coordinated approach between uniprofessional and interprofessional teaching will both meet the demands of professional competence and create greater applicability to future practice settings.

Contexte : Il est de plus en plus nécessaire que les professionnels de la santé aient les compétences nécessaires pour la prise en charge de la douleur au sein de la société. Le Programme interfacultaire sur la douleur du Centre pour l'étude de la douleur de l'Université de Toronto (UTCSP-IPC) est offert depuis 2002. Son contenu et son processus ont été mis à jour chaque année. Les programmes des professions du domaine de la santé participantes ont eux aussi perfectionné leur enseignement sur la douleur. Une radiographie du programme était donc nécessaire afin d'améliorer l'UTCSP-IPC de manière créative et constructive.Objectif : Recenser le contenu sur la douleur dans les programmes des professions du domaine de la santé participantes afin de l'inclure dans l'UTCSP-IPC en tant que première étape pour améliorer la conception du programme.Méthodes : Des membres du comité de l'UTCSP-IPC et des représentants des facultés de six programmes de professions du domaine de la santé ont répondu à un sondage en ligne comprenant 27 énoncés dans le cadre de cette étude collaborative. Des statistiques descriptives ont ensuite été compilées dans Microsoft Excel™.Résultats : Au total, l'UTCSP-IPC a donné en moyenne 43,4 % (entre 32 et 62 %) d'heures d'enseignement sur la douleur aux étudiants des professions du domaine de la santé participantes, et de huit à 100 % d'heures d'enseignement liées aux opioïdes. Les lacunes et les chevauchements dans le contenu portant sur la douleur ont été répertoriés. Cette information sera utilisée pour la mise à jour et la conception itérative de l'UTCSP-IPC. Quatre-vingt-treize pour cent des facultés des professions du domaine de la santé participantes ont souligné l'importance de continuer à mettre l'accent sur l'aspect interprofessionnel de la prise en charge de la douleur dans l'UTCSP-IPC.Conclusion : Cette étude a mis en évidence l'importance de l'UTCSP ainsi que les aspects du programme qui doivent être peaufinés pour maintenir sa pertinence en ce qui concerne le contenu sur la douleur au sein des six programmes des professions du domaine de la santé participantes. L'élaboration d'une approche coordonnée entre l'enseignement uniprofessionnel et l'enseignement interprofessionnel permettra à la fois de répondre aux exigences en matière de compétences professionelles et d'améliorer l'applicabilité dans les futurs milieux de pratique.

Functioning and disability in recent research from Cameroon: a narrative synthesis.

INTRODUCTION: People living with disabilities in Cameroon face many barriers to daily functioning and social participation. However, there is limited research on disabilities and their impact. We sought to examine the research related to disability from Cameroon. METHODS: We conducted a systematic review, bibliometric analysis, and narrative synthesis of research related to disability, functioning, and social participation from Cameroon published during 2005-2014. The articles were screened in duplicate to identify articles addressing impacts of disability on functioning. Disability was contextualized using the International Classification of Functioning, Disability and Health (ICF) framework. Data were analyzed narratively per identified themes using an inductive data-driven approach. RESULTS: A total of 46 studies were included following full-text review of which 36 addressed non-communicable diseases and conditions, 7 addressed infectious diseases and 3 addressed neglected tropical diseases. Among ICF Activity and Participation Restrictions, work and employment was the highest reported category (19 studies), followed by intimate relationships (14 studies), and looking after one's health (8 studies). Among ICF Environmental Factors, societal attitudes were the highest reported category (21 studies), followed by health services, systems and policies (14 studies) and support and relationships (11 studies). Among other common themes, knowledge and awareness was the highest reported category (22 studies), closely followed by traditional beliefs (20 studies) and financial barriers (9 studies). CONCLUSION: There is a small body of primary research from Cameroon on disability. The main themes related to disability are stigma, limited knowledge and awareness, poor quality of care and hindered employment opportunities. Further efforts are required to investigate the complexities of living with a disability in Cameroon and strategies to enhance adequate participation in activities of daily life.

Challenges and opportunities in country-specific research synthesis: a case study from Cameroon.

BACKGROUND: Research synthesis is an important approach to summarizing a body of literature. Usually, the goal is to determine the effectiveness of an intervention, to determine the strength of association between two factors, to determine the prevalence of a condition, or to scope the literature. Research synthesis methods can also be used to appraise the quantity and quality of research output from institutions or countries. In the latter case, standard quantitative systematic review methodologies would not apply and investigators must borrow strategies from qualitative syntheses and bibliometric analyses to develop a complete and meaningful appraisal of the literature from a given country. METHODS: In this paper, we use the example of Cameroon to highlight some of the challenges and opportunities of appraising a body of country-specific literature. A comprehensive and exhaustive search of the literature was conducted to identify health-related literature from Cameroon published from 2005 to 2014. Titles were screened in duplicate. RESULTS: A total of 8624 studies were retrieved of which 721 were retained. The main challenges were making a choice of synthesis approach; selecting the right databases, data storage and management; and sustaining the team. Key opportunities include enhanced networking, a detailed appraisal of funding sources, international collaborations, language of publication, and issues with study design. The product is a comprehensive and informative body of evidence that can be used to inform policy with regards to international collaboration, location of research studies, language of publication, knowledge areas of focus, and gaps. CONCLUSION: Knowledge synthesis approaches can be adapted for appraisal of country-specific research and offer opportunities for in-depth appraisal of research output.

Analyzing international clinical education practices for Canadian rehabilitation students.

BACKGROUND: Clinical training in low-income countries has become increasingly popular among pre-licensure trainees from high-income countries. The Working Group on Ethics Guidelines for Global Health Training ("WEIGHT Guidelines") were designed to identify and inform the complex and contentious field of international clinical education. The purpose of this study was to use the WEIGHT Guidelines to evaluate an international clinical internship programme for Master's-level rehabilitation students at a Canadian university. METHODS: In-depth, semi-structured interviews were conducted with eight Canadian rehabilitation researchers, educations and/or clinicians responsible for administering international internships across three clinical training programmes. Interview questions were informed by the WEIGHT Guidelines. Directed content analysis was used to identify priorities for policy, practice and research. RESULTS: Five themes relating to strengthening international clinical education were identified: (1) from one-time internships to long-term partnerships, (2) starting a discussion about "costs", (3) a more informed approach to student selection, (4) expanding and harmonizing pre-departure training across disciplines, and (5) investing in post-internship debriefing. CONCLUSIONS: International clinical education is fraught with ethical, pedagogical and logistical issues that require recognition and ongoing management. This is the first study to use the WEIGHT Guidelines as a qualitative research tool for assessing an existing global health education programme. Results highlight new priorities for action at the Canadian "sending institution", including more explicit attention to the costs (broadly defined) borne by all parties. A crucial next step is deepened engagement with educational partners at the "receiving organizations" based in low-income countries to nurture dialogue regarding reciprocity, trust and sustainability of the partnership. Education research is also needed that evaluates models of pre-departure training and post-internship debriefing for trainees.

Best practice guidelines for stroke in Cameroon: An innovative and participatory knowledge translation project.

BACKGROUND: Although the adherence to stroke guidelines in high-income countries has been shown to be associated with improved patient outcomes, the research, development and implementation of rehabilitation related guidelines in African countries is lacking. OBJECTIVES: The purpose of this article is to describe how a group of front-line practitioners collaborated with academics and students to develop best practice guidelines (BPG) for the management and rehabilitation of stroke in adult patients in Cameroon. METHOD: A working group was established and adapted internationally recognised processes for the development of best practice guidelines. The group determined the scope of the guidelines, documented current practices, and critically appraised evidence to develop guidelines relevant to the Cameroon context. RESULTS: The primary result of this project is best practice guidelines which provided an overview of the provision of stroke rehabilitation services in the region, and made 83 practice recommendations to improve these services. We also report on the successes and challenges encountered during the process, and the working group's recommendations aimed at encouraging others to consider similar projects. CONCLUSION: This project demonstrated that there is interest and capacity for improving stroke rehabilitation practices and for stroke guideline development in Africa.

The Prevalence of Impairments and Disabilities in the North West Region (Cameroon)

Purpose: This project addressed the lack of disability prevalence data in the North West Region of Cameroon. Methods: A multi-stage cluster design was used; and included urban; semi-urban and rural areas. In the first stage; the team screened 3;933 households; representing an estimated screening sample of 18; 878 individuals. In the second stage; structured interviews were conducted. The interviews included the International Classification of Functioning; Disability and Health (ICF) Checklist to confirm disability status and determine the nature of disability. Results: A total sample of 1;233 individuals screened positive for having a disability. According to this study's cluster design the prevalence of screening positive for disability in this region was 6.9 (95 CLs 5.7-8.2) and the population prevalence of disability was 6.2 (95 CLs 5.2-7.2 CLs 5.2-7.2). Of the individuals who screened positive for disability; 1;106 (89.7) of them had a participation restriction or activity limitation which was of moderate severity or greater; suggesting that the screening tool was useful for identifying many persons living with moderate or severe disability but not very sensitive at identifying people with minor disabilities. Conclusions: Although certain limitations in the study's methods must be taken into account; these results can be used to justify the need for; and inform the design of; programming for individuals with disabilities in this region

Global partnerships for international fieldwork in occupational therapy: reflection and innovation.

International fieldwork placements (IFPs) have become very popular among healthcare students including those in occupational therapy programmes. There are many potential benefits that can accrue to the students; however, there are critiques of international placements especially for students going to underserviced areas. The purpose of this paper is to provide a case study/model programme description that critically reflects on six partnerships in three underserviced countries that provide IFPs to students from one Canadian university. The personal opinions of each partner were collected verbally, by email and by a qualitative review of the past 10 years of partnership interaction. Some of the benefits reported by partners include the development of an increased number of sustainable long-term quality placements, orientation materials, student supports and the involvement of university faculty in research and capacity building projects in partner countries. A number of challenges were identified including the need for an expanded formal agreement, more bilateral feedback and examination of supervision models. This paper examines a limited number of partnerships with only one Canadian partner. Direct input of students is not utilized, although feedback given to co-authors by students is reflected. More research is needed on perspectives of partners in IFPs, impact of IFPs on clinical practice in student's home countries, impact of IFPS on underserviced areas and effective strategies for debriefing.

Epilepsy and cysticercosis in Northwest Cameroon: a serological study.

PURPOSE: The prevalence of epilepsy in Cameroon is higher than that of the industrialized world and other developing countries. Neurocysticercosis due to Taenia solium infestation has been reported as a major cause of epilepsy in some parts of Cameroon although there are some conflicting data. The prevalence of epilepsy is especially high in the Momo division of the North-West Province of Cameroon. We hypothesized that individuals with epilepsy in this region have a higher percentage of seropositivity to T. solium than matched controls. METHODS: We conducted a case-control study in the Momo subdivision of Ngie. Individuals with epilepsy were recruited from the health centers in Ngie. Control subjects were selected from 19 Ngie villages. Potential cases of people with epilepsy (PWE) were identified through a questionnaire applied by trained field workers, using history of epileptic seizures as a key indicator. Blood samples were taken from all consenting individuals by finger prick, stored in StabilZyme Select, and assayed for antibodies to T. solium in an Atlanta based reference laboratory. RESULTS: We accrued 249 patients with epilepsy, of whom 237 met the inclusion criteria, and 245 age-matched controls. There was no significant difference in seropositivity to T. solium between those individuals with epilepsy (5%) and controls (4.9%). CONCLUSIONS: Our data do not support the hypothesis that epilepsy is associated with seropositivity to T. solium. It is highly unlikely that cysticercosis plays a causative role in the high prevalence of epilepsy in this region of Cameroon.

A Canadian model of work integration for persons with mental illnesses.

PURPOSE: The many programmes, services and policy initiatives that focus on work integration for persons with mental illnesses and psychiatric disabilities reflect a multitude of beliefs and practices that lead the field to work in divergent, sometimes conflicting directions. This article presents a framework of the central constructs that dominate the field of work integration and mental illness. METHOD: Using the principles of constructivist grounded theory, an analysis of Canadian documents was conducted; the sample was comprised of 100 academic publications, 76 government documents, 138 popular press, 5 legal papers and 107 documents from work initiatives across Canada. In addition, semi-structured interviews were conducted with 19 key informants from across Canada. RESULTS: Five central perspectives were identified, around which the field of work integration currently operates: a competency perspective; a citizenship perspective; a workplace health perspective; a perspective focussing on potential, growth and self-construction; a community economic development perspective. CONCLUSIONS: Uncovering the varied discourses around work integration enables an understanding of the different ways in which the problem of work integration has come to be seen in today's context; how it is understood, spoken about, dealt with and internalised by individuals and groups. The framework sheds light on the rationale for the range of solutions that have been developed to address the problem of work integration, and it is useful in the analysis of how policy, practice and research initiatives are shaped and promoted.

Reproductive health experiences among women with physical disabilities in the Northwest Region of Cameroon.

OBJECTIVE: To investigate the reproductive health experiences among women with physical disabilities in the Northwest Region of Cameroon. METHODS: Data were collected in the city of Bamenda through semi-structured interviews with women with mobility impairments, discussions with healthcare providers, hospital observations, and field notes. Interviews were transcribed verbatim, coded and analyzed for key themes. RESULTS: The 8 participants included in the study had limited understanding of reproductive health and many had not received basic reproductive health education. Unplanned pregnancy was common and pregnancy was often feared. Respondents reported both positive and negative responses from family, community members, and healthcare workers regarding reproductive health. Most healthcare centers were physically and financially inaccessible. CONCLUSION: Women with disabilities need greater education on reproductive health and improved access to health care.

George's journey: developing a career path with supported employment.

BACKGROUND: This case study presents the career path of a young Canadian man, George, as he recovered from significant mental illness and became a support worker in the mental health field. APPROACH: The authors use a case study approach to highlight a unique and individualized partnership which developed between George and a supported employment program. FINDINGS: The staff in the program assisted George to find work and to embark on an exciting career path. The authors describe George's journey from unemployed client to volunteer and student to full-time worker. Several specific strategies and approaches were used including time unlimited support, attention to client preferences and personal growth, advocacy, and seeing the career journey as a multi-step process. CONCLUSION: Implications for other programs are discussed. The use of individual stories can deepen understandings of the benefits of supported employment programs. This case study reflects how a supported employment program successfully assisted one person's career path.

Understanding the stigma of mental illness in employment.

BACKGROUND: Stigma has been identified as an important barrier to the full community participation of people with mental illness. This study focuses on how stigma operates specifically within the domain of employment. OBJECTIVES: The purpose was to advance the development of theory related to the stigma of mental illness in employment to serve as a guiding framework for intervention approaches. METHOD: The study used a constructivist grounded theory methodology to analyze over 500 Canadian documents from a diverse range of sources and stakeholders, and interviews with 19 key informants. FINDINGS: The paper develops several key components central to the processes of stigma in the work context. These include the consequences of stigma, the assumptions underlying the expressions of stigma, and the salience of these assumptions, both to the people holding them and to the specific employment situation. Assumptions are represented as varying in intensity. Finally specific influences that perpetuate these assumptions are presented. IMPLICATIONS: The model suggests specific areas of focus to be considered in developing intervention strategies to reduce the negative effects of stigma at work.

Disability in low-income countries: issues and implications.

This article reports on a study conducted for the Canadian International Development Agency by The International Centre for Disability and Rehabilitation at the University of Toronto. We critically examined the broad literature in the area of disability and development and in this article we identify the key issues which emerged. Most of the data were collected from existing literature in the academic and practice settings and from the publications of key NGOs and governments. We first, examine disability in the context of low-income countries, and then discuss key critical issues: disability and poverty, disability and health, disability and education, disability and gender, disability and children/youth, disability and conflict/natural disasters and disability and human rights. In all these areas we find reports of discrimination, stigmatisation and marginalisation. We conclude that, as we address issues of multi-cultural disability services in developed countries, it is important to bear in mind the various issues that many people with disabilities and their families bring with them as the result of immigrating from a developing country. Although we address these issues within our own countries, we must bear in mind the changes that are occurring due to globalisation.