Identifying priorities for Australian disability research using Q methodology.

BACKGROUND: Globally, there are over an estimated one billion people with disability. Research priorities with a focus on diagnosis and treatment of conditions or policy and service initiatives, traditionally decided by researchers, may not align with priorities of those with lived experience of disability. OBJECTIVE: To explore and inform disability research for Australia, including perspectives of people with disability. METHODS: As part of a research program, we used Q methodology to explore "what should guide the Australian research agenda?" People with disability, their families, community organizations and researchers were purposively recruited and sorted 25 statements, developed iteratively using data collated from systematic research mapping and a prior consultation process. The sorting grid ranged from -4 to +4, according to "Which topics should guide disability research the least to the most?" Factor analysis revealed four distinct but interrelated participant viewpoints. RESULTS: 52 participants (65 % female, aged 18-65+ years, 37 % people living with disability), sorted the statements. Viewpoint 1 - design and delivery of services across the lifespan. Viewpoint 2 - understanding the diverse experience of those with disability. Viewpoint 3 - designing systems to address impacts of disability for the individual, their families and society. Viewpoint 4 - addressing mental health for those with disability no matter where they live. CONCLUSION: These viewpoints focused on design and delivery of services to address the impacts of disabling environments and attitudes on individuals living with impairments, their families and society. The four viewpoints provide a framework for future disability research in consultation with those with lived experience.

Craving inclusion: a systematic review on the experiences and needs of people with disability eating out.

Purpose: To systematically review the research relating to views and experiences of people with disability eating out in cafés, restaurants, and other settings; and identify factors that impede or enhance accessibility of eating out experiences, inform future inclusive research, and guide policy development.Materials and Methods: This study involved systematic search and review procedures with qualitative metasynthesis of the barriers to and facilitators for participation and inclusion in eating/dining-out activities. In total, 36 studies were included.Results: Most studies reviewed related to people with physical or sensory disability eating out, with few studies examining the dining experiences of adults with intellectual or developmental disability, swallowing disability, or communication disability. People with disability encountered negative attitudes and problems with physical and communicative access to the venue. Staff lacked knowledge of disability. Improvements in the design of dining spaces, consultation with the disability community, and staff training are needed.Conclusion: People with disability may need support for inclusion in eating out activities, as they encounter a range of barriers to eating out. Further research within and across both a wide range of populations with disability and eating out settings could guide policy and practice and help develop training for hospitality staff.

Some people with disability require support for increased self-determination and self-advocacy to access eating out experiences satisfactorily.Goals and strategies to increase access and participation in eating out activities for people with disability should include attention to the environment and hospitality venues and to staff training.Rehabilitation professionals have a role in training hospitality staff about disability access and inclusion in eating out activities.To enhance community inclusion and participation, rehabilitation professionals could focus more on the skills and strategies needed for people with disability to participate in eating out activities.Rehabilitation professionals could implement a range of facilitators that might strengthen participation in eating out activities for people with disability.

Going thirsty for the turtles: Plastic straw bans, people with swallowing disability, and Sustainable Development Goal 14, Life Below Water.

PURPOSE: This paper relates to the Sustainable Development Goal (SDG) Life Below Water (SDG 14) and the need to consider Better Health and Well-Being (SDG 3) in interventions designed to reduce plastic straw waste. The aim of this paper is to explore the competing demands of saving the world's oceans and sea life from plastic straw waste, and simultaneously meeting the health and social needs of people with swallowing or physical disability who use plastic straws for drinking. RESULT: In order to meet both SDG 14 and not compromise SDG 3 there is a need for collaborative and interdisciplinary, person-centred, inclusive innovation approaches to finding suitable and acceptable alternatives to plastic straws. Many people with swallowing disability will need a durable, flexible, and single-use straw that is resilient enough to withstand jaw closure without breaking. Co-design considerations include the alternative straw being (a) soft and flexible so as not to damage the teeth of people who bite to stabilise the jaw or who have a bite reflex; (b) suitable for both hot and cold drinks; (c) flexible for angling to the mouth; (d) readily, thoroughly and easily cleaned to a high standard of hygiene; (e) widely available for low or no cost wherever drinks are served; and (f) safe for people to use while reducing impact on the environment and being sustainable. CONCLUSION: Plastic straws are an assistive technology critical for the social inclusion of people with disability. In an inclusive society, reaching a policy position on the provision of plastic straws must include seeking out and listening to the voices of people with sensory, intellectual, physical, or multiple disabilities who use plastic straws.

Examining the Content and Outcomes of Training in Dysphagia and Mealtime Management: A Systematic Review Informing Co-Design of New Training.

PURPOSE: Dysphagia (swallowing difficulty) impacts physical health, quality of life, and mealtime enjoyment. Staff who provide mealtime assistance to people with dysphagia require adequate training to help ensure that the mealtimes are safe and enjoyable. This systematic review examined literature relating to training in dysphagia (e.g., recognizing signs and symptoms) and mealtime assistance, its components, and benefits for people with dysphagia. METHOD: In July 2020, five scientific databases were searched for papers meeting the inclusion criteria relating to mealtime assistance training. The quality of the studies was evaluated using the Quality Assessment Tool for Studies of Diverse Design, with scores ranging from 38.1% to 83.3%. We completed a qualitative synthesis using the data extracted from the included studies. RESULTS: Twenty-four studies met the inclusion criteria. Participants in these studies benefited from both group training and one-on-one training. Training programs had many formats including computer-based, face-to-face, individual training, and group training. Each included study demonstrated some level of positive impact to the learners, such as improved knowledge and skills in mealtime management for people with dysphagia. No studies reported negative outcomes. Training duration ranged from 30 min to 5 days. CONCLUSIONS: The benefits of different components of mealtime training (e.g., group training, or face-to-face training) for mealtime assistance for people with dysphagia were reviewed. Further research is needed to compare the effectiveness of different training formats, involving not only the assistant but also people with dysphagia as both trainers and trainees, and determine the health outcomes of training programs for people with dysphagia.

An accessible and inclusive public transportation management response to COVID-19 through a co-creation process with people with disability. The case of Metro Barcelona.

The literature on digitalization and accessibility changes to public transport in response to the COVID-19 pandemic is limited. This paper reports on the urban public transport measures against COVID-19 launched by a Spanish transportation operator, TMB (Transports Metropolitans de Barcelona), to ensure safe journeys where digitalization of services have been intensified. This study responds to the current trend whereby transport operators are quickly digitalizing their transportation services as a response to COVID-19. The outcome of the research is to apply contemporary academic theory to assist transportation managers in designing and enhancing transportation services for this group during the COVID-19 pandemic. While transport operators have improved their services to better address the needs of PwD, these changes are far from universal in approach. At the end of 2020, as part of an academic-industry collaboration with a Spanish transportation operator, 12 PwD, six transport staff members, and two representatives of two disability advocacy associations took part in an inclusive urban transportation research project in the city of Barcelona using the service-dominant (S-D) logic co-creation process with PwD through a comparative approach. Specifically, we assessed the value outcome perceived by PwD in their Metro experience when resources resulting from the co-creation process were digital (Study 1) and when they were a combination of digital and non-digital (Study 2). To examine the PwD experience, a qualitative methodology was employed that incorporated online focus groups, ethnographic techniques and post-experience surveys with participants. Study 2 indicted better outcomes and explained how ensuring the appropriate combination of digital and non-digital resource allocation for PwD can improve the public transport experience. Our findings can be used by public transport policymakers for enhancing accessibility to improve public transport experiences during and after the COVID-19 pandemic by implementing digital and non-digital resources.

The Future of Disability Research in Australia: Protocol for a Multiphase Research Agenda-Setting Study.

BACKGROUND: For people with disabilities to live a good life, it is essential that funded research in health and social care addresses their interests, meets their needs, and fills gaps in our understanding of the impact that services, systems, and policies may have on them. Decisions about research funding should be based on an understanding of the research priorities of people with disabilities, their supporters and allies, disability researchers, service providers, and policy makers working in the field. OBJECTIVE: The aim of this protocol is to describe the research design and methods of a large-scale, disability research agenda-setting exercise conducted in 2021 in Australia. METHODS: The research agenda-setting exercise involves 3 integrated phases of work. In the first phase, a previous audit of disability research in Australia is updated to understand previous research and continuing gaps in the research. Building on this, the second phase involves consultation with stakeholders-people with disabilities and their supporters and family members, the disability workforce, and people working within services and connected sectors (eg, aging, employment, education, and housing), academia, and public policy. Data for the second phase will be gathered as follows: a national web-based survey; a consultation process undertaken through the government and nongovernment sector; and targeted consultation with Aboriginal and Torres Strait Islander people, children with disabilities and their families, people with cognitive disability, and people with complex communication needs. The third phase involves a web-based survey to develop a research agenda based on the outcomes of all phases. RESULTS: We have started working on 2 parts of the research prioritization exercise. Through the research-mapping exercise we identified 1241 journal articles and book chapters (referred to as research papers) and 225 publicly available reports (referred to as research reports) produced over the 2018-2020 period. Data collection for the national survey has also been completed. We received 973 fully completed responses to the survey. Analysis of these data is currently underway. CONCLUSIONS: This multi-method research agenda-setting study will be the first to provide an indication of the areas of health and social research that people across the Australian disability community consider should be prioritized in disability research funding decisions. Project results from all phases will be made publicly available through reports, open-access journal publications, and Easy Read documents. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/31126.

Website accessibility in the tourism industry: an analysis of official national tourism organization websites around the world.

PURPOSE: To analyze the accessibility of official national tourism organization websites of countries around the world, in order to establish possible common patterns and rankings of those with exemplary practice through to those with the highest number of issues. The purpose for undertaking such an analysis is to provide a quasi-indicator of inclusive organizational practice for online accessibility for both destination managers and their accessible tourism consumers - domestic and overseas people with disability visiting the websites. METHOD: The official tourism websites of 210 countries included in the latest World Tourism Organization report were analyzed. A website accessibility evaluation tool (website accessible test) was used in the analysis, according to AA and AAA levels of conformance to Web Content Accessibility Guidelines 2.0 requirements. RESULTS: Different patterns compliance to Web Content Accessibility Guidelines 2.0 were established for the clusters, which were rather similar for both AA and AAA conformance levels. The main issues in the least accessible websites were also identified, mainly focused on the following guidelines: navigable, compatible, adaptability, text alternatives and also referred to other assistive technologies. CONCLUSIONS: Once the main issues were established several alternatives are suggested to address them, such as implementing more prescriptive laws and regulations, complying with mandatory benchmark standards and/or having external agencies audit website designs. However, in addition to using benchmark standards, efforts to improve this situation should also be made by programmers, who should also rely on preexistent experiences and develop more dynamic knowledge. This knowledge may include text alternatives for any nontext content; creation of content that can be presented in different ways without losing information; provide ways to help users navigate, find content, determine where they are and navigate websites to maximize compatibility with assistive technologies and user agents. Implications for rehabilitation Access to information - in this case, online information - is an important factor in the process of rehabilitation for people with disability and those supporting them. Failure to apply homogeneous criteria for website accessibility around the world can hamper access to information by people with disabilities. Travel planning requires access to mainstream tourist distribution networks where online inclusive practice is a precursor to information searching. Documents for destination managers and programmers the main problems of accessibility to websites and examples of models or solutions to follow and not. Establish the main inclusive website design criteria on which to focus on improving the access of people with disabilities to websites (e.g., text alternatives, content presented in different ways, navigating and improving compatibility with assistive technologies etc.).

I've got a mobile phone too! Hard and soft assistive technology customization and supportive call centres for people with disability.

PURPOSE: The purpose of this article is to examine the use of a mobile technology platform, software customization and technical support services by people with disability. The disability experience is framed through the participants' use of the technology, their social participation. METHOD: A qualitative and interpretive research design was employed using a three-stage process of observation and semi-structured interviews of people with disability, a significant other and their service provider. Transcripts were analyzed to examine the research questions through the theoretical framework of PHAATE - Policy, Human, Activity, Assistance and Technology and Environment. RESULTS: The analysis revealed three emergent themes: 1. Engagement and activity; 2. Training, support and customization; and 3. Enablers, barriers and attitudes. CONCLUSIONS: The findings indicate that for the majority of users, the mobile technology increased the participants' communication and social participation. However, this was not true for all members of the pilot with variations due to disability type, support needs and availability of support services. Most participants, significant others and service providers identified improvements in confidence, security, safety and independence of those involved. Yet, the actions and attitudes of some of the significant others and service providers acted as a constraint to the adoption of the technology. Implications for Rehabilitation Customized mobile technology can operate as assistive technology providing a distinct benefit in terms of promoting disability citizenship. Mobile technology used in conjunction with a supportive call centre can lead to improvements in confidence, safety and independence for people experiencing disability. Training and support are critical in increasing independent use of mobile technology for people with disability. The enjoyment, development of skills and empowerment gained through the use of mobile technology facilitate the social inclusion of people with disability.