BACKGROUND:Wellbeing has become an increasingly important focus of disability research as the field has shifted from deficit-oriented biomedical models toward multidimensional, biopsychosocial, and health equity frameworks. However, the rapid growth of disability wellbeing research makes it increasingly difficult to identify dominant themes, emerging priorities, and knowledge gaps. OBJECTIVE:This study aimed to analyse global scientific production on wellbeing among people with disabilities between 2019 and 2025. METHODS:A bibliometric analysis was conducted using the Web of Science Core Collection (SCIE, SSCI, ESCI). Publications were identified through a structured search strategy combining disability-related terms in the Title field and wellbeing-related terms in the Topic field. Bibliometric performance analysis and science mapping were conducted using Bibliometrix (R). Analyses included publication trends, leading journals, countries, institutions, collaboration networks, author keyword co-occurrence, strategic thematic mapping, and Bradford's and Lotka's distributions. RESULTS:A total of 8944 publications were identified, with an annual growth rate of 12.91%. Scientific production was concentrated in high-income countries, particularly the United States, the United Kingdom, Australia, and Canada. Quality of life emerged as the dominant conceptual theme, accompanied by mental health, rehabilitation, and participation, while social inclusion, digital health, and health equity represented emerging research topics. Important gaps remained regarding Global South representation, intersectionality, and policy-oriented disability research. CONCLUSIONS:Disability wellbeing research is characterised by sustained scientific growth and increasing conceptual diversification. Nevertheless, persistent geographic and conceptual imbalances highlight the need for more globally representative, inclusive, and policy-oriented research to advance disability health equity.
BACKGROUND:Adults with intellectual and developmental disabilities (IDD) experience disparities in access to timely, high-quality acute care. Mobile Integrated Health (MIH), a paramedic-led model that utilizes mobile assets to deliver in-home care in coordination with supervising physicians, may address these care gaps. Its adaptation for the IDD population has not been systematically examined. OBJECTIVE:The objective of this study was to evaluate stakeholder readiness, perceived barriers, and facilitators for adapting MIH for patients with IDD. METHODS:We recruited 2 community paramedics, 5 clinicians, 4 administrative leaders, and 3 caregivers to participate in semi-structured interviews. Interview guides were developed to assess readiness, barriers, and facilitators for implementing MIH for adults with IDD, informed by the Consolidated Framework for Implementation Research. Interviews were analyzed using a hybrid inductive-deductive thematic approach. Findings from the analysis were then integrated into an Implementation Mapping process. RESULTS:Stakeholders identified three major themes: (1) Effective MIH implementation requires integration with existing systems to support interdisciplinary coordination and sustainability, (2) protocols must be adapted to the behavioral and medical complexities of the IDD population, and (3) MIH overcomes barriers to access and resource utilization and facilitates patient-centered approaches to the care of patients with IDD. Implementation mapping identified multi-level barriers to MIH adoption, including limited awareness, unclear workflows, and funding uncertainty. CONCLUSIONS:MIH offers a community-based approach to patient-centered acute care for adults with IDD. Successful implementation will require coordinated strategies addressing clinical, operational, and policy barriers, emphasizing interprofessional collaboration and sustainable reimbursement mechanisms to support long-term adoption.
BACKGROUND:Federal disability data collection standards require national population health surveys to assess limitations across six functional domains. These questions underrepresent people with certain disabilities, posing challenges for estimating disparities and motivating efforts to develop alternative measures aligned with federal antidiscrimination law. OBJECTIVE:To examine who is captured by alternative measurement approaches but is missed by standard measures, including among adults with self-identified disabilities. METHODS:Using December 2024 data from a nationally representative survey of 18-64-year-old adults, we compare responses to the six-item American Community Survey (ACS-6) functional limitation questions; an alternative Comprehensive Disability Status (CDS) question about presence of a long-term health condition, impairment, or disability and related activity limitations; and disability identity. We examine who the CDS identifies beyond those captured by the ACS-6 and how responses among self-identified disabled adults are associated with sociodemographic characteristics using linear probability models. RESULTS:Thirteen percent of respondents self-identified as disabled, 20% reported a functional limitation based on the ACS-6, and 27% reported a long-term condition, impairment, or disability based on the CDS, half of whom had activity limitations. Among adults self-identifying as disabled, 76% reported a functional limitation from the standard ACS-6 question set and 90% responded affirmatively to the CDS. Compared with adults reporting one or more functional limitations from the ACS-6, those captured by the CDS but not the ACS-6 reported higher levels of employment, income, and educational attainment, with varying differences by disability identity. CONCLUSION:Understanding intersections between standard and alternative survey questions on disability status and disability identity can inform efforts to develop inclusive measurement approaches.
Background Home exercise programs extend the benefits of rehabilitation following acquired brain injury. However, they are not completed consistently. To improve rehabilitation outcomes greater understanding is needed of the patient experience when completing a home programs. Objective This qualitative descriptive study explored perceptions of patients with acquired brain injury regarding their home exercise programs (HEP) following inpatient rehabilitation. Methods Forty-eight patients with brain injury were recruited from one rehabilitation hospital. Participants spoke English, were between 18 and 85 years old, had no neurodegenerative disorders, and received HEPs before inpatient rehabilitation discharge. Participants completed semi-structured interviews about six months after discharge. Interviews were audio recorded and transcribed. The qualitative analysis involved an inductive content analysis. Specifically, we used an iterative process of consensus coding and theme extraction. Results Three primary themes with related subthemes emerged. First, participants expressed positive experiences and attitudes toward HEPs, including understanding the home program, its feasibility and value, adaptations over time, and recommending home programs to other ABI survivors. Second, participants identified facilitating and inhibiting factors to HEP adherence, indicating that their adherence changed over time. Participants identified intrinsic and extrinsic factors affecting adherence. Finally, participants connected their HEP and rehabilitation experiences including discussion of funding and insurance, and their experience or attitudes toward rehabilitation and clinicians. Conclusions Clinicians may consider home programs evolving nature, help patients plan for intrinsic and extrinsic factors impacting program completion, and leverage the perceived interconnectedness between home programs and rehabilitation.
Background Opioid use disorder (OUD) is highly prevalent among people with disabilities, who often experience cognitive and mental health impairments. These disabilities can complicate treatment and contribute to disparities in access and outcomes. Objective To explore staff perspectives on cognitive and mental health impairments among people who inject drugs (PWID) receiving buprenorphine treatment, and how these challenges affect care delivery. Methods From March 2025 to January 2026, 29 staff members from two buprenorphine clinics in the San Juan metropolitan area of Puerto Rico participated in semi-structured interviews. Data were analyzed using inductive and deductive coding to identify themes related to cognitive and mental health disabilities, treatment barriers, and management strategies. Results Staff encountered a wide range of cognitive and mental health challenges. Stigmatized severe mental health conditions, such as schizophrenia or bipolar disorder, tended to be hidden by patients, affecting treatment outcomes. Staff viewed severe intellectual disabilities as a barrier to treatment due to the perception that patients with such disabilities could not adhere to the requirements of the cognitive therapy employed by the clinics. Often patients exhibited both cognitive and mental health impairments simultaneously, adding complexity to buprenorphine treatment and erecting new barriers. Conclusion This study identifies cognitive and mental health impairments among PWID in buprenorphine treatment and highlights the challenges they pose for staff. The findings underscore the need for integrated, disability-informed approaches, including systematic screening, continuous assessment, culturally sensitive training, and community engagement and peer support, as well as further research on prevalence, barriers, and treatment outcomes.
BACKGROUND:Intimate partner violence (IPV) during the perinatal period poses serious risks to maternal and infant health. Women with disabilities and those from racially and ethnically minoritized groups experience disproportionately high rates of IPV, yet little is known about how these identities intersect to shape risk. OBJECTIVE:To examine the association between race, ethnicity, disability, and perinatal IPV in a nationally representative sample of U.S. RESPONDENTS: METHODS:This cross-sectional study analyzed 2018-2021 Pregnancy Risk Assessment Monitoring System data, including respondents with known IPV, race, ethnicity, and disability status. IPV was defined as self-reported violence in the 12 months prior to pregnancy and during pregnancy; given conceptual differences in timing, these periods were examined separately. Disability was assessed using the Washington Group Short Set. Logistic regression models estimated odds of IPV by race, ethnicity, and disability, with and without covariate adjustment for maternal age, insurance payer, and education. RESULTS:Our analysis included 39,914 respondents, with 2744 (7.0%) respondents reporting a disability. In adjusted models, disability remained a strong predictor of IPV in the 12 months prior to pregnancy and during pregnancy across all racial and ethnic groups. In the 12 months prior to pregnancy, compared to non-disabled respondents, Non-Hispanic American Indian/Alaska Native (aOR = 3.35; 95% CI 1.85-6.08), non-Hispanic White (aOR = 3.04; 95% CI 2.19-4.23), Hispanic (aOR = 2.75; 95% CI 1.62-4.66), and non-Hispanic Black (aOR = 2.77; 95% CI 1.83-4.19) respondents with disabilities faced a higher risk of IPV. During pregnancy, compared to non-disabled respondents, Non-Hispanic American Indian/Alaska Native (aOR = 4.13; 95% CI 2.19-7.78), non-Hispanic White (aOR = 2.97; 95% CI 1.92-4.57), Hispanic (aOR = 2.52; 95% CI 1.29-4.93), and non-Hispanic Black (aOR = 3.51; 95% CI 2.34, 5.26) respondents with disabilities faced a higher risk of IPV. CONCLUSIONS:Respondents with disabilities experienced substantially higher risk of IPV across all racial and ethnic groups. Findings highlight the need for accessible, trauma-informed IPV screening and intervention strategies that address both ableism and racism within perinatal care systems.
Background Long-term outcomes after traumatic spinal cord injury (TSCI) reflect secondary complications, rehospitalization, and participation restriction, yet longitudinal sex differences remain incompletely characterized. Objective/hypothesis To examine female-versus-male differences in secondary complications, rehospitalization burden, and community participation across post-injury anniversary waves. Methods We analyzed the SpinTal Cord Injury Model Systems Public Use Dataset 2021ARPublic. Of 34,675 baseline records screened, 29,049 participants with recorded female/male sex entered the longitudinal analytic cohort, contributing 72,299 person-waves across waves 1-40. Repeated-measures models adjusted for baseline sociodemographic/injury covariates. Urinary tract infection (UTI) and pressure-ulcer models used 2012-2021 interviews; fall and weeks-employed models used 2017-2021 interviews. Denominators varied by variable availability and valid responses. Results Women had higher adjusted odds of UTI (odds ratio [OR], 1.35; 95% confidence interval [CI], 1.25 to 1.45), higher pain interference (OR, 1.18; 95% CI, 1.11 to 1.24), and higher pain severity (beta, 0.32; 95% CI, 0.23 to 0.41). Women had lower pressure-ulcer odds (OR, 0.86; 95% CI, 0.80 to 0.94), similar fall odds, slightly higher any-rehospitalization odds, but fewer rehospitalization days. In participation subsets, women had lower Craig Handicap Assessment and Reporting Technique (CHART) Mobility, lower competitive employment, and fewer weeks employed, but higher CHART Occupation. Conclusions Sex-related differences after TSCI were multidomain and nonuniform. Women experienced greater urinary and pain burden with less favorable mobility and employment-related participation, but lower pressure-ulcer odds. These findings support sex-informed follow-up across complications, hospital use, and participation after TSCI, and caution against treating sex differences as uniformly favorable or unfavorable across outcomes.
BACKGROUND:Adults with disabilities have long faced lower dental utilization and greater cost-related barriers than adults without disabilities, yet the impact of the COVID-19 pandemic on these disparities among working-age adults has not been examined at the population level. OBJECTIVE:To examine whether disparities in dental care use and cost-related access barriers between working-age adults with and without disabilities changed during the COVID-19 pandemic. METHODS:We analyzed nationally representative data from the 2019, 2020, 2022, and 2023 National Health Interview Surveys (adults aged 18-64). Disability was defined using the Washington Group Short Set. Outcomes were three past-12-month measures: dental visit (exam or cleaning) and cost-related delayed and forgone dental care. Stratified weighted logistic regressions estimated average marginal effects relative to 2019, adjusting for demographic and socioeconomic factors. RESULTS:Among adults without disabilities, dental visits remained below 2019 levels in 2020, 2022, and 2023. Among adults with disabilities, dental visits declined in 2020 (-5.3 percentage points [pp]; 95% CI, -9.6 to -1.0) and 2022 (-4.8 pp; 95% CI, -9.2 to -0.5) but recovered by 2023; delayed care fell in 2022 (-4.6 pp; 95% CI, -8.4 to -0.9). Cost-related delayed and forgone care remained substantially higher among adults with disabilities throughout. CONCLUSION:COVID-19 was associated with larger short-term reductions in dental utilization among working-age adults with disabilities, but their utilization recovered by 2023 while disparities in cost-related unmet dental care persisted. Stabilizing dental care coverage and provider capacity, while protecting access during future public health emergencies, may help reduce these gaps.
BACKGROUND:People with intellectual and developmental disabilities (IDD) are at higher risk for chronic conditions (diabetes and hypertension) but may experience barriers to chronic disease management when primary care services are not tailored to their unique needs. OBJECTIVE:This quantitative study examines patterns of primary care service use, chronic disease management, and colorectal cancer screening among people with IDD and chronic disease and explores potential disparities in care. METHODS:We use population-based linked administrative data from British Columbia to identify people with diabetes and/or hypertension and compare patterns of health service utilization and evidence-informed chronic disease management stratified by recorded IDD diagnosis. RESULTS:Among people with diabetes and/or hypertension, people with IDD access outpatient primary care visits (nurse practitioners and general practitioners) at rates slightly higher than people without IDD (11.4 vs 9.2 visits per year), receive emergency department care three times as often (2.1 vs 0.6 visits per year), and are hospitalized four times as often (40 vs 10 hospitalizations per 100 people per year). Despite more frequent health care contact overall, individuals with IDD were less likely to receive recommended lab tests for chronic disease management and colon cancer screening (60.7% among people with IDD vs 75.9%). CONCLUSIONS:Disparities in chronic disease management and cancer screening, despite more frequent health system contact overall may explain poorer health outcomes for people with IDD and reflect persistent systemic and societal barriers. Addressing current barriers is critical to developing more equitable health systems.
BACKGROUND:Adults with Down syndrome (DS) have a high risk for Alzheimer's disease (AD). While exercise improves cognition and brain health in the general population, few long-term studies have evaluated its effects in DS. OBJECTIVE:We examined the impact of a 12-month remotely delivered exercise program on cognitive function and brain volume in adults with DS. METHODS:81 adults with DS (mean age = 27 years) were randomized to high-frequency remote exercise (3 sessions/week, RH), low-frequency remote exercise (1 session/week, RL), or a support and education control (SE). Cognitive function was assessed using the DS-adapted Cambridge Neuropsychological Test Automated Battery (CANTAB), and brain volumes were measured via MRI at baseline and 12 months. RESULTS:There were no significant changes in any group in executive function or episodic memory (all p > 0.05), but the RH arm significantly improved processing speed across the 12-month intervention (EMM change: 0.17; p = 0.04). No between-group differences were observed for changes in overall cognitive scores. The RL group showed a decrease in total grey matter volume (EMM change -0.82; p = 0.02) and the RH group had no change (EMM change: 0.08; p = 0.72), yielding a significant group effect across time (EMM: 0.90; p = 0.04). Additionally, the RH arm had an increase in right hippocampal volume over 12 months (EMM change: 0.004; p = 0.04). CONCLUSION:The improvements in reaction time, right hippocampal volume, and grey matter preservation suggest that structured exercise may influence cognition and brain health in adults with DS. CLINICAL TRIALS REGISTRATION:NCT04048759.
BACKGROUND:People with disabilities, including Deaf and hard-of-hearing (DHH) individuals, face disproportionate disaster risks due to communication barriers. Emergency alert systems are predominantly auditory-based, limiting their effectiveness for DHH populations. This gap is especially critical during armed conflict, where timely alerts can be life-saving. OBJECTIVE:This study examined emergency alert system accessibility and associated psychological distress among DHH adults during active armed conflict. METHODS:A cross-sectional online survey was conducted in Israel (October-November 2023) during the early phase of the Israel-Hamas War among DHH adults (N = 167), assessing daytime and nighttime alert accessibility and psychological distress. Analyses included McNemar's test, repeated-measures ANOVA with Bonferroni correction, independent-samples t-tests, and one- and two-way ANOVA. Effect sizes were reported throughout. RESULTS:Participants included 87 Deaf (52.1%), 73 hard-of-hearing (43.7%), and 7 (4.2%) identifying as "other," with a mean age of 55.3 years (SD = 16.4). While 69.5% received alerts via the national application during daytime, only 32.3% did so at night, indicating a substantial nighttime accessibility gap. Alert accessibility was only partially associated with psychological distress. Women reported significantly higher distress than men (p < .019). No significant differences emerged between Deaf and hard-of-hearing participants in alert use or distress levels. Education level did not predict alert accessibility, suggesting structural rather than user-dependent barriers. CONCLUSIONS:DHH individuals face systematic barriers to accessing emergency alerts, particularly at night. Equitable disaster preparedness requires multimodal systems incorporating visual, vibration, and text-based channels. Culturally accessible mental health support should be integrated into emergency response protocols.
BACKGROUND:Falls and related injury are understudied among people aging with long-term physical disabilities (PAwLTPD). OBJECTIVES:This study examined the prevalence of falling and injury among PAwLTPD over three years and explored associations of disability-related symptoms with these outcomes. METHODS:A longitudinal survey (annual, three years: T0, T1, T2) was conducted among PAwLTPD (45-65 years). Participants were queried about whether they fell in the past year and fall-related injury. PROMIS measures were used to assess depression, fatigue, and pain. RESULTS:323 PAwLTPD (69% women, 63% White, average age 56 years, average 19 years with disability) completed the three annual surveys. Over 65% fell in the past year at T0. Participants had lower odds of falling at T1 (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.36-0.85) and at T2 (OR 0.55, CI 0.36-0.85). Approximately 40% fell in all three years. At T0, 15% fell with major injury. The odds of falling with major injury were lower at T1 (OR 0.15, CI 0.06-0.37) and T2 (OR 0.17, CI 0.07-0.40). In multivariable models, increasing fatigue T-score was associated with increased odds of falling (adjusted OR [aOR] 1.08, CI 1.05-1.12), falling all three years (aOR 1.12, CI 1.06-1.18), and minor injury (aOR 1.09, CI 1.05-1.13). CONCLUSION:Falls across multiple years and related injury are common among PAwLTPD and associated with disability symptoms. Regular screening and interventions to manage these conditions, including fatigue, should be researched as possible methods to decrease falls and injury among this understudied population.
BACKGROUND:Learning disabilities (LD)-defined in the U.S. as specific learning disorders (e.g., dyslexia, attention-related difficulties) and distinct from intellectual disability-are associated with educational disadvantage, psychosocial stress, and constrained healthcare access. Evidence on whether adolescent LD predicts premature mortality in adulthood remains limited. OBJECTIVE:To examine the association between adolescent LD and premature mortality through early to mid-adulthood and assess whether these associations differ by gender. METHODS:Data were drawn from 17,478 U S. adolescents in Wave I (1994-1995) of the National Longitudinal Study of Adolescent to Adult Health, linked to National Death Index records through 2023. Cox proportional hazards models with school-clustered robust standard errors estimated hazard ratios (HR) for all-cause and cause-specific (disease, external, suicide) mortality. Sex-stratified models and LD × sex interactions assessed sex differences. RESULTS:Adolescents with LD had significantly elevated all-cause premature mortality (adjusted HR = 1.79 [1.47-2.18]). Associations were strongest for disease-related mortality (HR = 2.14 [1.61-2.85]) and elevated for external causes (HR = 1.57 [1.13-2.18]); suicide was non-significant. Sex-stratified analyses revealed substantially stronger effects among females than males (all-cause HR = 2.29 vs 1.58; disease-related HR = 2.87 vs 1.72); the LD × male interaction was statistically significant (p < 0.01). CONCLUSIONS:Adolescents with LD experience markedly elevated mortality through mid-adulthood, particularly from disease-related causes and especially among females. The findings position LD as a marker of cumulative social disadvantage shaped by stigma, exclusion, and unmet healthcare needs, calling for sustained, gender-sensitive support across educational, healthcare, and social systems.
BACKGROUND:Overweight and obesity affect over 60% of adolescents and young adults with intellectual and developmental disabilities (IDD) and are associated with impairments in cardiovascular (CV) function. OBJECTIVE:This study aims to evaluate the impact of weight loss on cardiac strain and other measures of CV function in adolescents and young adults with IDD and obesity, addressing a current literature gap. METHODS:Adolescents and young adults with IDD and obesity entering a weight loss parent trial (NCT02561754) were voluntarily co-enrolled in this observational ancillary study (49 participants representing 45% of those enrolled in the parent trial). The ancillary study CV testing was performed at baseline and 6 months including echocardiograms optimized for strain, pulse wave velocity, and treadmill stress testing. Changes in CV parameters were compared to changes in body mass index (BMI). Statistical analyses included medians (interquartile range), Spearman correlation with bootstrapping, and regression modeling (adjusting for IDD diagnosis), p < 0.05 significant. RESULTS:The ancillary study cohort consisted of 21 females (42%), 23 participants with Down syndrome (47%), and 26 with autism (53%); the mean age was 16.5 ± 2.4 years (range 13-21 years). Average weight loss through the parent trial intervention was 6.5% (BMI decreased 6.0%) over 6 months, with 9/49 (18%) losing >10% body weight. The decrease in BMI correlated with increases in left ventricular (LV) global longitudinal strain (p < 0.01), tricuspid annular plane systolic excursion (TAPSE) (p = 0.02), LV lateral E/e' (p = 0.007), LV global circumferential strain (p = 0.01), and LV end-diastolic strain rate (p = 0.005). Modest changes in LV global longitudinal strain (p < 0.001) and TAPSE (p = 0.003) remained significant on multivariant modeling. CONCLUSIONS:Weight loss in adolescents and young adults with IDD and overweight/obesity relates to improvements in certain parameters of ventricular function.
BACKGROUND:Evidence indicates that persons with disabilities in Ethiopia have greater unmet healthcare need. The notions of "leave no one behind" and "reach the furthest behind" require a disability-inclusive health policy. Sexual and reproductive healthcare policies play a paramount role in shaping equity and disability inclusion. OBJECTIVE:To examine the extent to which current reproductive health policies and related documents are inclusive of women with disabilities in Ethiopia. METHODS:The EquiFrame framework was applied to assess the inclusion of women with disabilities and the concept of human rights in Ethiopia's reproductive health policies. Using a data extraction matrix, 21 core concepts were mapped against 11 documents. References to each core concept were rated on a 0-4 scale (0 = not mentioned; 1 = mentioned; 2 = mentioned and explained; 3 = actions identified; 4 = monitoring intention expressed). Four composite measures were calculated: core concept coverage, core concept quality, total references and average score. RESULTS:Eleven policy and policy-related documents were included. Most documents, 9(81.8%), have the core concept coverage above fifty percent. However, none demonstrated a core concept quality above 50%. Only 10(47.6%) of the core concepts had an average score of two or above. Total reference ranges from 0.0% in core concept family support to 7.2% in core concepts such as non-discrimination, integration and individualized services. Average quality score ranges from 0 in family support to 2.6 in access. CONCLUSION:Although Ethiopia's constitution guarantees disability rights, the implicit inclusion of women with disabilities in reproductive health documents is concerning and calls for targeted policy action. Co-design with women with disabilities and organisations of persons with disabilities, along with comprehensive strategies, would ensure meaningful inclusion in reproductive health policies.
Refugees with disabilities remain among the most underserved groups in humanitarian and resettlement contexts, facing systemic barriers that are further compounded by the absence of reliable, disaggregated disability data. War, displacement, and climate-related crises have increased the prevalence of physical and mental disabilities among the displaced population. Simultaneously, inconsistent screening practices and diagnostic-only approaches that are not aligned with disability rights frameworks undermine equitable resettlement for refugees with disabilities in the United States and elsewhere. Barriers include limited access to healthcare, assistive technology, and vocational services. For example, the U.S. Centers for Disease Control and Prevention's Significant Medical Conditions (SMC) form, used to communicate refugee health needs, may not systematically capture functional limitations, accommodation needs/preferences, and non-diagnosed functional disabilities. As a result, resettlement agencies and disability service providers are ill-prepared to support refugees with disabilities upon arrival. Drawing on lessons learned from community-based research across multiple U.S. states, this commentary calls for a rights-based, standardized approach to disability data collection in refugee resettlement. We recommend supplementing the SMC with a comprehensive disability-status question, incorporating questions on accommodation needs and preferences, and strengthening referral pathways to community-based disability organizations upon arrival. Accurate and integrated disability data are essential for immediate support and for ensuring long-term integration, civil rights compliance, and equity in resettlement outcomes.
Background Despite legal and social deterrents, disability-based discrimination remains prevalent. Whether adults with hearing loss experience more discrimination is understudied. Objective To examine whether individuals with hearing loss, compared to those without, faced more day-to-day and lifetime experiences of discrimination. Methods This cross-sectional study included participants (n = 2954) from the Survey of the Health of Wisconsin (2008-2013). The determinant of interest was self-reported hearing loss. Outcomes were five self-reported experiences of discrimination capturing day-to-day (treated as less smart or with less respect) and lifetime (treated unfairly at school, in getting a job, or at work) discrimination. We used age-sex-adjusted and fully-adjusted (age, sex, race and ethnicity, educational attainment) multivariable generalized linear models with a binomial distribution and log-link function to test associations between hearing loss and discrimination. Results are presented as prevalence ratios (PR) with corresponding 95% confidence intervals (CI). Results Among the participants, 30.5% (n = 900) self-reported hearing loss. In age-sex-adjusted and fully-adjusted models, hearing loss was associated with higher prevalence of four experiences of discrimination, being treated (1) as though they were not smart (PR 1.33; 95% CI 1.15, 1.53), (2) with less respect or courtesy (PR 1.31; 95% CI 1.14, 1.50), (3) unfairly at school/training (PR 1.30; 95% CI 1.11, 1.52), and (4) unfairly at work (PR 1.16; 95% CI 1.06, 1.28). Hearing loss was not associated with being treated unfairly in getting a job (PR 1.10; 95% CI 0.95, 1.27). Conclusion Overall, findings suggest individuals with hearing loss experience higher levels of discrimination, underscoring the need for interventions to reduce these discriminatory behaviors.
BACKGROUND:Young adults with cerebral palsy (CP) experience challenges navigating adult healthcare systems due to limited access to age-appropriate, CP-specific information. Health literacy is a key enabler of autonomy and participation, yet few customised resources have been co-designed with this population. OBJECTIVE:To co-design and pilot an online health literacy education module 'Your health' with young adults with CP, their parents/carers, and healthcare professionals, and assess initial usability. METHODS:A three-stage sequential mixed methods design within an integrated knowledge translation framework was used. Stage 1 involved focus groups and interviews with young adults with CP (n = 8) and healthcare professionals (n = 14) to explore health information needs. Stage 2 involved iterative module co-design across 13 Working Group meetings with young adults with CP, parents/carers, and clinicians. Stage 3 involved usability testing with young adults with CP (n = 11) using a modified System Usability Scale (SUS) and optional qualitative feedback. Interview and feedback data were thematically analysed to identify key insights and usability considerations. RESULTS:Stage 1 findings highlighted unmet needs for credible, accessible, and individualised health information. The co-designed module addressed these needs via lived experience content, accessible design features, and user-driven navigation. Usability testing yielded a mean SUS score of 80.2 (range 57.5-100), indicating strong usability. Participants found the module engaging, clear, and relevant, with minor suggestions for improvement. CONCLUSIONS:This study demonstrates the feasibility and value of embedding co-design in health literacy resource development, providing a scalable model to support autonomy and healthcare participation among young adults with CP.
