Youth with disabilities have limited opportunities to participate in education. This study explored barriers and facilitators to educational success experienced by high-school students with disabilities in Ethiopia, Ghana, and South Africa. This participatory research involved youth with disabilities as core members of the research team. Participants were 58 youths with motor, hearing, and visual impairments (25 females and 33 males, aged 16 to 33) who took part in focus group discussions at one of the three sites. The research team analysed transcribed digital audio recordings using reflexive thematic analysis. Three themes emerged that reflect the mixed experiences of high-school learners, namely: 1. Psychosocial factors that influence learners’ learning. 2. Classroom factors that influence learners’ learning. 3. Personal agency strategies that learners develop to manage challenges. While the findings highlight some enabling experiences for learners with disabilities, they predominantly illustrate exclusionary practices and restrictions in high-school education for youth with disabilities. Their learning was negatively affected by exclusion from activities, others’ attitudes, inaccessible communication, and limited resources. We emphasise a critical need to address discriminatory practices and attend to factors that can enhance belonging and inclusion of youth with disabilities in education, leading to enhanced opportunities for social participation.
Youth with disabilities struggle to enter and maintain relationships due to social, cultural, and religious misconceptions. This study examines barriers to sexual experience faced by youth in Gweru, Zimbabwe. It interrogates the role of socio-cultural beliefs, myths, and misconceptions in creating barriers to sexual expression. The study relied on semi-structured interviews and focus group discussions to gather firsthand experiences of barriers to sexual experiences from twenty disabled youth and five key informants. Data were analysed through thematic analysis. Findings indicate that youth with disabilities still face numerous barriers due to the assumption that they are asexual. Cultural and religious attributions of disability, including contagion, curse, punishment, and sin, deterred youth with disabilities from engaging in intimate relationships. Findings pointed to predatory behaviours targeted at youth with disabilities, with perpetrators seeking primarily sexual favours and treating them as objects of sexual gratification. The study recommends state and non-state actors that work with youth with disabilities to involve traditional, religious, and other community leaders in their programming. This can help to correct myths and misconceptions more than using any other advocacy group.
Background: Family caregivers of children with rare diseases are more likely to have symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD). The WHO’s Group Problem Management Plus (Group PM+) is an evidence-based intervention providing psychological help for adults impaired by distress while exposed to adversity. Our objective was to adapt and beta test Group PM+ with family caregivers. Methods: Family caregivers were >18.0 years at enrollment experiencing psychological distress. Rare Group PM+ is five weekly sessions teaching stress management, problem solving, and building social support. Assessments were the PTSD Checklist for DSM-5 (PCL-5), Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7. Paired Wilcoxon signed-rank tests measured the median baseline and 2-week follow-up values. Results: Sessions were reduced to 90 min and delivered through telehealth. Eight participants enrolled, including seven females with mean age of 40 years. Completion and retention rate were 100% (8/8). Participant-identified barriers to joining included: time constraints; concerns about re-traumatization; and confidentiality. PCL-5 decreased from a median of 29 to 17.5; GAD-7 from 11.5 to 4.5; and PHQ-9 median scores decreased but not significantly. Conclusions: Rare Group PM+ demonstrated initial acceptability and feasibility. Future research should examine initial efficacy in a larger rigorous pilot randomized controlled clinical trial.
Programs for adults with visual impairment are diverse; however, the methods used to evaluate them have not been systematically mapped. We conducted a scoping review following Arksey and O’Malley’s framework and the PRISMA-ScR guideline. We searched peer-reviewed, English-language articles in PsycINFO, ERIC, PubMed, CINAHL, Scopus, and Web of Science Core Collection, with an original search on 1 October 2025 and an updated search on 1 May 2026. Two independent reviewers screened records in EPPI-Reviewer; disagreements were resolved through discussion. A total of 56 studies published between 1989 and 2024 were included. Most studies relied on summative pre-post assessment. Only two studies incorporated formative evaluation, and none used a logic model or an explicit theoretical framework. Sixteen studies included follow-up assessments, with limited variation in timing and frequency. Studies used both generic and vision-specific standardized instruments; however, vision-specific tools appeared in only three of five outcome domains. Accessibility accommodations were common, most often involving item read-aloud, with proxy reporting used in a small subset. Only four studies addressed the potential measurement bias associated with these accommodations. These findings highlight gaps in evaluation design, indicator selection, and the balance between accessibility and measurement validity, identifying priorities for future research.
Overnight programming is an effective intervention that builds social satisfaction, well-being and community; however, the mechanisms supporting these outcomes are not well understood. This qualitative study explores concepts that contribute to social benefits of overnight programs and outlines best practices. Using purposive convenience sampling of an agency that conducts overnight programming, eight adults with disabilities (ages 22–56) participated in semi-structured interviews. Researchers utilized thematic analysis to analyze the interviews. Five themes developed: (a) Experience (program activities, connection to friends, and fun), (b) Liminality (being away from everyday life, respite, and transitory spaces), (c) Opportunity (personal growth, and trying new things), (d) Social Facilitation (interactions between participants, like-mindedness and relationship building), and (e) Support (friends, and staff). Results illustrate overnight programming provides opportunities for participants to experience new things and build social connections. The findings of this study are consistent with the ideas of liminality and communitas, supported by sense of community theory. Practitioners should consider incorporating the four elements of sense of community (membership, influence, fulfillment of needs, and strong emotional connections) when designing overnight programming.
Autism is a neurodevelopmental condition that is often characterised by differences in social communication, sensory processes, and cognition. Due to the underdiagnosis of autism in women and girls, their voices are often missing from research, limiting our understanding of their experiences at school. This study addressed the gap around the factors which impacted women’s late and/or pre-diagnosed experiences of school by using semi-structured interviews with ten autistic women; among them, eight were diagnosed after school. The interviews were analysed through reflexive thematic analysis. Three themes and areas of insight were constructed from the data: (1) The impact of social norms on peer relationships. (2) We found ways of coping, but at what cost? (3) How schools could help someone like me. The findings show that all women in the study had negative school experiences, with diagnosis during school also being linked to identity and mental health difficulties. Schools should enhance pastoral support, foster positive relationships, improve communication, and use strengths-based approaches to improve outcomes for autistic girls. Proactively adopting neuroaffirming modifications may improve support during autistic girls’ formative years, leading to a lasting impact on their lives. This is particularly important for autistic girls, who face marginalisation on two levels: neurotypical expectations for females and stereotyped expectations of autism. The implications of these findings are discussed with suggestions for future research and practical implementations within mainstream school settings.
Objective: To analyse the rhetorical strategies employed in formal complaints regarding adult Attention Deficit Hyperactivity Disorder and Autism assessments, specifically where no service failure was identified. Methods: A rhetorical analysis was conducted on 48 complaints determined to be not upheld overall, submitted to a UK NHS Trust between 2024 and 2025. Results: Complainants demonstrated high rhetorical sophistication, frequently deploying a “Triple Core” strategy: Causal Attribution (blaming the service for life failures), Emotional Impact Description (framing dissatisfaction as medical trauma), and Procedural Challenge (alleging administrative breach). A minority (18.8%) employed economic arguments, whilst 81.2% included specific outcome demands, such as a prescription or a specific diagnosis. Conclusions: Complaints in this area of clinical practice demonstrate sophisticated rhetorical construction, functioning as instruments of organisational pressure. The “Triple Core” strategy creates an epistemic conflict where clinical judgement is contested by the patient’s lived experience narrative. These findings suggest that high complaint volumes may reflect a systemic gap between public expectation and clinical criteria rather than safety failures.
Approximately 16 per cent of the global population lives with a disability. Although there are no definitive figures, it is certain that a higher proportion of people with disabilities are poor compared with people who are living without disabilities. In the case of monetary poverty, evidence for their levels of poverty is not conclusive; however, it is well known that people with disabilities face direct and indirect costs associated with their condition, and therefore their levels of income and consumption are lower in comparison with those of persons without disabilities; but in some cases, monetary poverty lines do not capture those differences. This study aims to analyse the levels of poverty of people with disabilities after computing an equivalence scale to capture the needs of people with disabilities and their families. To achieve this objective, we used the Income and Expenditures Survey 2022 (ENAHO-2022) from Peru. We first tested whether the current poverty line in Peru captures the needs of people with disabilities. Then we analysed the consumption patterns of households with and without members with disabilities. Finally, we proposed to adapt the national poverty line for Peru using an equivalence scale that captures the extra costs of living with a disability in Peru. Using this equivalence scale, we recalculated the poverty rate for households with disabilities. The results revealed that the presence of a member with a disability in the household reduces household income and consumption. The estimation of the equivalence scale showed that a household of one member was equivalent to a household with two members without disabilities. When recalculating the incidence of poverty, the percentage of households with disabilities living in poverty increased from 35% to 50% or 760,000 people with disabilities and their families became poor.
Inclusion has become a central concept in disability policy, education, and welfare state reform, yet its practical implementation remains ambivalent. While inclusion is promoted as a rights-based ideal grounded in equality, it can also function as an administrative label that obscures persistent exclusion. Drawing on critical disability studies, this article analyses inclusion as a contested, power-laden concept and develops a three-stage framework—access, participation, and agency—to distinguish formal inclusion from substantive belonging and influence. The framework is applied to key domains of disabled people’s lives—education, housing, service systems, working life, crises, and digitalised everyday life—showing how ableist norms, managerial governance, and institutional logics can reproduce exclusion within ‘inclusive’ reforms, including forms of transformed institutionalisation. The article argues that meaningful inclusion requires dismantling ableist norms, addressing structural power relations, resourcing supports, and strengthening disabled people’s agency in decision-making.
Population aging requires residential environments that go beyond basic accessibility. This study theorizes and validates the Accessibility Gap (the divergence between regulatory compliance and the functional lived experience of older adults) using a Multi-Criteria Decision Analysis (MCDA) tool. The research uses a weighted linear aggregation model based on user-centered design and the International Classification of Functioning, Disability, and Health (ICF). Thirty dwellings-apartments, single-story, and two-story houses-were evaluated in Chile's Metropolitan Region. The model applies 40 indicators, normalized on a 0-100% scale across six dimensions, and weighted by older adults and caregivers. Results reveal fragmented accessibility gap: basic features often meet standards; yet important deficits remain in highly prioritized areas-autonomy, safety, and communication. The Global Performance Index (GPI) identifies "accessibility gaps" that traditional assessments miss. By combining objective metrics with subjective experiences, this study delivers a replicable, evidence-based framework. It shows that specific design choices, rather than architectural configuration, better support functional independence. The MCDA approach provides a robust tool for guiding housing rehabilitation and public policies that support aging in place and ensure homes meet the needs of an aging population.
Vocational integration (VI) services aim to support sustainable employment for persons with disabilities. However, in individuals with spinal cord injury, evidence on effective intervention targets and the evaluation of sustainable integration remains limited. The Work-Life Study aims to build an evidence base for supporting sustainable employment in Switzerland by (1) identifying typical work-life trajectories; (2) examining key work-life transitions and their predictors; (3) establishing a multi-state model for intervention targets; (4) exploring individual work-life narratives; and (5) developing guidelines for personalized VI practice. The study combines a mixed methods design with a collaborative Integrated Knowledge Translation approach, actively involving VI professionals and individuals with spinal cord injury. Participants are recruited from the Swiss Spinal Cord Injury Cohort Study (SwiSCI). Work-life history data are collected through a Biographical Survey and Biographical Interviews and analyzed alongside SwiSCI data. Guideline development includes a stakeholder meeting with representatives from the Swiss Paraplegic Group, spinal cord injury clinics, individuals with spinal cord injury, employers, and disability insurers. Of 2041 eligible SwiSCI participants, 478 (23.4%) completed the Biographical Survey (median age 57.5 years; median time since injury 19.1 years), with responders and non-responders showing comparable characteristics. Work-life data closely matched existing SwiSCI data (rho > 0.8), indicating good recall. The resulting guidelines will help VI providers coordinate rehabilitation services to optimally promote sustainable employment for individuals with spinal cord injury.
Stress is increasingly recognised as a key factor underlying health and behavioural problems in people with intellectual disabilities. However, little is known about chronic stressors embedded in residential care environments. This study aimed to identify chronic stressors in residential care for people with intellectual disabilities from the perspective of stakeholders. A group concept mapping design was used, combining qualitative data generation with quantitative clustering analyses. Direct support workers, family members, and experts by experience generated statements describing situations perceived as stressful in residential care settings. After data cleaning, 125 unique statements were retained. Participants subsequently clustered and rated these statements on frequency, impact, and controllability. Thirty-eight statements were identified as daily stressors with high frequency and impact. Ward’s hierarchical cluster analysis grouped the statements into eight clusters representing broader conditions within residential care environments. Several clusters contained multiple high-frequency, high-impact stressors and were therefore interpreted as potential chronic stressors. These clusters reflected structural characteristics of residential care, including dependence on support staff, limited autonomy, and shared living environments. Identifying chronic stressors provides a framework for studying chronic stress in people with intellectual disabilities and may inform organisational and environmental interventions aimed at reducing exposure to such stressors.
Background: Autism Spectrum Disorder (ASD) is characterized by social communication deficits, restricted/repetitive behaviors, sensory processing atypicalities, and impaired adaptive functioning. Neuropsychomotor Therapy of Early Development (TNPEE) integrates motor, cognitive, and socio-emotional domains, promoting functional skills, while Therapy in Aquatic Motor Activities (TAMA) targets motor and sensory engagement. This multicenter, 18-month study compared TNPEE, TAMA, and their combination, hypothesizing that TNPEE would drive core symptom and adaptive improvements, with TAMA providing complementary benefits. Methods: Seventy-seven children with Autism Spectrum Disorder (31.6% females) were recruited from four Italian centers (Palermo, Perugia, Sarno, Messina) and allocated to three groups: TAMA only, TNPEE combined with TAMA, and TNPEE only. Assessments included the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), the Childhood Autism Rating Scale, Second Edition (CARS-2), Vineland Adaptive Behavior Scales, Sensory Processing Measure and HAARS at baseline, 6, 12, and 18 months. Results: By 18 months, children receiving TNPEE, alone or combined with TAMA, exhibited significant reductions in autism severity, significant improvements in adaptive functioning, and enhanced sensory processing. In contrast, the TAMA-only group demonstrated improvements in aquatic competence (HAARS) but no statistically significant changes in ASD severity or adaptive functioning. Conclusions: TNPEE was the intervention most consistently associated with improvements in ASD severity, adaptive functioning, and sensory processing, whereas TAMA alone showed a more limited impact on broader developmental outcomes.
Motor impairments and limitations in functional performance are common in children with autism spectrum disorder, restricting participation in daily activities. This study aimed to compare the effectiveness of the MIG Program with conventional physical therapy in the development of socio-communicative motor skills and the achievement of functional goals. A mixed-methods randomized clinical trial was conducted with children with autism spectrum disorder aged 6 to 12 years (mean 8.73 ± 1.95; support levels 1 and 2), recruited from rehabilitation clinics in southeastern Brazil. Participants were randomly assigned to the MIG Program, which integrates contextualized functional motor training with narrative grammar strategies and the use of a therapeutic vest, or to conventional physical therapy based on traditional motor approaches. Primary outcomes included fundamental motor skills and functional goal attainment, while secondary outcomes were balance, gross and fine motor skills, and socio-communicative abilities. The RCT protocol was registered in the Brazilian Clinical Trials Registry (RBR-76pk39r), in 21 October 2025. The MIG Program was associated with greater improvements in fundamental motor skills and functional goal attainment compared to conventional physical therapy, with effects maintained at follow-up, as well as with more favorable trends in balance and communication outcomes; however, no clear differences were observed in gross and fine motor skills. Qualitative findings suggested increased engagement, autonomy, and participation in the MIG group. Overall, these preliminary findings indicate that the MIG Program may be a promising approach for supporting functional outcomes in children with autism spectrum disorder, although the results should be interpreted with caution given the small sample size and the number of outcomes assessed.
The Disability Royal Commission in Australia has reinforced concerns that segregated employment settings can increase risks of exploitation, violence and abuse, including within Australian Disability Enterprises (ADEs), strengthening the case for community-based employment options for people with intellectual disability. This qualitative study examined how features of supported employment might inform the design of an inclusive job guarantee (JG) model. Drawing on 77 interviews with supported employees and staff, we identified enabling conditions that support wellbeing and participation (including customised roles, structured routines, peer connection, and holistic support), alongside structural constraints that can limit inclusion and progression. While participants and staff described clear well-being benefits from supported employment, they also highlighted frustrations associated with disconnection from the wider community, low pay, and limited pathways to advancement or transition. Given that transition rates between supported and mainstream employment remain very low, the findings emphasise that any JG model seeking to include people with intellectual disability will need investment in supports and credible transition pathways. This paper concludes by outlining how these design implications intersect with the broader economic logic of unemployment and what an inclusive JG could contribute as part of a wider disability employment reform agenda.
Introduction: Increased life expectancy and the growing prevalence of disability have led grandmothers and grandfathers to assume a significant role in the care of grandchildren with disabilities. However, their experiences have been scarcely explored from a qualitative and occupational perspective. Objective: To examine the experiences of grandmothers and grandfathers in relation to their participation in caregiving tasks for grandchildren with disabilities. Methods: A qualitative exploratory study framed within a constructivist-interpretive paradigm was conducted. Eleven grandparents of children with disabilities participated and were selected through criterion-based purposive sampling complemented by snowball recruitment. Data were collected through flexible semi-structured interviews and a field diary and were analyzed using inductive thematic analysis. Results: Three main themes emerged: (1) caregiver time, characterized by constant availability and occupational reorganization; (2) emotional impact, with predominant feelings of satisfaction, fulfillment, and strengthening of the emotional bond; and (3) adaptation to change, described as a progressive process of learning, acceptance, information seeking, and negotiation of family roles. Conclusions: The caregiving experience profoundly transforms the daily lives of grandmothers and grandfathers, constituting a highly demanding yet meaningful occupation. The findings highlight the need to recognize their role within the family system and to incorporate an occupational perspective into the support provided to this population.
Despite the known benefits of workforce participation, many individuals with disabilities remain excluded. This exploratory study utilises selected analytical tools from constructivist grounded theory to investigate how 46 diverse stakeholders perceive disability during the transition from higher education to employment. Additionally, it examines how these perceptions influence efforts toward inclusion and the advice given regarding disability disclosure. Six workshops were conducted to facilitate dialogue on pathways to work for students with disabilities. The constructivist approach to analysis leads to the development of several concepts that capture stakeholders’ perspectives on disability, their strategies for promoting inclusion, and their recommendations regarding disclosure. Disabilities are conceptualised as an asset, a liability, or as insignificant. The views of disability as an asset or a liability influence advocacy strategies and disclosure recommendations, ranging from celebrating to concealing. These attitudes also shape how individuals who disclose disabilities are perceived. Society often expects people with disabilities to disclose their conditions to promote inclusion, even though performing such can involve risks like stigma and exclusion. At the same time, employers share responsibility for creating inclusive environments through universal design and supportive practices. The findings show that both disclosure and concealment can lead to inclusion or exclusion, emphasising the importance of universally designed institutions.
Purpose: Recent studies have shown that high-intensity interval training (HIIT) can improve cardiometabolic health in individuals with spinal cord injury (SCI); however, many barriers remain for individuals with spinal cord injury to participate in exercise such as lack of time, accessible equipment and facilities, and transportation. The use of telehealth interventions may be a form of exercise delivery that can ease the burden on the participant and lead to greater exercise participation. Thus, the purpose of this study was to determine the feasibility and efficacy of a home-based telehealth HIIT arm crank exercise training program for individuals with spinal cord injury. Methods: Participants were randomly assigned to 16 weeks of telehealth HIIT arm crank exercise training or a no-exercise control group. Body composition, resting energy expenditure (REE), blood lipids, insulin sensitivity, blood pressure, aerobic capacity (VO2 max), and a qualitative interview were assessed at baseline and at 16 weeks post intervention. Results: Six individuals (four male and two female, mean age 52.7 +/- 10.2 years) with spinal cord injury were recruited for this study. Four out of five HIIT participants showed improvements in aerobic capacity, insulin sensitivity, and resting energy expenditure. Three qualitative themes emerged: (1) convenience and perceived benefits were critical elements of engagement; (2) high-intensity exercise elicited time-sensitive responses; and (3) trainers played a key role in promoting strong program adherence. Conclusions: Overall, we found that this program could be easily implemented and per-formed at home in individuals with spinal cord injury. We also found that participants enjoyed the 1:1 training sessions with a telecoach and that the intervention was easy to adhere to, as demonstrated by participant attendance. There is a need for future randomized controlled trials to determine the efficacy of telehealth exercise training for improving cardiometabolic health in spinal cord injury.
The COVID-19 pandemic has significantly changed the way we work and live. For people with disabilities, the pandemic has differentially affected their healthcare experiences in several ways. Although existing studies have investigated health-related experiences during COVID-19 with individuals with disabilities, fewer research studies have explored the specific impact of the pandemic on individuals with disabilities in Taiwan. In Taiwan, the government implemented unique COVID-19 policies and measures, such as contact tracing. For individuals with disabilities, many of whom were influenced by the Independent Living Movement and in the process of exploring the possibilities of living on their own with support from others, the impact of the pandemic on their daily lives remained mostly unknown. Therefore, this study explored the perspectives of individuals with physical disabilities regarding COVID-19 control measures and how the pandemic affected their daily experiences, particularly their health-related experiences. We conducted semi-structured one-on-one interviews with 10 participants from Taiwan. After analyzing the participants’ experiences during the pandemic, three themes emerged: (1) concerns about COVID-19 policies; (2) emotional responses to the pandemic; (3) healthcare experiences during COVID-19. These themes guided our discussion of practice and policy implications.
Despite growing interest in three-dimensional (3D) printing for assistive technology (AT), limited research has examined how rehabilitation stakeholders perceive its role within service delivery. This study explored the perspectives of clients who use AT, their care partners, and rehabilitation clinicians to identify perceived affordances and barriers of 3D-printed AT. A qualitative design using purposive sampling targeted individuals with prior exposure to 3D printing. Four in-person focus groups (n = 17) were conducted with nine clinicians, seven clients, and one care partner. One additional semi-structured interview was conducted with a care partner. Data were analyzed using reflexive thematic analysis. Three themes were identified: (1) AT adapts to meet individual needs but encounters practical challenges; (2) 3D printing is an evolving and practical solution to enhance AT access; and (3) education and support are essential to optimize 3D printing service delivery. 3D printing is a feasible complement to traditional AT service delivery when integrated within collaborative, client-centered rehabilitation models. Addressing gaps in education, durability, and structured follow-up processes may enhance the adoption and long-term effectiveness of 3D-printed AT.
