Berth Danermark

Metatheory, interdisciplinarity and disability research : a critical realist perspective

Different methodological tendencies within the field of disability research are described, and the reductionism implicit in the historically dominant models is critiqued. The advantages of critical realism over rival metatheoretical positions, including empiricism, social constructionism, neo-Kantianism and hermeneutics, is shown, demonstrating in particular what is called the “double-inclusiveness” of critical realism. A non-reductionist schema for explanation in disability research is established, and the article argues that the phenomenon of disability has the character of a “necessarily laminated system”. The fruitfulness of this approach is then illustrated with an example drawn from the field, and the case for critical realism as an ex ante explicit metatheory and methodology for disability research is further developed. The conclusion reconsiders the nature of metatheory and its role in research.

Social Justice : redistribution and recognition – a non-reductionist perspective on disability

The purpose of this article is to present some recent contributions to discussions on social justice and recognition in the context of disability research. Nancy Frasers theory of redistribution and recognition, and her endeavour to include both a materialist and a cultural perspective in a theory of justice is examined. We also discuss Honneths Hegelian‐informed model of recognition. Critical realism, emphasizing a non‐reductionist perspective, is briefly presented and, finally, we put forward some ideas on how to analyse and understand disability within such a framework.

Psychosocial work environment, hearing impairment and health

This article summarizes results from a study of hearingimpaired men and women in the labour force in Sweden. A questionnaire about psychosocial work environment (in accordance with the Demand-Control Model), health and wellbeing was sent out and answered by 445 hearingimpaired people, 20-64 years of age. A large reference group had previously answered the same questionnaire. The results indicate that imbalances between demand and control (i.e. high demand and low control, so-called high stress work type) is more common among hearingimpaired people than in the reference group. The outcome of the combination high demand and low control among hearing-impaired people is (much) worse than among hearing-impaired people with other work types ( passive, active, low stress). Hearing-impaired people with the high-stress work type more frequently report bad physical health status and psychological wellbeing regarding a number of indicators. There is, moreover, a tendency for women to be worse off than men. Our data suggest that those involved in audiological rehabilitation should pay great attention to hearing-impaired people with jobs that can be characterized as high stress. Sumario Este artículo resume los resultados de un estudio en hombres y mujeres con hipoacusia, trabajadores de Suecia. Se distribuyó un cuestionario sobre el ambiente laboral psico-social (de acuerdo con el Modelo Demanda-Control), salud y bienestar, y fue contestado por 445 personas con trastornos auditivos, con edades entre 20 y 64 an˜os. Un grupo de referencia grande había respondido previamente el mismo cuestionario. Los resultados indican que los desbalances entre la demanda y el control (p.e., alta demanda y bajo control, el llamado tipo de trabajo de alto estrés) son más comunes entre personas con trastornos auditivos que en el grupo de referencia. El resultado de la combinación alta demanda y bajo control en gente hipoacúsica es (mucho) peor que en gente hipoacúsica con otros tipos de trabajos (pasivos, activos, bajo estrés). Las personas hipoacúsicas con el tipo de trabajo de alto estrés reportan más frecuentemente un mal estado de salud física y de bienestar psicológico, de acuerdo con un número de indicadores. Existe, más aún, una tendencia de que esto afecta más a las mujeres que a los hombres. Nuestros datos sugieren que aquellos involucrados en rehabilitación audiológica deberían prestar más atención a la gente con trastornos auditivos con trabajos que pueden caracterizarse como de alto estrés.

Interdisciplinary Research and Critical Realism The Example of Disability Research

The aim of the paper is to indicate a metatheoretical perspective on interdisciplinary research which includes some important ontological assumptions and its consequences for the interdisciplinary research practice. Interdisciplinary research can be characterised by its focusing on a complex problem and the aim of the research is to elaborate this problem. The presentation begins with a brief outline of critical realism. I will sketch five features of this approach and I will also try to show the implications of these features on how to look upon interdisciplinary research. The five features are (1) the stratified ontology, (2) the intransitive and intransitive dimension of reality, (3) causation in terms of generative mechanisms, (4) the importance of contextualisation, and (5) the empirical reality. The presentation is interfolied with examples from disability

International classification of functioning, disability, and health core sets for hearing loss: a discussion paper and invitation

Abstract The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) has adopted a multifactorial understanding of functioning and disability, merging a biomedical paradigm with a social paradigm into a wider understanding of human functioning. Altogether there are more than 1400 ICF-categories describing different aspects of human functioning and there is a need to developing short lists of ICF categories to facilitate use of the classification scheme in clinical practice. To our knowledge, there is currently no such standard measuring instrument to facilitate a common validated way of assessing the effects of hearing loss on the lives of adults. The aim of the project is the development of an internationally accepted, evidence-based, reliable, comprehensive and valid ICF Core Sets for Hearing Loss. The processes involved in this project are described in detail and the authors invite stakeholders, clinical experts and persons with hearing loss to actively participate in the development process. Sumario La Clasificación sobre Funcionalidad, Discapacidad y Salud de la Organización Mundial de la Salud (ICF) ha adoptado un acercamiento multifactorial de la funcionalidad y la discapacidad, fusionando un paradigma biomédico con un paradigma social de una forma más amplia. En su conjunto hay más de 1400 categorías ICF que describen diferentes aspectos de la funcionalidad humana y existe la necesidad de desarrollar una lista corta de categorías ICF para facilitar el uso de la clasificación en un esquema para la práctica clínica. Es de nuestro conocimiento que actualmente no existe un instrumento de medición estándar que facilite una forma válida y cómoda para evaluar los efectos de la hipoacusia en la vida de los adultos. El propósito de este proyecto es desarrollar un conjunto básico de condiciones de salud ICF para la hipoacusia que sea internacionalmente aceptado, basado en evidencia, confiable e integral. Se describen en detalle los procesos implicados en este proyecto y los autores invitan a las personas interesadas, a los expertos clínicos y a las personas con hipoacusia a participar activamente en el desarrollo de este proceso.

Quality of life, psychosocial consequences, and audiological rehabilitation after sudden sensorineural hearing loss.

Abstract Objective: Sudden sensorineural hearing loss (SSHL) is characterized by a rapid loss of hearing, most often of cochlear origin. Very little attention has been paid in the literature to quality of life (QoL), psychosocial consequences and audiological rehabilitation after SSHL. Design: We studied how level of hearing loss, hearing recovery, tinnitus and vertigo affect QoL after SSHL and the psychosocial consequences of SSHL in terms of sick leave. Furthermore, the audiological rehabilitation given to patients in connection with SSHL and the benefit of the rehabilitation were studied. Study Sample: Three hundred and sixty-nine (369) patients with SSHL were analysed in the present study. Results: Annoying tinnitus and remaining vertigo after SSHL were the strongest predictors of negative effects on QoL. Conclusions: The study indicates that patients with SSHL require extended audiological rehabilitation including a multi-disciplinary rehabilitation approach (medical, social and psychological) to cope with the complex issues that can arise after SSHL. Sumario Objetivo: La pérdida auditiva sensorineural súbita (SSHL) se caracteriza por una rápida pérdida de la audición, más a menudo de origen coclear. Se ha prestado muy poca atención en la literatura a la calidad de vida (QoL), a las consecuencia psicosociales y la rehabilitación audiológica después de una SSHL. Diseño: Estudiamos cómo los niveles de pérdida auditiva, la recuperación de la audición, el acúfeno y el vértigo, afectan la QoL luego de una SSHL, y las consecuencia psicosociales de la SSHL en términos de incapacidades laborales. Más aún, se estudió la rehabilitación audiológica dada a estos pacientes en conexión con la SSHL, y los beneficios de la rehabilitación. Muestra De Estudio: Trescientos sesenta y nueve (369) pacientes con SSHL fueron analizados en el presente estudio. Resultados: Un acúfeno fastidioso y un vértigo remanente luego de la SSHL, fueron los vaticinadores más fuertes de los efectos negativos sobre la QoL. Conclusiones: El estudio indica que los pacientes con SSHL demandan una rehabilitación audiológica extendida, incluyendo un enfoque de rehabilitación multi-disciplinario (médico, social y psicológico), sobrellevar los complejos asuntos que puede surgir luego de una SSHL.

Swedish Primary School Teachers' attitudes to inclusion : The case of PE and pupils with physical disabilities

Teachers play a decisive role in making inclusive education a reality. The particular case of inclusion in physical education (PE) poses a specific challenge to teaching practice. How PE teachers view inclusion may provide special insights into teachers’ general attitudes toward inclusion and inclusive practices in the general school curriculum. The aim of this study is to investigate Swedish PE teachers’ attitudes to inclusion of pupils with physical disabilities in mainstream PE classes at primary school. The sampling frame was members of the Swedish Teachers’ Union who had registered themselves as PE teachers and who indicated a current e‐mail address (n = 560). Respondents were invited to complete an e‐mail questionnaire with questions covering demographics, general attitudes, support from school management and staff, possible hindrances and personal experiences of inclusion. A total of 221 teachers (39%) responded, equal numbers of males and females with a bimodal age distribution (means of 28 and 44) with an average of eight years of service. On average, Swedish PE teachers are very positive to inclusion of pupils with physical disabilities into general PE. Gender, age, years of service and work satisfaction had no impact on general opinions of inclusive PE. PE teachers with actual previous experience of teaching pupils with physical disabilities were slightly more positive to inclusive PE. Stepwise multiple regressions were used to establish a predictive model of positive attitudes to inclusion based on: (1) having adequate training; (2) having general school support (from management and staff); and (3) demands on resources. This yielded an adjusted R 2 that explained 33% of variation in attitudes.

Towards a working life? Experiences in a rehabilitation process for people with psychiatric disabilities

The aim of this study was to reveal the meaning some people with psychiatric disabilities assigned to important personal experiences in relation to an ongoing rehabilitation process. The data comprises open-ended interviews of eight participants. A hermeneutic approach together with a content analysis was used to analyse the data. The results indicated the importance of not relying on simplified prognoses early in a rehabilitation process when assessing rehabilitation measures and/or work capacity. The phenomenon of rehabilitation seemed to be very complex, diverse, and changed over time depending on different circumstances that arose during the rehabilitation process. These circumstances arose on individual, contextual as well as structural levels and all had an impact on the outcomes. The results also indicated that it seemed to be possible to achieve success, change attitudes, and create a positive image of a future related to a working life if the support was perceived as relevant and the activities undertaken were perceived as contributing to achievement of the individuals goals. Regardless of which path the informants later chose these factors were seen to support an empowerment process and active participation in their own rehabilitation.

The ICF Core Sets for hearing loss – researcher perspective. Part I: Systematic review of outcome measures identified in audiological research

Abstract Objective: To review the literature in order to identify outcome measures used in research on adults with hearing loss (HL) as part of the ICF Core Sets development project, and to describe study and population characteristics of the reviewed studies. Design: A systematic review methodology was applied using multiple databases. A comprehensive search was conducted and two search pools were created, pool I and pool II. Study sample: The study population included adults (≥ 18 years of age) with HL and oral language as the primary mode of communication. Results: 122 studies were included. Outcome measures were distinguished by ‘instrument type’, and 10 types were identified. In total, 246 (pool I) and 122 (pool II) different measures were identified, and only approximately 20% were extracted twice or more. Most measures were related to speech recognition. Fifty-one different questionnaires were identified. Many studies used small sample sizes, and the sex of participants was not revealed in several studies. Conclusion: The low prevalence of identified measures reflects a lack of consensus regarding the optimal outcome measures to use in audiology. Reflections and discussions are made in relation to small sample sizes and the lack of sex differentiation/descriptions within the included articles.

Participation by doing: Social interaction in everyday activities among persons with schizophrenia

Schizophrenia impacts on social functioning and participation in everyday life. However, there is limited research describing how persons with schizophrenia interact with others when performing daily activities. The aim of this study is to describe how persons with schizophrenia interact with others while performing everyday activities in different contexts in terms of facilitating and hindering factors. Repeated participant observations of four persons with schizophrenia were conducted in their environment. The observed activities and social interactions were chosen from the participants daily routines. Field notes were taken during the observations. Qualitative content analysis was used to analyse the data. Two themes constitute the main result: Facilitating social interaction in activity performance and Hindering social interaction in activity performance. These two themes serve as headings for sub-themes representing factors influencing social interaction in activity performance. Through a further analysis of the themes the following dichotomous contexts were identified as influential: meaningful/not meaningful activity being performed; attitudes were trusting/lacking trust; and location, at home/outside the home. Conclusion: If the facilitating contextual factors are considered for each individual when planning and performing everyday activities together with others there is a possibility to improve social interaction skills and thereby participation.