Diane L. Smith

Disparities in health care access for women with disabilities in the United States from the 2006 National Health Interview Survey.

BACKGROUND The objective of this study was to determine the relationship between disability, gender and access to health care, especially for women with disabilities compared to women without disabilities and men with disabilities. METHODS Data from the 2006 NHIS were examined using chi square, linear regression, and logistic analysis to determine the relationship between health care access, severity of disability, and gender. Responses regarding functional limitations from adults aged 18 and over or their proxies were used to determine placement for analysis. The dependent variable was access to health care. The independent variables were disability and gender. RESULTS Women with disabilities had less access to health care than women without disabilities and men with disabilities. Disability and gender were predictive of lack of access to health care. Those who are disabled are 2.26 to 3.78 times more likely to not to have access to health care, and women were 1.26 times more likely not to have access to health care. CONCLUSION Health care professionals should advocate for more parity in health care access, removal of barriers and policies to provide needed funding for health care.

Personal emergency preparedness for people with disabilities from the 2006-2007 Behavioral Risk Factor Surveillance System

BACKGROUND People with disabilities may be disproportionately at risk of injury or death in emergency situations due to physical, cognitive, and socioeconomic factors. These factors individually or in combination have the potential to affect response to emergencies before, during, or after the incident. This study examines general emergency preparedness of persons with disabilities compared to those without disabilities. METHODS The 2006-2007 Behavioral Risk Factor Surveillance System of 6 states included 188,288 self-reported respondents with disabilities who were surveyed regarding their general emergency preparedness. Chi square analysis examined the relationship of general preparedness variables with disability status. Logistic regression analysis examined how various demographic variables affected the likelihood of being unprepared for an emergency. RESULTS Persons with disabilities were significantly more likely to state that they were not prepared at all for an emergency. They were also less likely to have a 3-day supply of water, a working battery-operated radio, and a working flashlight and to evacuate an emergency situation. Persons with a disability are 1.22 times more likely to be unprepared for an emergency. For those with a disability, being female, nonwhite, with less education, less income, and uncoupled and living in an urban area increase the likelihood of being unprepared for an emergency. CONCLUSION Increased effort must be made to empower persons with disabilities to become involved in their own emergency preparedness. Efforts are being made by several government and nongovernmental organizations to assist in this effort though most have not addressed specific needs of vulnerable populations within the disability community. Strategies for emergency preparedness must be considerate of these high risk populations. Finally, mechanisms must be developed to connect persons within the disability community to the information necessary on emergency preparedness through methods such as telehealth.

An occupational justice perspective of domestic violence against women with disabilities

This article explores domestic violence against women with disabilities from an occupational justice perspective. Domestic violence against these women warrants special attention because they are abused at rates equal to or greater than women without disabilities and they experience disability‐specific forms of abuse. The discussion adds to the body of knowledge of domestic violence by analyzing the occupational imbalance, marginalization, deprivation and alienation that women with disabilities experience as instances of occupational injustice that ultimately undermine health. Domestic violence against women with disabilities is also posited as an appropriate issue to examine from this perspective because of the layered injustices experienced. Finally, empowerment is proposed as a strategy to address the issues identified.

Examining the impact of physical and sexual abuse on the employment of women with disabilities in the United States: An exploratory analysis

Purpose. The relationship between the employment status of women with disabilities and the incidence of physical and sexual abuse in the United States was examined. Method. Data from the 2005 Behavioural Risk Factor Surveillance System (BRFSS) were analyzed using descriptive analysis and proportional analysis to determine the significance of the relationship between the experience of abuse and employment status for women with disabilities. Due to the large sample size, effect size was examined through Cohens h. Logistic regression analysis was also used to examine the risk of unemployment for women with disabilities who are abused. Results. Women with disabilities who have been abused have higher levels of unemployment than women without disabilities who have not been abused. In addition, women with disabilities who have been abused have higher levels of unemployment than women without disabilities who have not been abused. Finally, experiencing physical and sexual abuse increases the risk of unemployment for women with disabilities. Conclusion. Unemployment increases the disadvantage for an already vulnerable population and potentially prevents women with disabilities from being able to break the cycle of violence they are experiencing. Recommendations are discussed with regard to intervention by rehabilitation professionals to assist women with disabilities who experience abuse.

Evaluating two health care facilities' ability to meet health literacy needs: a role for occupational therapy.

ABSTRACT Many clients have difficulty understanding health information, which may lead to less use of preventive services, greater use of hospital emergency services, poor physical and mental health, and an increased risk of death. Therefore, the objective of this article is to present a review of the accessibility of a rehabilitation center and an independent living facility with regard to navigation of the facility, understandability of written and oral communication, use of technology, and implementation of policies and procedures within these facilities. Findings from the reviews identified areas for improvement for both facilities in navigation as well as written and oral communication. Recommendations to the facilities are discussed for revision of signage and written and oral communication. Implications for occupational therapy practitioners, including establishment of best practices for health literacy and providing consultation for other health care professions, are highlighted. Possible future research is explored regarding evaluation of the effectiveness of the intervention.

Is emergency preparedness a ‘disaster’ for people with disabilities in the US? Results from the 2006–2012 Behavioral Risk Factor Surveillance System (BRFSS)

This study compared emergency preparedness of people with activity limitations, with limitations who use specialized equipment, and with mental health conditions with that of people without these disabilities. Results of chi-square analysis and logistic regression analysis showed that people with activity limitations and/or mental health conditions were significantly less prepared for emergencies than people who used specialized equipment or persons without disabilities. Having an activity limitation and/or severe mental health conditions, and being non-white, uncoupled, female, and below the poverty line increases the likelihood of not being prepared. Suggestions for increasing preparedness related to training and policy development were discussed.

The relationship between employment and veteran status, disability and gender from 2004-2011 Behavioral Risk Factor Surveillance System (BRFSS).

BACKGROUND In 2011, about 1.8 million or 8 percent of the 22.2 million veterans were women in the US. The unemployment rate for female veterans of the wars in Iraq and Afghanistan rose to 13.5%, above the 8.4% for non-veteran adult women. OBJECTIVE To examine data from the Behavioral Risk Factor Surveillance System (BRFSS), from 2004-2011 to determine the relationship between employment and veteran status, disability and gender. METHODS Chi square analysis was used to determine if significant differences existed between the employment rate of female veterans with disabilities and female veterans without disabilities, female non-veterans with disabilities and male veterans with disabilities. Binomial logistic regression analysis was used to determine how veteran status, disability and gender affected the likelihood of not being employed. RESULTS Significant differences were found in employment rate between female veterans with disabilities and female veterans without disabilities, but not when compared to female non-veterans with disabilities or male veterans with disabilities. Disability was the strongest factor increasing the likelihood of not being employed, though veteran status and female gender were also predictive. CONCLUSIONS Female veterans with disabilities experience low levels of employment. Policies and programs are needed to address the unique needs of these veterans.

Evidence-Based Interventions for Increasing Work Participation for Persons With Various Disabilities

Title I of the Americans With Disabilities Act prohibits discrimination in employment; however, 26 years later, employment rates for persons with disabilities hover at 34%. This systematic review investigates the effectiveness of evidence-based interventions to increase employment for people with various disabilities. Forty-six articles met the inclusion criteria for evidence-based interventions. The majority of studies assessed interventions for persons with mental health disabilities. Strong evidence was found for ongoing support and work-related social skills training prior to and during competitive employment for persons with mental health disabilities. Moderate evidence supported simulation and use of assistive technology, especially apps for cueing and peer support to increase work participation for persons with intellectual disabilities, neurological/cognitive disabilities, and autism spectrum disorder. Many of the strategies to increase work participation were appropriate for occupational therapy intervention. Suggestions were made for research, specifically looking at more rigorous evaluation of strategies in the long term.

Disability, employment and stress regarding ability to pay for housing and healthy food

OBJECTIVE To determine if disability is a significant factor in increasing the likelihood of experiencing stress regarding the ability to pay for housing and healthy food. PARTICIPANTS 24.6% (n=16206) of 65,960 adults who responded to the social context optional module of 2009-2010 Behavioral Risk Factor Surveillance System identified themselves as having a disability. Adults with disabilities reported that they experienced significantly more stress about having money to pay for housing and healthy food than adults without disabilities. METHODS This research was a quantitative study using a publicly available dataset. A series of logistic regressions were performed to determine the extent that disability affected the likelihood of stress about having enough money for housing and healthy food. RESULTS Employed persons with a disability are 1.6 times and 1.9 times as likely as persons without a disability to experience stress about not having enough money to pay for housing and healthy food, respectively. Persons not employed with a disability are 1.56 times and 1.83 times as likely to experience stress about not having enough money to pay for housing and healthy food, respectively. For persons with a disability, being female, in poor health, without a health plan and having a lower income were also significant. Education and employment were not significant predictors of experiencing stress regarding money for food or housing. CONCLUSIONS Having a disability is more predictive of experiencing stress about having enough money for housing and healthy food than employment, though variables such as low income and having a health plan, dependent on employment are significant. Therefore, strategies and policy recommendations to reduce stress by increasing employment and income for persons with disabilities were presented.

Research focused on children and youth

We reviewed 22 articles on children and youth published in 2011 in the American Journal of Occupational Therapy and organized the articles by level of research and research type according to a framework adapted from the International Classification of Functioning, Disability and Health (ICF; World Health Organization, 2007). The largest percentage of articles described intervention effectiveness studies classified as Level III or IV. The bulk focused on the Body Function/Body Structure construct of the ICF, but as a whole the studies addressed all the constructs except Biomedical Molecular/Cellular. Rigor remains a concern, although laudable efforts have been made to increase strength of the evidence. Longitudinal, efficacy, and qualitative studies, as well as studies examining adolescents and the transition to adulthood, were absent from articles in this review and are important areas for future investigation. Several studies explicitly addressed intervention fidelity, an imperative in evidence-based research needed to move the profession toward the Centennial Vision.