Doctoral Thesis by Shaun Cleaver
The economic and epistemological dominance of the global North has outlived colonialism. This pos... more The economic and epistemological dominance of the global North has outlived colonialism. This postcolonial dynamic causes impairment in the global South and renders life more difficult for persons with disabilities (PWDs). This dynamic also limits the ability of people in the global South to respond to disability. This thesis aimed to challenge the postcolonial dynamic through the development of new ways to think about disability, and what to do about it, through a North-South collaboration with a North American rehabilitation provider and two disability groups and their members in Western Zambia.
This constructionist qualitative research project was informed by critical and participatory approaches to research. The participating groups included one based in an urban area and another in a rural area. A total of 81 individual members of the two groups participated. Data were generated through eight focus group discussions and 39 interviews and analyzed using thematic and reflexive analysis strategies.
The participants of this research were most concerned with poverty. The strategy that they suggested to improve their situation was help, a gift or grant of material resources shared in a relationship of expected compassion. This research was complicated by power dynamics and differences between the participants and researcher with respect to priorities and ways of thinking. The complications likely impacted what people talked about and the way they talked about it. The complications also meant that this research was less collaborative than planned.
This research showed that PWDs in Western Zambia had concerns, and suggested strategies to improve their situation, that were different than those that are most common in Zambia. Since the current ways of thinking about disability in Zambia are largely informed by the concerns and priorities of the global North, this research points to possible alternatives that are based in the realities of the country.
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Global health, disability & rehabilitation papers by Shaun Cleaver
Disability Studies Quarterly, 2023
Research is a critical starting point for public policy. For disability policy, calculation of pr... more Research is a critical starting point for public policy. For disability policy, calculation of prevalencethe percentage of persons with disabilities in a populationhas attracted significant attention. Multiple disability prevalence studies have been conducted in Zambia. We used data from semi-structured interviews about research and the policy process with twelve Zambian disability policy stakeholders to explore perspectives about disability prevalence research and policymaking. Policy stakeholders, disability advocates and policymakers, expressed more interest in prevalence than in other types of research. Participants perceived prevalence research according to three competing priorities: inclusion ('Involve us [for] good results'), pragmatism ('We have to use that [number]'), and granularity ('We need details'). Participants discounted the value of prevalence research that conflicted with their priorities. Better understanding of stakeholder perspectives of disability prevalence can illuminate ways that these perspectives influence the use of research evidence in disability policymaking.
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Physiotherapy Canada, 2022
Purpose: The objective of our study was to analyze visual and textual content of private physioth... more Purpose: The objective of our study was to analyze visual and textual content of private physiotherapy clinic Web sites with a critical analysis framework. Method: We analyzed 43 private physiotherapy clinics’ Web sites from all regions of one Canadian province (Quebec). For each Web site, we collected and aggregated the data using a standardized extraction grid to index visual and textual content. We then conducted an analysis of the collected data using the Seven-Step Framework for Critical Analysis proposed by Nixon and colleagues. Results: Most Web sites presented elements related to sports and active lifestyles in their names, logos, or pictures. Persons represented in the Web sites were mainly young, white, and active. Ethnic and body diversity were generally not depicted. Information encompassing manual therapy and sports injuries management largely prevailed. Conclusions: The textual and visual content of private physiotherapy clinic Web sites was not consistent to the physiotherapy community’s commitments to upholding equity principles and to serving a wide range of individuals. To fulfill the highest professional and ethical standards, the physiotherapy community should reflect on the representation of physiotherapy services and clients on Web sites to ensure that the trend towards privatization of physiotherapy services does not perpetuate the systems of inequality present in society.
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McGill Journal of Global Health, 2022
This paper presents a participatory qualitative case review of the employment of post-secondary e... more This paper presents a participatory qualitative case review of the employment of post-secondary educated assistants in a global health research program. The research program was initiated by a visiting Canadian researcher who was a supervised principal investigator exploring disability in Western Zambia. This research was supported by eight paid Zambian research assistants (RAs), three of whom participated in the case review. The case review was informed by a dialogue in which participants identified and shared their perspectives regarding the effects of the employment of RAs in the program. The perspectives of the RAs about the effects of their employment were identified as two themes: professional skill acquisition and increased quality of life. The perspectives of the visiting researcher regarding the effects of the RA employment were identified as four themes: increased productivity, access to skills, increased integration in the community, and continuity. From the collective perspective of all co-authors, the employment of RAs made this research program more productive, rigorous, and equitable while also creating opportunities for Zambian youth. The co-authors recommend that global health researchers consider employing post-secondary educated RAs and engage in a wider dialogue about expanding and improving this arrangement. These perspectives and recommendations have been generated according to a radical, participatory action, research tradition that should be taken into account as other members of the global health community assess this evidence to inform their own activities.
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Open Physio, 2021
Background: The COVID-19 global pandemic, and the policies created to respond to it, has had prof... more Background: The COVID-19 global pandemic, and the policies created to respond to it, has had profound and widespread impacts. We – three early career physiotherapist academics focused on equity and human rights – noticed both common and divergent experiences amid the impacts of the initial pandemic response.
Aim: To explore the professional contexts in which we operate as physiotherapist academics through an analysis of our COVID-19 pandemic-related experiences.
Methods: We used a professional practice analytic framework to conduct a collective biographical analysis of our individual and collective experiences. The analytic framework consists of three lenses (accountability, ethics, and professional-as-worker), each of which is considered through three questions.
Results: The analysis revealed the instability of our working conditions. Among us, there were experiences of the pandemic inducing unmanageable workloads and also experiences of the pandemic providing reprieve. We found that our accountability to departments and funders competed for our professional resources with our ethics of providing quality services. The combination of accountability obligations and ethics commitments often overwhelmed our capacities to sustainably maintain well-being. Caregiver status was an important characteristic determining whether the professional context improved or deteriorated in the early pandemic phase.
Conclusion: This analysis can help inform essential changes to professional and academic institutions during and after the COVID-19 pandemic.
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Physiotherapy Practice, 2020
Environmental physiotherapy is an important and growing movement. And yet, it is rarely discussed... more Environmental physiotherapy is an important and growing movement. And yet, it is rarely discussed in Canada. As an authorship team of PT students and early-to-mid career PTs, we present the argument that it is time for Canadian physiotherapists to embrace planetary health and environmental physiotherapy.
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Frontiers in Public Health, 2020
Background: Zambia has created new disability policies and updated existing policies to be consis... more Background: Zambia has created new disability policies and updated existing policies to be consistent with the United Nations Convention on the Rights of Persons with Disabilities. These initiatives require the widespread engagement of ministries and departments to achieve effective policy development and implementation. To pursue widespread engagement, the Government of Zambia developed a structure of disability focal point persons (FPPs). The Zambian disability FPP structure has not yet been explored systematically.
Objective: To explore disability policy stakeholder perspectives about FPPs as a feature of disability policy development and implementation.
Methods: We conducted semi-structured interviews with 24 disability policy stakeholders (10 policymakers, 2 researchers, and 12 disability advocates) as part of a larger study about the development and implementation of disability-related policies in Zambia. Interviews were audio recorded and transcribed. Data were analyzed using
content analysis.
Results: Participants presented FPPs as a promising way to mainstream disability within the government. According to participants, the initial launch of the FPP structure was ineffective, with a lack of clarity about the structure and an initial cohort of FPPs that wielded minimal influence. The FPP structure has since been revised. Participants
express promise that the improved second launch will achieve mainstreaming.
Discussion: Zambian disability policy stakeholders describe a disability FPP structure that is different from the models suggested for treaty implementation. Pre-established commitments to mainstreaming among stakeholders might have stimulated interest in following the cyclical development of the disability FPP structure, encouraging a whole-of-government approach to disability policy implementation.
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Southern African Journal of Policy and Development, 2020
The full Vol. 5, Iss. 1 is available from the publisher at: http://saipar.org/ojs-2.4.2/index.php... more The full Vol. 5, Iss. 1 is available from the publisher at: http://saipar.org/ojs-2.4.2/index.php/SAJPD/issue/view/10 and from McGill University's institutional repository at: https://escholarship.mcgill.ca/concern/articles/n296x362t
Disability has attracted attention in international human rights and development circles and Zambian domestic policy. The purpose of this research was to explore the perceptions of Zambian disability policy stakeholders about the ways that two international initiatives, namely the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) and the Sustainable Development Goals (SDGs), are being reflected in domestic policy. We collected data through semi-structured interviews with 22 policy stakeholders (12 disability advocates and 10 policymakers) and analysed these data using thematic analysis. The UNCRPD was perceived to be progressively integrated into Zambian disability policy although insufficiently implemented while the SDGs have provided rhetorical influence.
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Physiotherapy Practice, 2019
The most recent Canadian Physiotherapy Association Forum (CPA Forum 2019) was focused on advocacy... more The most recent Canadian Physiotherapy Association Forum (CPA Forum 2019) was focused on advocacy and leadership to promote healthy aging. The forum included significant content related to community-based group interventions (e.g., exercise programs for seniors) and a keynote address promoting community living and home-based healthcare justified by considerations of both cost and quality of service. In the context of the CPA Forum 2019, we – the authors of this article – led a workshop to explore ways that Canadian physiotherapists can engage in advocacy and leadership activities to promote equitable healthy aging.
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Journal of Humanities in Rehabilitation, 2019
Background: Strategies proposed to improve the situation of persons with disabilities in the glob... more Background: Strategies proposed to improve the situation of persons with disabilities in the global South are not always developed in consideration of local contexts.
Purpose: To explore and develop strategies to improve the situation of persons with disabilities in one context in the global South.
Method: We recruited two groups of persons with disabilities in Western Zambia. Eighty-one disability-group members participated in focus-group discussions and individual interviews, with a North American rehabilitation professional, in which they discussed life with a disability and what should be done to improve their situation. The transcribed audio-recordings of the focus-group discussions and interviews were analyzed thematically.
Results: The accounts of ways to improve the situation of persons with disabilities in this context were framed around a single theme: help (“kutusa” in Silozi). When expressed by participants in this research, help refers to gifts or grants of material resources from those with the means to share but influenced by the presentation of need by potential recipients. Help occurs in a relationship of expected compassion.
Conclusion: Help is very different from formal strategies that are currently being promoted to improve the situation of persons with disabilities in the global South.
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Physiotherapy Practice - Newsletter of the Canadian Physiotherapy Association, 2019
When thinking about the management of physiotherapy practice, physiotherapists often focus on del... more When thinking about the management of physiotherapy practice, physiotherapists often focus on delivering high quality care to each patient treated in their clinics or their department. Although this is clinically important and relevant on a one-to-basis rationale, the profession should also consider the global impacts of their practice management on the population as we strive towards high-quality physiotherapy services. The quality of physiotherapy practice has greatly evolved in many key dimensions. Unfortunately, one of these key dimensions has received comparatively little attention: equity.
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African Journal of Disability, 2018
BACKGROUND: Understandings of disability are rooted in contexts. Despite the world’s significant ... more BACKGROUND: Understandings of disability are rooted in contexts. Despite the world’s significant contextual diversity, postcolonial power dynamics allow influential actors from the global North to imagine that most people across the global South understand disability in one generalised way. When it informs programmes and services for persons with disabilities in the global South, this imagining of a single generalised view could reduce effectiveness while further marginalising the people for whom the programmes and services were designed.
OBJECTIVES: In the interest of better understanding a contextually grounded meaning of disability, we explored the expressed concerns of two organisations of persons with disabilities and their members in Western Zambia.
METHOD: In this qualitative constructionist study, data collection focused upon life with a disability and services available to persons with disabilities. Data were collected through 39 individual interviews and eight focus group discussions with 81 members of organisations of
persons with disabilities. Data were analysed thematically.
RESULTS: The participants’ main expressed concern was poverty. This concern was articulated in terms of a life of suffering and a need for material resources. Participants linked poverty to disability in two ways. Some participants identified how impairments limited resource acquisition, resulting in suffering. Others considered poverty to be an integral part of the experience of disability.
CONCLUSION: This study contributes to literature on disability theory by providing a contextually grounded account of a particular understanding of disability and poverty. The study also contributes to disability practice and policymaking through the demonstration of poverty as the main concern of persons with disabilities in this context.
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Stimulated by a disjuncture between the expectations and the experiences of conducting research o... more Stimulated by a disjuncture between the expectations and the experiences of conducting research on disability in Zambia, we reflexively reviewed our own research practice to find that it was premised upon an unconscious assumption about the value of productivity. This reflexive finding led us to reflect more deeply about the concept of productivity. From our own observations as health professionals and researchers in the global North complemented by literature, we described a hegemonic conception of productivity that we see to be represented. Through a more conscious articulation of our own approach to research and the responses that we observed from research participants with disabilities in Zambia, we articulated two alternative conceptions of productivity. We propose that the alternative conceptions of productivity are useful to inform more robust disability research in the global South. More generally, these alternative conceptions can be used as resistance to a narrowly conceived notion of productivity.
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Partnership with disabled persons' organisations (DPOs) is often presented as one mechanism to en... more Partnership with disabled persons' organisations (DPOs) is often presented as one mechanism to ensure the inclusion of persons with disabilities in research that concerns them. In working with two DPOs in Western Zambia, we learned that one of these groups was organised in a way that differed from our own presumptions and the descriptions of DPOs in literature: the group was fluid in membership and willing to re-formulate itself according to the priorities of visitors. From this we understand that limiting research partnerships to DPOs, as typically described, could lead to the inadvertent exclusion of people involved in many different forms of organising by persons with disabilities.
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Disability and the Global South, 2016
This article is a presentation of insights gained through critical reflection on the experience o... more This article is a presentation of insights gained through critical reflection on the experience of doctoral dissertation research on disability in Western Zambia. The framework guiding this critical reflection is the Principles for Global Health Research released by the Canadian Coalition for Global Health Research (CCGHR) in 2015. These six interrelated principles were developed in order to inform and foster research that better and more explicitly addresses health inequities. The principles are: humility, responsiveness to the causes of inequities, commitment to the future, inclusion, authentic partnering, and shared benefits. Critical reflection on the dissertation fieldwork raises the challenges of fulfilling each of the principles. Additionally, the structural power from a researcher in a position of relative privilege, as well as institutional power through the doctoral researcher's academic program, was apparent. The exercise of power enabled certain possibilities for action by the researcher and the participants with disabilities while constraining others. The insights generated inform the next steps for this project in Western Zambia and considerations for current and prospective doctoral student researchers.
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Physiotherapy Canada, 2016
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Columbia University Journal of Global Health, 2016
A large and growing number of doctoral students are involved with global health research. Here we... more A large and growing number of doctoral students are involved with global health research. Here we outline the Doctoral Student Complementary Approach (DSCA), a strategy to connect doctoral students from high-income countries (HICs) with counterparts from low-income countries (LMICs) in order to incur benefits for both students and improve the quality of global health research. In addition to presenting a description of the DSCA, we discuss its alignment with the Core Competencies for Global Health Research and Practice and some key barriers, challenges and opportunities related to its implementation. Although this presentation of the DSCA is an entry-point to new possibilities for doctoral students, the approach will benefit from further refinement through feedback. We therefore call upon our colleagues, especially those in LMICs, to provide input regarding the opportunities and challenges of a DSCA in practice.
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Health Sciences and Disease, Apr 24, 2014
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Disability and Rehabilitation, 2013
To identify the characteristics of peer-reviewed literature on community-based rehabilitation (CB... more To identify the characteristics of peer-reviewed literature on community-based rehabilitation (CBR) in low- and middle-income countries published in English from 2003 to 2012. This scoping review involved a systematic search of electronic databases using specific keyword/subject heading combinations. Journal articles were included if they were published in English, used "CBR" as related to rehabilitation with persons with disabilities and not limited to high-income countries (HICs). Data were charted according to both pre-determined and emergent categories. A subset of articles was charted by two reviewers to ensure reliability of variables. A total of 114 articles were included. Fifty-two articles presented empirical research and 49 were published in one of two journals. The articles represented CBR activity in 26 specific countries, although only two of these were in Europe and only one was in the Americas. Authors were predominantly affiliated at universities and in HICs. This scoping review identified and characterized a large pool of literature on CBR, facilitating its incorporation into research and practice. Future research should examine the engagement of persons with disabilities in creating CBR literature, and analysis of literature in languages other than English. Implications for Rehabilitation Community-based rehabilitation (CBR) has been promoted as a rehabilitation strategy of choice in low- and middle-income countries (LMICs), but it has been critiqued for lack of an evidence base. A large number (114) of peer-reviewed articles were published on CBR between 2003 and 2012. Just under half of these articles (45%) presented empirical research, indicating that the evidence base for CBR is growing but will benefit from continued, rigorous inquiry. Furthermore, researchers from LMICs appear to be largely under-represented in published CBR research, flagging the need to support LMIC partners to share their CBR research in peer-reviewed journals.
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Occupational Therapy International, 2013
The country of Zambia's Sixth National Development Plan includes many objectives related to parti... more The country of Zambia's Sixth National Development Plan includes many objectives related to participation and health that align with values underlying occupational therapy. Given this link, occupational therapy research has the potential to advance the Sixth National Development Plan and thereby enhance the participation and health of Zambians. However, there is neither a school of occupational therapy nor many occupational therapists working in Zambia. Using an example of a global research partnership between Canadian occupational therapy researchers and Zambian researchers, this paper examines the partnership using four criteria for global health research in order to derive lessons for future occupational therapy research partnerships. Implications for future occupational therapy research partnerships include the need for partners to combine their complementary skills and knowledge so that they may collaborate in mutually beneficial ways to address global health challenges and expand the reach of occupational therapy perspectives.
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Doctoral Thesis by Shaun Cleaver
This constructionist qualitative research project was informed by critical and participatory approaches to research. The participating groups included one based in an urban area and another in a rural area. A total of 81 individual members of the two groups participated. Data were generated through eight focus group discussions and 39 interviews and analyzed using thematic and reflexive analysis strategies.
The participants of this research were most concerned with poverty. The strategy that they suggested to improve their situation was help, a gift or grant of material resources shared in a relationship of expected compassion. This research was complicated by power dynamics and differences between the participants and researcher with respect to priorities and ways of thinking. The complications likely impacted what people talked about and the way they talked about it. The complications also meant that this research was less collaborative than planned.
This research showed that PWDs in Western Zambia had concerns, and suggested strategies to improve their situation, that were different than those that are most common in Zambia. Since the current ways of thinking about disability in Zambia are largely informed by the concerns and priorities of the global North, this research points to possible alternatives that are based in the realities of the country.
Global health, disability & rehabilitation papers by Shaun Cleaver
Aim: To explore the professional contexts in which we operate as physiotherapist academics through an analysis of our COVID-19 pandemic-related experiences.
Methods: We used a professional practice analytic framework to conduct a collective biographical analysis of our individual and collective experiences. The analytic framework consists of three lenses (accountability, ethics, and professional-as-worker), each of which is considered through three questions.
Results: The analysis revealed the instability of our working conditions. Among us, there were experiences of the pandemic inducing unmanageable workloads and also experiences of the pandemic providing reprieve. We found that our accountability to departments and funders competed for our professional resources with our ethics of providing quality services. The combination of accountability obligations and ethics commitments often overwhelmed our capacities to sustainably maintain well-being. Caregiver status was an important characteristic determining whether the professional context improved or deteriorated in the early pandemic phase.
Conclusion: This analysis can help inform essential changes to professional and academic institutions during and after the COVID-19 pandemic.
Objective: To explore disability policy stakeholder perspectives about FPPs as a feature of disability policy development and implementation.
Methods: We conducted semi-structured interviews with 24 disability policy stakeholders (10 policymakers, 2 researchers, and 12 disability advocates) as part of a larger study about the development and implementation of disability-related policies in Zambia. Interviews were audio recorded and transcribed. Data were analyzed using
content analysis.
Results: Participants presented FPPs as a promising way to mainstream disability within the government. According to participants, the initial launch of the FPP structure was ineffective, with a lack of clarity about the structure and an initial cohort of FPPs that wielded minimal influence. The FPP structure has since been revised. Participants
express promise that the improved second launch will achieve mainstreaming.
Discussion: Zambian disability policy stakeholders describe a disability FPP structure that is different from the models suggested for treaty implementation. Pre-established commitments to mainstreaming among stakeholders might have stimulated interest in following the cyclical development of the disability FPP structure, encouraging a whole-of-government approach to disability policy implementation.
Disability has attracted attention in international human rights and development circles and Zambian domestic policy. The purpose of this research was to explore the perceptions of Zambian disability policy stakeholders about the ways that two international initiatives, namely the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) and the Sustainable Development Goals (SDGs), are being reflected in domestic policy. We collected data through semi-structured interviews with 22 policy stakeholders (12 disability advocates and 10 policymakers) and analysed these data using thematic analysis. The UNCRPD was perceived to be progressively integrated into Zambian disability policy although insufficiently implemented while the SDGs have provided rhetorical influence.
Purpose: To explore and develop strategies to improve the situation of persons with disabilities in one context in the global South.
Method: We recruited two groups of persons with disabilities in Western Zambia. Eighty-one disability-group members participated in focus-group discussions and individual interviews, with a North American rehabilitation professional, in which they discussed life with a disability and what should be done to improve their situation. The transcribed audio-recordings of the focus-group discussions and interviews were analyzed thematically.
Results: The accounts of ways to improve the situation of persons with disabilities in this context were framed around a single theme: help (“kutusa” in Silozi). When expressed by participants in this research, help refers to gifts or grants of material resources from those with the means to share but influenced by the presentation of need by potential recipients. Help occurs in a relationship of expected compassion.
Conclusion: Help is very different from formal strategies that are currently being promoted to improve the situation of persons with disabilities in the global South.
OBJECTIVES: In the interest of better understanding a contextually grounded meaning of disability, we explored the expressed concerns of two organisations of persons with disabilities and their members in Western Zambia.
METHOD: In this qualitative constructionist study, data collection focused upon life with a disability and services available to persons with disabilities. Data were collected through 39 individual interviews and eight focus group discussions with 81 members of organisations of
persons with disabilities. Data were analysed thematically.
RESULTS: The participants’ main expressed concern was poverty. This concern was articulated in terms of a life of suffering and a need for material resources. Participants linked poverty to disability in two ways. Some participants identified how impairments limited resource acquisition, resulting in suffering. Others considered poverty to be an integral part of the experience of disability.
CONCLUSION: This study contributes to literature on disability theory by providing a contextually grounded account of a particular understanding of disability and poverty. The study also contributes to disability practice and policymaking through the demonstration of poverty as the main concern of persons with disabilities in this context.
This constructionist qualitative research project was informed by critical and participatory approaches to research. The participating groups included one based in an urban area and another in a rural area. A total of 81 individual members of the two groups participated. Data were generated through eight focus group discussions and 39 interviews and analyzed using thematic and reflexive analysis strategies.
The participants of this research were most concerned with poverty. The strategy that they suggested to improve their situation was help, a gift or grant of material resources shared in a relationship of expected compassion. This research was complicated by power dynamics and differences between the participants and researcher with respect to priorities and ways of thinking. The complications likely impacted what people talked about and the way they talked about it. The complications also meant that this research was less collaborative than planned.
This research showed that PWDs in Western Zambia had concerns, and suggested strategies to improve their situation, that were different than those that are most common in Zambia. Since the current ways of thinking about disability in Zambia are largely informed by the concerns and priorities of the global North, this research points to possible alternatives that are based in the realities of the country.
Aim: To explore the professional contexts in which we operate as physiotherapist academics through an analysis of our COVID-19 pandemic-related experiences.
Methods: We used a professional practice analytic framework to conduct a collective biographical analysis of our individual and collective experiences. The analytic framework consists of three lenses (accountability, ethics, and professional-as-worker), each of which is considered through three questions.
Results: The analysis revealed the instability of our working conditions. Among us, there were experiences of the pandemic inducing unmanageable workloads and also experiences of the pandemic providing reprieve. We found that our accountability to departments and funders competed for our professional resources with our ethics of providing quality services. The combination of accountability obligations and ethics commitments often overwhelmed our capacities to sustainably maintain well-being. Caregiver status was an important characteristic determining whether the professional context improved or deteriorated in the early pandemic phase.
Conclusion: This analysis can help inform essential changes to professional and academic institutions during and after the COVID-19 pandemic.
Objective: To explore disability policy stakeholder perspectives about FPPs as a feature of disability policy development and implementation.
Methods: We conducted semi-structured interviews with 24 disability policy stakeholders (10 policymakers, 2 researchers, and 12 disability advocates) as part of a larger study about the development and implementation of disability-related policies in Zambia. Interviews were audio recorded and transcribed. Data were analyzed using
content analysis.
Results: Participants presented FPPs as a promising way to mainstream disability within the government. According to participants, the initial launch of the FPP structure was ineffective, with a lack of clarity about the structure and an initial cohort of FPPs that wielded minimal influence. The FPP structure has since been revised. Participants
express promise that the improved second launch will achieve mainstreaming.
Discussion: Zambian disability policy stakeholders describe a disability FPP structure that is different from the models suggested for treaty implementation. Pre-established commitments to mainstreaming among stakeholders might have stimulated interest in following the cyclical development of the disability FPP structure, encouraging a whole-of-government approach to disability policy implementation.
Disability has attracted attention in international human rights and development circles and Zambian domestic policy. The purpose of this research was to explore the perceptions of Zambian disability policy stakeholders about the ways that two international initiatives, namely the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) and the Sustainable Development Goals (SDGs), are being reflected in domestic policy. We collected data through semi-structured interviews with 22 policy stakeholders (12 disability advocates and 10 policymakers) and analysed these data using thematic analysis. The UNCRPD was perceived to be progressively integrated into Zambian disability policy although insufficiently implemented while the SDGs have provided rhetorical influence.
Purpose: To explore and develop strategies to improve the situation of persons with disabilities in one context in the global South.
Method: We recruited two groups of persons with disabilities in Western Zambia. Eighty-one disability-group members participated in focus-group discussions and individual interviews, with a North American rehabilitation professional, in which they discussed life with a disability and what should be done to improve their situation. The transcribed audio-recordings of the focus-group discussions and interviews were analyzed thematically.
Results: The accounts of ways to improve the situation of persons with disabilities in this context were framed around a single theme: help (“kutusa” in Silozi). When expressed by participants in this research, help refers to gifts or grants of material resources from those with the means to share but influenced by the presentation of need by potential recipients. Help occurs in a relationship of expected compassion.
Conclusion: Help is very different from formal strategies that are currently being promoted to improve the situation of persons with disabilities in the global South.
OBJECTIVES: In the interest of better understanding a contextually grounded meaning of disability, we explored the expressed concerns of two organisations of persons with disabilities and their members in Western Zambia.
METHOD: In this qualitative constructionist study, data collection focused upon life with a disability and services available to persons with disabilities. Data were collected through 39 individual interviews and eight focus group discussions with 81 members of organisations of
persons with disabilities. Data were analysed thematically.
RESULTS: The participants’ main expressed concern was poverty. This concern was articulated in terms of a life of suffering and a need for material resources. Participants linked poverty to disability in two ways. Some participants identified how impairments limited resource acquisition, resulting in suffering. Others considered poverty to be an integral part of the experience of disability.
CONCLUSION: This study contributes to literature on disability theory by providing a contextually grounded account of a particular understanding of disability and poverty. The study also contributes to disability practice and policymaking through the demonstration of poverty as the main concern of persons with disabilities in this context.
Objectives: The aim of this study was to better understand mobility limitations in adults with intellectual disabilities, age 45 and over, by describing the prevalence and severity of mobility limitations and determining the association with living in a high support setting.
Methods: A systematic review of published literature on mobility limitations among adults with intellectual disabilities was conducted using a pre-determined search and extraction strategies. A cross-sectional study was then conducted among a representative sample of adults, age 45 and over with intellectual disabilities in South Eastern Ontario. Data was collected through standardized proxy response telephone surveys and analyzed descriptively to determine the prevalence and severity of mobility limitations in this population. A multivariate logistic regression model was then used to examine the association between mobility limitations and residential status.
Results: The systematic review identified 32 publications that met all inclusion criteria. Publications were generally not focused on mobility, cross-sectional in design and few investigators addressed key methodological features in their report. Original data was collected for 128 older adults with intellectual disabilities. The prevalence of mobility limitations varied according to the definition employed. Using comparable definitions, this prevalence was higher than what is seen in the general Canadian population. The prevalence of mobility limitations was not found to increase with age but was greater in females than males. People with intellectual disabilities and mobility limitations had 3.6 times greater odds of living in high support residential settings than those without mobility limitations. This difference was statistically significant.
Conclusion: Past epidemiological research on mobility limitations for people with intellectual disabilities is of poor quality. In addressing these limitations, this study found that mobility limitations are common among people with intellectual disabilities and are associated with meaningful outcomes, such as the place in which a person lives.
Methods: This study was a systematic review of the epidemiological literature (incidence and prevalence) of mobility limitations among adults with intellectual disabilities. Four electronic databases were searched from January 1980-May 2007 for publications according to pre-defined inclusion/exclusion criteria. Additional sources were consulted. Two reviewers extracted data from each of the included articles.
Results: Thirty-two publications representing 31 studies were ultimately included. In general, studies did not focus on mobility but were conducted for other purposes. All studies were conducted in industrialized countries. Only one study used a longitudinal design; the remainder were cross-sectional. Few investigators reported on the representativeness of the sample or the validity of the measurement tool. Study samples differed substantially and investigators used numerous definitions of mobility limiting comparability between studies.
Conclusions: There is a need for increased research on mobility limitations among adults with intellectual disabilities, particularly longitudinal research. Researchers investigating mobility limitations should use validated measurement tools and offer detailed descriptions of the study sample and how it compares to an identifiable population.
I wrote this post as part of the preparation of the "Justice Centered Rehabilitation" discussion panel at the 2021 World Physiotherapy online congress.
Posted on the blog for McGill University's Global Health Programs (GHP), I ask the question, "How does Tamil Nadu keep its spinal cord patients alive?" This question is informed by the experience of seeing too many people with spinal cord injuries decline rapidly and die within months of their traumatic event.
Through this blog post, I hope to stimulate a South-South dialogue, opening a space for people in various low-income settings to share what is going well and learn from each other.
The post is available at: https://blogs.mcgill.ca/spellyourscience/2018/10/18/having-a-disability-in-africa-whats-that-like/
This post is written for a general audience in the attempt to draw attention to the common prejudices of Canadians (and Westerners, in general) towards "Africans" with disabilities. Through this post, I hope to provide ways for audiences of Canadians to see persons with disabilities in Zambia differently; less as exotic, nameless beings in need of pity or charity, and more as fellow individuals, deserving of respect and dignity.
Available at: https://rehabinkmag.com/previous-issues/rehabink-fall-2016-volume-1-issue-2/%20how-function-and-disability-are-socially-constructed/