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Despite growing enrollment of university students with disabilities, they have not achieved academic parity with their non-disabled peers. This study matched 71 first-year university students with disabilities and students without disabilities on three variables: high school average when admitted to university, gender, and program of study. Both groups of students were compared on three measures of academic performance: GPA, failed courses, and dropped courses after first year of university. The relationship between accommodations and academic performance was also analyzed for students with disabilities. Even when matched on admission average, gender, and program of study, students with disabilities had a significantly lower GPA and were more likely to fail courses in their first year than their peers without disabilities. While note-taking in the classroom was associated with being less likely to drop a course, it was also associated with poorer academic performance, as was using a calculator or alternate format during exams. The more accommodations students lost in the transition from high school, the worse they performed academically at university. Students who lost human assistant support in the classroom and the use of a computer or a memory aid during exams had a significantly lower GPA and were more likely to fail courses in their first year of university compared with students who did not lose these accommodations. These findings have implications for accessibility offices and universities in supporting the access needs and academic success of students with disabilities.

Introduction: COVID-19-related restrictions resulted in changes to time use and occupational participation, impacting individual and collective well-being. This study addressed a knowledge gap concerning the adaptive process during periods of occupational disruption. We explored the experience of occupational disruption and how people managed disruption during the COVID-19 pandemic. Methods: We used a qualitative descriptive approach and interviewed 18 participants of a larger survey study of time use during the COVID-19 pandemic undertaken around a medium-sized city in Canada. Transcript analysis was conducted inductively using conventional content analysis. Findings: Two overarching themes were constructed during data analysis: The Disruption Experience and Adopting New Habits and Routines. In the face of disruption, participants described a sense of loss and disconnection, and challenges with time management. Establishing new habits and routines required new learning associated with increased time and flexibility, connecting with others and health and wellness. Conclusion: During changing pandemic restrictions, participants expressed a sense of loss, disconnection and time management challenges associated with occupational disruptions, but also described ways they adapted, improving their health and well-being. Strategies identified through this work may be used to enhance adaptation during disruptions. Future research should explore differences in adaptation, among more diverse populations. [ABSTRACT FROM AUTHOR]

Although more students with disabilities are attending university than ever before, many still have difficulties with the transition from high school. Transition research has extensively examined the factors and barriers that support or hinder successful transitions for students with disabilities. However, there has been little explicit focus on the intersection of experiences with transition and academic accommodations on the overall experience of students with disabilities at university. This study interviewed six participants with various disabilities who transitioned directly from high school to university. Thematic analysis showed that: (a) first-year students are unprepared for the bureaucratic nature of the accommodation process, but ultimately find it fair and non-stigmatizing; (b) first-year students discover that they have to play a more active role in their accommodation planning but ultimately find that this role, and the accommodations they receive, positively supports their autonomy and disability identity at university; and (c) some university instructors exhibit significantly negative attitudes towards students requiring accommodations. These findings have practice implications for disability service professionals in universities supporting the transition needs of students with disabilities. [ABSTRACT FROM AUTHOR]

Rationale: A troubling phenomenon for caregivers of elderly parents is their tendency to tell the same stories over and over. Repeated storytelling raises concerns about cognitive decline and memory loss and is often considered a disturbing harbinger of the possible onset of dementia. Purpose: This research aims to show that repeatedly told stories are important vehicles for intergenerational transmission of values. Methods: Using a narrative inquiry approach, this research involved structured interviews with middle‐aged adult children, asking them to tell us the stories they felt they were hearing or had heard repeatedly from their aging parent. Interviews were taped and transcribed, then coded for temporality, purpose and content. Results: Based on 126 stories told to 13 participants, it can be confirmed that there are approximately ten stories that older parents repeatedly tell to their adult children, mostly about experiences in their teens and twenties. The majority of the stories are told for the purpose of consolidating the elder's identity or sharing wisdom with the adult child. Key themes in the stories include seeking a better life, youthful fun, upholding standards, sticking together and doing what's right. These themes reflect the significant events and prevailing values of the early to mid‐twentieth century. Conclusion: This research offers a more constructive way for caregivers to hear the repeated stories told by their aging parents and to offer their loved one the gift of knowing they have been seen and heard. [ABSTRACT FROM AUTHOR]

The present study examined population level data on unmet needs for adults with physical, sensory and cognitive disabilities, using the National Population Health Survey. The study revealed that disabled adults (aged 20-64) reported more than three times as many unmet health care needs as their non-disabled counterparts. Even after controlling for the effects of age, gender and poor health, disability had a significant effect on the perception of unmet needs, particularly disabilities associated with pain, hearing impairment and emotional problems. The greatest deterrent to receiving needed services among individuals with disabilities was cost. Despite being publicly funded and thereby presumably equally accessible to all, the health care system in Canada fails to meet the needs of some of its most vulnerable constituents--adults with disabilities. (Contains 7 tables.)

Context: Farming is often imagined to be a serene and idyllic business based on historical images of a man, a horse, and a plow. However, machinery and equipment on farms, such as older tractors, grain dryers, and vacuum pumps, can have noise levels, which may be dangerous to hearing with prolonged, unprotected exposure. Purpose: This qualitative study in Ontario, Canada, explored the challenges and coping strategies experienced by dairy farmers with self-reported hearing loss and communication difficulties. Through indepth interviews, 13 farmers who experience significant hearing loss were questioned about the challenges they face as a result of hearing loss and the strategies they use to overcome or compensate for problems. Findings: The 2 major challenges encountered by dairy farmers with a hearing loss were: (1) obtaining information from individuals, within groups, and through electronic media; and (2) working with animals, machinery, and noise. To cope with these challenges, participants used strategies identified as problem and emotion focused. Conclusions: Four themes arose from analysis of the challenges encountered and strategies used: (1) Hearing loss is experienced as a "familiar," but "private," problem for dairy farmers; (2) Communication difficulties can negatively affect the quality of relationships on the farm; (3) Safety and risk management are issues when farming with a hearing loss; and (4) The management or control of excessive noise is a complex problem, because there are no completely reliable yet practical solutions.

Purpose: The purpose of this study was to describe factors contributing to the decision-making processes of elderly persons as they formulate advance directives in long-term care. Design and Methods: This study was qualitative, based on grounded theory. Recruitment was purposive and continued until saturation was reached. Nine residents of a long-term-care facility were interviewed by use of a semistructured format. Open and axial coding of interview transcripts were carried out and the factors contributing to the decision process were defined. Results: Elders based their decisions primarily on information gathered from personal experiences with death and illness. They obtained very little information from professionals or the media. Major factors considered by elders as they weighed information included spiritual, emotional, and social considerations. Implications: The factors considered during the decision-making process were oriented more toward the individual's experiences and less on contributions from objective sources than anticipated. Decision making for advance directives is a highly personalized process. The approach of health professionals when assisting with end-of-life decision making should be planned with these contributing factors in mind, so that the services offered to the individuals in this population best meet their needs.

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A phenomenological study of seven teenagers with physical disabilities attending a regular secondary school focused on social integration and the factors influencing it. Results showed extrinsic and intrinsic factors that facilitate or limit integration. Occupational therapists can ensure that schools are inclusive and that clients are capable of participating fully. (Contains 50 references and the interview questions.) (JOW)

In Ghana, many persons with physical disabilities are members of populations who face health disparities including physical, structural, knowledge, attitudinal and financial barriers to various health care services compared to those without disabilities. However, there is limited evidence on how to improve access to primary health care services for persons with physical disabilities. This study aimed to understand persons with physical disabilities' experiences and health care providers' perspectives for improving access to primary health care for persons with disabilities in rural Ghana. We used a qualitative approach and interviewed 33 persons with physical disabilities and health care providers, and thematically analysed data from in-depth interviews. We identified 4 major themes. According to the participants, health care could be more accessible by: i) Making it more affordable; ii) Increasing the availability of providers and services; iii) Providing more education about system navigation; and iv) Improving access to disability friendly health facilities and equipment. Participants' recommendations were nested in the areas of policy and practice modifications. Policy makers need to consider supporting persons with physical disabilities who cannot afford non-medical services (i.e., cost of transportation). In terms of practice, the provision of education and training related to physical disability issues should be extended to both clinical and nonclinical health workers for better client centered care. There is an urgent need for policy makers and relevant key stakeholders to include persons with physical disabilities in designing and implementing policies and programs to ensure that they are meeting their needs. [ABSTRACT FROM AUTHOR]

Most professionals in health and long-term care know the importance of spirituality for well-being among older people; however, they are challenged to know how to approach the topic or what to do to enable the power of spirituality in their setting. This paper is based on an extensive search and content analysis of literature in the health and social sciences, and offers a step-wise approach to engaging with older adults on spiritual issues. The content analysis identified five levels of intervention. The first two levels require no special training (listening and acknowledging, referring). The next three levels—asking about spirituality, indirect, and direct interventions—each depend on a greater degree of preparation and expertise. All the levels offer the possibility of spiritual expression for clients/residents, and the opportunity for health and social service professionals to respond to these important issues. [ABSTRACT FROM AUTHOR]

The study objectives were to assess the prevalence of, and factors associated with the use and costs of nonprescription medications among people with spinal cord injury. Observational design; a cross-sectional online survey. Community in Canada. Individuals with spinal cord injury (N=160). Not applicable. Not applicable. A total of 160 individuals participated in this study. Of all study participants, 83% reported that they used at least 1 nonprescription medication over the last 12 months. On average, participants spent $52 per month on nonprescription medications. The average use and monthly expenditure did not differ significantly by age, sex, or injury parameters. Vitamins and minerals were most commonly used and constituted 62% of all nonprescription medications listed by the participants. Musculoskeletal issues were the most common health problems for which nonprescription medications were used. Nonprescription medications are a common part of therapeutic drug regimens for people with spinal cord injuries and are purchased as an out-of-pocket expense. These products may or may not have established benefits. Knowledge about the use of nonprescription medications may help prescribers to improve drug safety, medication affordability, and quality of pharmacotherapy for patients with spinal cord injury. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to describe factors contributing to the decision-making processes of elderly persons as they formulate advance directives in long-term care. Design and Methods: This study was qualitative, based on grounded theory. Recruitment was purposive and continued until saturation was reached. Nine residents of a long-term-care facility were interviewed by use of a semistructured format. Open and axial coding of interview transcripts were carried out and the factors contributing to the decision process were defined. Results: Elders based their decisions primarily on information gathered from personal experiences with death and illness. They obtained very little information from professionals or the media. Major factors considered by elders as they weighed information included spiritual, emotional, and social considerations. Implications: The factors considered during the decision-making process were oriented more toward the individual's experiences and less on contributions from objective sources than anticipated. Decision making for advance directives is a highly personalized process. The approach of health professionals when assisting with end-of-life decision making should be planned with these contributing factors in mind, so that the services offered to the individuals in this population best meet their needs. Key Words: End of life, Advance care planning, Theoretical model, Grounded theory

Parkinson's disease is a complex condition that affects many different aspects of a person's health. Because of its complexity, people with Parkinson's disease require access to a variety of healthcare services. The aim of the present study was to identify the barriers to access healthcare services for people with Parkinson's disease. We conducted a scoping review according to guidelines posed by Arksey & O'Malley (2005). A search of MEDLINE, Embase, CINHAL, and PsycINFO databases was conducted, and 38 articles were selected based on the inclusion criteria. The review findings identified person-level and system-level barriers. The person-level barriers included skills required to seek healthcare services, ability to engage in healthcare and cost for services. The system-level barriers included the availability of appropriate healthcare resources. Based on the existing barriers elucidated in the scope review, we have discussed potential areas in healthcare that require improvement for people with Parkinson's disease to manage their healthcare needs more equitably. [ABSTRACT FROM AUTHOR]

Background: Canadians with MS are high users of healthcare services, yet they report multiple unmet needs, high disease burden, and low satisfaction with care. Engaging patients in healthcare planning can lead to improvements in access and care. There is currently limited evidence that has harnessed the perspectives of Canadians with MS. Objective: To identify and prioritize the healthcare access concerns of Canadians with MS. Methods: A cross-sectional online survey informed by the Concerns Report Methodology was used to address the objective. Participants were recruited through multiple methods. Descriptive statistics were used to identify the main barriers to healthcare providers, and concerns report methods were used to calculate needs indexes to prioritize concerns of participants. Results: 324 Canadians with MS participated in the study between November 18, 2019 and March 27, 2020. The most pressing healthcare access concerns of Canadians with MS were related to availability of healthcare providers with MS knowledge and affordability of services that aim to improve wellness. Conclusion: These findings provide healthcare planners with prioritized access concerns of Canadians with MS, which can be used to guide strategic planning to improve the quality of life of these individuals. [ABSTRACT FROM AUTHOR]

Relationships between social support and coping were examined over a one-year period in a sample (n = 120) exposed to a specific stressor (i.e. a spinal cord injury). Two issues were evaluated: (1) patterns of social support and coping over time: and (2) the direction of the effects of coping on social support or vice versa. Subjects had incurred a spinal cord injury within the preceding year, completed their rehabilitation, and returned to the community. They were assessed at 1, 4 and 12 months post-discharge to capture possible changes in patterns of social support and coping. Covariance structure modelling indicated a single-factor construct based on three measured subscales for social support (instrumental/informational/emotional), and for coping (problem-oriented/perception-oriented/emotion-oriented). While the factor structure of coping was invariant over time, the structure of social support changed from a high concentration of informational support at one month to a higher saturation of emotional support at 4 and 12 months, potentially reflecting changes in the salience of different components of the network. The perceived availability of social support was seen to have direct effects on future coping. At one month, social support had a direct positive effect on coping at four months. However, at four months social support had a negative effect on coping at 12 months, which may reflect a change in the structure of the social support construct itself. That is, as the factor structure of social support varied with time, coping may also have been influenced by differing perception of one's needs and circumstances. Thus, the study provides evidence for the dynamic effects of social support on coping, depending on one's stage in the process of long-term adjustment. The findings underscore the interplay between social support and coping, and the need for future research and practical applications to recognize temporal effects on the relationships between these two complex constructs. Key words - social support, coping, disability

Canada has one of the highest rates of multiple sclerosis (MS) in the world, affecting 1 in every 385 individuals. This neurodegenerative condition is unpredictable and variable in symptom profile and disease course making it difficult to manage. Canadians with MS are high users of healthcare services; however, they report multiple unmet needs, high disease burden, and low satisfaction with healthcare. Access to healthcare is vital to health maintenance and may explain these poor experiences. Access is often measured using utilisation as a proxy, which may fail to capture the complexities of access experiences that this population faces. The Candidacy Framework offers an alternative to utilisation measures, by examining the process of accessing care, while considering the impact of social patterning and health system environments on this process. The aim of the current study is to align the experiences of persons with MS in accessing healthcare services with the stages of the Candidacy Framework. Forty‐eight individuals with MS living across Ontario were recruited to participate in one of five focus groups or ten individual interviews. Analysis included a first inductive phase, using constant comparative methods, followed by a deductive phase, using content analysis. The Candidacy Framework was not able to capture all experiences shared by persons with MS, including patient‐centred care, past experiences and outcome expectation, and care outcomes. We propose these concepts be included as refinements to the current Framework, providing a more thorough explanation of the experiences of persons with MS in accessing care to manage their condition. [ABSTRACT FROM AUTHOR]

An editorial is presented on the propose to explore the similarities and differences between occupational performance problems and disabilities, and to reflect on the lessons that occupational therapists can offer to the field of disability studies, and conversely that disability studies can offer to occupational therapy. The article discusses that the Occupational performance problems are activities that a person "wants to do, needs to do, or is expected to do.

Background: People with multiple sclerosis (MS) require complex care throughout life. Canadians with MS are high users of health‐care services, yet still report unmet health‐care needs and low satisfaction with services received. Objective: This study aimed to investigate the health‐care access experiences of Ontarians with MS as they manage their condition. Design and Participants: Interpretive description guided data collection and analysis. Forty‐eight people living across seven communities participated. Thirty‐eight participated in one of five focus groups; the remaining 10 participated in an individual semi‐structured interview. Results: Participants described the experience of accessing care as a decisional process, guided by a form of cost‐benefit analysis. The process determined whether seeking conventional health‐care services 'is worth it'. Most participants felt that the energy and resources required to access the health‐care system outweighed their expected outcomes, based on past experiences. Participants who did not see the benefit of care seeking turned to self‐treatment, use of complementary and alternative services, and engaged in patterns of health‐care avoidance until a crisis arose. Discussion and Conclusion: Findings suggest that a renewed effort to promote patient‐centred care and a biopsychosocial approach may improve the health‐care access experiences of persons with MS and reduce service avoidance. [ABSTRACT FROM AUTHOR]