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Transportation is integral to the employment accessibility and sustainability of people with disabilities. This study aims to identify barriers, facilitators, and solutions to commuting for people with disabilities, drawing from their perspectives as well as those of employers and transportation providers. Through semi-structured individual interviews, insights were gathered from sixteen individuals with disabilities, seven employers, two job integration agents, and four transporters. Qualitative analysis of the interview transcripts revealed factors influencing commuting, including personal attributes and environmental factors. This study underscores the significant impact of environmental factors, particularly the role of social networks and transport infrastructure in either supporting or hindering public transportation use for people with disabilities who commute to work. For example, employers’ limited awareness of their employees’ commuting challenges contrasts with their recognition of their potential role in supporting it. Training and disability awareness initiatives emerge as pivotal solutions to empower individuals within the social network, including transport personnel, fellow passengers, and employers, to facilitate public transportation use by people with disabilities for work commutes.

Treatments for adolescent cancer can cause debilitating side effects in the short- and long-term such as nausea and malnutrition but also cardiometabolic disturbances. Although the risk for cardiometabolic complications is greater for adolescents with cancer than younger ones, adolescents typically respond poorly to family-oriented health promotion programs. This study aims to assess the needs, barriers and facilitators to healthy lifestyle promotion interventions for adolescents with cancer and how to best adapt these interventions for them. Interviews were held with adolescents treated for cancer (n = 9) and parents (n = 6), focus groups were conducted with stakeholders working in oncology (n = 12) and self-report questionnaires were sent to stakeholders involved in a health promotion intervention (n = 6). At the time of interview, mean age of adolescent participants (40% female) was 17.0 ± 1.9 years (mean age at diagnosis: 14.6 ± 1.6 years). Verbatim and responses to questionnaires were coded and analyzed using qualitative methods. Stakeholder stated that adolescents with cancer need to access activities adapted to their age, to communicate with peers going through a similar experience, and to preserve their schooling and friendships. Barriers to intervention reported by adolescents, parents and stakeholders include lack of motivation, schedule conflicts, fatigue and treatment side effects. Some of the barriers mentioned by adolescents and parents include pain, post-surgery problems, school, physical deconditioning, and lack of time. Facilitators mentioned by adolescents and parents comprise trust in stakeholders’ expertise, personalized approaches, scheduling flexibility. Stakeholders recommended to build trust in the relationship, favoring non-moralizing teachings, adapt interventions to adolescents’ limited attention span and avoiding the use of long-term health benefits as a motivator.

Introduction: Driving is an important activity for the social participation of young people with physical and cognitive disabilities. Learning to drive, however, presents difficulties for this population. Innovative services have been developed in the province of Québec, Canada, but the extent to which they are evidence-based is not known nor are optimal parameters for learning to drive. Objectives: The aims of this study were to 1) explore users' views and preferences with respect to learning to drive; 2) create indicators based on science, experience, and users' views and preferences that can be used to evaluate driver education programs; and 3) use these indicators to measure the gaps between knowledge and practice in an existing adapted driver education program. Method: Based on an integrated knowledge translation model, this study used a qualitative and quantitative design consisting of three steps: 1) focus group meeting and telephone interviews with users, 2) definition and validation of criteria and indicators, and 3) chart audit. Results: 1) Users' needs and expectations were documented from the focus group meeting and three interviews. 2) Building on the results of step 1 and a review of the literature, including expert opinions on adapted driver's education, 34 quality indicators were created. These indicators were supported by information from the literature (42%), expert opinions (33%), and users' views (25%). 3) Forty charts from an existing program were audited and showed that the indicators are relevant to evaluate the quality of this type of program. Conclusion: These preliminary indicators were created to facilitate the implementation of new evidence-based adapted driver education programs. This entire initiative will make it easier for young adults with disabilities to obtain a driver's licence, which will ultimately foster more satisfactory social participation.

The electronic Driving Observation Schedule (eDOS) is a novel approach to assessing older drivers’ performance in their everyday driving environment on their chosen routes. The original eDOS total score is generated using the count of driving errors, which does not account for distinct risk levels of different types of driving errors made in different complexity of driving environments. This study was conducted to create one score to represent the complexity of driving route during each eDOS observation and one weighted eDOS total score to represent older drivers’ performance accounting for the risk of driving errors by their type and the complexity of maneuvers in their corresponding environments. A literature review, a two-round survey with 13 experts in driving evaluation, and iterative discussions between primary investigators were conducted for generating these scores. Two formulae were created to calculate a weighted maneuver/environmental complexity score and a weighted eDOS total score. • An advanced weighted score is created to represent one’s on-road driving performance in their everyday driving environment not only using the count of driving errors, but also accounting for the risk level of each error. • The complexity of driving maneuver and environment in each on-road driving trip can be systematically rated.

Introduction: Driving an automobile is an important activity for the social participation of individuals with traumatic brain injury (TBI). Return to safe driving is usually addressed during rehabilitation, but we know little about driving behaviors in the years following TBI rehabilitation.Objective: To explore self-reported and objective (official driving records) post-rehabilitation driving behaviors and offenses in individuals with TBI: (a) having passed a driving evaluation, (b) who did not undergo a driving evaluation, and (c) non-injured controls.Methods: Cross-sectional design with 162 adults: (a) 48 participants with mild, moderate, or severe TBI whose drivers' license was suspended and reinstated following a driving evaluation during rehabilitation (TBI-DE; M = 42.2 years of age, SD = 11.5); (b) 24 participants with TBI who maintained their driving privileges without undergoing a driving evaluation (TBI-NE; M = 36.5 years of age, SD = 9.9); (c) 90 non-injured controls (M = 43.8 years of age, SD = 11.4). Participants with TBI were recruited from seven rehabilitation centers, 2–3 years after the end of rehabilitation in the province of Quebec, Canada. During a telephone interview, data were obtained regarding self-reported driving: (a) habits; (b) self-efficacy; (c) anger expression; (d) sensation-seeking; (e) violations/errors; (f) accidents, driving offenses, and demerit points for the two-year interval predating the study. Objective data for driving offenses, accidents, and demerit points were obtained from the automobile regulatory body for the same period and for the two-year interval before the injury for the TBI groups.Results: Compared to non-injured controls, the TBI-DE group reported significantly lower scores for self-reported verbal aggressive expression of anger and driving violations/errors. Conversely, their official driving records showed significantly more demerit points for the last 2 years, and a significantly higher frequency of serious post-rehabilitation accidents (10), compared to the TBI-NE group (one) and the control group (none). Compared to pre-injury levels, individuals with TBI had significantly more demerit points post-rehabilitation.Conclusions: Individuals with TBI may underestimate risky driving behaviors even if they have been deemed fit to drive. Reduced self-awareness, memory, and dysexecutive problems following TBI could influence self-report of driving behaviors and explain discrepancies between self-reported and objective driving-related behaviors. Recommendations for research and practice are provided.

The Decisional Balance Scale (DBS) was developed to assess older adults’ attitudes related to driving and includes both intra- and inter-personal motivations for driving. The current study examines the DBS in a sample of older drivers from Australia (n = 257). Longitudinal evaluation of the DBS subscales revealed that changes in attitudes covary with changes in self-regulatory driving practices across 6 annual assessments. Specifically, negative attitudes related to inter-personal motivations for driving (con-other) were associated with participants’ scores on the Situational Driving Frequency (SDF) scale. Negative attitudes related to intra-personal motivations for driving (con-self) were associated with participants’ scores on the Situational Driving Avoidance (SDA) scale. These findings highlight the importance of considering attitudes in understanding older drivers’ decisions to regulate their driving practices.

To date, there is no consensus on how to assess functional impairment in individuals with mild cognitive impairment (MCI), and this lack of consensus is reflected in the clinical practice. Since the criterion used in the literature is very vague, clinicians are still left without much guidance in this area. Thus, the main goal of this study was to examine how functional impairment in individuals with MCI has been assessed in the literature. An electronic database search strategy was developed in consultation with an experienced librarian. Four databases (CINAHL, PsycINFO, PubMed, and MEDLINE) were searched from 2000 to May 2014 to provide a comprehensive coverage of the literature. The literature search yielded 14 tools that assessed functional impairment in MCI. Among those, nine tools were performance-based measures in which participants were observed while executing a task in a simulated environment using real life material. In terms of questionnaires (either informant- or self-reports), five tools were found. Different functional domains have been assessed in each tool. According to this review, the characteristics of the instruments used in the literature to assess functional impairment in individuals with MCI vary greatly. Nonetheless, results of this study allow clinicians to make better-informed decisions when choosing a functional assessment for this population.

Introduction. After a mild traumatic brain injury (mTBI), individuals quickly resume driving. However, relatively little is known about the impact of mTBI on driving ability and, notably, on the perceived influence of postconcussive symptoms on driving. Hence, the objective of this study was to document the perception of driving abilities in individuals with mTBI. Method. Twenty-seven drivers with mTBI were interviewed to document their perception regarding their driving abilities. Both driving-related difficulties and compensatory strategies used to increase driving safety were documented. A mixed quantitative and qualitative analysis of the data was completed. Results. 93% of participants reported at least one difficulty perceived as having an impact on everyday activities. Most frequently named problems affecting driving were fatigue and reduced concentration. In addition, 74% of participants had adapted their driving or developed strategies to compensate for driving difficulties. Discussion/Conclusion. Postconcussive symptoms have repercussions on driving ability. However, people with mTBI tend to be aware of their difficulties and develop, over time, adaptive strategies. Preventive measures are thus warranted to increase health care professionals' awareness of the potential consequences of mTBI on driving ability and to promote guidelines for the safe resumption of driving after injury.

The nature of relationships between service providers and parents of children with disabilities influences the health and wellbeing of parents and ultimately the quality of life of their children. The aim of this study was to explore parents' perceptions of their partnerships with service providers. We explored what was and was not working within these service relationships and solicited ideas for improved partnerships and services. We employed a qualitative, participatory research approach and adapted the Reflexive Methodology of Analysis in Partnership developed by Boudreault and Kalubi (2006). Thematic analysis and critical interpretation of the statements created in two focus groups by eight parents of nine children with disabilities generated eight themes: system complexity; funding; communication; navigation and advocacy; education; segregation; emotional support; and connecting with parents. Parents described difficulties in mediating partnerships in an ineffective disability service system and proposed practical solutions to these problems. We suggest that the structure of the disability service system is the root of these problems and must be radically changed to realize true partnership and client-centered services. Implications from this study for policy and practice include transforming the structure of the system, streamlining the organization and location of service information and delivery, including parents on decision-making bodies, and creating spaces for mutual peer support for parents of children with disabilities.