西方残障身份发展理论述评及本土化思考

积极的残障身份认同对残障者本身具有重要意义,残障身份发展是残障者实现身份认同的路径,理解残障身份发展的过程也可以让残疾人工作者更好地为残障者提供教育、康复等相关服务。本文通过梳理较为典型的西方残障身份发展理论,结合国内残障身份相关研究及本土社会文化背景展开讨论。文章认为,在西方残障身份发展理论框架下,残障者形成积极身份认同的关键在于认同并融入一套在残障社区内共享的残障文化,而在我国社会文化背景下,目前并没有一套成体系的残障文化,残障者也难以体会残障的文化身份感,国内残障者的身份认同缺少本土残障文化依靠。     

The impact of function on work status for community dwelling disabled persons with arthritis: an analysis of the National Health Interview Survey Disability Supplement

Arthritis is one of the most common diseases and a leading cause of disability in adults. Returning injured workers to work and preventing work disability is the primary mission of occupational health professionals. The purpose of this study was to identify risk factors associated with work disability and intervention strategies. This study is a retrospective cohort analysis of secondary individual level data. The data for the study were collected by the National Health Interview Survey, Disability Supplement (NHIS-D) 1995. Community dwelling disabled persons with functional limitations due to arthritic conditions were included in this analysis. A total of 286 records were available for logistic regression analysis. The outcome variable was work status, either working or not working. The significant predictors of working status were ability to lift 10 pounds (OR = 1.64), college education (OR = 0.21), age (OR = 1.03), and less than high school education (OR = 2.48). Thirty-four percent of the variance in working status was explained by the model that also included health status, difficulty standing, difficulty walking up steps, difficulty walking 1/4 mile, ethnicity, and gender. Younger disabled persons with arthritis, who have little difficulty lifting 10 pounds, and have some college education have better odds of working. Occupational health professionals need to look for ways to improve the educational status and functional lifting ability of disabled individuals with arthritis.     

When do older adults become "disabled"? Social and health antecedents of perceived disability in a panel study of the oldest old

Disability carries negative social meaning, and little is known about when (or if), in the process of health decline, persons identify themselves as "disabled." We examine the social and health criteria that older adults use to subjectively rate their own disability status. Using a panel study of older adults (ages 72+), we estimate ordered probit and growth curve models of perceived disability over time. Total prevalent morbidity, functional limitations, and cognitive impairment are predictors of perceived disability. Cessation of driving and receipt of home health care also influence older adults 'perceptions of their own disability. A dense social network slowed the rate of labeling oneself disabled, while health anxiety accelerated the process over time, independent of health status. When considering perceived disability, the oldest old use multidimensional criteria capturing function, recent changes in health status and social networks, and anxiety about their health.     

Delivery of dental care to persons with disabilities and other special populations

Although humankind has long suffered from dental ills, and despite progressive efforts by the field of dentistry to provide dental healthcare in a compassionate and anxiety-free manner, the profession of dentistry has suffered a tarnished reputation. Going to the dentist is considered painful and induces fear among most people; however, this mindset is changing. Dentists of today are beginning to take their rightful place as integral members of the health care team, including disability management initiatives. The public and other health care providers are beginning to recognize the importance of oral health to the overall health of the body. Dental care is a vital component to rehabilitation planning. Unfortunately, some government agencies, insurance companies, and other policy making bodies have failed to grasp the importance of this concept. Also, professionals within the field of dentistry have not fully grasped the important of continued dental care for persons with disabilities, geriatric patients, the deinstitutionalized, and others in need of rehabilitation services. Problems associated with the delivery of dental care to patients with disabilities are discussed.     

Creating Disability in the Home: the role of environmental barriers in the United States

One thousand persons with disabilities were sampled to discover the types of barriers they encountered in their home while carrying out their daily activities. A 43 percent response rate was obtained. The open-ended questions were submitted to a process of analytic coding and suggested 27 different categories of barriers existed in the homes of persons who have disabilities. The findings have implications for rehabilitation practice. Performance of daily activities is greatly diminished by the presence of architectural barriers. Environmental supports can greatly improve performance in daily tasks. These findings are discussed in light of disability policy and implications for improving performance of persons who have disability.     

Spinal Cord Injury

ABSTRACT

This article provides an overview of spinal cord injury (SCI) that is useful and informative for social workers and other health care professionals who work with this population. Social workers new to the specialty of spinal cord injury must expand their knowledge base of this chronic injury. Social workers contribute to the rehabilitation process through assessment, education, and discharge planning. This article also may be used to inform persons with spinal cord injury and their families and to encourage them to engage in dialogue about SCI in the earliest stages of treatment and rehabilitation.     

High incidence of disability pension with a psychiatric diagnosis in western Sweden. A population-based study from 1980 to 1998

Regional differences in Sweden in the prevalence of disability pension with a psychiatric diagnosis are unexplained, in spite of the significant impact on the population's health, rehabilitation systems, and the health care system. The purpose of this study was to describe the pattern of disability pensions with a psychiatric diagnosis and to analyze the impact of age and gender. We examined the incidence rates in one urban and one semi-rural region and compared these to national rates. The study sample was drawn from employed persons between 16-64 years of age who, because of their sickness insurance coverage, would be eligible to access disability pensions should it be necessary. Analysis of annual incidences and standardized morbidity ratios were made for 1980, 1985, 1990, 1995, and 1998. Data on disability pension cases were collected from the National Social Insurance registers. In the urban region we found that the proportion of men and women clearly outnumbered the national average: approximately twice the number of persons between 16-64 years of age with a psychiatric diagnosis were receiving a disability pension. In the semi-rural region there were fewer men overall on disability pensions with psychiatric disorders, but in 1980, 1985, and 1995 women clearly outnumbered men. Access to psychiatric care, unemployment, alcohol dependence, and previous sickness absence are suggested as possible factors that might affect the rates of disability pension in different geographical settings.     

Disability pension among adult former child welfare clients: A Swedish national cohort study

Using longitudinal register data on all persons born in Sweden 1973–1978, we report on prevalence of disability pension among young adults who were child welfare clients during their formative years, and explore risk factors for this long-term outcome. For most child welfare subgroups, prevalence approached or exceeded ten percent. Multivariate logistic regression analyses found high crude odds ratios of disability pension among child welfare alumni. These were substantially reduced – but not obliterated – after adjustments for a host of background factors. Decomposition analyses revealed that child welfare alumni’s poor school performance and low educational attainment accounted for most of the confounding effects. We also found that child welfare clients with a disability pension had far higher rates of psychosocial problems in their adult lives than other peers with a disability pension.Child welfare alumni should be regarded as a high risk group for future disability pension and for permanent exclusion from the labor market. Rates of suicidal behavior in adult age were extreme among some subgroups of child welfare alumni with a disability pension, which should be communicated to agencies who are likely to meet these groups (eg. primary health care).     

Utilizing research in professional practice

A review of the rehabilitation, disability studies, and allied health literature suggests the presence of numerous factors that impede the utilization of research by practitioners. The purpose of this article is to describe these factors and offer potential solutions that could enable rehabilitation professionals to integrate research findings into their practice. Specifically, the authors recommend strategies to (a) contextualize research throughout pre-service curricula, (b) establish researcher-stakeholder partnerships, (c) increase the accessibility of research to practitioners, and (d) establish professional and peer support for implementing research in field practice.     

A voice in the chorus: perspectives of young men of color on their disabilities, identities, and peer-mentors

With the rise of violence during the 1990s, the number of persons who acquired a spinal cord injury as a result of gunshot trauma increased dramatically in the United States. This qualitative study examined disability, race, and contribution of peer-mentors to the development of identity. Six men with a violence-related spinal cord injury participated in a focus group. They were injured for at least two years, making positive gains in their lives, and training to become peer-mentors at a rehabilitation hospital. In addition, 16 men with a newly-acquired spinal cord injury from gunshot trauma participated in an individual interview. These sixteen participants were all mentees (or recipients) of the peer-mentor program. Principles of grounded theory were used to code and analyze data. Data converged on three main themes: (1) disability viewed as a wake-up call or blessing, (2) disability viewed as a turning point, and (3) disability viewed as identity transforming.     

Children's perceptions of their disabled siblings: ‘she's different but it's normal for us’

This paper reports on a two‐year study exploring children's understandings of disability. It focuses on findings from interviews conducted with 24 children, aged 6 to 19, who had disabled siblings, exploring their perceptions of impairment, disability and difference. Most were very aware of their sibling's impairment but the majority did not see that as making their siblings different. Where difference was perceived, this was sometimes attributed to their siblings' experience of disability—unequal treatment and the hostile attitudes of others. Most children saw their disabled sibling as holding various identities and their shared biographies, as members of the same family, may have taken precedence over any perceived differences.     

The attitudes of medical professionals toward children and children at risk of separation from parents in Eastern Europe

This article reports the findings of a multi-country study of medical professionals' perceptions and evaluations of children. The primary aim of the study was to establish the perceptions medical professionals working in three Eastern European countries (Romania, Bulgaria, Moldova) hold toward children identified as “typical”, “at-risk” and “with disability”. A second aim was to explore the existence of country-level differences in medical professionals' perceptions of children. The third aim was to examine the pattern of associations between attitudes toward children and a change in use of institutional care to family and community-based alternatives. Over 800 respondents provided survey responses using paper-based and online returns. Findings indicated that positive affect toward children was associated with the favourability of attributes generated about “typical” children. In contrast, positive affect toward children was associated with less favourability toward at-risk children. Attribute favourability ratings generated for at-risk children were positively associated with attributes generated for children with disability. Differences were identified between respondents working across the three countries. No association was identified between attitudes toward children and endorsement of a statement supportive of de-institutionalisation as part of child protection reforms. These findings illuminate how children are conceptualised and understood by a group of medical professionals who hold considerable sway over decisions and recommendations about their relative risk and vulnerability.     

Prediction of future low levels of sickness absence among young persons sick listed with back, neck, or shoulder diagnoses

In recent years sickness absence has increased in most Western countries. Risk factors for sickness absence and disability pension have been emphasised in studies, while focus on factors predicting low sickness absence is very rare. This paper is an attempt to apply such a perspective in an 11-year prospective cohort study of young persons n = 213) who in 1985 were sick listed > or = 28 days with back, neck, or shoulder diagnoses. Having had no sick-leave spells > 14 days in 1992-1996 was used as the outcome measure. Sixty-nine persons (34%) had no such spells, with an unexpected similar proportion of men and women. Data on prior sick leave and demographic variables were analysed using univariate and multiple logistic regression. Factors that predicted low sickness absence were having prior low sickness absence, being a white-collar worker, and being married. We concluded that individuals with a history of low sickness absence have an increased odds for remaining in the work force after a single long sick-leave spell, and might need less attention in rehabilitation compared to persons with a history of high sickness absence. Focusing on low sickness absence led to different results than those discussed in previous studies on risk factors for disability pension.     

Parent-perceived Attitudes of Professionals: Implications for Service Providers

While parents' reactions to a diagnosis of disability in their child have been well documented, less is known of parents' reactions to the professionals who provide the diagnostic and support services used by parents. This study identified four major parameters within which the attitudes of professionals are perceived by parents of children/teenagers diagnosed as intellectually disabled. Comments of the 131 mothers and fathers interviewed helped to shed light on what they have expected of service providers, and suggest adjustments that may need to be made by professionals to the attitudes they convey in interaction with parents.     

Examining the structure of awareness and perceptions of groundnut aflatoxin among Ghanaian health and agricultural professionals and its influence on their actions

This study uses a modified health belief model (HBM) within a socio-economic framework to evaluate the influence of awareness and knowledge on actions to reduce aflatoxin (AF) contamination in groundnuts (peanuts). Data were collected in 2002 through a self-administered questionnaire from a sample of 367 individuals. Socio-economic factors affecting perceptions, awareness, knowledge, and action were examined using structural equation modeling. The perceived benefits of good quality groundnuts and/or groundnut products were the most important determinants of awareness and knowledge of AF among agricultural and health professionals in Ghana. Awareness, in turn, had a significant causal effect on the professionals’ decisions to take actions to increase the level of awareness of AF in the society. Demographic factors, such as gender and level of education significantly influenced knowledge of AF and the perception of the benefits of good quality groundnut. Type of profession had a significant influence on awareness and perceived seriousness of the AF problem. Education was a significant determinant of awareness of AF in groundnuts. The study generates important information for policy decision making when considering resource allocation to reduce food contamination in developing economies.     

Disabled People,Health Professionals and the Social Model of Disability: Can there be a research relationship?

The social model of disability is proposed as an alternative to models that have viewed disability as an individual, rather than a socio-political issue. The use of this model to guide both research theory and practice is proposed in order to equalise research power relationships, and involve and empower disabled people. Health professionals have traditionally reinforced the medical model of disability in both research and practice, and this has been seen as contributing to the oppression and marginalisation of disabled people. If the social model is to achieve wider dissemination, it would appear important to develop a dialogue between disabled people and health professionals. However, because of negative perceptions it can be difficult for health professionals to find an appropriate position in relation to disabled people, research and the social model of disability. While not denying the past, it appears essential to look at ways in which disabled people and health professionals can work together to overcome the oppression and marginalisation that has been linked to the provision of health services.     

The health belief model and the contraceptive behavior of college women: implications for health education

This study applied the "health belief model" in a comparison of the subjective perceptions, attitudes and beliefs between college women who were adequate or inadequate contraceptors. The 171 sexually active subjects were ascertained from clients of the Family Planning Clinic at the University of Illinois. A questionnaire was designed and tested to measure variables of perceived susceptibility to pregnancy, seriousness of unplanned pregnancy, benefits and barriers of contraceptive use. Inadequate contraceptors or risk-takers were defined as women who used no contraception, less effective methods such as rhythm, spermicides only or withdrawal, or effective methods sporadically. 49.5% of the subjects were risk-takers. Among the inadequate contraceptors, 17% were nonusers, 29% relied on ineffective methods, and 52% used effective methods sporadically. There was no difference between the 2 groups in their belief in seriousness of an unplanned pregnancy. The groups differed significantly in their perceived susceptibility to pregnancy (p.001). They also differed significantly in perception of overall costs and benefits of contraception (p.001), a score created by combining 12 questions on topics such as difficulty and embarrassment in obtaining contraceptives and inconvenience and awkwardness in dealing with them. There was a smaller significant difference (p.05) in a score termed "general use cost benefits," but no difference in a score called "method specific perceptions." These results were corroborated by a discriminate analysis which singled out the perceived costs and benefits and the perceived susceptibility variables as accurate predictors of the adequate contraceptor group. The health belief model showed considerable utility in explaining contraceptive behavior.     

From symptom recognition to services: how South Asian Muslim immigrant families navigate autism

This study examined the experiences of three South Asian Muslim immigrant families who have a young child with autism. It describes the early period of their child’s disability as the families encountered four critical issues in their lives: a complex disability, the culturally diverse conceptualizations of the disability, family‐professional dynamics in cross‐cultural encounters and the search for appropriate services. Analyses were based on interviews with parents, supplemented by 17 months of participant‐observation in homes and community. Parents narrated their experiences beginning with symptom recognition through help seeking, diagnosis and subsequent service provision. Results suggest that for these families the challenging process of diagnosing and ameliorating autism is complicated by their unique positioning within and between diverse meaning systems. Challenges include American health and education professionals’ misunderstandings of their family organization and linguistic practices, and difficulties in cross‐cultural communication with professionals. Implications for professionals are discussed.