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Disability and Culture. Universalism and Diversity
... Moreover, the bio-psycho-social approach highlights that environmental and cultural features can mediate the impact of physical conditions on the quality of life (Johnston & Pollard, 2001). Each community develops traditions and beliefs concerning body functions, causes, and treatment of diseases, and the impact of physical and mental impairments on the person's functioning (Ingstad, 1999;Simeonsson, Lollar, Hollowell, & Adams, 2000;?st?n et al., 2001). Social and family relationships, education and job opportunities, architectonic and interpersonal facilitators and barriers have a large effect on the quality of life of people dealing with suboptimal physical conditions (Meyers, Anderson, Miller, Shipp, & Hoenig, 2002). ...
... Moreover, the bio-psycho-social approach highlights that environmental and cultural features can mediate the impact of physical conditions on the quality of life (Johnston & Pollard, 2001). Each community develops traditions and beliefs concerning body functions, causes, and treatment of diseases, and the impact of physical and mental impairments on the person's functioning (Ingstad, 1999;Simeonsson, Lollar, Hollowell, & Adams, 2000;Üstün et al., 2001). Social and family relationships, education and job opportunities, architectonic and interpersonal facilitators and barriers have a large effect on the quality of life of people dealing with suboptimal physical conditions (Meyers, Anderson, Miller, Shipp, & Hoenig, 2002). ...
This study aimed at investigating the daily experience of adults with achondroplasia. From the perspective of positive psychology, the experience reported in work, family, and relationships was analysed to detect resources and opportunities for social integration and personal growth. Participants were ten women and eight men, members of AISAC–the Italian Association for the Knowledge and Study of Achondroplasia. Following a mixed method approach, quantitative data gathered through the Experience Sampling Method provided information on daily activities and their associated experience, while qualitative data obtained through the Flow Questionnaire and Life Theme Questionnaire enabled us to explore optimal experience and associated activities, participants' present challenges and future goals. Results highlighted the role of work as a key resource to achieving well-being. Interactions with parents and siblings provided support and relaxation, while building one's own family emerged as a major future goal. Participants associated socialising with highly positive experiences of involvement and creativity; however, they reported spending a large percentage of time alone. Findings suggested that challenging and qualified work opportunities are crucial in promoting the personal growth and social integration of persons with achondroplasia. Promoting socialisation and removing social and communication barriers should be major issues for policy makers, health professionals, and associations.
... Disability was defined in accordance with the World Health Organization (WHO) definition as "a complex phenomenon that manifests itself at the body, person or social level. According to this model, these three dimensions of disability are outcomes of interactions between health conditions, other intrinsic features of the individual and extrinsic features of the social and physical environment" [5]. ...
... It is therefore not surprising that other impairments, such as albinism or epilepsy, are only peripherally discussed. However, in some African contexts, these might well be considered disabilities due to social stigma [5,24-26]. This is a particular area of concern since many studies argue that disability is a social phenomenon and should be seen in this light. ...
This systematic review focuses on empirical work on disability and HIV/AIDS in Africa in the past decade and considers all the literature currently accessible. The review presents data from different surveys and summarizes the findings. In this way, it convincingly reveals that people with disabilities are very vulnerable to contracting HIV, and lack access to information, testing and treatment. The review further reveals gaps in the research and areas of concern. While vulnerability and accessibility have been investigated, there are few prevalence studies or evaluations available. A certain amount of work has focused on the deaf population, but little has been done for other disability groups. A growing area of concern is sexual abuse and exploitation of people with disabilities. Only a few studies or interventions focus on this crucial area.
... The concepts and definitions of disability change over time 1 and adapt more and more to an inter-sectoral context, beyond the mere health sector. From the perspective of human performance of the World Health Organization (WHO), disability is universal; it is part of the human condition and is not a purely biological or exclusively social phenomenon 2 . ...
Introduction: Low vision and blindness make up the visual disability, one of the types of disability with the highest worldwide prevalence, and apparently the most frequent at a Colombian level. The conventional etiology of permanent and transitory deficiencies responsible for visual impairment such as glaucoma, cataract, infectious blindness and uncorrected ametropias, may be changing due to the presence of other entities and results of public health programs, and it is necessary to extend the etiological spectrum to both Ophthalmological causes as not ophthalmological. Objectives: To identify the etiology and the most relevant clinical characteristics in an adult population with visual impairment. Materials and methods: Descriptive cross-sectional study in 96 adults with confirmed visual impairment. Results: 61% with low vision; in 55% the etiology of the visual deficiency was in the posterior segment, 21% in the anterior segment and 10% in the pathway and/or visual cortex. The most frequent individual pathologies: Pathological myopia, non-glaucomatous optic neuropathy, glaucoma and macular degeneration related to age. Conclusions: In this study, pathologies with posterior segment involvement occupied the most frequent etiologies related to visual disability, and the neuro ophthalmological and ocular trauma entities were identified as a potential source of visual deficiencies. It is necessary to continue carrying out studies that clarify whether the spectrum of conventional etiologies causing visual disability has changed, with the aim of redirecting programs of promotion, prevention, diagnosis, treatment and rehabilitation in low vision and blindness. © 2018 Sociedad Mexicana de Oftalmología. Published by Permanyer México SA de CV.
... Substance use disorders are highly stigmatised, with several studies reporting that these disorders are more stigmatised than other physical [6-8] and mental disorders [9-12]. For example, a cross-national study conducted by the World Health Organization (WHO) that examined 18 of the most stigmatised conditions (e.g., being a criminal, HIV positive, or homeless), ranked alcohol addiction as the fourth most stigmatised condition, while drug addiction was ranked as the most stigmatised condition [13]. Additionally, although persons with psychotic disorders are often viewed as dangerous and unpredictable, substance use disorders appear to elicit more stigmatising reactions than schizophrenia [14,15]. ...
Little research has examined attitudes towards people who use substances in low and middle income countries (LMIC). Therefore, the present study examined the attributions made by the general South African population about people who use substances and whether these attributions differ by the type of substance being used, the gender of the person using the substance, or the characteristics of the person making the attribution.
A convenience sample of 868 members of the general public was obtained through street-intercept methods. One of 8 vignettes portraying alcohol, cannabis, methamphetamine or heroin, with either a male or female as the protagonist was presented to each respondent. Respondents' attitudes towards the specific cases were investigated.
Respondents held equally negative views of the presented substances, with the exception of the cannabis vignette which was considered significantly less "dangerous" than the alcohol vignette. Respondents were more likely to offer "help" to women who use alcohol, but more likely to suggest "coercion into treatment" for men. Individuals who scored higher on the ASSIST were more likely to hold negative attitudes towards substance users and black African respondents were more likely to offer help to individuals who use substances.
The stigma associated with substance use in South Africa is high and not necessarily dependent on the drug of choice. However, a range of factors, including gender of the substance user, and ethnicity of the rater, may impact on stigma. Interventions designed to strengthen mental health literacy and gender-focused anti-stigma campaigns may have the potential to increase treatment seeking behaviour.
... Indeed, the research has provided further evidence of the way in which drug addiction is highly moralised, and has shown that primary healthcare practitioners are not exempt from this. This is perhaps not surprising given the widespread stigma and marginalisation experienced by drug using members of society [17,18]. In our study, there was much evidence of stereotypical views held of prescription drug misusers as 'addicts', with associated, often negatively portrayed, lifestyles and appearance. ...
Many health professionals engage in providing health services for drug users; however, there is evidence of stigmatisation by some health professionals. Prescription drug misusers as a specific group, may also be subject to such judgment. This study aimed to understand issues for primary care health practitioners in relation to prescription drug misuse (PDM), by exploring the attitudes and experiences of healthcare professionals with respect to PDM.
Tape-recorded interviews were conducted with a purposive sample of general practitioners (17), community pharmacists (16) and 'key experts' (18) in New Zealand. Interviews were transcribed verbatim and a thematic analysis undertaken. Participants were offered vouchers to the value of NZ$30 for their participation.
A major theme that was identified was that of two different types of patients involved in PDM, as described by participants - the 'abuser' and the 'overuser'. The 'abuser' was believed to acquire prescription medicines through deception for their own use or for selling on to the illicit market, to use the drugs recreationally, for a 'high' or to stave off withdrawal from illicit drugs. 'Overusers' were characterised as having become 'addicted' through inadvertent overuse and over prescribing, and were generally viewed more sympathetically by practitioners. It also emerged that practitioners' attitudes may have impacted on whether any harm reduction interventions might be offered. Furthermore, whilst practitioners might be more willing to offer help to the 'over-user', it seemed that there is a lack of appropriate services for this group, who may also lack a peer support network.
A binary view of PDM may not be helpful in understanding the issues surrounding PDM, nor in providing appropriate interventions. There is a need for further exploration of 'over users' whose needs may not be being met by mainstream drug services, and issues of stigma in relation to 'abusers'.
http://apps.who.int/iris/bitstream/handle/10665/43974/9788562599514_por.pdf;jsessionid=20F627C8BAEEBAD9C29D0E26CAC6918C?sequence=19
Health in the Biopsychosocial PerspectiveDisability as a Resource: Two ExamplesSuggestions and Warnings from Positive Psychology
Harms from alcohol experienced by someone other than the drinker have received increasing attention of late, but have not been compared to harms from others' drug use. The aim of the current study is to compare the reported harms that are attributable to the alcohol use of others to those attributable to drugs, distinguishing between different types of harm in order to highlight how reported harms may be influenced by perception and social standing of use of the substance.
Respondents aged 16-24 from Victoria, Australia, completed the Victorian Youth Alcohol and Drug Survey (n=5001), including questions on demographics, drug and alcohol consumption, on the types of harms they experienced attributable to drugs and alcohol, as well as harms they perpetrated after using drugs or alcohol.
For both drug and alcohol related harms, reports of harms loaded into two groups using multiple correspondence analysis: tangible harms such as assault, and amenity impacts such as being annoyed by people under the influence. Amenity impacts attributed to alcohol were more likely to be experienced by those who reported drug use and vice versa, while the tangible impacts were more likely to be reported by those who used both drugs and alcohol.
Reports of amenity impacts from others appear to be influenced by the perception of the drug in question more than tangible impacts such as assault. Particularly for amenity impacts, the greater stigma attached to drug use may make respondents more likely to consider themselves harmed by drugs than they would when compared to alcohol, something that needs to be taken into account when assessing harms by either alcohol or drugs.
Resumen
Objetivos
Explorar la perspectiva de los usuarios y analizar los factores que influyen en su vinculación en un programa de reducción de daños (REDAN) que presta los siguientes servicios: intercambio de jeringuillas, espacio educativo de calor y café, programa de mantenimiento con metadona, sala de consumo higiénico supervisado, espacio para la higiene personal y seguimiento sanitario y psicosocial. Este programa presenta la particularidad de estar integrado en un ambulatorio de drogodependencias situado en un recinto hospitalario.
Métodos
Estudio descriptivo realizado con metodología cualitativa. Se realizó un muestreo teórico. Se saturaron los contenidos mediante 12 entrevistas en profundidad y un grupo focal con ocho participantes. El análisis de la información se basó en la Grounded Theory. Las transcripciones literales fueron codificadas descriptivamente y luego se generaron categorías amplias. Este procedimiento se realizó en un principio por tres investigadores y finalmente un cuarto investigador trianguló la información.
Resultados
Emergen cinco dimensiones (accesibilidad, servicios, relación, localización e identidad) compuestas por diferentes temas valorados desde las expectativas y experiencias de los usuarios. La dimensión «identidad» otorga un elemento distintivo respecto a la vinculación con el programa.
Conclusión
En general, los usuarios valoran positivamente el programa REDAN. Respecto a la vinculación, describen aspectos facilitadores y otros deficitarios que pueden suponer barreras, frente a las cuales realizan sugerencias. Aspectos como la convivencia entre los usuarios del programa REDAN y los pacientes en tratamiento orientado a la abstinencia generan ambivalencia, pero se identifica que la gestión por parte del equipo minimiza estas dificultades.
Disability studies, with their direct challenge to theories of alterity, subaltern status and ideologies of domination, open up ways of examining cultural diversity that cannot otherwise be approached. This paper examines disability studies as a position from which multicultural studies can be interrogated, and through which critical questions about social hierarchies can be confronted. Given that national population policies and world-views underpin both multicultural and disability practices, an analysis which recognises this commonality seems overdue. The paper addresses the Australian environment, in which the politics of recognition, the nature of discourses of the normal, and the tensions generated in the politics of redistribution, merge in strategies adopted by the state to control the 'quality' of its population.
Of the 22,5 million people in Afghanistan about 800,000 are disabled (28%) mainly because of preventable diseases and mine accidents. Although these impressive data are supplied by surveys supported by the UN, the new Afghan Government does not have a clear population census. Italian Cooperation experts with the supervision of a team of the University of Rome “La Sapienza”, in collaboration with the non-governmental organization GVC - Civil Voluntary Group, have carried out a survey on health and health-related conditions as a pilot project. These conditions, considered as disability dimensions according to the biopsychosocial model, were studied in 65 schools of Kabul with a twofold purpose: to offer reliable information to the Afghan policy makers, and to validate the ICF classification in the school environment. About 1.300 questionnaires were distributed from which data were electronically entered.
Drawing on evolutionary psychological logic, we describe a model that links evolved mechanisms of disease-avoidance to contemporary prejudices against individuals with physical disabilities. Because contagious diseases were often accompanied by anomalous physical features, humans plausibly evolved psychological mechanisms that respond heuristically to the perception of these features, triggering specific emotions (disgust, anxiety), cognitions (negative attitudes), and behaviors (avoidance). This disease-avoidance system is over-inclusive: Anomalous features that are not due to disease (e.g., limb amputation due to accident) may also activate it, contributing to prejudicial attitudes and behaviors directed toward people with disabilities. This model implies novel hypotheses about contemporary variables that may amplify or reduce disability-based prejudice. We discuss past research within this context. We also present new evidence linking chronic and temporary concerns about disease to implicit negative attitudes toward and behavioral avoidance of disabled others. Discussion focuses on the conceptual and practical implications of this evolutionary approach.
To describe the development of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for measuring functioning and disability in accordance with the International Classification of Functioning, Disability and Health. WHODAS 2.0 is a standard metric for ensuring scientific comparability across different populations.
A series of studies was carried out globally. Over 65,000 respondents drawn from the general population and from specific patient populations were interviewed by trained interviewers who applied the WHODAS 2.0 (with 36 items in its full version and 12 items in a shortened version).
The WHODAS 2.0 was found to have high internal consistency (Cronbach's alpha, α: 0.86), a stable factor structure; high test-retest reliability (intraclass correlation coefficient: 0.98); good concurrent validity in patient classification when compared with other recognized disability measurement instruments; conformity to Rasch scaling properties across populations, and good responsiveness (i.e. sensitivity to change). Effect sizes ranged from 0.44 to 1.38 for different health interventions targeting various health conditions.
The WHODAS 2.0 meets the need for a robust instrument that can be easily administered to measure the impact of health conditions, monitor the effectiveness of interventions and estimate the burden of both mental and physical disorders across different populations.
Our aim was to assess the content validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) social health item banks by comparing a prespecified conceptual model with concepts that focus-group participants identified as important social-health-related outcomes. These data will inform the process of improving health-related quality-of-life measures.
Twenty-five patients with a range of social limitations due to chronic health conditions were recruited at two sites; four focus groups were conducted. Raters independently classified participants' statements using a hierarchical, nested schema that included health-related outcomes, role performance, role satisfaction, family/friends, work, and leisure.
Key themes that emerged were fulfilling both family and work responsibilities and the distinction between activities done out of responsibility versus enjoyment. Although focus-group participants identified volunteerism and pet ownership as important social-health-related concepts, these were not in our original conceptual model. The concept of satisfaction was often found to overlap with the concept of performance.
Our conceptual model appears comprehensive but is being further refined to more appropriately (a) distinguish between responsibilities versus discretionary activities, and (b) situate the outcome of satisfaction as it relates to impairment in social and other domains of health.
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