Shikha Gupta

Background: The COVID-19 pandemic and related public-health measures, including physical distancing and the use of personal protective equipment (PPE), disrupted routine healthcare communication and care delivery for older adults with combined hearing and vision loss, or dual sensory loss (DSL). Around 1.1 million older Canadians are living with DSL and rely on multimodal communication to support assessment and continuity of care. Objectives: This study explored healthcare professionals’ (HCPs) perspectives on older adults with DSL accessing health services and information, and providers’ challenges delivering care during and after COVID-19. Methods: Following a nationwide online survey with 228 HCPs in Canada, in-depth qualitative interviews were conducted with 24 survey respondents to obtain their insights. Data were analyzed using qualitative content analysis. Results: HCPs reported that the pandemic introduced novel challenges due to the lack of training and technical resources to facilitate healthcare communication with their patients with DSL. HCPs faced difficulty in clinical assessments and diagnosis due to restrictions while using PPE, such as masks. Participants reported strategies such as alternative formats, use of gestures or pictures, assistive devices, and caregiver support and accompaniment that helped provide services to older adults with DSL. Conclusions: Study findings suggest that older adults with DSL were underserved during the pandemic and underscore the need for continuing education/training on DSL for HCPs in order to provide better care to this group.

Individuals with spinal cord injury deal with multiple health complications that require them to use many medications. The purpose of this paper was to find the most common potentially harmful drug...

Introduction: Academic writing is a core element of a successful graduate program, especially at the doctoral level. Graduate students are expected to write in a scholarly manner for their thesis and scholarly publications. However, in some cases, limited or no specific training on academic writing is provided to them to do this effectively. As a result, many graduate students, especially those having English as an Additional Language (EAL), face significant challenges in scholarly writing. Further, faculty supervisors often feel burdened by reviewing and editing multiple drafts and find it difficult to help and support EAL students in the process of scientific writing. In this study, we explored academic writing challenges faced by EAL doctoral students and faculty supervisors at a research intensive post-secondary university in Canada.Methods and Analysis: We conducted a sequential explanatory mixed-method study using an online survey and subsequent focus group discussions with EAL doctoral students (n = 114) and faculty supervisors (n = 31). A cross-sectional online survey was designed and disseminated to the potential study participants using internal communications systems of the university. The survey was designed using a digital software called Qualtrics™. Following the survey, four focus group discussions (FGDs) were held, two each with two groups of our participants with an aim to achieve data saturation. The FGD guide was informed by the preliminary findings of the survey data. Quantitative data was analyzed using Statistical Package of Social Sciences (SPSS) and qualitative data was managed and analyzed using NVivo.Discussion: The study findings suggest that academic writing should be integrated into the formal training of doctoral graduate students from the beginning of the program. Both students and faculty members shared that discipline-specific training is required to ensure success in academic writing, which can be provided in the form of a formal course specifically designed for doctoral students wherein discipline-specific support is provided from faculty supervisors and editing support is provided from English language experts.Ethics and Dissemination: The general research ethics board of the university approved the study (#6024751). The findings are disseminated with relevant stakeholders at the university and beyond using scientific presentations and publications.

Purpose: The objectives of this study were to determine the effects of hearing disability on employment rates; examine how various factors are associated with employment; and identify workplace accommodations available to persons with hearing disabilities in Canada. Material and methods: A population-based analysis was done using the data collected through the 2017 Canadian Survey on Disability (CSD), representing 6 million (n = 6 246 640) Canadians. A subset of the complete dataset was created focusing on individuals with a hearing disability (n = 1 334 520). Weighted descriptive and multivariate logistic regression analyses were performed. Results: In 2017, the employment rates for working-age adults with a hearing disability were 55%. Excellent general health status (OR: 3.37; 95% CI: 2.29–4.96) and daily use of the internet (OR: 2.70; 95% CI: 1.78–4.10) had the highest positive effect on the employment rates. The top three needed but least available accommodations were communication aids (16%), technical aids (19%), and accessible parking/elevator (21%). Conclusion: Employment rates for persons with a hearing disability are lower than the general population in Canada. Employment outcomes are closely associated with one’s general health and digital skills. Lack of certain workplace accommodations may disadvantage individuals with a hearing disability in their employment.

Background: Many individuals with disabilities face barriers to meaningful employment. Legislation has been put in place to ensure employment equity for individuals with disabilities in Canada. However, little is known about the employment profile and experiences of people with seeing disabilities. Objectives: The objectives of our research study were to explore the employment rates of people with seeing disabilities in Canada, the factors associated with being employed, and supports and barriers that affect their work participation. Methods: We used the nationally representative data from the Canadian Survey on Disability (CSD) 2017, collected by Statistics Canada. The CSD is a national cross-sectional survey of Canadians 15 years of age and above who face a functional limitation due to a health-related condition, representing more than 6 million (n = 6,246,640) Canadians. Our analyses focused on people who reported having a seeing disability. A subset of the complete dataset was created, focusing on individuals with a seeing disability. Weighted descriptive analyses were performed using SPSS. Multivariate logistic regression analyses were conducted for individuals between 25–64 years of age to identify predictors of employment. Results: Out of the estimated 892,220 working-age adults (25–64 years) with a seeing disability who were represented by the survey, 54% were employed, 6% were unemployed and 40% were not in the labour force. Early onset of seeing disability (OR: 1.33; 95% CI: 1.32–1.35), less severe seeing disability (OR: 1.51; 95% CI: 1.49–1.53), education above high school (OR: 2.00; 95% CI: 1.97–2.02) and daily use of the internet (OR: 2.46; 95% CI: 2.41–2.51) were positively related with employment. The top three employment accommodations that were needed and were made available included: modified work hours (45%); work from home (38.5%) and a modified workstation (37%). The top three needed but least available accommodations were technical aids (14%), communication aids (22%) and a computer with specialized software or adaptation (27%). Overall, 26% reported that an accommodation was required but was not made available by the employer. While 75% of individuals with a seeing disability were out of the labour force due to their condition, the remaining identified barriers that prevented them from working which included (top 3): (i) too few jobs available (20%); (ii) inadequate training/experience (19%), (iii) past attempts at finding employment were unsuccessful (19%). Conclusion: Adults with seeing disability in Canada experience lower labour force participation than the general population. Rigorous programs are required to assist them with the job search, job retraining and workplace accommodations. It is important for governments to improve efforts towards inclusive education and develop strategies that promote digital literacy of employees and job seekers with visual impairments. Although accessibility legislations have been put in place, programs should be established that provide accessibility solutions for various employers, enabling them to hire individuals with different abilities.

Study design Observational cross-sectional study. Objectives To describe the most common prescription medications used and the extent of out-of-pocket cost, insurance coverage, and cost-related nonadherence (CRNA) for those medications by people with spinal cord injury (SCI) in Canada. Setting Community in Canada. Methods It was an observational study wherein data were collected through a cross-sectional online survey from individuals living with an SCI in Canada. We used descriptive statistics to describe the extent of drug cost, insurance coverage and CRNA among study sample, and analytical statistics to find association of CRNA with sociodemographic, injury-related and medication-related characteristics of the sample. Results Individuals with an SCI (n = 160) used an average of five medications and spent a median of $49 (interquartile range: $234.75) per month on their medications. More than 90% of participants had some form of drug insurance, though 37% reported CRNA. The most common medications that were forgone due to cost included opioids, antidepressants, and drugs for genitourinary and muscular spasms. Individuals with paraplegia and nontraumatic SCI had higher drug costs, though injury-related characteristics did not influence CRNA. Sex, monthly drug expenditure, and monthly additional healthcare costs were significantly associated with CRNA. Conclusions People with SCIs are at risk of experiencing CRNA to their prescription medications despite having insurance coverage. Decision makers for the national pharmacare in Canada should account for their concerns judiciously.

Despite the abundant literature on the burden of rising costs of prescription medications, there is limited research to explore how these costs affect people and the decisions they are forced to make within the context of disability. In this qualitative study we explored strategies adopted, factors influencing, and the impact of some of these strategies to manage the burden of medication cost among persons with disabilities. We interviewed 12 adults with spinal cord injuries living in Canada, using a general inductive approach to analyze the data. We found that before cutting back on medications due to costs, participants generally tried and sought help from the government, employers, and/or their prescribers to improve their drug coverage. The key factors that participants considered while making decisions on the strategies included the cost and perceived importance of medications, their financial status, other competing needs, and their relationship with the prescribers. While some of their efforts were successful, many participants were still not able to obtain their medications as prescribed. In those cases, patients resorted to rationing strategies such as cutting back on medications, other essential needs, or selling assets. These strategies had serious implications on their health, healthcare utilization, and quality of life.

Despite emerging evidence on cost-related nonadherence (CRNA) to prescription medications, there is little conceptualization and exploration of this phenomenon with respect to disability. Specifically, there is a gap in the literature that explores factors influencing medication cost–adherence relationship among individuals living with a disability. To advance research on and policy for CRNA to medications among people with disabilities, we need a framework that can contribute towards guiding solutions to this problem. We examined the applicability of Piette and colleagues’ existing model for CRNA to the context of people with disabilities and suggested an adapted model (CRNA to medications for persons with disability [CRNA-d]) that can provide a more specific conceptualization of CRNA with respect to disability. The adapted CRNA-d model depicts that CRNA to prescription medications with respect to disability is a dynamic and multifaceted phenomenon, determined by various socioeconomic, disability-related, medication-related, prescriber-related, and system-related factors. We discuss how higher susceptibility to health complications, barriers to income and employment, additional health care costs, the complexity of medical regimens, limited access to physician services, and other policy-related factors increase the risk of persons with disabilities to face cost-related barriers to fulfill their necessary medications.

Background: Various injury characteristics such as cause, level, severity, and time since injury divide individuals with spinal cord injury (SCI) into many subgroups. The heterogeneity among individuals' injuries and personal characteristics has significant implications for SCI rehabilitation practice, specifically directed toward community reintegration, which is a key goal of rehabilitation interventions for people with disabilities. Purpose: This study aims to summarize the evidence on attributes that make the SCI population heterogeneous, the impact of these attributes on community reintegration, and the implications of heterogeneity for rehabilitation interventions directed toward optimizing community reintegration. Methods: We used an integrative review approach to conduct this study. MEDLINE, PubMed, CINAHL, EMBASE, Google Scholar, and PsycINFO were searched from inception until May 2017. Out of 670 articles retrieved, 49 provided evidence on the impact of various attributes that make SCI heterogeneous on rehabilitation outcomes related to community reintegration. Results: An array of injury-related, personal, social, and environmental factors are associated with various rehabilitation outcomes that affect community reintegration of people with SCI. There is level 1 evidence that social support, self-efficacy, and self-esteem facilitate community reintegration among people with SCI while there is level 5 evidence that presence of psychological or medical complications decreases it. There is lack of clarity on the impact of injury-related factors on community reintegration. Conclusion: This integrative review found that social support and individuals' self-efficacy can improve community reintegration of people with SCI. However, evidence regarding the impact of injury characteristics on community reintegration is still underdeveloped. Approaches directed at community reintegration should involve components of psychosocial, physical, and vocational rehabilitation while considering personal and societal aspects of an individual's life.