case study of an individual with disability in hindi

Disability Discourse in Hindi Literature

A review of jeevan sangram ke yoddha: divyang patron ki prasiddh kahaniyan, edited and collected by sandhya kumari.

Santosh Kumar CHRIST (deemed to be University)

Author Biography

Santosh kumar, christ (deemed to be university).

English and Cultural Studies

Assistant Professor

Anand, S. (2013). Historicising disability in India: Questions of subject and method. In R. Addlakha (ed.), Disability Studies in India, New Delhi: Routledge India, pp. 35-60.

Chander, J. (2016). Disability of language: Disabled peoples are not blessed with divine organs, Language and Language Teaching, 5(2). pp. 34-37.

Ghai, A. (2012). Engaging with Disability with Postcolonial Theory. In: D. Goodley, B. Hughes, L. Davis, (eds.) Disability and Social Theory, London: Palgrave Macmillan. https://doi.org/10.1057/9781137023001_16

Kawale, R. B. (2013). Swatantrayotar Hindi Katha Sahitya me Vikalng Charitra, Ph.D. Thesis, Unpublished. Dr. Babasaheb Ambedkar Marathwada Viswavidhalaya, Aurangabad. Shodhganga.

Kumar, S. (2018). A Sociolinguistic Analysis of Stereotypes, Prejudices and Discrimination of Gender and Disability in Talk and Text. Ph.D. Thesis, Unpublished, University of Delhi.

Kumari, S. (2019). Jeevan Sangram Ke Yoddha: Divyang Patron ke Prasiddha Kahaniyan, Delhi: National Book Trust.

case study of an individual with disability in hindi

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v.11; 2020 Aug

Multidimensional poverty and disability: A case control study in India, Cameroon, and Guatemala

Mónica pinilla-roncancio.

a School of Medicine, Department of Public Health, Universidad de los Andes, Carrera 7 # 116 -05, Bogotá, Colombia

Islay Mactaggart

b International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom

Hannah Kuper

Carlos dionicio.

c National Council on Disability, Guatemala City, Guatemala

Jonathan Naber

G.v.s. murthy.

d Indian Institute of Public Health, Hyderabad, India

e Department is Clinical Research, Infectious Tropical Diseases Faculty, London School of Hygiene & Tropical Medicine, London, United Kingdom

Sarah Polack

Associated data.

Although the association between disability and multidimensional poverty has been consistently found in several studies in Low- and Middle-Income Countries. None of these studies so far has used an extended and internationally comparable questionnaire (extended Washington Group Questionnaire) and a clinical screening of disability. The purpose of this article is to calculate, compare and analyse the levels of multidimensional poverty of people with and without disabilities in Guatemala (national), in one district of Cameroon (Fundong Health District, North West Cameroon) and in one district in India (Mahbubnagar District, Telangana State). We used a case-control study approach; adults with disabilities identified in a population-based disability survey using the Washington Group Extended Questionnaire were matched to age-sex matched controls without disabilities and interviewed about their levels of access and use of different social services. Following the Alkire-Foster method, the levels of multidimensional poverty between cases and control were computed and compared. Additionally, we analysed how disability and other individual characteristics are associated with being poor in each country. The results showed that people with disabilities in all three-study settings face significantly higher levels of poverty and the intensity of their poverty is higher. In the case of Cameroon, differences in the levels of deprivation between people with and without disabilities were smaller than those observed in India and Guatemala. This might suggest that in countries with higher levels of human, economic and social development people with disabilities are being left behind by public policies aiming to reduce poverty and deprivation in basic indicators. In addition, indicators related to health contributed the most to the levels of multidimensional poverty for people with disabilities. These findings provide important evidence about the association of multidimensional poverty and disability and underline the importance of including indicators capturing individual deprivations to analyse poverty for this group.

• Case control study analysing the levels of multidimensional poverty of people with and without disabilities in one province of India, Cameroon and in Guatemala.
• People with disabilities in the three countries have higher levels of multidimensional poverty and deprivation.

Introduction

It is estimated that around 15% of the global population lives with any type of disability ( Mitra & Sambamoorthi, 2014 ; World Health Organization & The World Bank, 2011 ) and 80% of those, live in Low and Middle Income Countries (LMICs) ( World Health Organization & The World Bank, 2011 ). Understanding the relationship between disability and poverty has gained increasing attention in the development literature ( Banks, Kuper, & Polack, 2017 ). The Sustainable Development Agenda 2030 for the first time recognises people with disabilities as a vulnerable group and the importance of measuring poverty on all its dimensions. These two aspects have increased the visibility of people with disabilities in the development agenda and also have made a call to calculate and analyse the levels of multidimensional poverty of this group ( Inter-Agency and Expert Group on Sustainable Development Goal Indicators, 2016 ). Currently, there are no official estimates of how many people with disabilities are income or multidimensionally poor globally, nor about the severity of their poverty. However, different studies have shown that people with disabilities have higher levels of income poverty, based on international or national income poverty lines ( United Nations, 2018 ) and they are recognised as one of the poorest group in a society ( Chronic Poverty Advisory Network, 2014 ; World Health Organization & The World Bank, 2011 ).

Disability and poverty are related in a bidirectional manner ( Yeo & Moore, 2003 ). On the one hand, people with disabilities have a higher risk of becoming poor given their lower levels of access to health care, education, employment, and social participation. On the other hand, poor individuals are more likely to become disabled, as a result of their lack of access to preventive health care services, undernutrition and their riskier living conditions ( United Nations, 2018 ; World Health Organization & The World Bank, 2011 ; Yeo & Moore, 2003 ).

Poverty is understood and measured from different theoretical and methodological perspectives. On one hand, it is possible to measure poverty as the lack of income or consumption that a household has (monetary or indirect measures). On the other hand, poverty is related to the lack of access to basic services and opportunities (non-monetary or direct measures) ( Ringen, 1988 ). Under the last perspective to measure poverty (direct measures). different approaches have been proposed, including the Capability Approach. This approach aims to capture non-monetary aspects of poverty, understanding that poverty goes beyond income, and it is related to the lack of access to practical opportunities, which limits the possibilities that an individual has to live the life she or he wants and values ( Sen, 2009 ).

Under the capability approach, disability has been identified as a situation that limits the access to practical opportunities among people with impairments ( Mitra, 2006 ). People with disabilities are in high risk of poverty, given the difficulties to convert their income into practical opportunities and also the extra needs they face ( Sen, 2009 ).

When talking about the relationship between disability and poverty, aspects related to the type and number of practical opportunities of people with disabilities should be considered. Evidence suggests that people with disabilities face lower opportunities to access education, health, employment and have lower levels of social and political participation ( Baart & Taaka, 2018 ; Mactaggart et al., 2018a ; Mactaggart et al., 2018b ; Mitra, 2018a ; Mizunoya, Mitra, & Yamasaki, 2018 ; Sakellariou & Rotarou, 2017 ; Trani, Bakhshi, Brown, Lopez, & Gall, 2018 ; United Nations (UN), 2018 ). In addition, people with disabilities and their families face extra direct (e.g. health care costs, transportation costs), indirect (e.g. no participation in the labour market of people with disabilities or their caregiver) and opportunity costs (e.g. limited labour opportunities) ( Kuklys, 2005 ; Mitra, Palmer, Kim, Mont, & Groce, 2017 ) factors that increases their risk of poverty. Therefore, people with disabilities and their families have fewer tools to move out of poverty and may require more supporting strategies (e.g. social protection programmes covering for the extra costs of disability) to reach at least a minimum acceptable level of wellbeing.

Mitra (2018b) presents the Human Development Model of Disability, Health and Wellbeing , which considers that resources, structural factors, personal characteristics, impairments, health conditions, wellbeing and deprivations are all interlinked in bidirectional ways. Therefore, there are bidirectional links between impairments and health conditions, on the one hand, and wellbeing and deprivations on the other, and they can be jointly affected by, or affect, other outcomes such as violence or access to health care services. It also points at the importance of third factors that may lead to poverty and disability simultaneously, such as violence, low quality, and expensive health services.

Given the complexity of the different mechanisms that increase the risk of poverty and deprivation for people with disabilities, it is important that poverty measures capture deprivation in different areas of development, such as health, education and employment and provide evidence to identify policy priorities to reduce poverty and deprivation. In this context, there has been increasing recognition of the importance of assessing multidimensional poverty in the context of disability in LMICs ( Mitra, 2018b , pp. 9–32; Mitra, Posarac, & Vick, 2013 ; Pinilla-Roncancio, 2018 ; Pinilla-Roncancio & Alkire, 2017 ; Trani & Cannings, 2013 ; Trani et al., 2013 , Trani et al., 2015 , Trani et al., 2016 ; Trani & Loeb, 2012 ). However, comparability between studies and settings in LMICs is limited by the range of different methods used. Therefore, there is a need for comparable studies analysing the relationship between disability and multidimensional poverty in different countries, using a common definition and measure of disability, which captures a longer list of health functionings and has been validated in different context, such as the Washington Group (WG) Extended Questionnaire.

To contribute in this field, we aim to assess the levels of deprivation and multidimensional poverty of adults with and without disabilities in three different LMICs: Guatemala (national), in Cameroon (Fundong Health District, North West Cameroon) and in India (Mahbubnagar District, Telangana State), using a population-based case-control study design and the extended questionnaire of the WG. This is the first study that to our knowledge using this questionnaire to identify functional limitations, when measuring multidimensional poverty for people with disabilities, using a case-control design in different LMICs.

Methodology

Methods overview.

We undertook all-age population-based surveys of disability in one district of India and Cameroon and at national level in Guatemala (Mactaggart et al, 2016, 2018a). Participants were screened for disability using both self-reported functional limitation tools and a battery of clinical impairment screening tools. A case-control study was nested within these surveys to compare people with and without disability in key life areas (e.g. health, education, work, water and sanitation). Using this information, we designed and calculated and compare the levels of multidimensional poverty for both groups using the Alkire-Foster (AF) method. While the same broad methodological approaches were used in each setting, there was some variation in terms of sampling and disability assessment between the national survey in Guatemala and the India and Cameroon studies, as described below.

Study settings

The study was conducted in Fundong Health District, North West Cameroon in 2013, Mahbubnagar District, Telangana State in India in 2014 and nationally in Guatemala in 2016. A detailed description of the process of selecting the settings is presented in Mactaggart et al. (2018a) .

Survey population and sampling

In Cameroon and India, the required sample size was 4056 based on an estimated prevalence all-age disability of 4% in Cameroon and India, precision around the estimate of 20%, 95% confidence, a design effect of 1.4 and 20% non-response (disability was defined as self-reported limitations and/or presence of moderate or greater clinical impairment, epilepsy or depression). In Guatemala, the required total sample size (calculated to allow prevalence estimates at regional level) was 13,800, assuming a 6% overall disability prevalence, precision of 20%, 95% confidence, a design effect of 1.5 and 15% non-response. The prevalence of disability in Guatemala was defined based on previous studies. Specific types of difficulties were not considered when defining the sample size in any of the three countries ( Mactaggart et al., 2016 for more details).

Multistage sampling was used. Probability proportionate to size sampling was used to select 51 clusters of 80 people in India and Cameroon and 280 clusters of 50 people in Guatemala. Sampling frames were the most recent census (Guatemala and Cameroon 2010; India 2011). Within clusters, we used a modified compact segment sampling: a cluster sketch map was created together with local leaders, and divided into segments of approximately 80 people (India and Cameroon) or 50 people (Guatemala). Survey teams then visited households in one randomly selected segment door-to-door (guided by a community member) until the target number of people were enumerated. In India and Cameroon, participants were invited to attend a local, central location for screening over the following two days. In Guatemala, data collection was undertaken in their homes.

Screening for disability

Participants were screened for disability using: i) self-reported functioning limitations tool and ii) clinical assessment for vision, hearing, musculoskeletal impairment and depression (in India and Cameroon). In each setting, participants were screened for self-reported functional limitations using the Washington Group Extended Set on Functioning (for Adults) and the UNICEF/Washington Group Child Functioning Module. These tools comprise questions about level of difficulty with different domains of functioning (e.g. seeing, hearing, mobility, self-care, communication, cognition, anxiety and depression), scored on a severity scale of no difficulty, some difficulty, a lot of difficulty and cannot do.

In India and Cameroon all study participants were also assessed for vision, hearing and musculoskeletal impairments, epilepsy and depression using pre-existing tools (as detailed in previous publications ( Mactaggart et al., 2016 ). Participants identified as having a vision, hearing or musculoskeletal impairment (henceforth MSI) were then examined by the relevant clinician in the team to determine cause and refer to appropriate services. In Guatemala, participants reporting some or more difficulty in one of the functional domains of the Washington Group questions were administered a clinical screen corresponding to that domain.

Defining disability

For the purposes of the case-control study, people were categorised as having a disability according to the following definitions.

Cameroon and India:

- Self-reporting: ‘a lot of difficulty’ or ‘cannot do’ in seeing, hearing, walking, understanding, being understood, remembering, concentrating, self-care, upper body strength and fine motor dexterity.
- and/or moderate or severe vision, hearing or musculoskeletal impairment or severe depression (Vision Impairment: presenting vision in better eye of <6/18. Hearing Impairment: Presenting average hearing threshold in better ear of >40dBA. Musculoskeletal Impairment: structure impairment with moderate effect on the musculoskeletal system's ability to function as a whole 25–49% or greater. Epilepsy: three or more tonic clonic seizures previously experienced. Depression: score of 20 or above on PHQ-9).
- Reporting ‘A lot of difficulty’ or ‘cannot do’ in seeing, hearing, walking, understanding, being understood, remembering, concentrating, self-care, upper body strength
- and/or, reporting “a lot” of anxiety/depression daily.

Nested case-control study

All participants aged 5 years or older, who were identified as having a disability (‘case’) in the surveys (according to the above criteria) were invited to participate in the nested case-control study alongside an age and sex matched ‘control’ (participants without a disability) from within the same cluster. Age matching of controls was within ± 5 years for adults in Cameroon and India ( ±10 years in Guatemala) and ± 2 years for children. In Cameroon and India, to ensure adequate sample size for the case-control study, two additional children and one additional adult with a disability were identified through community key informants (e.g. local health workers). These participants were selected from an adjacent segment in each cluster.

People with and without a disability were interviewed using a standardised questionnaire about health, education, employment, social participation, attitudes, and discrimination as well as household level living standard indicators (e.g. access to water, sanitation, and asset ownership). Proxy responders were used for children and people who were unable to respond independently.

Data analysis

The Alkire- Foster (AF) method was used to calculate the levels of multidimensional poverty. The AF method is based on a counting and axiomatic approach and extends the Foster-Greer-Thorvecke (FGT) measures. These measures identify multidimensionally poor individuals and aggregate them in a unique measure of poverty. The definition of the structure of the measure is based on different normative decisions around the purpose of the measure, the dimensions and indicators to be included, the relative importance of each of dimension and indicator and the definition of the poverty line ( Alkire & Santos, 2013 ).

The AF method uses a dual cut-off approach. This means that each dimension has a deprivation cut-off, which identifies who is deprived or not in each indicator and a poverty cut-off that is the weighted sum of individual deprivations and identifies multidimensionally poor individuals ( Alkire et al., 2015 ). It is important to highlight that the higher the sum of weighted deprivations, the more severe the levels of poverty. Three indicators are created using the method AF, the incidence, which is the percentage of individuals living in multidimensional poverty; the intensity that represent the average of deprivation faced by the poor and M 0 , which is the product of the incidence and the intensity.

Multidimensional poverty analysis

The purpose of the analysis of multidimensional poverty of this study is to calculate and compare the levels of multidimensional poverty among people with and without disabilities in each study setting. The measure uses the individual as the unit of identification and analysis, and it is restricted to adults aged 18 years or older in the three countries, aiming to avoid problems of comparability between the levels of education of children and the difficulties of capturing disability for children ( Meltzer, 2016 ).

The measure includes four dimensions and 12 indicators as shown in Table 1 . The dimensions are 1. Health (1 indicator), 2. Employment, education, and social protection (3 indicators); 3. Social participation (4 indicators) and 4. Living standards (4 indicators). Although the inclusion of other indicators (e.g. access to vocational education, health care expenditures or other indicators on health care, type of employment) is desirable, data limitations restricted the set of indicators included in the analysis.

Dimensions, indicators, deprivation cut-offs and weights.

Indicators in each dimension aim to capture deprivation in access to basic services and opportunities. Deprivation cut-offs are defined based on international standards (SDGs standards for access to water and sanitation) or following international approach to measure multidimensional poverty. In the case of access to health care or social benefits, deprivation cut-offs capture the lack of access to these services. For indicators related to environment or attitudes, deprivation cut-offs aim to capture facing discrimination or attitudinal barriers at least once a month. Of the 12 indicators of the measure, eight are collected and computed for each individual (access to health care, level of education, employment status, social benefits, difficulties with transportation, information, attitudes at work, and discrimination), thus these indicators capture individual deprivations. The four Living Standards indicators capture household-level deprivations (access to water, sanitation, asset ownership, and housing materials).

We used nested weights to calculate the measure, as has been used in previous studies analysing multidimensional poverty for people with disabilities ( Mitra et al., 2013 ; Trani & Cannings, 2013 ; Trani et al., 2015 ) and has been used by most national multidimensional poverty measures ( United Nations development Programme (UNDP) & Oxford Poverty and Human Development Initiative (OPHI), 2019 ). This set of weights gives the same relative importance to each dimension and to each indicator inside the dimension. A person was classified as multidimensionally poor if s/he was deprived in 40% or more of the weighted sum of indicators, which is equivalent to being deprived in two or more dimensions or the weighted sum or indicators, given that each indicator has a different weight depending on the dimension they belong.

Robustness tests, changing the poverty cut-off, found that the index is robust from a poverty cut-off ( k) equal to 20% – 60%, indicating that, the selection of a poverty cut-off within this range produces robust results. In addition, robustness tests changing the weight structure showed the results were robust with different weight structures. Finally, a similar analysis was conducted using different measures of disability. In a first case using the levels of severity reported in each of the questions included in the extended Washington Group Extended Questionnaire, a three-level variable was created adding the information on the severity of functional limitation in each domain, considering that the variable takes a value of three when the person present severe limitation or report cannot do at least one of the activities, two if the person reported having a lot of difficulty in at least one of the activities and one when the person reported to have some difficulty or no difficulty in all the activities. In addition, to this analysis and following Mitra (2018b, pp. 9–32) a three level measure was designed, classifying the person as no moderate/severe functional limitation, moderate functional limitation and severe functional limitation. Finally, a third robustness analysis was conducted in Cameroon and India using the results of the clinical assessment for vision, hearing, musculoskeletal impairment, and depression. In this case a person was classified as a person with disabilities if he or she were screened positive to any moderate/severe clinical impairment.

The same specification of the index is used in each study country to allow comparisons within and between countries. In addition, among people with disabilities we assess the relationship between multidimensional poverty, age and sex. We use t-tests for continuous variables to compare the results between groups.

Analysing the characteristics of multidimensionally poor individuals

Finally, a regression model for categorical data (probit model) is estimated to identify individual characteristics increasing the risk of being classified as multidimensional poor. In this model, the dependent variable is multidimensional poverty (1 = yes, 0 = no) and the independent variables are sex, age, disability status, area of residence, ethnic group (or caste) and rural/urban areas. The marginal effect on the mean are computed to analyse how the probability of being multidimensionally poor changes when the person has disability. All the results are computed using Stata 15.

The total number of people with disabilities (cases) and people without disabilities (controls) aged 18 years and above varied by country; in India, there are 324 cases and 241 controls; in Cameroon there are, 206 people with disabilities and 154 controls and in Guatemala there are 707 people with disabilities and 465 controls. Table 2 presents the characteristics of participants included in the case control analysis. Cases are on average older than controls, but well matched in terms of sex.

Characteristics of individuals included in the analysis.

Deprivation among people with and without disabilities in the three countries

When the deprivations of people with and without disabilities are analysed (without considering their levels of multidimensional poverty), it is found that people with disabilities in Cameroon face the highest deprivation in housing materials, school attainment and access to social benefits. In India, the highest levels of deprivation for this group are found in access to sanitation or to a clear source of water and school attainment. Finally, in Guatemala, the highest levels of deprivation are observed in social benefits, school attainment and employment. In the three countries, differences are consistently found across these measures between cases and controls (people with and without disabilities), and people with disabilities face higher deprivations in housing materials (p-value<0.001), employment (p-value<0.001) school attainment (p-value<0.001) and access to health care (p-value<0.001) compared to people without disabilities.

Incidence, intensecsity and multidimensional poverty

In the three countries, people with disabilities have significantly higher incidence of multidimensional poverty (defined as the proportion of people in the study population who experience multiple deprivations) compared with the control subjects ( Table 3 ). The largest difference is seen in India where 41.4% of people with disabilities are multidimensionally poor compared to 13.3% controls (p-value <0.01). The intensity of poverty among those who are multidimensionally poor is also higher among people with disabilities compared to controls in each country. The largest difference is found in India, where people with disabilities experience on average 54.3% of the weighted sum of deprivations compared with people without disabilities who are multidimensionally poor, who face on average 45.7% of the weighted sum of deprivations. Cameroon has the highest overall levels of incidence, intensity and multidimensional poverty for both people with and without disabilities.

Incidence, Intensity and Multidimensional Poverty per disability status in each country.

Incidence: Proportion of persons who are multidimensionally poor. Intensity: Average number of deprivations experienced by the poor. Multidimensional Poverty Adjusted Ratio (M 0 = H*A).

Differences between groups, t -test differences between groups **p < 0.01, *p < 0.05.

Levels of deprivations among the poor

When analysing the levels of deprivation in each of the indicators for multidimensionally poor individuals, we find that, in each country, people with disabilities face higher levels of deprivation in all indicators (except access to sanitation in Cameroon) compared to people without disabilities. However, the statistical significance of those differences varied between countries, with access to health care services being the indicator that was consistently significantly different between people with and without disabilities in each setting (p-value<0.01).

The overall highest level of multidimensional poverty is identified in Cameroon and people with disabilities face higher levels of deprivations in all dimensions, compared to controls. Comparing between countries, although levels of poverty are consistently higher among people with disabilities in each setting, the extent of this difference is larger in India compared to Cameroon and Guatemala. In the case of India, people with disabilities face higher levels of deprivation in all indicators compared to people without disabilities, these differences are all significant at p < 0.05. In Guatemala, the largest differences are seen in the indicators related to social benefits, education, and employment, all of which are significant at p < 0.05 ( Fig. 1 , Fig. 2 , Fig. 3 ).

Proportion of people with and without disabilities, who are multidimensionally poor experiencing deprivations in different indicators in India.

Significant differences at 5%: Access to clean source of water, access to sanitation, asset ownership, housing materials, access to health care, school attainment, occupation, social benefits, barriers transportation, access to information, attitudinal barriers, discrimination.

Proportion of people with and without disabilities, who are multidimensionally poor experiencing deprivations in different indicators in Cameroon.

Significant differences at 5%: Access to water, housing materials, access to health care, school attainment, occupation, social benefit.

Proportion of people with and without disabilities, who are multidimensionally poor experiencing deprivations in different indicators in Guatemala.

Significant differences at 5%: Access to sanitation, access to health care, school attainment, occupation, social benefits, barriers transportation, access to information, attitudinal barriers and discrimination.

The contribution of each indicator to the multidimensional poverty measure, called “the percentage contribution”, varied between countries. In the case of Cameroon and Guatemala, the indicator that contributes the most to the levels of multidimensional poverty is access to social benefits; followed by education and housing materials (walls and floors). In the case of India, years of schooling and access to health care services are the two indicators with the highest contribution. When the contribution of each indicator to the measure is compared between people with and without disabilities, we found that in the three countries the contribution of access to health care services to the measure was higher for people with disabilities compared to people without disabilities ( Fig. 4 ). Therefore, a larger proportion of the levels of poverty of people with disabilities can be explained by deprivation in access to health care services.

Percentage contribution of each indicator to the adjusted multidimensional headcount ratio (M 0 ) per country.

Relationship between multidimensional poverty, age and sex among people with disabilities

We found that only in Cameroon a higher percentage of women compared to men with disabilities (82.3% vs 73.2%) are multidimensionally poor, although the difference is not significant. In India, the proportion of women and men with disabilities living in multidimensional poverty is similar (40.2% vs 42.2%). No differences between men and women with disabilities in Guatemala.

When age group are analysed, it was found that in the case of Guatemala and India a higher percentage of individuals with disabilities 60 years or older are multidimensional poor, compared to people with disabilities aged 18–59 years. However, people with disabilities aged 35–59 years old face the highest intensity of multidimensional poverty in the three countries. Indeed, people with disabilities 35–59 years living in India faced on average 56.3% of deprivations compared to 51.3% of average deprivation faced by multidimensional poor individuals with disabilities aged 18–34 years. However, neither of these results are significant at 5%.

The analysis per indicator reveal that women with disabilities face generally higher levels of deprivation than men with disabilities in Cameroon in all indicators, except for Information Barriers, Attitudinal Barriers and Discrimination . However, these differences are not significant. In India, women with disabilities face higher levels of deprivation in indicators such as Access to a clean source of water, Housing materials, Education attainment, Employment, Social benefits, Attitudinal barriers and Discrimination compared to men with disabilities, but as in the case of Cameroon, these differences were not statistically significant. In contrast in Guatemala the levels of deprivation are similar for women and men with disabilities.

Robustnesssec analysis

The results of the robustness test for different disability measures reveal that people with severe functional limitations face higher levels of multidimensional poverty, compared to people with mild and moderate disabilities in Guatemala and India. In the case of Cameroon, a larger percentage of people with moderate disabilities was multidimensionally poor compared to people with severe disabilities. In addition, the intensity of their poverty is higher compared with the both people with mild and moderate disabilities in Cameroon and Guatemala, but in India people with moderate disabilities face more severe levels of multidimensional poverty than people with mild and severe disabilities.

When the second measure of disability was used (following Mitra, 2018 ), the results suggest that the increase in the severity of disability is associated with higher levels of poverty in the three countries. Indeed, people with severe disabilities face higher levels of multidimensional poverty in the three countries compared with people living with mild and moderate disability, and for people with moderate disabilities their levels of incidence and intensity of poverty are higher than for people mild disabilities. Table A1 in the annex presents the results of the incidence, intensity, and adjusted headcount ratio for both robustness analysis.

It is important to highlight that in this analysis compares between groups of severity and not between cases and controls. In addition, because the data collected in the three countries is not representative for different types of impairments it is not possible to compare the levels of poverty between types of impairments and their severity. The detailed results are available upon request.

Finally, when the information on moderate/severe clinical impairment was used to identify a person with disability, the results were consistent with the main findings of the article. Indeed, in both Cameroon and India people with moderate/severe clinical impairments faced higher levels of multidimensional poverty, the intensity of their poverty was higher and faced higher deprivations in most of the indicators.

Disability as a correlate of multidimensional poverty

To analyse if disability is associated with being multidimensionally poor and can be understood as a correlate that increases the probability of being poor, we estimated a probit regression model including all cases and controls. The independent variables were related to individual characteristics such as disability, sex, age, and ethnic groups. In the three countries, being a person with disabilities significantly increases the probability of being multidimensionally poor by more than 10 percentage points (pp) compared to not being disabled (control group). For example, in Cameroon, a person living with disability has 15 pp higher probability of living in poverty than a person without disability (controls). A similar situation is observed in Guatemala, where the probability increases by 13 pp. In the case of India, living with a disability is one of the variables with the larger coefficients, increasing the probability of being multidimensionally poor by 26 pp, more than any other individual variable included in the regression model.

Other variables that also were associated with increasing the probability of being multidimensionally poor were sex, ethnic group, and case. Indeed, in Cameroon, women have 12.5 pp higher probability of being multidimensionally poor compared with men. In India being female (14.6 pp compared to men) and belonging to any caste (>20pp depending on the caste) are independently associated with being multidimensionally poor. In Guatemala, individuals who considered themselves as Ladino or mixed ethnic group have 9 pp lower probability of being multidimensionally poor compared to belong to the Mayan ethnic group ( Table 4 ).

Regression analysis of multidimensional poverty per country.

Confidence Intervals in brackets. **p < 0.01, *p < 0.05.

This study computed, analysed, and compared the levels of multidimensional poverty between people with and without disabilities in Guatemala, one district of Cameroon (Fundong Health District, North West Cameroon) and in one district in India (Mahbubnagar District, Telangana State). The results found that people with disabilities faced higher levels of multidimensional poverty compared to people without disabilities in the three countries, and these disparities between groups were larger in India. The results revealed that people with disabilities face higher levels of deprivation in aspects related to access to health care, levels of education and employment compared to people of similar age and sex without disabilities in the three countries. In addition, disability was one of the most important individual characteristics associated with facing a higher probability multidimensional poverty.

As expected, a higher percentage of people with disabilities had higher levels of incidence, intensity and multidimensional poverty in the three countries. This finding was robust to different definitions of disability. Indeed, when the analysis was conducted considering the severity of the functional limitation, people with more severe limitations were poorer than other groups and faced a larger number of deprivations. This is a similar finding to the one presented by Mitra (2018b, pp. 9–32) using data from Ethiopia, Malawi and Tanzania. This finding has important policy implications, because it reveals that the severity of disability is associated with higher risk of multidimensional poverty and deprivation and implies that even the severity of disability is not as severe, people with moderate functional limitations face higher levels of deprivation and makes them more vulnerable to poverty or chronic poverty compared to people without disabilities.

Despite the inclusion of the same list of indicators in the three countries, poverty and deprivation profiles of people with disabilities were different between countries. Therefore, although people with disabilities faced higher levels of multidimensional poverty, in other words, they were poorer, they presented different needs, and policies implemented to reduce their levels of poverty must be tailored to the context and to the specific needs of people with disability in a country. In the case of Cameroon, differences in the levels of deprivation between people with and without disabilities were smaller than those observed in India and Guatemala. This might suggest that in countries with higher levels of human, economic and social development people with disabilities are being left behind by public policies aiming to reduce poverty and deprivation in basic indicators. This pattern has been observed in previous studies ( Banks et al., 2017 ; Groce & Kett, 2013 ; Mitra et al., 2013 ; Pinilla-Roncancio & Alkire, 2017 ) and has been termed the ‘Disability and Development Gap’.

In addition, the results of this study revealed that individual deprivations such as access to health care, employment, facing discrimination and attitudinal barriers were consistently higher for people with disabilities compared to person without disabilities in the three countries included in the analysis. This finding aligns with previous studies on multidimensional poverty and disability ( Mitra, 2018a ; Mitra et al., 2013 ; Trani et al., 2015 , Trani et al., 2016 , Trani et al., 2018 ) and present an opportunity and a challenge for policy makers to prioritize strategies to reduce deprivation in these indicators and therefore reduce poverty for this group.

Living with a disability might be considered as a factor increasing the probability of being multidimensionally poor ( Pinilla-Roncancio & Silva, 2017 ; Trani & Cannings, 2013 ; Trani et al., 2013 ). The findings presented here revealed that people with disability in the three countries were more likely to live in multidimensional poverty compared to a person without disabilities of a similar age, sex and living in the same area. The increase in the probability was 26 pp in India and higher than 10pp in Guatemala and Cameroon. In addition, people living with more severe or complex limitations faced higher levels of multidimensional poverty, making people with severe disabilities more vulnerable to chronic poverty and probably one group that is left behind. Finally, although these differences were not significant, it is important to highlight that our findings suggest that women with disabilities had a higher probability of living in multidimensional poverty compared to men with disabilities in Guatemala and Cameroon. This last result aligning with other literature on multidimensional poverty and disability ( Trani & Cannings, 2013 ; Trani et al., 2013 , Trani et al., 2015 ) which suggests women with disabilities might face discrimination and social barriers related both to their disability and their gender, making them more vulnerable to poverty and deprivation in basic services and opportunities.

To guarantee that social policies and poverty reduction strategies adapt and include people with disabilities, there is a need to understand what aspects create the levels of multidimensional poverty of this group. In this context, the results of the analysis of multidimensional poverty allow the understanding of how individual, household, social and community characteristics might facilitate (or limit) how efficient strategies to reduce poverty and deprivation are in different countries.

Given its multidimensional nature and human rights-based dimensions, a multidimensional poverty approach could potentially be applied in community-based rehabilitation (CBR) programs, specifically in assessing participants' poverty profiles and measuring the impact of the intervention on their profiles over time. CBR programmes can complement poverty reduction strategies and can be a powerful tool for planning and implementing specific programs to reduce poverty and deprivation for this group ( Khasnabis et al., 2010 ).

Strengths and limitations

This is one of the first studies analysing the levels of multidimensional poverty of people with disabilities, using a case-control study design with matching methods and the Washington Group Extended Questionnaire in three different LMICs. One advantage of case-control designs s is that it allows to compare individuals controlling for some individual characteristics that might be associated to poverty. Although it is not possible to define the existence of a causal relationship between disability and poverty, the results provide important and strong evidence that disability and poverty are related.

Another strength of this study is the use of a comparable data source between countries, using the questions recommended by the Washington Group, in three countries with different economic, social and political characteristics. In addition, the fact that people with disabilities were assessed with different tools to define their disability status allow us to compute different measures using other definition of disability and testing how robust our results were.

In addition, the characteristics of the data allowed the design and computation of a multidimensional poverty adjusted ratio using the individual as unit of identification. Indicators included in our analysis are mostly related to individuals’ deprivations capturing perceptions of attitudes and discrimination as well as access to basic opportunities (e.g. employment, education and health).

In terms of limitations, the first is that data from India and Cameroon were only collected in one district, therefore may not be generalizable to the whole country. Also, although the matching process allowed to control for individual characteristics it was not possible to control for other factors (such as level of education, employment, relationship with the head of the household), which might influence the association observed between disability and poverty. Another disadvantage is the fact that the data was collected in different years, aspect that limits the direct comparability of the results, therefore the comparison of the results should be carefully done. Finally, it was not possible to include important dimensions and indicators such as social participation or formal employment, given data limitations or other health indicators, and given data limitations some indicators might capture different phenomena in each country (for example social benefits).

Conclusions

This study analysed the levels of multidimensional poverty of people with disabilities in India, Cameroon and Guatemala and found that this group faces higher levels of multidimensional poverty in the three countries and have higher levels of deprivation in important indicators such as access to health care, school attainment and employment. In the three countries, disability was an important factor associated with living in multidimensional poverty and the increase in the probability of poverty was larger compared to other individual characteristics. The findings of this article provide important information in the monitoring of the achievement of the Agenda 2030 for people with disabilities. It is necessary to motivate governments to disaggregate their data by disability status and to analyse the achievements of different SDG indicators for this group. Only with this information, it will be possible to guarantee people with disabilities are not leave behind form development and poverty reduction strategies.

Financial disclosure

The data collection of this research was funded by CBM International ( www.cbm.org ) under Project Number 2058–2012 Code 06.05. The funder did not have any role in study design, collection, analysis or interpretation of the data, writing the manuscript or the decision to submit the article for publication.

Declaration of competing interest

There is not conflict of interest in this research.

Appendix A Supplementary data to this article can be found online at https://doi.org/10.1016/j.ssmph.2020.100591 .

Results from robustness analysis

Appendix ASupplementary data

The following is the Supplementary data to this article:

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Case studies on disability and inclusion.

To document UNICEF’s work on disability and inclusion in Europe and Central Asia region, UNICEF Regional Office for Europe and Central Asia has developed a set of five case studies.

UNICEF takes a comprehensive approach to inclusion, working to ensure that all children have access to vital services and opportunities. When UNICEF speaks about “inclusion” this encompasses children with and without disabilities, marginalized and vulnerable children, and children from minority and hard-to-reach groups.

The case studies have a specific focus on children with disabilities and their families. However, many of the highlighted initiatives are designed for broad inclusion and benefit all children. In particular, this case study, covers such topics as: Inclusive Preschool, Assistive Technologies (AT), Early Childhood intervention (ECI), Deinstitutionalisation (DI).

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Case study 1: “Open source AAC in the ECA Region”

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Case study 2: “Inclusive Preschool in Bulgaria”

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Case study 4: “Early childhood intervention in the ECA region”

Case study 5: “Deinstitutionalization in the ECA region”

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Aesthetics Of Disability: The Growing Interest In Disability In Popular Hindi Cinema

Disability studies have emerged as an important field of critical studies. It has branched itself out beyond its limited medical and psychological sphere and has placed itself in the social, cultural sphere as well. As a marginalised 'body', disability has also inter mingled itself with theories of gender or post colonization. Especially in its representation in media and literature; Disability has posed a challenge against its traditional, stereotyped presentation and demands for a centralized representation of the disabled body. This article shall study the idea of representation of disability in the context of Indian cinema and the change of attitude towards Disability in modern Indian cinema. In this article, only hindi films have been used, keeping in mind the receptivity of the language and its reach. Koshish, Sparsh, "Black" and Barfi are the key cinemas that are dealt with, in the essay.

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A Model Case: Specialized Group Home for Girls with Disabilities in India

Published: 08 August 2019
Volume 37 , pages 315–327, ( 2020 )

Cite this article

Anjali J. Forber-Pratt ORCID: orcid.org/0000-0001-9061-2382 1 &
Dominique A. Lyew 1

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The purpose of this intrinsic case study research was to better understand inclusion of girls with disabilities in Kolkata, India at a home and school for orphan girls. Non-institutionalized, inclusive, community-based care is rare in India, specifically for individuals with disabilities. This case study involved interviews (n = 32) with students, teachers and staff, observations, and document analysis. All transcripts were analyzed using structural and in vivo codes. A continuum of inclusion, designed to be culturally responsive, showcases different levels of integration. The end goal is true inclusion where individuals with disabilities are fully included in all aspects of their community such as education, employment and living. Once achieved, inclusion is embraced as the norm and can be a catalyst for growth. In this study, themes included: peer supports, creation of home, awareness of discrimination and staffing. Together, these embodied inclusive living at Shishur Sevay. Inclusive living serves as the foundation to build an inclusive education.

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Acknowledgements

This research was supported by Peabody College through an internal small grant awarded to Dr. Anjali Forber-Pratt (PI) at Vanderbilt University. Thank you to all current and former members of Dr. Forber-Pratt’s research lab for their assistance and thoughtful contributions to this project, especially to Leah Samples for early contributions to this work.

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Forber-Pratt, A.J., Lyew, D.A. A Model Case: Specialized Group Home for Girls with Disabilities in India. Child Adolesc Soc Work J 37 , 315–327 (2020). https://doi.org/10.1007/s10560-019-00633-8

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Case study on the effects of a disability inclusive mindset in a large biotechnology company

Journal of Work-Applied Management

ISSN : 2205-2062

Article publication date: 3 September 2021

Issue publication date: 5 April 2022

Employers increasingly seek a competitive advantage through inclusive hiring practices and recruitment of persons with disabilities. Early research indicates when employers consider individuals for their strengths rather than solely for their needs, the organization prospers. However, details about how companies pursue a disability inclusive workplace and the effect of those efforts are poorly understood.

Design/methodology/approach

An inductive qualitative case study approach was utilized to understand one biotechnology corporation and their approach to recruiting, hiring, and retaining employees with disabilities. Individual and focus group interviews were conducted.

Results suggest that when the company lives its mission around wellness and inclusivity, they benefit from working with and learning from a range of perspectives, furthering their growth. Placing equal emphasis on hiring a diverse workforce and prioritizing supports and wellness practices lead to greater productivity and innovation.

Practical implications

This study illustrates how one company successfully recruits and hires persons with disabilities, resulting in benefits to their financial bottom line and to the organizational culture.

Originality/value

This paper offers insights for other companies intentionally hiring persons with disabilities, providing accommodations in the workplace, and creating an organizational culture where all employees feel valued and supported. These steps have a direct impact on employee engagement, productivity, and retention.

Diversity initiative
Inclusivity
Recruitment
Employees with disabilities

Ochrach, C. , Thomas, K. , Phillips, B. , Mpofu, N. , Tansey, T. and Castillo, S. (2022), "Case study on the effects of a disability inclusive mindset in a large biotechnology company", Journal of Work-Applied Management , Vol. 14 No. 1, pp. 113-125. https://doi.org/10.1108/JWAM-06-2021-0045

Emerald Publishing Limited

Published in Journal of Work-Applied Management . Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode

Introduction

Employers increasingly recognize the benefits to productivity and organizational culture resulting from hiring persons with disabilities (PWDs) ( Lindsay et al. , 2018 ). Approximately 26% of people in the United States live with one or more of six functional types of disability, including cognitive, hearing, mobility, vision, self-care or independent living-related ( Centers for Disease Control and Prevention, 2018 ). Representing just over 25% of the US population, PWDs compose a large and valuable pool of current and potential members of the US workforce. However, PWDs continue to face challenges finding gainful employment in the United States, such that PWDs have an unemployment rate more than twice that of people without a disability ( US Bureau of Labor Statistics, 2020 ).

This lack of representation signals a significant problem of missed opportunity, as disability-inclusive hiring practices have been associated with improved productivity at the employee and organizational level ( Tompa et al. , 2021 ). One potential method of increasing rates of employment for PWDs is by increasing companies' awareness of the how much PWDs can contribute to the workforce, particularly in companies that maintain a disability-inclusive mindset ( Lindsay et al. , 2018 ). Companies with a disability-inclusive mindset go beyond maintaining the minimum legal requirement of anti-discrimination laws to create a disability-inclusive culture in all their thinking, policies, and operations. Such companies proactively focus on making the necessary changes needed to identify and remove barriers to full workplace participation for PWDs, including the removal of physical, communication, and attitudinal barriers ( CDC, 2020 ). This kind of mindset is represented by the concept of customized employment, which encourages organizations to customize the relationship between employee and employer based on the individual strengths and needs of both parties ( Inge, 2006 ). Despite several studies demonstrating the benefits of an inclusive culture and workforce at the individual, organizational, and societal level ( Tompa et al. , 2021 ) a specific roadmap for implementing this type of corporate culture remains elusive.

According to Weick's (1979 ) organizational information theory, people in organizations play active roles as creators of their environment through interpretation of information on a systemic level. Specifically, Weick (1979) emphasized the importance a company engaging in ongoing sensemaking, which is the process of rendering meaning from experience and constructing order out of disorder ( Patriotta, 2016 ). Within a company, sensemaking is a reciprocal relationship, such that individuals both create and are influenced by their organizational environment ( Weick, 1979 ). By focusing on communication from both top-down and bottom-up perspectives within a company, sensemaking provides a method of promoting disability-inclusive mindsets through centralized communication and information processing within a company ( Glynn and Watkiss, 2020 ; Weick, 1979 ). Weick conceptualizes sensemaking as central to organizing around a common mission and goal ( Weick, 2005 ). This theory is utilized in the current study by highlighting how a common organizational mission can allow employees across departments to make sense of their role in the company and of the company's role in the community. By engaging in the sensemaking process, leaders of companies can create a disability-inclusive mindset that influences the company culture on all levels to remove barriers and promote inclusive policy and culture for the hiring and retention of PWDs. Weick's theory applies to this case in that the way the organization and its members make sense and meaning of their work through identifying with the organization's inclusive mission and commitment to diversity. Previous studies have applied Weick's theory to various aspects of organization and management ( Tsoukas et al. , 2020 ), including process research ( Langley et al. , 2013 ) and organizational cognition ( Eden and Spender, 1998 ), among others. We extend findings from these and other previous studies to understand how sensemaking as a process furthers mission-based practices centered on diversity and inclusion.

Companies are increasingly moving to appreciate disability inclusion as a valuable contributor to diversity in the workplace ( Gilbride, et al. , 2003 ; Padkapayeva et al. , 2017 ). Research has revealed that companies identify several benefits to employing PWDs, including an expanded hiring pool, positive psychosocial impacts of retention of PWDs on employees with or without disabilities, and increased diversity of the workplace ( CDC, 2020 ; Lindsay et al. , 2018 ). By modifying recruitment and retention strategies, developing disability inclusion mediations, personalizing workplace and workspace modifications for PWDs, and matching the needs and skills of PWDs with the needs of the company, company leadership and human resources (HR) professionals can create disability inclusive mindsets by creating positive social attitudes regarding hiring PWDs ( Gilbride et al. , 2003 ; Padkapayeva et al. , 2017 ).

Research has also suggested that employee job fit, company culture, and previous employer experience with hiring PWDs all increase recruitment and retention of PWDs, which in turn shapes future HR hiring practices and the assumption of inclusive attitudes and perspectives company-wide ( Gilbride et al. , 2003 ). This aligns with findings that companies that reflect on their own practices, learn from their past organizational choices, and adapt to the internal and external environment are more sustainable in the long-term ( Fam et al. , 2017 ; Fergusson et al. , 2020 ). Additionally, HR employees with a higher degree of social awareness can increase the pace at which PWDs are recruited as well as the pace at which exposure-based disability-inclusive mindsets are encouraged in the workplace ( Chan et al. , 2010 ). This is especially important considering the growing centrality of social consciousness in what attracts new employees to work for organizations, underscoring the overall sustainability of that organization ( Brockhaus et al. , 2017 ; Rimanoczy and Pearson, 2010 ). Employing PWDs tends to decrease employer misconceptions, such as the idea that PWDs are not seeking work or are not qualified for company positions ( Bonaccio et al., 2020 ). Employing PWDs has been shown to increase future hiring and retention of job applicants with disabilities resulting in increased integration of workers with disabilities, development of disability-inclusive workplaces, and more sustainable futures for employees and organizations ( Bonaccio et al. , 2020 ; Fergusson et al. , 2020 ). These and other recent studies illustrate the unique benefits to hiring persons with disabilities, yet few offer a specific roadmap for how to actively recruit and hire PWDs and provide individualized accommodations to allow them, and the organization as a whole, to be successful. The current paper attempts to offer tangible suggestions through the illustration of one mid-sized company's successful implementation of a disability-inclusive mission and practices.

This paper is structured as follows. The first section outlines the methods used in this study, which is an inductive case study of one company's approach to hiring and retainment of PWDs. The organization and its specific subdivisions involved in the recruitment, hiring, and retainment of PWDs are described. The results of the study are then outlined, highlighting the company's mission and values, the actual inclusivity practices employed, and the impacts of these practices. The next section of the paper discusses the main findings of the study and connects those findings to existing research on PWDs in the workplace and general organizational culture. In this study, it was found that recruiting, hiring, and supporting PWDs in the workplace resulted in more workplace diversity, a willingness to provide accommodations for all employees, positive corporate climate, and increased productivity. Thus, this paper contributes evidence in support of the positive impacts of initiatives for hiring PWDs on employees, including PWDs, as well as the organization as a whole.

The purpose of this study was to implement an in-depth case study of a biotechnology company that has expressed commitment to inclusive hiring and retainment and a clear recognition of the company-wide benefits of hiring PWDs. We hoped to understand more about the company's mission and values and how these values translate into policy and action that supports hiring, retaining, and supporting all employees, including PWDs. This study was guided by the following questions: (1) What are the overarching attitudes, values, and approaches taken by this company in their efforts to be inclusive and diverse? And, (2) How does this company extend their message of wellbeing and support throughout all levels and departments of the company?

Given the formative nature of this investigation, we used a qualitative case study design that allowed for exploration of events or phenomena from multiple sources, with the purpose of looking into the unique experience of the people's lives and interactions with the environment ( Corbin and Strauss, 2015 ). This inductive qualitative design allowed for an open evaluation of the complexities and considerations involved in recruiting, hiring, supporting and retaining PWDs through in-depth interviews with multiple staff members at different levels within the company ( Maxwell, 1996 ). Interviews and focus groups were utilized to gain an open, in-depth understanding of employees' beliefs and experiences which was essential to informing our qualitative inquiry ( Gill et al. , 2008 ). As this investigation is exploratory in nature and our aim is to place greatest emphasis on the voices of our participants, a qualitative approach was necessary ( Miles and Huberman, 1994 ). The research team involved in data collection and analysis was comprised of six rehabilitation psychology faculty and doctoral students across three universities in the United States. Team members discussed potential biases prior to engaging in data collection and again before completing the analysis to reduce the potential for biases to influence the results.

Organization

The subject of this study is a large biotechnology company centralized in the Midwest. This company has been recognized as a Great Place to Work-Certified™ company, meaning they have been independently evaluated by the third party and recognized for having a positive workplace culture.

Organizational structure

This biotechnology company was described as using a Matrix Organization style where managerial teams spanned different units within the company ( Galbraith, 1971 ). The HR director noted this as key to maintaining priority on employee retention across all units. Part of the company's success in supporting and accommodating their employees was attributed to the division of responsibility within the company. Rather than processing all accommodations requests through a general HR team, their approach involved multiple specialized teams working together to recruit and retain employees. These included teams focused on (1) Recruitment, (2) Wellness, (3) Leaves and Accommodations, (4) Business Partners, and until recently (5) Security, which aligned under another unit in the organization.

The Leaves and Accommodations team has a lead role in processing accommodation requests while also ensuring that all employees and teams are aware of the potential for accommodations and how to use them. As one employee described, “I did not know until I received that initial email that we do have the entire accommodations team. They can reach out if you need anything.” The Business Partners act as the HR representatives across each unit in the company (e.g., the clinical lab). Business Partners were said by the HR director to play a key role in informing the HR team of needs within a particular unit while also ensuring that the company culture, priorities, and values extends to each unit. The Security team, although no longer part of HR, continue to fill several roles in the company, including acting as first responder for physical and mental health needs. These teams do not want the onus to always be on employees but seek to preemptively act in providing support by assessing potential problems within the company's various departments and teams.

Researchers worked with state employment agencies to identify companies with a reputation for inclusive disability hiring. Once identified as a company of interest, the research team worked closely with leadership from the biotechnology company to organize a site visit and to conduct interviews and focus groups. Prior to the site visit, the research team requested access to any written information, forms, or documents relevant to their disability efforts (e.g., company policies). Key personnel were also asked to provide a few written answers regarding the implementation of practices and policies related to their disability initiative. These were reviewed by the research team prior to the site visit in order to allow for better understanding of company activities prior to conducting interviews and focus groups. Researchers met on the day of the site visit to discuss potential biases and strategize how these biases could be minimized. The present study consisted of interviews with the director of human resources (HR) as well as members of the teams responsible for recruiting and for providing accommodations. A focus group was held with four direct-line supervisors and another with seven current employees, some of whom identified as having a disability that significantly impacted their work. All interviews were conducted in person at the company headquarters in the Midwest. Interviews and focus groups were complimented by information obtained through on-site observation, company policies and other written materials, the company website, and a climate survey described in the measures section below. A tour of the facility with an emphasis on any disability-related environmental adjustments, modifications, or supports helped inform data collection and analysis. The interviews and site tour led to the collection of more written policies and procedures that were added to the materials for analysis.

Focus groups and interviews ranged from 20 to 90 min in length. All interviews and focus groups were completed with two members of the research team present, serving to reduce to the possibility of interviewer bias while also enriching the data collection process with multiple perspectives. Audio recordings of all interviews and focus groups were later transcribed for analysis. Approval from the university's Institutional Review Board was also obtained to conduct this study with human subjects, and informed consent was obtained from all participants.

In addition to the on-site observations of the research team, a climate and policy checklist was used to assess the different disability-related aspects of the company during the post-site visit analysis of data. This checklist consisted of 70 disability-related policies or practices that were marked as being present or not present in the company. The semi-structured interviews and focus groups conducted on-site included primarily open-ended questions addressing the recruitment, hiring, integrating, and retaining workers with disabilities. The interviewees were asked to reflect on the company's practices and policies that were intended to create an inclusive environment for workers with disabilities and the results of these efforts.

Data analysis

All data sources were reviewed and coded by two coders before coming to consensus on the major themes and insights. Interview and focus group transcripts were read by each coder initially and data were categorized into practical and mindset themes. Further categories were determined by grouping data into subthemes, including a focus on inclusive practice, supportive climate, emphasis on retainment, and being mission driven. In the event of a disagreement between two coders, a third coder was included to discuss the item until an agreement was reached. Once created, the coding and narrative of the case study were brought to the larger research team for a community-based approach to refining and improving the accuracy of the case study.

This case study focuses on the inclusive hiring and retention practices of a large biotechnology company and the perceived impact of these efforts. In contrast to many other disability diversity case studies, this was not focused on a disability program but rather on capturing a company culture focused on seeking to make disability inclusivity part of all that they do. Results emerged from data collected over several months of 2019 and include analysis across individual and group interviews as well as on-site observation, the climate survey, and written policies (e.g. employee handbook, Autism Workforce guide). Results are broken down into the following categories: (1) Company Mission and Mindset, (2) Disability Inclusive Practices, which include both hiring and retention practices, and (3) Impact of Inclusive Practices. We proceed with a review of each category and their domains.

Company Mission and Mindset

An overarching theme noted throughout the interviews, whether senior management or recent hire to work in the lab, was the sense of the company's value-driven mission. An internal document describing the company Wellness program provided a Vision Statement that captures the ethos of their mission: “We believe our employees are our most valuable resource and through educating and encouraging the health and well-being of our employees, we in turn can achieve a higher level of patient care.” Throughout every interview and every evaluation of the company's organizational documentation and structure, this mission-driven focus emerged. As a member of the Leaves and Accommodations team stated, “We live our mission statement here, whereas other companies have a mission statement. And it's getting everyone on board from top down to have an environment of support.” Multiple members of the management team noted that this sense of mission did not happen by accident or stem from policy alone but was the result of embedding themselves within departments and consistently communicating those core values. Of their role, one manager stated, “We're out there being that kind of culture keeper.”

The first question a lot of companies will ask is, “Are we legally required to do this?” Which is a fine question. It's a valid question because you want to make sure that you're doing everything legally. But I feel like [company's] first question, because we already know we're in legal compliance across the board for Leaves and Accommodations is, “Why not?” and “What can we do?”

I think it starts with that commitment that we want to be an inclusive workforce, but you cannot always anticipate what that is going to mean for the next person who walks through your door. I think if you're coming at it with that yes mindset … You know if you start there, you can usually find a way to make it work.

You're not asking all of your employees to fit one exact requirement, once you're thinking, “What do they need?” and “How do they learn?” … just the mindset of how to help them be successful here, “What does that mean for them?” That's a real shift from, “I'm the boss, and this is how it works here.”

Disability Inclusive Practices

The mission and mindset of the company produced a number of inclusive practices that could be categorized into hiring, retention or some combination of the two.

Inclusive hiring practices

The director of HR spoke to the company's consideration of community in shaping their hiring practices and performance saying, “We look for partnerships with different organizations, both because we want to be a good partner and because of the organization's being really good conduits for people looking for work.” Another manager emphasized the importance they place on partnering with specific government and non-profit agencies aimed at improving the education and employment of diverse members of the local community and organizations in the area.

Speaking to the inclusive mindset that fuels this biotechnology company, an HR manager spoke of how they work with applicants saying, “whether there's a disability or not, our team approaches these interviews with the same level of fairness and equality. And I think that's become just part of the [company's] DNA.” Part of this DNA, or inclusive mindset, was noted to stem from their resources to work with a diverse workforce. The HR manager continued by saying applicants with disabilities “do not even phase our hiring team now because we are so used to the support we get from our Leaves and Accommodation team.”

Inclusive retention practices

The emphasis on retaining employees was consistent across all collected information. Multiple HR management spoke of viewing employees as being in long-term careers when hiring on with the company. Employees seem to get the message with one stating, “We heard management talk about wanting to create careers,” in contrast to what the employee described experiencing in other companies as being used for a couple of years. Two methods employed for fostering this career mentality were supporting employees in pursuit of upward movement and facilitating employee engagement within the company. Leadership emphasized providing employees with what they need to be successful, including a change in position or environment when needed. An HR director reported the mutual benefit of this approach by saying, “I am a firm believer that culture and engagement of employees has a very positive effect on revenue, on your total growth as an organization. If we were constantly replacing people, that would be a big time and money sinkhole.” He concluded that recruiting for diversity and then “giving them the tools and the support to really be successful” benefits all.

Inclusive retention practices were often very individually based. One frontline supervisor said, “I do not have any accommodation that's exactly like the other. The [Leaves and Accommodation Team] really tailor to the individual.” A member of the Recruitment team emphasized the importance of getting the employee's perspective when addressing accommodation needs stating, “It might not be something that our team is familiar with, but we get familiar with it really quickly.”

creating a welcoming environment and teaching people what it’s like to work here … The first step is really that inclusive culture of teaching and recognizing that people are coming from different places and at different levels of their readiness in order to actually hit the floor for their job.

Regarding supervisor training, an HR director described the Family and Medical Leave Act (FMLA) and ADA training they provide to supervisors, with the comment that “We do not ask [supervisors] to understand all of the intricacies of it. What we do want them to understand through the training is to be receptive.” Multiple supervisors described the trainings with appreciation for their thoroughness and for the support that was available to them, as captured by the supervisor who stated, “There's [a training] for the inclusive workplace, which is wonderful training.” This supervisor continued, “The fact that they even do that is impressive to me.” It was noted across interviews that providing the trainings in multiple formats (audio-video, written, etc.) was appreciated by supervisors and employees with disabilities alike.

The company was noted for taking a proactive approach to accommodations as part of their retention efforts. One employee shared his experience saying, “Because I identified with a disability through the onboarding process, probably within a week or two from hire, I got an email saying, “Hey, you identified with a disability. Are there any accommodations that we can provide?” Another employee described their supervisor's approach to accommodations after having already been with the company, reporting, “When I started in the lab, I never knew how physical that was. It was actually my supervisor that pulled me aside and said, ‘You know, we have accommodations and we can help you through this.’”

Inclusivity as organizational identity: impact of Inclusive Practices

I would absolutely say that it’s a benefit … By recruiting a diverse population and then giving them the tools and the support to really be successful, that goes a really long way towards engagement and culture, and that certainly has direct impact on the bottom line.

Another manager talked of how providing employee accommodations according to their need improved performance and retention. A front-line supervisor spoke of an employee who was about to be terminated for poor performance. In one of the final meetings before termination, the employee disclosed a hidden disability that had been affecting their work performance. Accommodations were put in place and the employee retained their position through strong performance.

Through working with [PWDs], we've found some of the things that we offer would actually be good to offer to a broader population as well. If we are looking at different ways of learning, different ways of training, for instance, even if somebody has not self-identified as having a disability, we all learn differently … Personally, I think that it gives you a more open mindset, things that I had not considered before.

I think there's an effect on morale … We get a lot of really positive feedback about the diversity of our team. A lot of people who choose to work at [company], I find that a big driver behind their decision to work here is because they have a personal connection to our mission. They feel good about working for a company that offers these accommodations for their colleagues and coworkers. They can see people of different abilities working in different ways towards the same mission.

These positive perceptions often connected directly to job satisfaction and a desire to stay with the company. A front-line supervisor said, “I think it helps us retain the employees who truly want to be here … and helps us keep really talented people.” One employee with a disability stated that she is quick to tell her friends and acquaintances to work at this company. She continued, “If you're looking to improve your life, apply.” More seriously, another employee with a disability described being made fun of at her previous company and how refreshing it was to be able to trust that she would be treated respectfully at this biotechnology company. One of the strongest statements on the retention efforts of the company came from an employee who talked of switching from his partner's health insurance for the first time in years because of the stability he felt in his work. He stated with a tone of pride, “I'm actually going to be taking over the insurance because I feel comfortable here.”

Workplace challenges faced by PWDs result from the intersection of individual needs, societal structures, and employer initiatives, policies, and procedures that influence company culture ( Chan et al. , 2010 ). One way to minimize workplace experiences of discrimination and invalidation for PWDs is for companies to actively value diversity and inclusivity in mission, mindset, and policies through organizational sensemaking. By engaging in ongoing sensemaking, companies can allow for individuals to promote disability-inclusive mindsets by both creating and influencing their organizational environment ( Weick, 1979 ; Glynn and Watkiss, 2020 ). The company at the center of this study specifically organizes their work around the central mission of disability-inclusivity and overarching support and accommodations for all—a common mission through which, as was shared in interviews, employees make meaning of their work. As meaning-making is a human-driven process, this study illuminates how Weick's theory of organizational information can explain the practical implications of organizing a corporate culture around a common goal ( Tsoukas et al. , 2020 ). This approach recognizes PWDs as assets as companies provide them with the supports needed to be successful. Such efforts uplift the individual employee and the company-wide productivity and culture ( Lindsay et al. , 2018 ). This company offers a useful model for other companies looking to implement a disability-inclusive approach that values the contributions of all employees.

Organizational culture as a reciprocal process

Interview participants made it clear that this company values a sense of connectedness and reciprocal respect among team members. Weick (1979) suggests that organizations and those belonging to them experience a reciprocal relationship—that is, individuals both create and are influenced by their organizational environment through the process of sensemaking. This proposition suggests that general organizational attitudes (such as prioritizing inclusivity and diversity in the workplace) must be fed through both top-down and bottom-up pathways. Weick further suggests that the way members of an organization make sense of experiences informs organizational action in a recursive process. This sensemaking process is often equally cognitive and emotional ( Mikkelsen et al. , 2020 ) and can stretch from broad, company-wide search for meaning to the minutiae of even the language used by an organization ( Bakken and Hernes, 2006 ).

Using this framework, the company at the center of this study appears to make opportunistic sense of diversity, seeing PWDs as introducing unique skills, perspectives and talents to the company. This sensemaking process is likely driven both by a recognition of the overall productivity and economic benefits as well as employees' emotional investment in the value of working alongside and learning from diverse team members. The development of an organizational culture and mission is more recursive than linear where both meaning and action influence sensemaking and contribute to the ultimate climate ( Glynn and Watkiss, 2020 ). The company as a whole and the individual employees reciprocally influence each other in terms of company values, productivity, and inclusive culture. This organization clearly benefits from such symbolic interactionism, as interviews with employees and management revealed an unequivocal emphasis placed on supporting and being supported by employees with disabilities.

Dedication to morale and community

Staff and leaders both reported a felt sense of community and a dedication to elevating morale throughout this company. It seems that promoting a sense of connectedness and support fosters positive attitudes, productivity, and customer service for this mid-sized organization. Some researchers suggest that leaders can improve productivity, employee relations, and talent development when they align their actions with valuing a diverse workforce ( Hughes, 2016 ). Thus, fostering acceptance, support, and growth for diverse employees is fundamental to prosperous relationships internally and externally for the organization.

Previous findings suggest that high levels of cohesion among members of a group may predict performance ( Gammage et al. , 2001 ). Additional research suggests when a group agrees on the same organizational goals, they subsequently experience higher rates of group drive, cohesion, and productivity ( Greene, 1989 ). This is apparent in the current case, as interview participants reported feeling the congruence with the company goals of commitment to customer service and valuing and supporting team members.

How to replicate elsewhere

It's deciding as a company, “Are you going to be willing to go that much further for the employee to go above and beyond what the federal government is asking you to do?” But it is completely replicable if you desire that for your company.

I think it starts with that commitment to be an inclusive workforce … But you cannot always anticipate what that is going to mean (The next person who walks through your door, what might they need to be successful?). It is not necessarily something that I think every organization wants to do.

The HR director also encouraged companies to think about their employees in terms of their unique value rather than their ability to fit the model of the organizations' values. Overall, this biotechnology company's employees and administrators seemed optimistic about the possibility of their model, philosophy, and approach to hiring and recruitment to be replicated elsewhere. This approach becomes possible through a stance of curiosity, a willingness to learn, and approaching each potential employee as having a unique skillset and worldview.

Conclusions and implications

Intentionally recruiting, hiring, and retaining PWDs in the workplace increases the diversity of perspectives in the workplace and positively impacts the company bottom line;

Successful outcomes from a company-wide diversity and inclusivity initiative results from both top-down and bottom-up implementational commitment; and

Increasing corporate diversity through this kind of initiative has a positive effect on employee attitudes and engagement and the overall corporate climate.

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Acknowledgements

Preparation of this manuscript was supported in part by the National Institute on Disability, Independent Living, and Rehabilitation Research through Grant # HHS-2016-ACL-NIDILRR-RT-0138 to Virginia Commonwealth University, Rehabilitation Research and Training Center on Employer Practices. The opinions expressed herein do not necessarily reflect the endorsement or position of the U.S. Department of Health and Human Services.

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Disability Discourse in Hindi Literature

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Multidimensional poverty and disability: A case control study in India, Cameroon, and Guatemala

Islay Mactaggart

Hannah Kuper

Jonathan Naber

Sarah Polack

Introduction

Methodology

Study settings

Survey population and sampling

Screening for disability

Defining disability

Nested case-control study

Data analysis

Multidimensional poverty analysis

Analysing the characteristics of multidimensionally poor individuals

Deprivation among people with and without disabilities in the three countries

Incidence, intensecsity and multidimensional poverty

Levels of deprivations among the poor

Relationship between multidimensional poverty, age and sex among people with disabilities

Robustnesssec analysis

Disability as a correlate of multidimensional poverty

Strengths and limitations

Conclusions

Financial disclosure

Declaration of competing interest

Appendix ASupplementary data

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Case studies

Case study 1: “Open source AAC in the ECA Region”

Case study 2: “Inclusive Preschool in Bulgaria”

Case study 3: “Assistive technology in Armenia"

Case study 4: “Early childhood intervention in the ECA region”

Case study 5: “Deinstitutionalization in the ECA region”

Aesthetics Of Disability: The Growing Interest In Disability In Popular Hindi Cinema

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A Model Case: Specialized Group Home for Girls with Disabilities in India

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Case study on the effects of a disability inclusive mindset in a large biotechnology company

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