Transition from higher education to National Health Service for visually impaired physiotherapists: An interpretative phenomenological exploration

Abstract

This idiographic study aims to hear the voices of a small group of visually impaired physiotherapists to explore their lived experience¹ of transition from higher education (HE) into employment. The findings are based on six semi-structured interviews analysed using an interpretative phenomenological approach. Participants were visually impaired physiotherapists who are either working, or have worked, in the National Health Service (NHS). A number of interrelated themes emerged concerning the work of the disabled self, compensation, stigma and passing, disclosure, barriers, disempowerment, and positive experiences. These appear to be linked to a reluctance by participants to engage with their disability identity. The experiences and perceptions of participants do not provide evidence of a commitment to disability-related support for disabled health-care professionals. The results of this study indicate that a wide range of both personal and institutional barriers still exist in the NHS.

Keywords

Visual impairment physiotherapy transition lived experience barriers

Introduction

Visual impairment² and physiotherapy

Historically, the physiotherapy profession, in the United Kingdom, was identified as a suitable career option for ex-servicemen who sustained sight damage in the First and Second World Wars. Over time, other groups of visually impaired people were accepted for training. As Thomas (1957) noted ‘Today the blind physiotherapist is recognised as a valuable member of an honourable profession, but such recognition was only won by hard work over many years’ (p. 97). Visually impaired people have continued to enter the profession, initially educated in a segregated setting, and since 1992, through mainstream provision.

An all graduate profession since 1992, physiotherapy acts as preparation for National Health Service (NHS) employment. The degree provides a qualification for school leavers and can be an option for people seeking a career change. This becomes particularly significant for adults experiencing sudden or gradual visual loss.

Since 1991, Royal National Institute of Blind People’s (RNIB) Physiotherapy Support Service (PSS), based at the University of East London, has facilitated the education and employment of visually impaired physiotherapists throughout the United Kingdom.

Education and employment

Employment rates of disabled people tend to be low (48.8% compared with 77.5% for non-disabled people) (Office of Disability Issues [ODI], 2012). Regarding job losses in the recent recession, figures indicate that disabled workers have not been disproportionately affected. With the continued cuts in public spending, however, more disabled people may lose jobs because they tend to work in the public sector:

The progress disabled people have made getting into decent work will be at best stalled, and at worst put into reverse. (Trades Union Congress [TUC], 2011)

As the level of qualification increases, the disparity between the number of non-disabled and disabled people entering employment decreases. Graduates’ experiences are most positive, although the percentages of both groups in full-time work have decreased: in 2010, 45.5 percent of disabled graduates compared with 49 percent of non-disabled graduates (Association of Graduate Careers Advisory Services Disabilities Task Group [AGCAS], 2012). These figures suggest that higher education’s (HE) role is vital in enabling disabled people to realise their employment potential.

Visually impaired people are slightly less likely to be employed than other disabled people (48% compared to 50%, respectively) (Meager & Carta, 2008). AGCAS (2012) also note that of all students with single disabilities, visually impaired students are the least likely to obtain graduate-level employment. Figures suggest, however, that physiotherapy offers a more secure career route with 83% of the 2377 physiotherapists who qualified in 2008 obtaining employment (Chartered Society of Physiotherapy, 2009). It is not possible to estimate how many visually impaired physiotherapists there are practising in the United Kingdom as the professional body does not collect impairment-specific information from members. In our experience of supporting visually impaired graduates, however, we have not found any evidence to suggest that their employment rates are significantly lower than those of non-disabled physiotherapists.

Since 1991, our experience of supporting visually impaired physiotherapy students and employees has confirmed that these individuals regularly encounter prejudice and discrimination. Fear and anxiety can prevent disclosure and a consequent failure to negotiate reasonable adjustments. In addition, employers’ fear, anxiety, and lack of awareness about disability can erect barriers to disabled employees’ full participation.

Legislation and disclosure

Under the 2006 Disability Equality Duty, HE institutions and NHS trusts had to consult disabled people when writing their Disability Equality Statements. In April 2011, the Equalities Act 2010 enforced the new public sector equality duty, requiring organisations to produce Equality Objectives. They must provide relevant evidence and announce the steps they will take to achieve such objectives (Equality Challenge Unit, 2010).

Embedding the legislation into practice has proved to be challenging, requiring fundamental institutional change. Factors including resistance, negative attitudes, and lack of awareness of disability issues must be addressed (Seale, 2006) because they result in a medical model approach.

Many people who disclose their disabilities experience discrimination and labelling by employers (Shier, Graham, & Jones, 2009). Stanley, Ridley, Manthorpe, Harris, and Hurst (2007, p. 33) describe disclosure as a ‘risky process’. Although the legislation has resulted in some positive change, for example, increased awareness of disability issues and reasonable adjustments, more work is essential to bridge the gap between policy and practice. Theoretically, this should reduce the stereotypical responses and discrimination that disclosure often triggers.

Disabling relationships

Campbell (2010) posits that professionals and disabled people are complicit, albeit unconsciously, in ‘maintaining the practices and discourses by which disabling relationships are materialised’ (p. 1). While we acknowledge that this may be an issue in all employment contexts, physiotherapists operate within a medical culture of diagnosis, treatment, and cure, therefore encouraging a tendency to adopt a medical model perspective. Professional socialisation³ legitimises the use of terminology that depersonalises patients, conceptualising them as medical objects: ‘the stroke’ or ‘the fractured neck of femur’. The habitual use of this terminology reinforces the medical model approach and legitimises the way in which practitioners treat others. Almost inevitably, therefore, physiotherapists focus on disabled colleagues’ limitations rather than their potential. In the absence of contrary evidence, this could result in a reluctance to regard them as effective physiotherapists. In many contexts, disabled students and employees accept this as ‘the way things are’ seeing no alternative (Campbell, 2010). Titchkosky (2007) notes that this unchallenged medicalised approach to sense-making leads to the conclusion that

disability easily becomes meaningful as a type of problem a community would be better off not to have in its midst. (p. 106)

The perception that disabled people are vulnerable and the recipients of care, rather than effective practitioners, must be challenged.

Most research involving disabled people is quantitative and conducted by professionals for whom ‘the medical story has pride of place’ (Frank, 1997, p. 7). The disabled person is systematically ignored and regarded as a ‘problem’. While more qualitative research is being conducted with marginalised groups, studies involving interviews with visually impaired adults are uncommon (Thurston, Thurston, & McLeod, 2010).

Disclosure and transition

A significant number of people, who are classified as disabled, do not consider themselves to be so. In 2010, 9.6 percent (20,450) of students gaining first degrees identified themselves as disabled (AGCAS, 2012). It can be assumed that this is an underestimation as many have unseen impairments and may not disclose. During transition into employment, fear and anxiety relating to job prospects may discourage disclosure. A visually impaired job applicant was informed that ‘the manager had reservations about whether “they” could do the job properly’ and was subsequently not invited for the interview (Rands, 2010). This was reflected in our interviews where all participants reported feeling apprehensive about disclosure, sometimes to the point of not disclosing at all.

This study

The principles of interpretative phenomenology were used to explore the experiences of visually impaired physiotherapists moving into NHS employment. It aimed to capture the quality and texture of these experiences (Willig, 2008).

Our question was as follows:

Can you tell me about your experiences in higher education and your move into employment in the NHS? What were those experiences like for you as a disabled person?

These questions elicited wide-ranging responses from the participants which in turn generated the follow-up questions that differed from interview to interview. This method provided the opportunity to collect expansive data, and its flexibility meant that it allowed for unexpected themes to emerge (Smith, 2004).

Interpretative phenomenology is one version of phenomenological research methods, and as the name suggests, it is concerned with hermeneutics and is an ideographic⁴ approach (Langdridge, 2007; Willig, 2008). Detailed ideographic examination provides the researcher with the means to explore participants’ experiences. It is concerned with how people make sense of, and draw meaning from, those experiences. It is essential that, as far as is possible, the idiographic examination enables the experience to be articulated in its own terms and not in relation to any predefined categories. Participants are experts on their own situations and experiences and provide researchers with understandings about these through telling their stories in their own words.

Adhering to the principles of Interpretative Phenomenological Analysis (IPA), we did not enter the research process with predetermined hypotheses or prior assumptions but with a more exploratory approach. Our focus was on participants’ perceptions of their experiences and what these meant for them (Langdridge, 2007).

Method

Sample and recruitment

The PSS database was used to recruit participants. Overall, 20 graduates were approached and 6 agreed to be interviewed. It is acknowledged that individuals who agree to be interviewed usually have something to say about the issue under consideration. This was a purposive sample,⁵ which provided a range of male (n = 3) and female (n = 3) participants who qualified between 2003 and 2009. Five are registered as sight impaired/partially sighted⁶ and one as severely sight impaired/blind, and two are from minority ethnic backgrounds (1 male, 1 female). All have been visually impaired since birth or early childhood, five attended mainstream schools, and one a school for visually impaired students. They studied at different universities and are employed (or have been employed) in English NHS Trusts.

Data collection

The data was collected via informally conducted semi-structured interviews. A schedule was developed which enabled us to anticipate what we expected the interview to cover. Prompts were identified to enable deeper exploration or to move the interview forward if necessary. In practice, prompts were rarely necessary as participants’ responses were extensive and free flowing.

Interviews were arranged at mutually convenient times and places and lasted between 40 minutes and 1 h 20 min. Informed consent was obtained from all participants, one of whom requested an interview transcript. A digital recorder was used, and the interviews transcribed adhering to IPA principles.

Data management

Transcripts were analysed on a case-by-case basis and emergent themes were identified. These were organised into related clusters that became super-ordinate themes. These themes were examined across cases to identify patterns and higher order concepts, which the cases shared, as well as examples of divergence. In presentation of the data, pseudonyms are used throughout.

Findings

It will be seen in the following account that participants encountered barriers in obtaining initial employment and in the transition process. It is difficult, however, to tease out whether this was as a result of disclosing their impairment or because of the more general reduction in employment prospects in the NHS over the last 5 to 7 years. Our contention is that these barriers may have arisen as a combination of both factors.

Only one participant obtained an interview through the Guaranteed Interview Scheme,⁷ while most felt that the system did not work.

Anne said,

I wanted a guaranteed interview under the Guaranteed Interview Scheme which didn’t happen . . . still no interview even though . . . I knew I met the criteria.

Participants indicated unease with regard to whether they were discriminated against when applying for jobs:

I must have applied for more than 200 jobs over those 2 years and I’ve had 12 interviews . . . Some interviews I thought were brilliant, I did really well. And some . . . that I’ve been to . . . they didn’t get back to me . . . and didn’t give me any feedback. (Ali)

Theme 1 – work of the disabled self

This theme emerged strongly within and across all interviews. All participants indicated that their impairment directly impacted upon their experiences in HE and employment. While it is acknowledged that physiotherapy is an intensive programme and transition to employment is stressful for everyone, our participants experienced pressures over and above those of their peers as a consequence of their visual impairment. They had to work hard to manage their disabled selves.

Ali described situations where visual deterioration occurred at key times during his career. Already feeling under pressure to demonstrate professional competence, he had the additional stress of developing new strategies. He acknowledged these difficulties but also talked about his determination to continue. While his intellectual self recognised the need to change, his emotional self fought against this:

it’s my independence and when my vision is affected . . . it’s going and by struggling I make it worse . . . and every time I lose more independence . . . I feel like I get that bit more determined to hold onto it even though I should learn from the past . . . I really have to fight myself. (Ali)

A sense of exhaustion and frustration became apparent when Chris reflected on his experience:

I had no assistance during the induction, a lot of it was very visual . . . I was expected to cope . . . it was difficult from the onset.

Another aspect of the work of the disabled self was the requirement to be an educator for colleagues:

[Regarding the Access to Work Scheme⁸] . . . they hadn’t heard of it at all . . . so it was me explaining to them what was going to happen. (Anne)

Sue talked about the stress of making a good impression:

any transition . . . for somebody with any sort of disability really is a pretty daunting experience . . . it takes a lot of guts . . . very very stressful because you want to make an impression . . . and that you’re good at what you do and you deserve to be there.

Sue perceived that she needed to work harder to be regarded as competent.

There is divergence within this theme. Some participants were pragmatic but still worked harder or experienced additional stress. For others, however, managing the disabled self was almost the main focus, probably detracting from the ability to fulfil a physiotherapist’s role. The overall impression is that they preferred to struggle rather than to engage with their disability identity to obtain support.

Theme 2 – compensation⁹

Lack of disability-related support was evident from participants’ comments:

initially I felt, I had to work harder to be at the same level as everybody else . . . that was taking a lot out of me but the only way was to adapt and that’s what I did. (Ali)

We noted a sense of resignation: there was no choice but to work harder. Participants did not seem empowered to challenge this situation. They perceived that they were expected to do more in order to prove themselves:

I feel . . . every day I have to prove myself to people around me. (Ali)

nobody’s ever questioned my ability . . . I have to work pretty damned hard at being able to prove myself . . . I have to work extra hard to get myself the credit I deserve. (Sue)

I felt under pressure at the time so . . . I ended up working a lot later than I . . . should have been . . . to try and cover the work that was expected of me. (Steve)

It is sometimes unclear exactly where the pressure to work harder and longer originated. It could have been self-imposed or due to inadequate support.

The impression of needing to do more sometimes seems to be linked to what participants believed other people were thinking rather than overt behaviour or comments from colleagues or managers:

that makes me think ‘OK are they going to get rid of me because they think I’m not safe?’ Even though it is a stupid thought . . . that’s been playing on my mind. (Ali)

Some participants noted that they thought any instance of lower than expected performance would automatically be attributed to their visual impairment:

it’s made it hard because . . . they think that Anne can’t see, it’s a big problem. (Anne)

Participants’ discourses indicated that they have a need for normalisation. Their lived experiences resulted in internal and external expectations to be, or to behave, as non-disabled people. Intellectually, participants recognised the need to undertake some activities differently, take longer to do them, or occasionally, to be unable to do them. Emotionally, however, there was conflict, sometimes resulting in setting impossible goals and reinforcing the unrealistic expectations of others. This suggests an element of collusion between the disabled person and non-disabled peers and may be a reason why compensation emerged as a theme.

Theme 3 – disclosure

Many factors influence disclosure. While participants acknowledged their visual impairments, disability identity was not perceived as a focus. The preference was to minimise the impairment or even to ignore it:

I’d rather just manage . . . they don’t really understand . . . that there’s a problem – and that’s what I’d rather have. (Anne)

The fear was that pity might be elicited:

when I was younger people would see my visual impairment before me . . . I don’t want [them] to feel sorry for me. (Ali)

Divergence existed regarding the necessity to disclose. Sadia adopted a pragmatic approach:

I felt I had to be [proactive] because . . . you’re not doing yourself a justice . . . because if you’re not disclosing you’re not going to get . . . help.

Irrespective of legal requirements, participants still had the responsibility for organising reasonable adjustments.

Sue was less positive and described disclosure as putting her in a vulnerable position, revealing a strong psychological response:

I had to say ‘I’m visually impaired’ . . . I hated it . . . because I thought why should I have to tell it to somebody?

Other participants spoke of their willingness to disclose. Responses they received concerning support, however, were often negative. Even with systems in place, they still had to push for support if they received any at all:

Chris said,

I felt very comfortable at interview . . . and I’ve never really had a problem of . . . talking about problems I may foresee.

Then he noted,

Looking back . . . I don’t feel I had the support and a structured induction that I should have had.

Participants described circumstances that can be interpreted as oppressive and yet generally, they avoided disclosure. Many disabled people are isolated and have no peer support making the difficult and complex process of ‘coming out’ a precarious undertaking (Shakespeare, 1996).

Theme 4 – stigma and passing

Stigma

Stigma is a broad and complex concept, the exploration of which goes beyond the boundaries of this article. Elements of stigmatisation or fear of this were, however, evident during interviews. For people whose impairments have been present since birth or childhood, chronic stigmatisation can start early (Dovidio, Major, & Crocker, 2000). Ali commented,

Even as a child I was told that I should not even try to go to university that I would be better off being on benefits because I wouldn’t be able to have a job.

Sadia described strategies to manage her impairment, regarding these as integral to her daily activities:

I’ve adapted my own way of doing things . . . it’s almost second nature because you don’t normally think of how you do things differently because you do it so naturally.

Some participants reflected on situations in which they felt judged as falling short of the required standard. This relates to rejection and the subsequent effects on thoughts, feelings and behaviour:

I always thought it was a joke them saying ‘oh you can see a lot more than you make out’ . . . I’d laugh it off but in hindsight . . . I think they might think that. (Chris)

This exemplifies a common issue: confusion and misunderstanding by observers due to lack of awareness and assumptions about visual impairment. Visually impaired people are often mobile, negotiating the environment independently but may fail to recognise familiar people. In addition, when accessing text, they may use different methods. This apparent inconsistency elicits confusion in the observer possibly resulting in a failure to trust the disabled person’s competence to practice.

Chris found this situation challenging:

When I’m used to an environment, I don’t use the dog, I don’t use a stick, I walk unaided . . . I’ve had people say, ‘how is it if you’re blind you can see where you’re going?’ . . . there’s this incongruency . . . they don’t seem to understand that you might not have hardly any visual acuity . . . not be able to read or write or . . . cope visually in other respects.

Sue found it difficult to speak about her impairment, feeling responsible for the observer’s response:

You say to somebody ‘Oh I have a disability’ and that makes them feel bad because they’ve mentioned it maybe in a joking way . . . so that’s really, really hard.

Observers may make unfounded assumptions about disabled people’s abilities, triggering negative psychological responses:

For no reason . . . they said I couldn’t walk around the school without being accompanied . . . I was absolutely gobsmacked. (Chris)

Assumptions can also be made that overlook individual abilities:

[Assumptions made about Anne by another visually impaired person based on his own experiences]

The guy from Access to Work, he obviously knew too well what the implications were, how bad it should be . . . what somebody of my level of sight ‘should be’ like.

Stigma is thus a collective, cultural, and interpersonal phenomenon related to ‘the context in which it is encountered” as well as “individual differences in experiences, beliefs, values, goals and roles’ (Dovidio et al., 2000, p. 15).

Passing¹⁰

Participants spent considerable time consciously minimising or concealing their impairment. Their comments indicated that they are not necessarily seen as disabled at first; they responded differently to being discredited. Sue sounded relieved when her impairment was unrecognised:

A lot of people don’t believe me . . . because I don’t look like I have a disability . . . I can get away with looking completely normal.

There is an element of conscious minimisation of impairment.

Sadia and Steve, while aware that they initially appear non-disabled, adopted a more pragmatic approach:

People pick it up anyway and I . . . think because I’m open about it, it’s not really been a major problem. (Sadia)

I’m conscious that I don’t appear sight impaired at all . . . my sight problem is . . . totally unseen. (Steve)

He commented,

It’s not something I’ve felt particularly embarrassed about . . . disclosing it or having people know.

It seemed important for participants to be regarded as ‘normal’ and assimilated into the NHS culture. Inability to conform is disempowering, calling competence into question:

I don’t want to be seen like the troublemaker . . . the outsider . . . now it’s like because of my vision I can’t do anything. (Ali)

Issues related to ‘passing’ seemed less acute with time. Having worked in an environment for a period, participants earned respect from managers, colleagues, and other personnel.

Theme 5 – barriers

Lack of support

Colleagues failed to provide agreed support even when this had been negotiated:

The best I got was ‘I’ll get that done, I’ll do it sometime’ . . . so you end up not getting a lot of information . . . this is incredibly frustrating. (Chris)

Ali encountered barriers concerning employment of a support worker:

I was supposed to have a support worker . . . but that didn’t happen for about 3 months.

When support was implemented, it was possible to manage the environment. When it was not, however, stress increased. This prevented Ali from carrying out his duties:

I can’t do anything . . . couldn’t fill any medical [notes], couldn’t see anyone . . . couldn’t do anything because I couldn’t read the medical notes and then I get pulled up – ‘surely you can be doing something instead of standing around’.

Equipment

Equipment and/or assistive technology is often required to access text and computer screens. Obtaining this can be problematic during transition. Sadia and Ali commented,

In terms of computer access I was limited because I couldn’t read the screen. I did contact Access to Work . . . was in contact with IT . . . but that didn’t work . . . I’d hit a brick wall. (Sadia)

It took forever to get my ZoomText . . . I was struggling with the screens and asking for help . . . and then my laptop didn’t arrive. (Ali)

Once equipment arrived, managing the environment became easier. Difficulties arose due to delays in arrival or when it was not requested.

Behaviour

These barriers can be divided into (a) those erected by colleagues and (b) those erected by participants.

Examples of (a): barriers erected by colleagues

They hadn’t heard of it [Access to Work] . . . so it was me explaining to them what was going to happen. (Anne)

[Lack of care] . . . you ask, ‘is it possible to get it on disk’? . . . it’s not always possible I understand . . . but I hardly ever got that sort of care. (Chris)

[Attitudinal] they weren’t applying the concept of ‘reasonable adjustment’ which . . . became a barrier which I thought was . . . because of my sight. (Steve)

Chris seemed dissatisfied with the NHS:

I’ve never been part of an organisation that can be so . . . just not proactive.

Examples of (b): barriers erected by participants

Sue acknowledged that she erected barriers by restricting her choice of work environment. This was compounded by her unwillingness to discuss support requirements:

I’m limiting myself even more . . . I was being limited on top of that because other people were not helping.

Anne’s barrier was created by denial of her support needs and insistence on independence:

It was always having to explain to them, you don’t have to make a big deal out of it, I’m just going to go and try and manage it.

Both categories of barrier are complex and associated with disclosure, compensation, and stigma. Issues relating to identity management and interpersonal relationships emerged as particularly relevant. The focus on ‘passing’ and denial of impairment imposed limitations on participants’ abilities to interact with colleagues and to engage effectively. This can lead to feelings of disempowerment and isolation.

Theme 6 – disempowerment

Loss of control, decrease in confidence, and self-esteem were triggered by actions of others leading to feelings of disempowerment.

Anne reflected on her Access to Work assessment conducted by a visually impaired assessor. She described his failure to acknowledge her needs and felt disempowered by his assumptions. When her manager adhered to the recommendations, this compounded the situation:

The report says that she’s photophobic . . . she can’t be near a window so I’ve been moved to the other end of the office . . . all because of his report . . . I’d rather be part of a group than isolated because I’m visually impaired.

She expressed feelings of disadvantage and discrimination and felt unable to challenge this decision because of her probationary status.

Following visual deterioration, Ali described a senior colleague questioning his competence. He felt his position to be precarious:

She’s always watching me . . . always there and she thinks I can’t see, but I can . . . my confidence is the worst that it’s ever been.

This situation could have been challenged. We believe, however, that Ali’s need to deal with his deteriorating vision left him without personal resources on which to draw to protect himself.

Chris felt out of control on losing his support worker. Being expected to cope alone was disempowering:

absolutely physically drained . . . when things started to go tail up . . . it became irreversible . . . and completely out of control . . . I’ve never been in that situation before of being so low . . . and not knowing who to turn to.

Lack of resources can result in critical incidents leading to demoralisation and disempowerment.

Theme 7 – positive experiences

Positive experiences facilitated participation. Anne reflected on her helpful relationship with a supervisor which enabled her to talk about the impact of her visual impairment and helpful strategies:

That was actually my favourite one because it was really hands on . . . and me and my educator really got on . . . I was happy to talk to her.

Disability-related issues were not always defining factors in improving the workplace experience. Ali related a feeling of importance to being ‘normal’:

They were happy to have me because I spoke Punjabi . . . I could translate . . . I felt really important . . . I felt normal for the 1^st time in my life.

Chris was delighted when asked how he would like to receive materials for in-service training:

I’m doing this presentation next week . . . how do you want the information? Brilliant.

Sue was relieved when a supervisor was flexible and willing to discuss support strategies:

She was open to the idea of: ‘how do I support her – let’s try and find a way to do this?’ . . . she made that [the placement] for me.

These illustrate approaches that disabled people find helpful in negotiating support: openness, flexibility, collaborative working, a proactive and inclusive approach, and preparation and provision of accessible materials in advance. These are inexpensive, easy to implement, and take little time to organise. For the participants, however, this type of systemic support was rarely available.

Limitations

The issues identified in this study do not necessarily indicate any fundamental truth about the experiences of participants or those of other disabled people. The findings may offer limited transferability. When considered in the wider context, however, we believe that our interpretations contribute to the overall picture. We suggest that they challenge the authority of medicalised ‘truths’ and provide opportunities for discussion and exploration.

We obtained rich and expansive data, which took unanticipated directions. Time for analysis was limited, and while we believe that we have identified important issues, the themes and our interpretations could be further refined.

Conclusion

The majority of research relating to visual impairment is rooted in the medical model, focusing on diagnosis, treatment, and rehabilitation (Dale, 2010). Visually impaired people’s voices are noticeably absent in most cases (Thurston et al., 2010) and those of disabled physiotherapists are rarely heard. Our aim was to provide space for those voices to be heard to contribute to redressing the balance.

The detailed ideographic examination of the data provided the means to explore participants’ lived experiences and enabled reflection upon the ways in which they make sense of, and meaning from, those experiences (Smith, Larkin, & Flowers, 2009). Each person’s story is unique and the lived experiences are different, yet our interpretation identifies what we believe to be convergence in their narratives.

The themes appear to be inextricably linked. Participants live in a visually dominated world and work in a culture in which disability is generally regarded as needing rehabilitation. Largely negative societal attitudes result in the creation of external barriers. Visual impairment has consequences for identity development which can, in turn, erect internal barriers to engagement in daily activities.

An overarching theme which emerged, for all participants, was the reluctance to ‘come out’: to positively identify with their disabled selves (Shakespeare, 1996). They appeared reluctant to engage with this; they tended to avoid it because they felt uncomfortable.

Participants rarely spoke about their visual impairments. Two of them commented that, by verbalising their experiences, they realised their complexity. They believed that no one would be interested in listening to their stories. Some also found that talking about their lives as visually impaired physiotherapists was helpful. Perhaps the interviews provided a safe environment in which they experienced unconditional positive regard (Rogers, 1957), which they had not encountered before. This further reinforces our contention that they are entrenched within the medical model, ignore their disabled selves, and fail to question their own passivity.

Our participants have had few opportunities to consider wider perspectives of disability. They appear to be isolated. Consequently, their lived experiences as disabled people are relatively impoverished. None referred to the current debates on disability-related issues or to the literature produced over the last 30 years. There was no indication that they engage with politicised disabled people. Three participants mentioned being in contact with the Association of Visually Impaired Chartered Physiotherapists. While they perceived this group as supportive, it is an interesting paradox that they described themselves as different from its members.

It is not surprising that our participants were constantly challenged by disability-related barriers. Their focus was on being competent physiotherapists and yet, by not embracing their disability identity, they created internal barriers that were significant during the transition process. None received assistance, either from university or workplace personnel. No advice or guidance was provided on the support they could expect; they were not furnished with details of useful contacts. We regard these findings as crucial to the future development of our service, which strives to be evidence based. The results of this study are being used to modify and add to our service provision in the following ways:

Contacting students in advance of qualification to discuss disability-related support in the NHS;

Provision of guidance materials on job-seeking skills and the Access to Work Scheme;

Follow-up seminars and/or one-to-one contact before, during, and following transition; and

Training for academic and clinical staff on disability-related issues on transition to work.

Ethical approval was obtained from the Institute of Education, London University

Footnotes

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

1.

‘Lived experience’ – most of the time we are simply immersed in our experiences and often unaware of much that is happening. Momentarily, we can become aware of the flow of our experience and become explicitly attuned to a specific event. This experience may, however, have greater significance for us and take on a range of additional meanings or significance linked to other wishes, concerns, thoughts, or earlier experiences. Thus, we can explore a hierarchy of experiences with our participants, which comprises a range of ‘parts of a life’, separated in time but ‘linked with a common meaning’ (Smith et al., 2009, p. 2). The aim of the interview is to recall these parts and connections and explore this common meaning.

Notes

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