Factors associated with willingness to work among unemployed persons with a disability in a large urban area: A short communication

1 Introduction

Even though the right of persons with disabilities to work is ensured by the Convention on the Rights of Persons with Disabilities, and endorsed by the United Nations, their engagement in working life has proved to be a challenging task in practice [1]. The unemployment rate amongst people with disability remains high [2]. One of the reasons for the challenge is a lack of knowledge on factors determining the employment of people with disability [2].

Work participation is increasingly seen as a primary outcome of rehabilitation measures, yet only a few factors constraining or facilitating the employment of persons with disabilities have previously been described. Most of the previous studies focused on specific health problems (e.g. mental or neurological) or on specific interventions. It has been proposed that age, disability type (by anatomical system involved), gender, degree of independence and educational level of people with disabilities may affect their return to work and the success of the vocational rehabilitation interventions [3–9]. While it is important to investigate the role of environmental factors (such as social attitudes and employment services), it is self-evident that also measuring intrinsic factors like willingness to gain employment or to participate in vocational rehabilitation may also play a central part in successful employment [10]. The concept “willingness to work” is understood here as one’s readiness to participate in remunerative work life. Additionally to individual factors, e.g. disability, willingness to work (understood as a part of a more common concept of work ability) can be affected by such environmental factors as attitudes prevailing in society, insurance system, employers, and co-workers [11]. Factors associated with willingness and attitudes towards work have not been studied sufficiently amongst the general population of people with impaired functioning [12]. Recognizing and improving attitudes to work and vocational rehabilitation may increase the employment rate of persons with disabilities [13].

The objective of this study was to investigate the influence of some demographic factors on a willingness to work and a need for vocational rehabilitation amongst unemployed persons with confirmed disability.

2 Methods

The data were gathered from a questionnaire containing 30 items regarding demographics, a need for vocational rehabilitation, and a willingness to gain employment. The survey was conducted in 2015. In Russian Federation, special ‘bureaus of medical and social expertise’ assist persons with confirmed disability to create an individual rehabilitation plan including vocational rehabilitation. Then, after obtaining a signed agreement from the client, rehabilitation plans are sent to municipal employment services and officers make first contact by email or by phone. This way, all persons with legally confirmed disability of any grade and who had been registered in municipal employment services have been asked to participate when visiting employment service offices or vocational rehabilitation centres. Persons registered in municipal employment services are obliged by law to visit a service office at least twice a month. Therefore, within one month, all the 2 002 persons have responded to the survey presented by officers. Concerning the topic of interest, Russian legislation has not been substantially changed since the survey. The sample for the present study was formed from 1 547 (77%) respondents who have reported an overall interest in obtaining or switching work and considered being unemployed.

Age was defined in groups: 16 to 29, 30 to 39, 40 to 50, and >50 years. Age was limited to 55 years for women and 60 years for men – the ages of retirement for women and men in Russian Federation. Marital status was defined as ‘single’ versus ‘married’ or ‘co-habiting’. The respondents have reported their grades of disability as severe (grade 1), moderate (grade 2), and mild (grade 3) as established formally by public institutes of health care and social security. Grade 1 requires an inability to independently move around, perform self-care, and interact with people. Grade 2 is defined by incomplete independence with occasional help from another person in self-care and moving around, an ability to interact with people using assisting devices, and necessary adjustments made at home or at a place of work to accommodate the disability. Grade 3 is defined by independence but with occasional or regular use of assistive devices or other environmental adjustments. The type of disability was defined as ‘congenital’ versus ‘acquired’. Occupational education, previous work history, wish to work in adjusted workplaces, and perceived need for vocational rehabilitation were dichotomized as ‘yes’ versus ‘no’. Target salary rate was defined in Russian rubles per month: <10 000, 10 000 to 19 000, 20 000 to 29 000, and >30 000 rubles. Willingness to start working was defined as willingness to start working within a month, or after some treatment or rehabilitation procedures, or the lack of such willingness at all.

3 Results

The sample consisted of 1 547 unemployed respondents. Their basic characteristics are shown in Table 1. The sample was slightly predominated by men (58%). The severe disability has been confirmed in 3% of the respondents. Respectively, 36% had moderate and 61% had mild levels of disability. The exact causes of disability were out of the scope of the present study. Only about a quarter of patients (23%) had a congenital cause for their disability. The majority (86%) had some work history and 74% had vocational education of diverse levels. Only 14% were seeking an adjusted job and 65% were ready to start working within a month. A need for rehabilitation was expressed by approximately half (45%) of the respondents.

The need for vocational rehabilitation was significantly associated with older age, lower disability grade, and lower expectation of a desired salary (Table 2). The older (RR 1.36, 95% CI 1.2 to 1.5) respondents with milder disabilities (RR 1.30, 95% CI 1.06 to 1.60) stated the need for rehabilitation more often. The expectation of higher salary rate was negatively associated with a need for rehabilitation (RR 0.77, 95% CI 0.67 to 0.88). Other associations were insignificant. The model was robust with Chi² 75.3, p-value <0.0001, and pseudo R² 0.04.

Older age (RR 1.31, 95% CI 1.14 to 1.51), more severe disability (reversed figure – RR 0.75, 95% CI 0.60 to 0.93), the existence of previous occupational education (RR 1.15, 95% CI 1.04 to 1.26), and expectation of adjusted work environment (reversed figure – 0.90, 95% CI 0.81 to 0.99) were associated with a delayed willingness to work (a wish to start working only after some treatment or rehabilitation procedure) (Table 3). Persons with congenital disability were more prone to report that they are not ready for work (reversed figure – RR 0.42, 95% CI 0.20 to 0.89). For reasons unknown, targeting unadjusted work environment increased the probability of reporting a lack of readiness for work (RR 1.36, 95% CI 1.04 to 1.77). Other associations in this analysis were insignificant. The model was robust with Chi² 67.6, p-value <0.0001, and pseudo R² 0.03.

In this cross-sectional survey-based study amongst 1,547 unemployed persons with disabilities, the willingness to work was positively associated with younger age and milder disability level. The significance of other studied factors was weak (statistically significant but close to 1.0 confidence intervals) or insignificant. The older respondents with milder disabilities and lower expectations regarding the rate of possible salary reported a need for vocational rehabilitation more often.

The sample was large enough to produce a statistically robust model and some credible inferences can be established. To some extent, these findings are probably bound to legislation, customs, and attitude of a specific society and, as such, any generalizations to other populations should be made cautiously. Additionally, in this study, a very rough grading scale of disability severity was used, and the results may be different with more precise grading. The sample represented mostly persons with mild and moderate disabilities with only 3% of the respondents having confirmed severe-grade disability. The original purpose of the survey was to provide the city authorities with data regarding the need of employment assistance amongst people with disabilities. Thus, the items for this 4-page questionnaire have been chosen based rather on their importance to the employment agencies than on scientifically validated psychometric properties. This study employed only part of the items included in questionnaire. The questionnaire (in Russian) is available on request from a corresponding author. In this study, ‘willingness to work’ was simplified by measuring it using a single question about willingness to start working within a month or after some procedures. In reality, the concept of ‘willingness to work’ is more complex. It is influenced by sociodemographic factors incorporating aspects of believe in a realistic possibility for successful work reintegration (finding a suitable job, being able to access the workplace, a labor market situation etc.) and a self-evaluation of the benefits of being at work. Such benefits may include material values, as e.g., desired income, but also personal values such as integration into society, self-esteem and having a purpose in life.

Our results are hardly comparable with previous knowledge on the topic, as only a few studies have investigated the role of intrinsic factors in employment amongst a general population of people with disabilities. The findings are, however, in line with previous studies that have connected willingness to work with age and level of functioning and independence of persons with disabilities [8, 12]. We could not confirmed any connection between willingness to work and gender or previously reported educational level [14]. The reasons for these differences might be due to variations in the studied samples, with potential differences in the particular cause of disability, age group, and regional or national customs. Further research in different settings and legislation systems is needed to generalize reliably these findings.

The results of this study should be taken into account when allocating vocational rehabilitation and employment services amongst people with impaired functioning.

Conflict of interest

None to declare.