Scoping review of women with disabilities’ livelihood occupation experiences: An equity perspective

Abstract

BACKGROUND:

Globally, persons with disabilities are faced with unemployment and reduced income opportunities. Barriers to employment tend to be severe for women with disabilities who occupy marginalized positions in labor markets. ‘Livelihood occupations’ are conceptualized for this review to denote everyday activities that are done for subsistence and survival, and to broaden presentations of activities normally termed ‘work’, ‘employment’, ‘job’ or ‘productivity’ that people do to earn money and non-monetary gain.

OBJECTIVE:

This scoping review, undertaken as part of a broader interpretive phenomenological analysis of livelihood occupations of women with disabilities, maps research on the subject of livelihood occupations for women with disabilities.

METHODS:

The Arksey and O’Malley framework and PRISMA extension for scoping reviews were utilized to guide the five stage scoping strategy used to screen and select sources. Data from selected sources were synthesized using deductive qualitative content analysis to fit experiential components into equity categories determined a-priori from the Equitable Total Rewards model, to determine if these experiences connote equity or lack thereof.

RESULTS:

Nineteen sources, mainly from high income countries, are identified. Aspects of benefit and career inequity were largely evident in the experiences of the women across all sources.

CONCLUSION:

There is considerable lack of research on experiences of livelihood occupations in low and middle income countries contexts justifying further research. Women with disabilities report experiencing inability to realize career goals and occupational choice.

Keywords

Work narratives disabled persons work employment equity

1 Introduction

This scoping review, done to map research on the subject of livelihood occupations for women with disabilities, is framed around the concepts of occupation, livelihood, disability and gender. The results are presented from an equity perspective using parameters of pay, benefit and career equity as they are defined in The Equitable Rewards Model.

Livelihoods provide the assets people draw upon including the range of activities, choices and strategies people develop to make a living [1]. These provide the context within which a livelihood is developed and those factors that make the livelihood more or less vulnerable to shocks and stresses [2]. The focus on livelihoods stems from an interest in the lived realities of members of poor and vulnerable groups in low income settings and how these groups make their living in the context of risk and stress caused by socio-economic challenges. Occupations are personalized everyday activities that people do as individuals, in families, and with communities to occupy time and bring meaning and purpose to life [3]. Payne’s [4] conceptualization of ‘occupation’ included “connotations of income, . . . levels of skill and educational entry requirements, and therefore lifestyles; sets of options, values and attitudes and therefore political behaviors; collectives of work-based friendships, and therefore group identity; social prestige and therefore influence outside of the work setting . . . ” (p19). This conceptualization is by no means exhaustive. The concept of ‘occupation’ also connotes health and wellbeing, experience and meaning [5].

The term ‘livelihood occupations’ was conceptualized for this review to denote any everyday activities that are done for subsistence and survival, and to broaden presentations of activities that people do to earn money and non-monetary gain. This includes the terms ‘work’, ‘employment’, ‘job’ or ‘productivity’, used in literature and dominant occupational therapy models. Within this conceptualization, livelihood occupations include everything that people do to earn an income (or a living). Even occupations that are illegal, unhealthy, deviant and not socially sanctioned are included [6]. The term livelihood occupations denotes occupations with a particular livelihood-creation purpose. Such a lens is especially relevant in low to middle income countries, where livelihood occupations might be more diverse and less conventional than in higher income contexts. The livelihood occupation lens links occupational terminology to contemporary political, economic, spatial and cultural conditions within which such occupations occur, thus shaping meaning and experience. This thinking resonates with the argument that there is questionable value in categories of work and other occupations that are standardized especially when these are named and valued differently by different cultures [7] and builds on the impetus to build a rationale for scholarship that embraces a more inclusive understanding of human occupations [8]. Studies on experiences of work or livelihood creation in occupational therapy have tended to look at transition into employment or return to work and have not focused greatly and specifically on women in general and women with disabilities in particular.

Globally, persons with disabilities are faced with unemployment and they have reduced income opportunities, with an outlook that is worse for women [9]. Research has shown that women with disabilities earn lower wages than their male counterparts and women without disabilities [10]. Disparities in employment have been shown to cause low self-assessed quality of life for women with disabilities [11]. Barriers to employment tend to be severe for women with disabilities who have been observed to occupy marginalized positions in labor markets [12] and lack career development opportunities [13]. Mckinsey [14] showed that women’s jobs have been 1.8 times more vulnerable during the COVID-19 crisis when compared to men’s jobs. Further, women have reported experiencing exhaustion and burn out at work and take the major responsibility for domestic duties as caregivers [14].

The notion of equity implies a state of fairness where everyone has access to similar opportunities [15]. The World Health Organisation (WHO) defines equity as “the absence of avoidable or remediable differences among groups of people . . . defined socially, economically, demographically, or geographically or other dimensions of inequality . . . ” [16]. Equity relates to social justice. Both these terms are subsumed within occupational justice. Groups of people may experience inequity by virtue of being poor, female, and/or members of a marginalized racial, ethnic or religious group [17]. Categories of difference can put women with disabilities in multi- and intersecting forms of disadvantage [18] evidenced by gaps in access to, utilization and quality of livelihood occupations, employment and work opportunities that promote health and wellbeing. Therefore, women’s experiences have to be distinctly examined as they are unique.

Although conversations around the concept of equity have occurred in occupational therapy, the discourse has focused on equity within occupational therapy, particularly diversity, health equity, inclusion and access of services [19 –21] but not equity as it relates to the livelihood occupations people engage in. Equity and justice are represented in occupational therapy practice in ways that are complex and varied by settings and roles [19]. For this study, the authors opted to use an established framework, that is, The Equitable Total Rewards Model (ETRM), to comprehend the state of equity in livelihoods as they are experienced by women with disabilities. The ETRM is made up of three main equity categories (pay, benefits, and career) that are further delineated according to four dimensions of well-being (emotional, financial, social and physical). In the ETRM, pay equity is defined as fairness and adequacy of pay/wages including whether or not income was fair, competitive and aligned to skills. Benefits equity is viewed in terms of tangible and intangible things that accrue to the participant outside pay and career growth, for example, how the occupation helps grow social networks, opportunities for savings, having an identity and fulfilling roles. Career equity is defined as those aspects of the experience that reflect career development, equal access to opportunities, personal growth in the workplace and fairness in terms of up-skilling and reskilling. The model was developed for assessing equity in employment during the COVID-19 era and to improve health, wellbeing and access. Although the model embraces the notions of diversity and inclusion [21], only the equity dimensions were used for this scoping review. The ETRM was chosen as it focuses on both process and outcomes and is applicable across different livelihood creation activities. Instances of where an equity lens has been used in occupational therapy include health equity and disparities [22 –24], and epistemic dominance of the Global North [23]. The use of the ETRM model in this paper reflects the lack of custom occupational therapy equity models for analysis of livelihood oriented occupations.

There has been an increasing need for occupational therapists to pay more attention to inequitable contextual and environmental factors that constrain occupational opportunities [25]; this will require re-directing some of the focus given to remediating occupational performance components [23]. Having a livelihood can be a way to enable independent living and foster the engagement in livelihoods, and it is therefore part of the service that occupational therapists need to provide for their service users. An occupational therapy service is not complete if it strives to address the individual abilities of clients without attending to unjust and/or unfair occupational opportunities. This scoping review was undertaken to systematically explore literature on experiences of women with disabilities in livelihood occupations and thus provide a conceptual foundation for a broader phenomenological exploration of experiential facets of livelihood occupational engagement in a low middle income context that faced socio-economic disruption in the last two decades. The scoping review is envisaged to provide a window into the extent and nature of knowledge available globally on the subject of livelihood occupational engagement for women with disabilities. An equity lens is applied on the findings pertaining to experiential facets of the occupations women with disabilities engage in within the selected sources.

1.1 Aim

Scoping review methodology is a multidimensional approach of synthesizing literature to answer broad questions and map available evidence [26] in disciplines with emerging evidence and a growing knowledge base [26, 27]. The aim of this review was to map available literature on the subject of livelihood creation as an occupation for women with disabilities. The following questions were addressed: a. What is the distribution of research pertaining to livelihood occupation experiences in terms of location and research tradition utilized?, b. What are the experiences of women with disabilities when engaging in livelihood occupations? and; c. What are the equity characteristics of these experiences, and the link, if any, to occupational justice?

2 Materials and methods

2.1 Scoping review strategy

A protocol was developed a-priori guided by the Arksey and O’Malley [28] framework and the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-ScR) [29]. The protocol was made up of five-stages that were followed in the scoping review as follows:

Stage 1: Identifying and articulating the research question

The question was premised on the person, concept and context (PCC) mnemonic: Population –women with disabilities involved in livelihood occupations; Context –low to high income countries as ranked by World Bank and; Concept –Livelihood activity, workplace, work, occupation, experience, and productivity.

Stage 2: Identifying relevant studies

Selection criteria were iteratively developed, refined and applied with the assistance of three librarians, two from Stellenbosch University and one from University of Worcester. Sources were included if these contained primary research on adult women with disability’s experiences of livelihood occupations and were published in English, between January 1992 and October 2022. The significance of the year 1992 is tied to the broader interpretive phenomenological study done in Zimbabwe by the primary author, exploring the livelihood occupations of women with disabilities that this scoping review forms part of. In Zimbabwe, a progressive piece of legislation that recognized the value of livelihoods for persons with disabilities, namely the Disabled Persons Act (Chapter 17 : 01) (sections 9-11) [30], was passed into law in 1992; it provided for criminalization of workplace discrimination. This legislative change was in keeping with an international trend of passing human rights-based disability legislation in the 90 s, for example Russia (The decree of the President of the Russian Federation of 22 December 1993, No. 2254, on measures of state support for the activity of all-Russian associations of persons with disabilities. 1993), USA (The Americans with Disabilities Act 1990), Zambia (The Persons with Disabilities Act 1996), United Kingdom (Disability Rights Act 1999), and Australia (Disability Discrimination Act 1992) [31]. In addition to the selection criteria, the participants in the sources must have been residing in their communities NOT in institutions of care or under a treatment program. Studies on women with disabilities in institutions of care or in an intervention program were not considered in order to align this scoping review with the broader study for which this scoping review was foundational.

Stage 3: Search, data management and review

Librarians assisted in the search process by advising on appropriate Medical Subject Headings (MeSH terms). The librarians also assisted with, modifying MeSH terms for the different databases and locating articles that were not readily available or accessible. The MeSH terms build up and definitions is presented in Table 1.

Table 1
Terms and meanings of corresponding MeSH headings used in PubMed Search builder

Term MeSH headings Definition in PubMed

Experience Personal Narratives Works about accounts of individual experience in relation to a particular field or of participation in related activities

Personal Satisfaction The individual’s experience of a sense of fulfilment of a need or want and the quality or state of being satisfied

Thinking Mental activity that is not predominantly perceptual by which one apprehends some aspect of an object or situation based on past learning and experience.

Mental Recall The process whereby a representation of past experience is elicited

Personal Narrative [Publication Type] Work consisting of accounts of individual experience in relation to a particular field or of participation in related activities.

Learning Relatively permanent change in behavior that is the result of past experience or practice. The concept includes the acquisition of knowledge.

Imagination A new pattern of perceptual or ideational material derived from past experience.

Attention Focusing on certain aspects of current experience to the exclusion of others. It is the act of heeding or taking notice or concentrating.

Livelihood Occupations Occupations Crafts, trades, professions, or other means of earning a living

Workplace Place or physical location of work or employment

Employment The state of being engaged in an activity or service for wages or salary

Work Productive or purposeful activities

Work Engagement Extent to which members of a workplace perceive their emotional commitment to and involvement in the organization and its goals.

Disabilities Disabled persons Persons with physical or mental disabilities that affect or limit their activities of daily living and that may require special accommodations

Intellectual Disability Subnormal intellectual functioning which originates during the developmental period. This has multiple potential etiologies, including genetic defects and perinatal insults. Intelligence quotient (IQ) scores are commonly used to determine whether an individual has an intellectual disability. IQ scores between 70 and 79 are in the borderline range. Scores below 67 are in the disabled range. (from Joynt, Clinical Neurology, 1992, Ch55, p28)

Learning Disabilities Conditions characterized by a significant discrepancy between an individual’s perceived level of intellect and their ability to acquire new language and other cognitive skills. These may result from organic or psychological conditions. Relatively common subtypes include DYSLEXIA, DYSCALCULIA, and DYSGRAPHIA.

Communication Disorders Disorders of verbal and nonverbal communication caused by receptive or expressive LANGUAGE DISORDERS, cognitive dysfunction (e.g., MENTAL RETARDATION), psychiatric conditions, and HEARING DISORDERS.

Mentally Disabled Persons Persons diagnosed as having significantly lower than average intelligence and considerable problems in adapting to everyday life or lacking independence in regard to activities of daily living.

Chronic Disease Diseases which have one or more of the following characteristics: they are permanent, leave residual disability, are caused by nonreversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation, or care. (Dictionary of Health Services Management, 2d ed)

Term	MeSH headings	Definition in PubMed
Experience	Personal Narratives	Works about accounts of individual experience in relation to a particular field or of participation in related activities
	Personal Satisfaction	The individual’s experience of a sense of fulfilment of a need or want and the quality or state of being satisfied
	Thinking	Mental activity that is not predominantly perceptual by which one apprehends some aspect of an object or situation based on past learning and experience.
	Mental Recall	The process whereby a representation of past experience is elicited
	Personal Narrative [Publication Type]	Work consisting of accounts of individual experience in relation to a particular field or of participation in related activities.
	Learning	Relatively permanent change in behavior that is the result of past experience or practice. The concept includes the acquisition of knowledge.
	Imagination	A new pattern of perceptual or ideational material derived from past experience.
	Attention	Focusing on certain aspects of current experience to the exclusion of others. It is the act of heeding or taking notice or concentrating.
Livelihood Occupations	Occupations	Crafts, trades, professions, or other means of earning a living
	Workplace	Place or physical location of work or employment
	Employment	The state of being engaged in an activity or service for wages or salary
	Work	Productive or purposeful activities
	Work Engagement	Extent to which members of a workplace perceive their emotional commitment to and involvement in the organization and its goals.
Disabilities	Disabled persons	Persons with physical or mental disabilities that affect or limit their activities of daily living and that may require special accommodations
	Intellectual Disability	Subnormal intellectual functioning which originates during the developmental period. This has multiple potential etiologies, including genetic defects and perinatal insults. Intelligence quotient (IQ) scores are commonly used to determine whether an individual has an intellectual disability. IQ scores between 70 and 79 are in the borderline range. Scores below 67 are in the disabled range. (from Joynt, Clinical Neurology, 1992, Ch55, p28)
	Learning Disabilities	Conditions characterized by a significant discrepancy between an individual’s perceived level of intellect and their ability to acquire new language and other cognitive skills. These may result from organic or psychological conditions. Relatively common subtypes include DYSLEXIA, DYSCALCULIA, and DYSGRAPHIA.
	Communication Disorders	Disorders of verbal and nonverbal communication caused by receptive or expressive LANGUAGE DISORDERS, cognitive dysfunction (e.g., MENTAL RETARDATION), psychiatric conditions, and HEARING DISORDERS.
	Mentally Disabled Persons	Persons diagnosed as having significantly lower than average intelligence and considerable problems in adapting to everyday life or lacking independence in regard to activities of daily living.
	Chronic Disease	Diseases which have one or more of the following characteristics: they are permanent, leave residual disability, are caused by nonreversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation, or care. (Dictionary of Health Services Management, 2d ed)

Notes: MeSH terms are as they are defined in PubMed at the period of development and implementation of the search strategy unless otherwise cited.

Systematic searches were initially and iteratively done in PubMed with the MeSH terms being refined in meetings until an agreement was made on the final search string for PubMed (see Table 2). The MeSH terms were then respectively tailored and applied to the four remaining databases namely EBSCOhost (Academic Search Premier, Cinahl, ERIC, Africa Wide Information), PROQUEST, Scopus and Sabinet (see Table 2). These five databases were selected because they provide wide coverage of material on livelihoods and occupational therapy including topical issues on disability, gender and social justice. Grey literature appearing in selected databases was also parsed and included conference abstracts, book reviews, commentaries or editorial articles from the databases. The Sabinet database was included to broaden chances of locating grey and unpublished literature from the African context.

Table 2

Search strings used in respective databases

Database	Search Terms	Search Strategy
PubMed	(“Personal Narratives as Topic”[Mesh] OR “Personal Narrative”[Publication Type] OR “Thinking”[Mesh] OR “Mental Recall”[Mesh] OR “Learning”[Mesh] OR “Imagination”[Mesh] OR “Attention”[Mesh] OR “Personal Satisfaction”[Mesh]) AND “Occupations”[Mesh]) OR “Work”[Mesh]) OR “Work Engagement”[Mesh]) OR “Workplace”[Mesh]) OR “Employment”[Mesh]) AND (“Learning Disabilities”[Mesh] OR “Disabled Persons”[Mesh] OR “Mentally Disabled Persons”[Mesh] OR “Chronic Disease”[Mesh] OR “Communication Disorders”[Mesh] OR “Intellectual Disability”[Mesh])	Filters activated: Abstract, Publication date from 1992/06/01 to 2019/06/01, Female, Adult: 19 + years.
Ebscohost databases: Academic Search Primer, Africa Wide Information, Cinahl, ERIC	SU (Experiences OR Attitudes OR Perceptions OR Views OR Feelings OR Perspective OR Satisfaction) AND SU (Women OR Females OR Woman OR Female) AND SU (Disability OR Disabilities OR Impaired OR Disabled OR Impairment OR Chronic illness OR Chronic disease) AND SU (Livelihood OR Work OR Productivity OR Career OR Job OR Occupations OR Employment OR Labour Market)	Limiters -: - aged, 80 &over: - aged: 65 + years: - middle aged: 45-64 years: - adult: 19-44 years: - all adult: - english - Boolean/Phrase. Additional limits –Date: From 01 January 1992 to 31 January 2021
Scopus	(TITLE-ABS-KEY (experiences OR attitudes OR perceptions OR views OR feelings OR perspective OR satisfaction) AND TITLE-ABS-KEY (women OR females OR woman OR female) AND TITLE-ABS-KEY (disability OR disabilities OR impaired OR disabled OR impairment OR chronic AND illness OR chronic AND disease) AND TITLE-ABS-KEY (livelihood OR work* OR productivity OR career OR job OR occupations OR employment OR labour AND market)) AND PUBYEAR > 1991	Additional limits –Date: From 01 January 1992 to 31 January 2021
Sabinet	Experiences OR Attitudes OR Perceptions OR Views OR Feelings OR Perspective OR Satisfaction AND Women OR Females OR Woman OR Female AND Disability OR Disabilities OR Impaired OR Disabled OR Impairment OR Chronic illness OR Chronic disease AND Livelihood OR Work* OR Productivity OR Career OR Job OR Occupations OR Employment OR Labour Market	Additional limits –Date: From 01 January 1992 to 31 January 2021
Proquest	mainsubject(Experiences OR Attitudes OR Perceptions OR Views OR Feelings OR Perspective OR Satisfaction) AND mainsubject(Women OR Females OR Woman OR Female) AND mainsubject(Disability OR Disabilities OR Impaired OR Disabled OR Impairment OR Chronic illness OR Chronic disease) AND mainsubject(Livelihood OR Work* OR Productivity OR Career OR Job OR Occupations OR Employment OR Labour Market)	Additional limits –Date: From 01 January 1992 to 31 January 2021 Applied filters: NOT (adolescent AND child AND children AND children &youth AND disabled children AND child, preschool)

Sources from each database were exported to separate folders in Mendeley®; then merged into a composite folder for de-duplication. The composite folder was then exported to Covidence® for further de-duplication. Screening of titles and abstract ensued for the remaining 7098 titles. The PRISMA flow chart in Fig. 1 illustrates the search process and how the nineteen sources that were then synthesized in this review were obtained. Of the grey literature, none ended up in the final list of articles.

Fig. 1

PRISMA flow diagram for the scoping review exploring literature on livelihood occupational engagement experiences.

The screening process commenced with all three authors screening the first fifty sources using provisional selection criteria, followed by a meeting to discuss and refine the selection process and criteria. The remaining sources were then all reviewed by first author, with second and third authors sharing the responsibility of being second reviewer. Full text screening followed, using the same review pattern. Conflicts were managed by way of iterative meetings with second and third authors alternately assuming the roles of second and third reviewer.

Stage 4: Extracting and charting the data

A nineteen item data extraction template was iteratively developed on the Covidence® platform to extract data from the nineteen included sources and all authors participated. Extracted data covered the following: author (s), year and type of publication, country of origin, aim/purpose, study population and sample size, methodology and experiential facets. Data were then extracted and charted by the first author and condensed for presentation in this publication (see Table 3), again, after a meeting to ensure that the process maintained consistency with the aim of the review. The second and third authors then verified accuracy of the data extraction undertaken by first author by checking 20% of the extracted and charted data for accuracy.

Table 3

Characteristics of included sources

Authors and year of publication	Study context	Study paradigm/Theoretical framework	Study participants/target population	Disability Type	Occupations	Tradition
Hanlon and Taylor, 2022	Australia	Qualitative/Critical Disability Theory and Intersectionality	8 females (aged 20 to 29 years)	Physical, hearing and visual disability	Middle to high skilled	Descriptive
Varshney, 2022	India	Qualitative/Not specified	18 females (aged 25 to 45 years)	Physically disabled	Low to middle to skilled	Interpretative phenomenology analysis
Hughes and Trip, 2021	New Zealand	Qualitative/Not reported	9 females, 1 male (aged 20 to 69 years)	Varied	High skilled	Descriptive
Ababneh and AlShaik, 2020	Jordan	Quantitative/Not reported	306 females (working in the Jordanian public sector)	Physical, hearing, visual and mental disability	High skilled	Descriptive analytical approach
Auerbach and Richardson, 2005	USA	Qualitative/Not reported	Four females and two males (aged 21 to 60 years)	Severe persistent mental illness	Not specified	Grounded theory
González, 2009	Spain	Qualitative/Feminist perspective	Twenty-six females (aged 20 to 60 years)	Physical, Hearing, Visual	Not specified	Ethnography course life perspective
Korzon, 2014	New Zealand	Qualitative research/Not reported	Females (aged mid-20 s to early 60 s)	Varied	High skilled	Descriptive
Peter et al., 2018	Saudi Arabia	Qualitative research/Yosso’s cultural capital	Nine females (aged 28 to 52 years)	Visual, hearing, Physical	High skilled	Phenomenology
Bricker-Katz, Lincoln and Cumming, 2013	Australia	Qualitative research/Not reported	Four females and five males (aged 29 to 61 years)	Stuttering	High skilled	Interpretative phenomenological analysis
Njelesani et al., 2015	Zambia	Qualitative research/Intersectionality	Twelve females and nine males (demographics not given)	Physical, hearing, visual, developmental (HIV)	not reported	Interpretive
Fadyl and Payne, 2016	New Zealand	Collective Instrumental case study/Bourdieu’s notions of social capital and habitus	Two females and two males (demographics not given)	Traumatic brain injury and spinal cord injury	Low to high skilled	Foucault’s discourse analysis
Minis et al., 2014	Netherlands	Qualitative research/Not reported	Five women and eleven males (aged 41 to 46 years)	Slow progressive adult type neuromuscular disease	Low to high skilled	Constant comparison method inspired by hermeneutics
Crooks, 2007	Canada	Qualitative research/Not reported	Eighteen females (aged 26 to 69 years)	Musculoskeletal disease. fibromyalgia syndrome, lupus, osteoarthritis or rheumatoid arthritis	Low to high skilled	Descriptive and interpretive
Sabatello, 2014	USA	Case report/CRPD	One woman in mid-thirties	Traumatic brain injury	High skilled	Descriptive
Siporin and Lysack, 2004	USA	Qualitative case study/Not reported	Three females (aged 46, 49 and 61 years)	Developmental disability	Low skilled enclave	Constant comparative method
Mackenzie et al., 2013	Australia	Qualitative research/Not reported	Ten females and eleven males (aged 23 to 70 years)	Mental health	Unskilled to high level skilled	Framework analysis
Jennings et al., 2013	Canada	Qualitative research/Not reported	Six females and six males (aged 43 to 73 years)	Hearing Loss	High skilled	Descriptive
Quinton, 2014	United States	Case report/Not reported	One 53-year-old woman	Multiple severe physical disabilities	High skilled	Descriptive
Helfrich et al., 2006	United States	Qualitative research/Not reported	Seven women (aged 26 to 47 years)	Physical and mental health	low to high skilled	Constant comparative method

Notes: Studies with male participants were considered if there was clear delineation or disaggregation of data on women. The occupations were classified by the authors into unskilled, low, medium and high skilled due to their wide range. Examples of low skilled were care work, medium – sales work and high skilled – specialist nurses, doctors and management positions.

Stage 5: Analysis, summarizing and reporting the results

A basic numerical computation was undertaken to quantify studies fitting into specific criteria as per the data extraction criteria. Qualitative content analysis was then used to explore data on the experiences of women with disabilities. Themes, meanings or concepts within textual matter were derived from the sources in order to make meaning of it in a shorter brief way which is a recommended method for areas where not much is known [32, 33]. Deductive content analysis undertaken using priori categories contained in the ETRM comprising three main considerations (pay, benefits, career) that are further delineated according to four well-being dimensions (emotional, financial, social and physical) [34]. In the coding process, the theoretically derived dimensions, of equity namely; pay, benefits and career equity were coded as priori categories for the experiential text in a methodologically controlled assignment of concepts and key words from the equity theory as initial coding categories [35]. The aim was to identify the implied equity characteristics within the experiential descriptions.

3 Results

3.1 Description of included sources

Table 3 provides a summary of sources included in the review. The publication period of included sources ranged from 2004 to 2022. The majority [n = 16] of the papers were from high income countries namely USA [n = 5] [36 –40], Canada [n = 2] [41, 42], Australia [n = 3] [43 –45] and New Zealand [n = 3] [46 –48], Saudi Arabia [49], Spain [50] and Netherlands [51] [n = 1 respectively]. Three sources were from low-middle income countries, namely Zambia [n = 1], India [52] and Jordan [n = 1] [53]. The included studies were generally aimed at exploring experiences/perceptions of work while trying to earn a living as a woman with a disability.

All but one source fitted a qualitative research paradigm (n = 18). The research traditions used were ethnography [n = 1] [50], collective instrumental case study [n = 1] [47], and case reports (n = 3) [37 –39]. A few of the sources [n = 6] reported using a conceptual framework, namely intersectionality [54], feminist perspective [50], convention on the rights of persons with disabilities [37], Yosso’s cultural capital conceptual framework [49], Bourdieu’s notions of social capital and habitus [47] and, critical disability theory and intersectionality [45] while thirteen did not report using a conceptual framework.

A combination of one or more of agencies/communities of persons with disabilities, advocacy groups and service providers assisted in participant recruitment for the majority of sources. The strategies employed were posters, snowballing and posts on websites of the organizations and groups. The term ‘livelihood occupation’ was not used in any of the sources. The terms ‘work’, ‘employment’ and ‘productivity’ were used interchangeably across all the sources.

3.2 Experiences pertaining livelihood occupations

This section looks at experiences and equity characteristics of the included studies. Table 4 was drawn up to chart the result of content analysis of experiential features of the occupations and the equity dimensions of included sources. The table shows the experiential facets from the sources and how the facets were deductively situated into the three dimensions of equity derived from the Equity Total Rewards model.

Table 4
Qualitative content analysis of experiential claims and equity

Category Definition of equity Experiential examples of Equity Experiential examples of Inequity Coding Rules

Pay equity Physical n/a Consider fairness

Financial –Competitive pay, Pay progression, wealth creation- “Access to loans” [39] “Trying hard to succeed –(additional income not enough from social security payments, food stamps and relatives)” [38], “low salaries and not being paid for overtime” [44] and adequacy of pay/wages, whether occupation is paid or not paid

Social – Fair pay, Pay for skills/value, Pay transparency “Wages and conditions –inequitable” [44], “Performing the work; housework” [50]

Emotional –Living wage, Aligned incentives, Pay clarity

Benefits equity Physical – Health benefits, Paid time off, Financial –Retirement/savings benefits, Financial literacy/decision support, “Work Was an Antidote to the Person’s Problems . . . External Motivators Drew the Person to Work” [36] Aspects considered should be those tangible and intangible things that accrue to the participant outside pay and career growth for example how work helps grow social networks, opportunities to have and grow savings, having an identity and fulfilling roles

Social –Benefits access, Flexible, customized benefits, Family-friendly; caregiving benefits, Purpose-driven benefits “Work Was a Contributor to the Person’s Identity” [36], “The value and contribution of paid work (work is valued and being part of the community, having responsibility)” [50], “Satisfaction in the exploration and development of roles such as mother, family member, church member, com-munity participant, and hobbyist” [40], “Experiences regarding the meaning of work: Work is belonging” [51], “Having a buddy system” [42] “ambivalence towards the worker role, impact of disability on the worker role, and the relationship of the worker role to other life roles” [40], “people that see [my autoimmune disease] and then just [write me off]...I don’t even get interviews nowadays” [48]

Emotional –Behavioral and Mental health benefits, Real-time emotional support, Stress management “clients show compassion and sympathy”[53], “Solving problems oneself: I am not going to tell; Reaching a turning point: I have to be realistic; and Taking into account environmental aspects: I can understand both sides” [51], “Feeling comfortable” [42], “beneficial to mental health” [44], “a sense of belonging and support” [45] “Psychosocial Work environment causing stress” [44], “clients do not prefer them to do their transactions” [53], Lack of confidentiality [48]

Career Equity Physical – Flexible work arrangements, Physically safe work environment “generally comfortable and satisfied with the design of the workplace and the availability of furniture”[53], “I started full time now I am part time and comfortable” [52] “special tools and equipment for persons with disabilities (such as elevators, voice and light alarms, chairs and tables) are the lowest in availability” [53], “needs to enable her to perform were also often unmet, job termination during probation and after raising complaints of unfavorable environment” [37], “Number and scheduling of hours” [44], “Success with use of IT/Assistive technology and reduced direct interaction with clients” [39], “Seeking out, Modified duties, Modified hours of employment, Physical accommodation, Having little control over being accommodated, Working in jobs that did not allow for modified hours, Wanting to work from home, Difficulties commuting to work, Wanting to work part-time while receiving income assistance” [41], “I always work extra assignments and duties . . . to compensate for being a misfit”, “Most of the value assignments are given to the employees who are normal... I have missed out on key projects” [52], “no organisation wide help and support”, “seeking out their own resources and supports for accommodations” [48], No workplace accommodations and negative accessibility experiences [45] All the aspects of the experience have to reflect aspects of career development, equal access to opportunities, personal growth in the workplace

Financial –Reskilling/up-skilling, Career journeys, Career progaression “Was a Conduit to Personal Growth and the Development of Competencies” [36], “having work and career aspirations, persisted in their job search”[49], Job suitability motivation and training and development [53], “Wanting some more” [38], “Employment insecurity” [44] “Using personal resources” [42], “Stuttering limits occupational progression” [43]. None were able to realize career goals and occupational choice [40], “Difficulties in obtaining a job” [50], “lacked instrumental assistance in accessing work KSA policies to support women and people with disabilities to obtain employment are not adequately enforced, and negative attitudes toward people with disabilities are widespread” [49], “Qualification, disqualification or limitation of value associated with the impaired body . . . the individual task of producing an employable self” [47], “ . . . Awareness of impairment as a source of dissatisfaction and criticism of performance”[37], “diminished access to the labor market” [41], “managers did not think that women with disability held leadership aspirations”, “at the high end [of management] is not where women belong” [45]

Social –Inclusive representation, Anti-bullying/harassment, Culture of dignity “an opportunity to show they can do” [46], “navigated barriers” [49], Workplace acceptance building confidence [45] “supervisors and colleagues have a negative view toward them that they do not communicate or find it difficult to communicate with them, evaluate them incompetent and do not invite them participate in social events as it should be due to their disability”[53], “Disability discrimination, Public attitude to disability” [39], “Disability and HIV is not inability, How work influences HIV” [54], “sense of otherness . . . hindered them from being an equal member” [45]

Emotional –Fair goals and performance expectations, Emotionally safe culture “Outperformed colleagues” [37], “Feeling comfortable, It gets easier with time” [42], “I plan my work carefully beforehand . . . taking an extra step ahead to prevent being left behind” [52], “whether I am disabled or not doesn’t count at all” [52], Helpful and caring individuals, receiving support from supervisor [48] “treated by supervisors and colleagues with compassion and kindness, but they do not receive reasonable assistance to perform their tasks” [53], “Doing what I am told” [38], “Stuttering is always there, Stuttering at work reveals a problem, Stuttering impacts communication” [43], “A triple burden” [54], “Co-workers and employers’ attitudes, disbelief, and lack of understanding, maintaining their roles in the paid workforce was a particularly stressful experience” [41], “colleagues planning for them without their input, feelings of pity, excluded out of work based on disability, disclosure dilemma” [46], non-disclosure of disability due to fear of discrimination [52], “It is a heavy load on me to act smarter and more able than my colleagues without disabilities . . . also, sometimes the sympathy and concern make me feel low”, “I feel mentally inferior to (my non-disabled colleagues” sometimes” [52], “fear of disclosing”, and whether the disability or impairment was “visible or invisible” and “if you disclosed, you (are) treated unfairly” [48]

Category	Definition of equity	Experiential examples of Equity	Experiential examples of Inequity	Coding Rules
Pay equity	Physical n/a			Consider fairness
	Financial –Competitive pay, Pay progression, wealth creation-	“Access to loans” [39]	“Trying hard to succeed –(additional income not enough from social security payments, food stamps and relatives)” [38], “low salaries and not being paid for overtime” [44]	and adequacy of pay/wages, whether occupation is paid or not paid
	Social – Fair pay, Pay for skills/value, Pay transparency		“Wages and conditions –inequitable” [44], “Performing the work; housework” [50]
	Emotional –Living wage, Aligned incentives, Pay clarity
Benefits equity	Physical – Health benefits, Paid time off, Financial –Retirement/savings benefits, Financial literacy/decision support,	“Work Was an Antidote to the Person’s Problems . . . External Motivators Drew the Person to Work” [36]		Aspects considered should be those tangible and intangible things that accrue to the participant outside pay and career growth for example how work helps grow social networks, opportunities to have and grow savings, having an identity and fulfilling roles
	Social –Benefits access, Flexible, customized benefits, Family-friendly; caregiving benefits, Purpose-driven benefits	“Work Was a Contributor to the Person’s Identity” [36], “The value and contribution of paid work (work is valued and being part of the community, having responsibility)” [50], “Satisfaction in the exploration and development of roles such as mother, family member, church member, com-munity participant, and hobbyist” [40], “Experiences regarding the meaning of work: Work is belonging” [51], “Having a buddy system” [42]	“ambivalence towards the worker role, impact of disability on the worker role, and the relationship of the worker role to other life roles” [40], “people that see [my autoimmune disease] and then just [write me off]...I don’t even get interviews nowadays” [48]
	Emotional –Behavioral and Mental health benefits, Real-time emotional support, Stress management	“clients show compassion and sympathy”[53], “Solving problems oneself: I am not going to tell; Reaching a turning point: I have to be realistic; and Taking into account environmental aspects: I can understand both sides” [51], “Feeling comfortable” [42], “beneficial to mental health” [44], “a sense of belonging and support” [45]	“Psychosocial Work environment causing stress” [44], “clients do not prefer them to do their transactions” [53], Lack of confidentiality [48]
Career Equity	Physical – Flexible work arrangements, Physically safe work environment	“generally comfortable and satisfied with the design of the workplace and the availability of furniture”[53], “I started full time now I am part time and comfortable” [52]	“special tools and equipment for persons with disabilities (such as elevators, voice and light alarms, chairs and tables) are the lowest in availability” [53], “needs to enable her to perform were also often unmet, job termination during probation and after raising complaints of unfavorable environment” [37], “Number and scheduling of hours” [44], “Success with use of IT/Assistive technology and reduced direct interaction with clients” [39], “Seeking out, Modified duties, Modified hours of employment, Physical accommodation, Having little control over being accommodated, Working in jobs that did not allow for modified hours, Wanting to work from home, Difficulties commuting to work, Wanting to work part-time while receiving income assistance” [41], “I always work extra assignments and duties . . . to compensate for being a misfit”, “Most of the value assignments are given to the employees who are normal... I have missed out on key projects” [52], “no organisation wide help and support”, “seeking out their own resources and supports for accommodations” [48], No workplace accommodations and negative accessibility experiences [45]	All the aspects of the experience have to reflect aspects of career development, equal access to opportunities, personal growth in the workplace
	Financial –Reskilling/up-skilling, Career journeys, Career progaression	“Was a Conduit to Personal Growth and the Development of Competencies” [36], “having work and career aspirations, persisted in their job search”[49],	Job suitability motivation and training and development [53], “Wanting some more” [38], “Employment insecurity” [44] “Using personal resources” [42], “Stuttering limits occupational progression” [43]. None were able to realize career goals and occupational choice [40], “Difficulties in obtaining a job” [50], “lacked instrumental assistance in accessing work KSA policies to support women and people with disabilities to obtain employment are not adequately enforced, and negative attitudes toward people with disabilities are widespread” [49], “Qualification, disqualification or limitation of value associated with the impaired body . . . the individual task of producing an employable self” [47], “ . . . Awareness of impairment as a source of dissatisfaction and criticism of performance”[37], “diminished access to the labor market” [41], “managers did not think that women with disability held leadership aspirations”, “at the high end [of management] is not where women belong” [45]
	Social –Inclusive representation, Anti-bullying/harassment, Culture of dignity	“an opportunity to show they can do” [46], “navigated barriers” [49], Workplace acceptance building confidence [45]	“supervisors and colleagues have a negative view toward them that they do not communicate or find it difficult to communicate with them, evaluate them incompetent and do not invite them participate in social events as it should be due to their disability”[53], “Disability discrimination, Public attitude to disability” [39], “Disability and HIV is not inability, How work influences HIV” [54], “sense of otherness . . . hindered them from being an equal member” [45]
	Emotional –Fair goals and performance expectations, Emotionally safe culture	“Outperformed colleagues” [37], “Feeling comfortable, It gets easier with time” [42], “I plan my work carefully beforehand . . . taking an extra step ahead to prevent being left behind” [52], “whether I am disabled or not doesn’t count at all” [52], Helpful and caring individuals, receiving support from supervisor [48]	“treated by supervisors and colleagues with compassion and kindness, but they do not receive reasonable assistance to perform their tasks” [53], “Doing what I am told” [38], “Stuttering is always there, Stuttering at work reveals a problem, Stuttering impacts communication” [43], “A triple burden” [54], “Co-workers and employers’ attitudes, disbelief, and lack of understanding, maintaining their roles in the paid workforce was a particularly stressful experience” [41], “colleagues planning for them without their input, feelings of pity, excluded out of work based on disability, disclosure dilemma” [46], non-disclosure of disability due to fear of discrimination [52], “It is a heavy load on me to act smarter and more able than my colleagues without disabilities . . . also, sometimes the sympathy and concern make me feel low”, “I feel mentally inferior to (my non-disabled colleagues” sometimes” [52], “fear of disclosing”, and whether the disability or impairment was “visible or invisible” and “if you disclosed, you (are) treated unfairly” [48]

3.3 Experiential facets

The experiences of women with disability were varied. The negative experiences were largely attitudinal defined by lack of reasonable accommodations in the workplace. Participants reported experiencing challenges such as difficulty acquiring employment or limited access to the job market [41 , 50] largely due to perceptions of inability associated with disability. Another cause of limited access to the job market was a lack of instrumental support [49] reported to be experienced by women in Saudi Arabia. Some participants were not accommodated in terms of flexible working hours [37 , 45] and/or physical environmental modifications [41]. Disability was indicated as limiting occupational progression which influenced day to day experiences [43, 45]. Participants also experienced being given commands and being directed as to what to do while engaged in the occupation [38] while some had work planned for them without their input [46].

Participants indicated experiencing roles such as mother, hobbyist and community participant [40] through the livelihood occupations. Livelihood occupations were cited as a contributor to the person’s identity [42]. Two sources [45, 51] highlighted “belonging” as a dominant experience marked by generally being recognized as part of the community, playing a part in the community life and having a buddy system. The livelihood occupations also enabled positive self-value, ability to contribute to the community and assist spouses with household expenses [50]. Participants also reported opportunities to show they are capable of doing or carrying out activities expected of them in the workplace [46] and outperforming colleagues [37] despite their disability.

3.4 Equity and Inequity facets

Aspects of equity and inequity were evident in the experiences of the women across all sources. Benefit equity, the most prominent of the three categories of equity in the selected sources, was pronounced in terms of belonging, identity formation and building connections especially for persons with mental illness [36, 44]. For the preceding sources [36, 44], livelihood occupation was viewed as an antidote for the participant’s problems and also beneficial to mental health. The contribution of livelihood occupations to achieving benefit equity was shown through enabling an identity [36], being valued as a member of the community and family [40, 50].

One source reported positive experiences related to pay equity. The participant in the source opted to start her own business and managed to access loans after initially experiencing discrimination in a competitive employment setting [39]. On the other hand, pay inequity was indicated in only three sources [38 , 50] where additional income from social security payments, food stamps and relatives was not enough, and participants had low salaries with unpaid overtime.

Disability had significant negative impact on experiences relating to career equity. Career inequity was indicated in sixteen [37–50 , 55] of the sources. Notably, experiential facets leading to career inequity included lack of reasonable accommodation related to the physical environment and modified hours [41, 44], and discrimination related to disability [39 , 46]. Employment insecurity related to disability was also cited. Participants reported being sexually harassed and not reporting because of fear of being fired. Many were employed on a temporary basis which gave room for their hours to be reduced to encourage them to leave [44]. Participants with stuttering reported having a constant reminder and awareness of its presence [43] and indicated that this presented problems as it limited occupational progression. Career inequity was similarly identifiable for persons with neuromuscular disease as they reported that maintaining roles in the paid workforce was stressful [41]. Conversely career equity was indicated through livelihood occupations being a conduit for personal growth and developing competences [49]. Although engagement in livelihood occupations also presented opportunities to demonstrate that participants were competent, they were faced with disclosure dilemmas and their colleagues planned work for them due to pity [46, 48].

4 Discussion

A significant gap in research pertaining to women with disability, and their experiences in livelihood occupations was illustrated. This is the case particularly for Africa, and other low to middle income contexts, as only three of the nineteen studies were from a low-middle income context in Southern Africa. The WHO [56], noted that data on disability for low to middle income countries are lacking. This has been the case since the beginning of the new millennium. Historically, there has been little data on disability in the developing world and available data had deficiencies in quality, applicability and comparability, was unreliable and out of date [56, 57]. Low income contexts are comparatively characterized by social and institutional environments which have challenges that affect equity in health promoting occupational opportunities and how occupation is experienced. There is evidence that occupation is a determinant of health and well-being [5, 58] yet, in the African context in particular, women with disabilities struggle to access health promoting occupational opportunities and little is understood in this regard. These challenges inevitably affect the ability of people to engage in occupations of their choice, leading to occupational injustice which is conceptualized as the non-availability of equitable opportunity and resources to enable people’s engagement in meaningful occupations [23].

The lack of research and pursuant lack of data on disability in low to middle income countries accompanies substantial gaps in service delivery for persons with disability in general and in particular women with disabilities, with the result that disability is associated with a lower standard of living [59]. The paucity of reliable and empirical data on disability is acknowledged by scholars in the field of disability [60, 61]. This paucity is underscored by the fact that disability prevalence is higher in low-income countries [62], and more common among the poor [63]. An estimated one billion people have disabilities and eighty percent of these live in the developing world [64].

Some of the sources identified in this review covered a range of disabilities. Those sources that concentrated on one specific disability had a focus on less common disabilities which may be overlooked in research and policy, for example, stuttering [43], hearing loss [42] and neuromuscular disease [51]. These disabilities, also termed ‘low incidence disabilities’ are visual or hearing impairment, or simultaneous visual and hearing impairments, or a significant cognitive impairment, defined by rare or low occurrence within the general population [65, 66]. Some of these can be deemed invisible because of their lack of immediate apparentness to the onlooker [67]. These disabilities are characterized by lack of research as empirical studies on them are scarce. Norstedt [68] looked at working life of people with invisible disabilities in Sweden and found out that despite the relatively well regulated work environment people with low incident disabilities were faced with vulnerabilities. Visibility of an impairment can amplify performative difficulties, as observed by Ababneh and AlShaik [53] who found out that persons with physical disabilities experienced more difficulties when compared with hearing, visual and mental disability. Hughes, Trip and Rose confirmed the same [48] for nurses using aids, for example walking sticks and hearing devices.

Experiential features of the livelihood occupations were largely attributable to attitudinal and work environment factors. Positive experiential facets were mainly related to benefits accruing to the individuals by virtue of ‘doing’ which buttresses the need for inclusive policies that place importance on equitable access to occupations promoting health and wellbeing. The importance of having an equitable livelihood occupation environment was also shown through women with disabilities in the sources having benefits equity. Social markers such as having an identity, belonging, contributing to family and community and having roles such as mother and family member contributed to benefit equity in the selected sources. The implication is that women with disabilities who do not have livelihood occupations might face a dual loss as the social status or identity of not being a livelihood or income earner is added into the dimensions of intersectional discrimination that they experience. Additionally, discrimination is perpetuated on the basis of being viewed as people who need to be looked after as they have no social standing as a contributor to community. In systematic reviews [69, 70] the disadvantages that women experience resulting in poor employment outcomes was confirmed but the reviews have not used an equity perspective. In another review, Bend and Fielden [71] observe that women are more likely to experience the ‘glass ceiling’ effect, a metaphorical barrier that they cannot get beyond in terms of progression, and if they do progress to higher occupational status they can encounter a ‘glass cliff’ effect in that their positions become prone to discriminatory practices. In the current review, gender was found to have resulted in the disadvantage of reducing the opportunities for securing employment for women while promoting employment for men. Occupational therapists can thus focus on occupations that promote development and growth of connections and belonging as this can significantly reduce the prejudices experienced by women with disabilities and enrich their livelihood creation opportunities.

The high income countries, where the majority of the studies were carried out, generally have progressive disability legislation, relatively well-developed social protection systems with disability benefits and some women with disability hold high skilled jobs. According to International Labor Organization [72], social protection systems in high-income countries offer near-universal coverage of persons with disabilities thanks to a combination of contributory and tax financed schemes. This might explain why pay inequity was less pronounced when compared to benefit and career equity. However, observations show that in western society, gender and able-bodied norms are heavily ingrained [71] and that positive attributes associated with being in the workplace are more rhetoric than reality [45]. Even when characterized by progressive legislation, Hammell [23] observes that the occupational therapy profession in the Global North, has neither advanced occupation as a determinant of health, nor provided sufficient professional attention to ensure equity of occupational opportunities.

In the selected sources, pay inequity was experienced by persons with persistent serious mental illness and developmental disabilities. Persons with mental health conditions, speech and communication challenges, intellectual disabilities have been found to be particularly disadvantaged in terms of pay inequity [73]. As a result, persons with intellectual disabilities, communication challenges and mental health conditions find themselves working in sheltered employment whose aims, activities, wages and benefits, conditions of work, opportunities for advancement and levels of community involvement differ [74]. On the contrary, sources included in the review, showed that women with disabilities can occupy highly skilled occupational positions. An explanation for this can be the importance placed on adherence to disability legislation in high income countries where most of the literature was from. For example Canada has moved in the direction of fully implementing the UNCRPD [75]. Further, 66% of high income countries have legislation with broad base prohibitions on disability discrimination in the workplace [76]. Blanck [77] gives a case study of how a woman with a spinal disability was assisted to have workplace accommodation using the American With Disabilities Act. The case study shows that women with disability, when supported with progressive policy, are able to work across all work categories, including skilled positions. In some instances, employers may be liable to punitive damages if they engage in discriminatory practices. Avoidance of liabilities may lead to tokenism in terms of equality and employment of women with disabilities. However, where there is existence of equality in terms of opportunities and pay equity, it has been shown that other forms of equity might not [78]. For example, able-bodied and gendered performative expectations may result in inability to maintain employment [71]. Brown and Moloney [79] have also found out that women with disabilities are more affected by “inequitable workplace situations partly because they earn less, are exposed to more workplace stress, and are less likely to experience autonomous working conditions” (p94).

Experiences of the women with disabilities in the studies highlight inequity concerns, particularly career inequity marked by discrimination based on perceptions of lack of value associated with disability, difficulty acquiring a job and lack of reasonable accommodations. Gupta [73] has also shown the same phenomenon where lack of minimal accommodations preclude people from the labor market. The impact of the disability also shaped career inequity where the participants were constantly conscious of the presence of disability, the limitations it imposed and the consequent reactions of workmates. It is difficult to distinguish where, when, and how workplace discrimination occurs, for example, determining whether or not disability or lack of performance is the cause of lower wages [80]. An equity lens informed by occupational science can enable such analysis and hence promote sustainability of occupations that marginalized groups of people can engage in over their life course. Black, disabled and indigenous peoples are groups of people that are “equity deserving” as the College of Occupational Therapists Ontario (COTO) [19] observes. These equity deserving groups, COTO adds, are those who feel or are made to feel that they do not belong. Such groups, including women with disabilities, therefore should not be the ones to have the burden of seeking equity or getting it as a privilege from those who have the power to give it, because those with the power to give can also have the power to take it back, COTO concludes. COTO in this instance advances the ideal that equity should be an attribute readily inherent in all livelihood spheres. Essentially, occupational therapy practice needs to take into cognizance the inequitable situations that persons with disabilities are discharged into as it may perpetuate equity disparities by discharging rehabilitated persons to inequitable situations. Women with disabilities, in the study by Ababneh and AlShaik, “recommend (ed) training and rehabilitation programs as a major crucial suggestion to overcome most of the difficulties they face at work” (p. 335). The participants in Hanlon and Taylor’s [45] study adopted strategies where they projected themselves as distinct rather than different in order to be valued and also assumed disability advocacy roles.

Amongst the selected studies in the review, there was no study with direct and explicit focus on occupational justice but there were implications. For example, participants in Gonzalez’s [50] study were willing to accept poor conditions in order to be able to work and visible disabilities were a disadvantage for a woman who wanted to work. The women reported experiencing inability to realize career goals and occupational choice [40]. These observations are indicative of occupational injustice. Issues of equity need to be looked at eclectically, in combination with other perspectives. Examining experiences of women with disabilities can add a unique perspective to how the intersection of gender and disability produces specific inequities.

5 Strengths and limitations

The Equitable Total Rewards Model is not an occupational therapy model and gives a lens through which livelihood occupations can be looked at, but may not provide a comprehensive picture. The study excluded non-English sources and these could have added a voice to the scoping review as some of the non-English speaking countries are in the low to middle income strata where research was deemed to be scant as per the findings of this review. Disability, livelihood and occupations are broad concepts, therefore search terms were developed based on the specific conceptualization of these terms in the study and as guided by the MeSH terms initially generated in PubMed as per PRISMAScR guidelines. The use of these terms also varies across cultural, political and policy contexts thus shaping disability terminology. We acknowledge that the use of different search terms may have yielded different outcomes. In addition, the search strings utilized person-first rather than identity-first disability terms in line with the UNCRPD which may have narrowed down the number of other studies.

6 Conclusion

The scoping review mapped literature, mainly from high income countries, which indicates a dearth of research on the subject of livelihood occupations, equity and experiential facets of occupations for women with disabilities in low to middle income contexts. Livelihood occupations are a means to deriving benefit equity with disadvantage experienced in terms of career and pay equity. This knowledge is beneficial for occupational therapy, particularly those targeting reasonable accommodations and attitudinal barriers experienced as part of career inequity. More research is needed to understand the aspect of equity in occupations and experiential facets of these occupations in low to middle income contexts.

Ethical approval

The study was approved by the Health Research Ethics Committee –Stellenbosch University (Ref: S16/04/059) and the Medical Research Council of Zimbabwe (Ref: MRCZ/A/2121).

Informed consent

Due to the nature of the study, informed consent was not required.

Conflict of interest

The authors declare no conflicting interests.

Footnotes

Acknowledgments

The authors thank Ingrid van der Westhuizen and Tracey Louw (Faculty Librarians, Medicine and Health Sciences Library, Stellenbosch University), Clive Kennard (Academic Liaison Librarian, Institute of Health & Society, Library Services, University of Worcester) and Covidence® for full rights use of their platform for data management.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The study was part of a self-funded PhD study at the University of Stellenbosch.

References

Chambers

, Conway

. Sustainable rural livelihoods: practical concepts for the 21st century, vol. 296. IDS Discussion Paper, 1991, Accessed: Jun. 29, 2022. [Online]. Available: https://www.ids.ac.uk/download.php?file=files/Dp296.pdf.

Admire

, Mitchell

. Food security and rural livelihoods in the doldrums: exploring alternatives for Sanyati through sustainable development goals. Africanus. 2018;48(2):1–16, doi: 10.25159/0304-615X/4752.

World Federation of Occupational Therapists, Definitions of Occupational Therapy, 2018. doi: 10.1097/00002060-194002000-00007.

Payne

. Mobility and Change in Modern Society. Palgrave Macmillan UK, 1987.

Reitz

, Scaffa

. Occupational therapy in the promotion of health and well-being, Am. J. Occup. Ther. 2020;74(3). doi: 10.5014/AJOT.2020.743003.

Kiepek

, Beagan

, Rudman

, Phelan

. Silences around occupations framed as unhealthy, illegal, and deviant. J. Occup. Sci. 2019;26(3):341–353, doi: 10.1080/14427591.2018.1499123/FORMAT/EPUB.

Townsend

. Occupation: Potential for personal and social transformation. J. Occup. Sci. 1997;4(1):18–26, doi: 10.1080/14427591.1997.9686417.

Kiepek

, Beagan

, Laliberte Rudman

, Phelan

. Silences around occupations framed as unhealthy, illegal, and deviant, 2018, doi: 10.1080/14427591.2018.1499123.

International Labour Organization (ILO) and Organization for Economic Co-operation and Development (OECD), Labour market inclusion of people with disabilities: Paper presented at the 1st Meeting of the G20 Employment Working Group, Buenos Aires, 2018. Accessed: Sep. 07, 2022. [Online]. Available: http://www.ilo.org/dyn/natlex/natlex4.detail?p_lang=en&p_isn=103080&p_country=IDN.

10.

Graham

, Moodley

, Ismail

, Munsaka

, Ross

, Schneider

. Poverty and Disability in South Africa, 2014, Accessed: May 29, 2022. [Online]. Available: www.uj.ac.za/csda.

11.

Barisin

, Benjak

, Vuletić

. Health-related quality oflife of women with disabilities in relation to their employmentstatus, Croat. Med. J. 2011;52(4):550–556, doi: 10.3325/cmj.2011.52.550.

12.

Chouinard

. Women with disabilities’ experiences of government employment assistance in Canada, Disabil. Rehabil. 2010;32(2):148–158, doi: 10.3109/09638280903023389.

13.

Doren

, Gau

, Lindstrom

. The role of gender in the long-term employment outcomes of young adults with disabilities. J. Vocat. Rehabil. 2011;34(1):35–42, doi: 10.3233/JVR-2010-0532.

14.

Mckinsey and Company, Women in the workplaces 2021, 2021. Accessed: Mar. 12, 2022. [Online]. Available: https://wiw-report.s3.amazonaws.com/Women_in_the_Workplace_2021.pdf.

15.

Leenman

, Arblaster

. Navigating rocky terrain: a the matic analysis of mental health clinician experiences of family-focused practice. Ment. Heal. Training, Educ. Pract. 2020;15(2):71–83. 10.1108/JMHTEP-04-2019-0022.

16.

World Health Organisation, Health Equity, 2019. https://www.who.int/health-topics/health-equity#tab=tab_1.

17.

Braveman

. Defining equity in health. J Epidemiol Community Heal. 2003;57:254–258, doi: 10.1136/jech.57.4.254.

18.

CBM UK, The Intersection of Disability and Gender in the Global South: Narratives, Gaps and Opportunities – CBM UK advocacy paper, 2018, Accessed: Feb. 14, 2022. [Online]. Available: http://www.unwomen.org/en/digital-library/publications/2017/6/issue-brief-making-the-sdgs-.

19.

Ontario College of Occupational Therapists, Culture, Equity, and Justice in Occupational Therapy Practice. 2021.

20.

Charlène Rochefort-Allie,Working Towards Health Equity in Occupational Therapy, Dalhousie University, Halifax, Nova Scotia. 2020.

21.

Wilson

, Smith

, Hunter-Bennett

, Hoyt

, Dorsey

, DeAngelis

. Occupational therapy’s commitment to diversity, equity, and inclusion. 2020;74.

22.

Bass

, Baker

. Occupational Therapy and Public Health: Advancing Research to Improve Population Health and Health Equity. OTJR (Thorofare. N. J). 2017;37(4):175–177, doi: 10.1177/1539449217731665.

23.

Hammell

. Action on the social determinants of health: Advancingoccupational equity and occupational rights Ações nosdeterminantes sociais de saúde: Avançando na equidadeocupacional e nos direitos ocupacionais 1. Cad. Bras. Ter. Ocup. 2020;28(1):378–400, doi: 10.4322/2526-8910.ctoARF2052.

24.

Jull

JEG

, Giles

. Health equity, aboriginal peoples and occupational therapy, Can. J. Occup. Ther. 2012;79(2):70–76, doi: 10.2182/CJOT.2012.79.2.2.

25.

Galvin

, Wilding

, Whiteford

. Utopian visions/dystopian realities: Exploring practice and taking action to enable human rights and occupational justice in a hospital context. Aust. Occup. Ther. J. 2011;58(5):378–385, doi: 10.1111/j.1440-1630.2011.00967.x.

26.

Munn

, Peters

MDJ

, Stern

, Tufanaru

, McArthur

, Aromataris

. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med. Res. Methodol. 2018;18(1), doi: 10.1186/s12874-018-0611-x.

27.

Peters

MDJ

, McInerney

, Munn

, Tricco

, Khalili

. Chapter 11: Scoping Reviews (2020 version), in JBI Manual for Evidence Synthesis, JBI, E. Aromataris and Z. Munn, Eds. 2020.

28.

Arksey

, O’Malley

. Scoping studies: towards a methodological framework. Int. J. Soc. Res. Methodol. J. Int. J. Soc. Res. Methodol. 2005;8(1):1364–5579, doi: 10.1080/1364557032000119616.

29.

Tricco

, et al. , A scoping review on the conduct and reporting of scoping reviews. BMC Med. Res. Methodol. 2016;16, doi: 10.1186/s12874-016-0116-4.

30.

Parliament of Zimbabwe, Disabled Persons Act Zimbabwe. Act 5/1992, 22/2001 (s. 4), 6/2000 (s. 151). 1992.

31.

United Nations, Disability Laws and Acts by Country/Area | United Nations Enable. https://www.un.org/development/desa/disabilities/disability-laws-and-acts-by-country-area.html (accessed Sep. 08, 2022).

32.

Vaismoradi

, Turunen

, Bondas

, Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs. Heal. Sci. 2013;15(3):398–405, doi: 10.1111/nhs.12048.

33.

Green

, Thorogood

. Analysing qualitative data, in Qualitative Methods for Health Research, 1st ed., D. Silverman, Ed. Sage Publications. 2004:173-200.

34.

Bremen

, Levanat

, Hathaway

. Equitable Total Rewards: Driving resilience and sustainability – WTW, 2020. https://www.wtwco.com/en-CA/Insights/2020/12/equitable-total-rewards-driving-resilience-and-sustainability (accessed Jan. 30, 2022).

35.

Elo

, Kääriäinen

, Kanste

, Pölkki

, Utriainen

, Kyngäs

. Qualitative Content Analysis. SAGE Open. 2014;4(1):215824401452263, doi: 10.1177/2158244014522633.

36.

Auerbach

, Richardson

. The long-term work experiences of persons with severe and persistent mental illness. Psychiatr. Rehabil. J. 2005;28(3):267–273, doi: 10.2975/28.2005.267.273.

37.

Sabatello

. If you can’t do it now, you’re out the door: Employees with traumatic brain injury-A case study. Work. 2014;48(3):373–379, doi: 10.3233/WOR-131792.

38.

Siporin

, Lysack

. Quality of life and supported employment: A case study of three women with developmental disabilities. Am. J. Occup. Ther. 2004;58(4):455–465, doi: 10.5014/ajot.58.4.455.

39.

Quinton

. Self-employment as a solution for attitudinal barriers: A case study. Work. 2014;48(1):127–130, doi: 10.3233/WOR-141861.

40.

Helfrich

, Badiani

, Simpson

. Worker role identity development of women with disabilities who experience domestic violence. Work. 2006;27(3):319–328, [Online]. Available: http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=106216255&site=ehost-live&scope=site.

41.

Crooks

, Women’s experiences of developing musculoskeletal diseases: employment challenges and policy recommendations.. Disabil. Rehabil. 2007;29(14):1107–1116, doi: 10.1080/09638280600948193.

42.

Jennings

, Southall

, Gagné

. Social identity management strategies used by workers with acquired hearing loss. Work. 2013;46(2):169–180, doi: 10.3233/WOR-131760.

43.

Bricker-Katz

, Lincoln

, Cumming

. Stuttering and work life: An interpretative phenomenological analysis. J. Fluency Disord. 2013;38:342–355, doi: 10.1016/j.jfludis.2013.08.001.

44.

Mackenzie

, Keuskamp

, Ziersch

, Baum

, Popay

. A qualitative study of the interactions among the psychosocial work environment and family, community and services for workers with low mental health. BMC Public Health. 2013;13(1), doi: 10.1186/1471-2458-13-796.

45.

Hanlon

, Taylor

. Workplace Experiences of Women With Disability in Sport Organizations, Front. Sport. Act. Living. 2022;4(January):1–13, doi: 10.3389/fspor.2022.792703.

46.

Korzon

. Learning from the experiences of disabled nurses. , Kai Tiaki Nurs. New Zeal.. 2014;20(5):28–30, [Online]. Available: http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=107858798&site=ehost-live&scope=site.

47.

Fadyl

, Payne

. Socially constructed ‘value’ and vocational experiences following neurological injury. Disabil. Rehabil. 2016;38(22):2165–2177, doi: 10.3109/09638288.2015.1116620.

48.

Hughes

, Rose

, Trip

. Registered Nurses’ Experiences and Perceptions of Practising With a Disability. Kai Tiaki Nurs. Res. 2021;12(1):7–15, [Online]. Available: https://search-ebscohost-com-443.web.bisu.edu.cn/login.aspx?direct=true&db=cin20&AN=154034608&lang=ja&site=ehost-live.

49.

Peter

, Alem

, Knabe

. Reassessing cultural capital: access to employment for women with disabilities in Saudi Arabia. Equal. Divers. Incl. An Int. J. 2018;37(3):265–282, doi: https://dx-doi-org.web.bisu.edu.cn/10.1108/EDI-08-2017-0156.

50.

González

. Getting to know reality and breaking stereotypes:the experience of two generations of working disabled women. Disabil. Soc. 2009;24(4):447–459, doi: https://dx-doi-org.web.bisu.edu.cn/10.1080/09687590902879056.

51.

Minis

MAH

, et al. , How persons with a neuromuscular disease perceive employment participation: A qualitative study. J. Occup. Rehabil. 2014;24(1):52–67, doi: 10.1007/s10926-013-9447-8.

52.

Varshney

. ‘Why don’t you hear us?’: Interview Narratives of Disabled Working Women in Private Small Business Firms in India. J. Int. Womens. Stud. 2022;23(1):1–21.

53.

Ababneh

, AlShaik

. Working women with disabilities: evidence from the Jordanian public sector. Int. J. Organ. Anal. 2021;29(2):322–341, doi: 10.1108/IJOA-12-2019-1970.

54.

Njelesani

, Nixon

, Cameron

, Parsons

, Menon

. Experiences of work among people with disabilities who are HIV-positive in Zambia. African J. AIDS Res. 2015;14(1):51–56, doi: 10.2989/16085906.2015.1016985.

55.

Lysaght

, Petner-Arrey

, Howell-Moneta

, Cobigo

. Inclusion Through Work and Productivity for Persons with Intellectual and Developmental Disabilities. J. Appl. Res. Intellect. Disabil. 2017;30(5):922–935, doi: 10.1111/jar.12284.

56.

World Health Organisation, Strengthening the collection of data on disability, 2022. https://www.who.int/activities/collection-of-data-on-disability (accessed Apr. 02, 2022).

57.

Eide

, Loeb

. Data and statistics on disability in developing countries, 2005, Accessed: Jun. 19, 2018. [Online]. Available: http://www.firah.org/centre-ressources/upload/notices2/juin-2014/data-and-statistics-on-disability-in-developing-countries.pdf.

58.

Hammell

. Action on the social determinants of health: Advancing occupational equity and occupational rights. Cad. Bras. Ter. Ocup. 2020;28(1):378–400, doi: 10.4322/2526-8910.ctoARF2052.

59.

Pinilla-Roncancio

. Disability and poverty: two related conditions. A review of the literature Discapacidad y pobreza: dos condiciones relacionadas. Una revisión de la literatura. Fac. Med. 2015;63:113–136, doi: 10.15446/revfacmed.v63n3sup.50132.

60.

Eide

, Ingstad

. Disability and poverty –Reflections on research experiences in Africa and beyond. African J. Disabil. 2013;2(1), doi: 10.4102/ajod.v2i1.31.

61.

Blaser

, Ladner

. Why is Data on Disability so Hard to Collect and Understand?, 2020 Res. Equity Sustain. Particip. Eng. Comput. Technol. RESPECT 2020 – Proc., 2020, doi: 10.1109/RESPECT49803.2020.9272466.

62.

World Bank, Disability Inclusion.World Bank,Washington, DC, Apr. 14, 2022, doi: 10.1596/31005.

63.

Hosseinpoor

, et al. , Socioeconomic Inequality in Disability Among Adults: A Multicountry Study Using the World Health Survey. Am. J. Public Health. 1286;103(7):1278–1286, doi: 10.2105/AJPH.2012.301115.

64.

World Health Organisation, Disability and health, Dec. 24, 2021. https://www.who.int/news-room/fact-sheets/detail/disability-and-health (accessed Sep. 08, 2022).

65.

Tenessee Department of Education, Low Incidence, 2022. https://www.tn.gov/education/student-support/special-education/low-incidence-.html (accessed Oct. 31, 2022).

66.

El Dorado Charter Special Education Local Plan Area, Guidelines and Resources: Low Incidence, 2021. Accessed: Oct. 31, 2022. [Online]. Available: https://charterselpa.org/wp-content/uploads/2017/05/Charter-Low-Incidence-Guidelines-2021-08-04.pdf.

67.

Coton

. What Are Invisible Disabilities? University of Glasgow, Institute of Health and Wellbeing. 2019.

68.

Norstedt

. Work and invisible disabilities: Practices, experiences and understandings of (non)disclosure. Scand. J. Disabil. Res. 2019;21(1):14–24, doi: 10.16993/sjdr.550.

69.

Lindsay

, Cagliostro

, Albarico

, Mortaji

, Srikanthan

. Gender matters in the transition to employment for young adults with physical disabilities. Disabil. Rehabil. 2019;41(3):319–332, doi: 10.1080/09638288.2017.1390613.

70.

Achterberg

, Wind

, De Boer

AGEM

, Frings-Dresen

MHW

. Factors that promote or hinder young disabled people in work participation: A systematic review. J. Occup. Rehabil. 2009;19(2):129–141, doi: 10.1007/s10926-009-9169-0.

71.

Bend

, Fielden

. I see you but you don’t see me: the ‘two-way mirror effect’ of gender and disability in employment. Gend. Manag. 2021;36(7):821–838, doi: 10.1108/GM-03-2019-0049.

72.

ILO, World Social Protection Report 2017-19: Universal social protection to achieve the Sustainable Development Goals, Geneva. 2017.

73.

Gupta

, An issue of occupational (in)justice: A case study. Disabil. Stud. Quartely. 2012;32(3).

74.

Akkerman

, Janssen

CGC

, Kef

, Meininger

, Perspectives of Employees with Intellectual Disabilities on Themes Relevant to Their Job Satisfaction. An Explorative Study using Photovoice. J. Appl. Res. Intellect. Disabil. 2014;27(6):542–554, doi: 10.1111/jar.12092.

75.

Hoffman

, Sritharan

, Tejpar

. Is the UN Convention on the Rights of Persons with Disabilities Impacting Mental Health Laws and Policies in High-Income Countries? A Case Study of Implementation in Canada. BMC Int. Health Hum. Rights. 2016;16(1):1–18, doi: 10.1186/S12914-016-0103-1/TABLES/4.

76.

Stein

, Bantekas

. Including Disability in Business and Human Rights Discourse and Corporate Practice. Bus. Hum. Rights J. 2021;6(3):490–513, doi: 10.1017/BHJ.2021.13.

77.

Blanck

. Resolving disputes under the Americans with Disabilities Act. A case example of an employee with a back impairment – PubMed. Spine (Phila. Pa. 1976). 1995;20(1):853–859, [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/7701403/.

78.

Ballo

, Labour market participation for young people with disabilities: The impact of gender and higher education, Work. Employ. Soc. 2019;1-20, doi: 10.1177/0950017019868139.

79.

Brown

, Moloney

. Intersectionality, Work, and Well-Being: The Effects of Gender and Disability. Gend. Soc. 2019;33(1):94–122, doi: 10.1177/0891243218800636.

80.

O’hara

. Twice Penalized:Employment Discrimination Against Women with Disabilities. J. Disabil. Policy Stud. 2004;15(1):27–34, doi: 10.1177/10442073040150010501.