Environmental factors associated with employment post-SCI
The environment consists of several different dimensions including the physical, social, and cultural environment. When thinking about the SCI population the most obvious barriers and facilitators are related to the physical environment particularly for those individuals who have difficulty with mobility. However the social and cultural environment can also been seen to create barriers when one considers the economic disincentives faced, not only by the employers, but also employees with SCI. Moreover the attitudes of other employees can also act to influence the worksite acceptance of individuals with SCI. In the following section, barriers facilitators are presented separately but, in different contexts a single environmental factor can be perceived either as a barrier or a facilitator to employment based on its presence/absence in one’s environment and its impact on effective returning to work.
The influence of environmental factors associated with employment post-SCI is based on observational studies with level 5 evidence. A total of 18 studies were identified that discussed environmental factors that either promote or limit return to work after SCI, and are summarized in tables 3 and 4.
Financial disincentives are gaining support as having a detrimental effect on return to work post-injury. For example, in British Columbia, Canada, social assistance deters recipients from returning to work because once more than $400/month is earned, benefits received while on social assistance, such as dental care and prescription medication, are lost (Jongbloed et al. 2007). This also appears to be the case in Australia as the perceived disadvantages of losing social security benefits (which would lead to exclusion from accessing government funded equipment and medical supplies) seemed to deter people from seeking employment post-SCI (Conroy and McKenna 1999).
Workplace discrimination can be further classified into ‘disability discrimination’ and ‘racial discrimination’, the latter being addressed in the personal factor section. Disability discrimination is due largely to negative or naïve employer perceptions about the potential productivity of individuals with SCI. Ravaud et al. (1992) found that companies tend to discriminate against individuals with SCI by offering interviews less frequently when the injury was disclosed. Similarly, 80% of Canadians agreed with the statement that “Canadians with disabilities are less likely to be hired for a job than those without disabilities, even if they are equally qualified” (Social Development Canada 2004). Not surprisingly, Jongbloed et al. (2007) found that individuals with SCI viewed the negative attitudes of employers regarding people with disabilities as a barrier to employment.
Being an independent driver was positively associated with returning to work post-injury. Reduced dependence on the inflexible, inaccessible, or unreliable options of public transport was likely to be the main reason for this finding (Conroy and McKenna 1999). People with SCI who have computer skills tend to return to work faster after suffering their injury, and to have higher earnings, than otherwise similar workers who lack computer skills (Kruse et al. 1996). Studies specific to persons who experience SCI, reported that of those who return to work, the majority were able to do so, in part, because of modifications to the work including job adaptations and decreased work hours.
- There is level 5 evidence that financial discentives, 'disability, discrimination' andÂ inaccessibility of workplace are environmental barriers negatively influencing employment after SCI.
- There is level 5 evidence that ability of using transportation independently and technological devices, and having access to job accomodation are positively influencing employment after SCI.
- Environmental barriers to employment are social or physical and include financial disincentives, discrimination associated to negative attitudes toward people with disabilities and difficulties with physical access to workplace.
- Environmental facilitators include having access to various assistive devices, using transportation independently and having the possibilities of job accommodation including reduced work hours.
- A single environmental factor can be perceived either as a barrier or a facilitator to employment based on its presence/absence in oneâ€™s environment and its impact on effective returning to work.