THE IMPACT OF COVID-19 ON PERSONS WITH DISABILITIES

The impact of the outbreak of COVID-19 on persons with disabilities is apparent and an expected outcome. Forty-six percent of disabled people are approximately more than 60 years old. In addition, there are around one billion disabled people in the world, 80% of whom are living in developed and underdeveloped countries (WHO, 2011). The spread of the new COVID-19 epidemic, like other previous pandemics, caused more psychological, social, and physiological stress. The state of being under stress could be temporary, where the individual suffers for a short period and then the stress ends without leaving long-term effects. Stress could also be long term, where persons with disabilities suffer from diseases and chronic health problems (Groce, 2005). The psychological and social adaptation among the families of persons with disabilities in the face of COVID-19 helps in promoting psychological and social well-being, for it is considered a form of prevention of the virus. Several groups of disabled people suffer great marginalization. For instance, people with intellectual and psychosocial disabilities do not receive support and services, but rather, they experience abuse and violence.

The common responses of people affected directly or indirectly by COVID-19 show the fear of this epidemic’s effect on the well-being of families of persons with disabilities. Some of these responses were the fear of death from the virus and the family’s feeling of inability to protect its members from the virus. Families were also afraid of refusing to care for people with disabilities after quarantining their relatives or their carers, the feeling of boredom and isolation, and the fear of deteriorating health status for people with disabilities, especially if their caregivers are quarantined (Thelwall & Levitt, 2020).

The fear and anxiety resulting from the outbreak of the COVID-19 may lead to enormous psychological pressure on members of society, which constitutes social rejection for people with disabilities because of their fragile immunity and vulnerability to infection with the new COVID-19. Therefore, psychological and social support must be available and be an essential component of any general health response in a manner that is suitable for the needs of this group of society.

COVID-19 did not just bring a health impact on persons with disabilities but also impact on the psychological, social, and economic aspects of this category of people (United Nations, March 2020). As mentioned above, many obstacles face the implementation of protective measures to support persons with disabilities. The vulnerability of persons with disabilities is caused by their special health conditions. Persons with disabilities are more exposed to secondary conditions and other deceases, such as diabetes, obesity, lung issues, and heart disease. These co-morbidities are increased and become worse if the person is infected with COVID-19 (Singh et al., 2020). Providing health care for such a group in the circumstances of the spread of COVID-19, in the appropriate manner, becomes challenging.

Older disabled people are highly affected by the spread of the virus. According to the OECD Health Statistics (2019a, b, c), people with disabilities form the largest group of people who are in a medical institution. In addition, there are also disabled people in prisons, mental institutions, detention institutions, and psychiatric clinics, who receive less support than expected. Such persons with disabilities face barriers in receiving information, support, and appropriate healthcare to prevent them being infected with COVID-19. Comas-Herrera et al. (2020) provide evidence that people who are located in institutional settings have higher rates of infection from the virus and even higher rates of deaths.

PRINCIPLES FOR SUPPORTING PERSONS WITH DISABILITY FOR COVID-19

Any response plan or recovery measures should be based on a human rights approach to include persons with disabilities and their families and avoid the feeling of being left behind. The United Nations insisted on the inclusion of persons with disabilities in the response and recovery plans and programs (United Nations, April 2020). Persons with disabilities have similar needs as other people. Therefore, any support may continue to provide normal services found in any support program for persons with disabilities. However, some principles are important to provide optimal support.

Firstly, non-discrimination is one of the main principles of human rights. Disability should not be any basis of discrimination when providing support to fight COVID-19. It is important to identify the needs of persons with disabilities and anticipate the required support to be provided regardless of gender, age, or the type of disability (Smith, 2019). The second principle is intersectionality, as persons with disabilities experience different kinds of discrimination because of their ethnicity, gender, race, age, legal status, and other factors. Therefore, any response to COVID-19 should pay attention to these discrepancies among persons with disabilities and their families. Another essential principle in supporting persons with disabilities is accessibility to the required facilities and services that such a group needs. Some families might find difficulties and challenges to reach supporting services in the time of quarantine and the curfews happening in different countries (Thelwall & Levitt, 2020).

There are different barriers to support people with disabilities during the outbreak of the new COVID-19. Firstly, there are environmental obstacles. Many health centers are not available for people with disabilities due to the restrictions imposed by the virus on movement and curfews within cities and villages, which does not allow such people to access health care facilities. Secondly, there are institutional obstacles. The cost of health care for infection with COVID-19 is high. The lack of protocols developed for people with disabilities in quarantine may prevent such people from accessing basic health care. Thirdly, there are personal obstacles. Prejudices against people with disabilities that they cannot contribute to responding to the emerging outbreak of COVID-19 or make their own decisions may lead to additional pressure on people with disabilities and their caregivers.

PREVIOUS RESEARCH

Research into the impact of COVID-19 is still scarce and many areas need to be covered. Few empirical studies have been published on the psychological and social adaptation of families of persons with disabilities. The reason behind this is the new emergence of the virus and the lack of information on its cause, treatment, or other related aspects. However, some studies have tackled the impact of COVID-19 on intellectual disabilities and the methods to be used by governments and authorities to include persons with disabilities in response plans.

Skalski et al. (2020) evaluated the relationship between ego-resiliency, social support, coronavirus anxiety, and trauma effects. The study used the Polish adaptation of the Coronavirus Anxiety Scale (CAS). The study was applied to 515 individuals aged 18-78. The results revealed that ego-resiliency and social support were correlated and decreased the severity of the novel coronavirus anxiety. The results also indicated that practitioners should pay attention to the interventions related to improving resiliency and social support to improve mental health during the COVID-19 pandemic.

Tummers et al. (2020) identified full-text articles that contain terms related to intellectual disabilities and applied a text mining technique. The results of this review showed that one hundred fifty-nine articles contained one or more of our specified terms related to ID. The researchers grouped these articles into five groups in terms of five areas: diagnoses and treatments, mental health, viral diseases, genetics, and maternal care and pediatrics. The review suggested that these five areas are important for research concerning COVID-19 and intellectual disabilities.

Pineda and Corburn (2020) suggested a new perspective for ensuring that response plans to COVID-19 should focus on promoting more inclusive and healthy cities for all, including persons with disabilities and their families. Their perspective recommended the following areas to be considered in the response plans: accessible information access, inclusive decision-making, accessibility through continuity of care and social support, economic support, and non-discrimination.

Stankovska et al. (2020) reviewed different studies and experiences that tackled the connection between depression, stress, anxiety, and viral diseases such as COVID-19. The review concluded that any psychological intervention should take into consideration the importance of engaging communities in the different stages of the interventions and improving the care system of vulnerable groups of persons, especially persons with disabilities.

Sivashanker et al. (2020) developed a pragmatic COVID-19 exposure disclosure checklist to help workers who support patients and families in the time of the COVID-19 outbreak. The study identified five core competencies that are important, which are risk management, clinical, language, psychosocial, and infectious disease. The purpose is to train facilitators on this checklist to help support families. These measures are now implemented and used in Brigham and Women’s Hospital, Boston. The study proved that using such categorization is helpful to identify areas of support to provide for patients and families.

Brooks et al. (2020) reviewed the psychological impact of quarantine. The review found (3166) papers in different databases, from which 24 were included in this review. The result of the review showed that the majority of these articles reported negative psychological effects, such as confusion, anger, and post-traumatic stress symptoms. The review also found the existence of stressors, such as frustration, infection fears, inadequate supplies, boredom, and financial loss. The review suggested that when quarantine is important, it should be for sufficient time that does not affect the psychological and mental well-being of people.

These studies tackled the impact of COVID-19 on people in general and persons with disabilities in specific. It is notable that there are psychological and social consequences for the spread of the virus, whether for those infected, people in quarantine, or those at home in times of curfew. The present study attempted to investigate such impacts on the families of persons with disabilities in the Kingdom of Saudi Arabia in terms of the psychological and social impact on these families as they support their disabled members.

The problem of the study is related to the emergence of the new COVID-19 virus around the world, which made people with disabilities and their families more vulnerable to the virus. From a health perspective, persons with disabilities are among the most vulnerable categories in any society. Therefore, they require urgent psychological and social support in addition to medical support. There is a research gap in addressing the issue of psychosocial and social support to families of people with disabilities in times of epidemics, such as COVID-19. The virus is new and the effects on families of persons with disabilities are also new to the field. Coping with the crisis is one of the major issues to address to provide relief and support to these families. Therefore, this study attempts to fill this gap and investigate the effect of the spread of the virus on these families to provide more insights to decision-makers.

The results obtained from this study will be significant for two reasons. The first is the theoretical aspect. Studying the psychological and social adaptation of families of persons with disabilities reveals different issues to be discussed. Families are expected to comply with the regulations of preventing infection with the virus and they are obligated to prevent falling into psychological and social anxiety and isolation. The second is the practical significance, which stems from determining the extent to which families of persons with disabilities need a system of psychological and social adaptation to facilitate a safe and stable psychological and social life in a world of successive variations due to the spread of the COVID-19. Therefore, this study seeks to evaluate the effect of the spread of COVID-19 on the psychological and social adjustment of families of persons with disabilities and to obtain statistical descriptive indications about the variables related to people with disabilities such as type of disability and age.

To address the problem, this study aims to achieve the following objectives:

PARTICIPANTS

The study population consisted of all families of persons with disabilities in the Asir region in Saudi Arabia. Because of the difficulties of reaching more families in the area, the study selected 100 families of persons with disabilities randomly. Families responded to the adaptive psychological and social behavior questionnaire (Table 1). The families were asked about the level of disability its member has to face, connecting the psychological and social adaptation to the severity of the disability. This kind of inquiry helps in identifying the levels of adaptation and the needs (or no needs) to intervene.

RESEARCH INSTRUMENT

The research instrument used in this study was a questionnaire consisting of 20 paragraphs written in positive formats and using a five-point Likert scale. In this type of scale, respondents choose between strongly agree (5 points), agree (4 points), hesitant (3 points), disagree (2 points), and strongly disagree (1 point). A score of (85) and above represented a high level and a score below (85) represented a low level (see Appendix).

The validity of the scale means the ability of the scale to answer the questions of the study (Thorndike et al., 1991). The validity of the questionnaire has been evaluated by presenting it to ten experts working in the field of education, who reviewed the questionnaire and provided their feedback. Their suggestions, comments, and changes were considered accordingly. All items were revised and approved by judges in terms of word usage and the relevance of the content. Based on the judges’ suggestions, one item was deleted from the questionnaire and two items were added. Paragraphs were revised until all judges approved the phrases used and the correctness of the content. The validity indicators of the scale were verified by running an exploratory study on a sample of 20 families similar to the population of the study. The paragraphs of the questionnaire were analyzed and the coefficient of discrimination of each paragraph was calculated. The coefficient of discrimination is an indicator of validity for each paragraph in the form of a correlation coefficient between each paragraph and its associated variable. The correlation coefficient was in the range .63-.86, which represented statistical significance at the level of p = .05, and therefore, the scale can be considered generally valid (Table 2).

The reliability of the scale was determined using the test-retest method by applying it to a pilot study of 20 families of persons with disabilities. The Pearson correlation coefficient between scores was calculated on the two tests. The Spearman correlation coefficient using the return method was .83 for the scale as a whole. The stability coefficient was calculated using the Cronbach’s α, and the final internal consistency coefficient was .90, which indicated that the scale has an appropriate level of reliability.

DATA COLLECTION AND ANALYSIS

The researcher collected data from 100 families of persons with disabilities in the Asir region in Saudi Arabia. First, an electronic version of the questionnaire was created and sent to those families who have been contacted and notified via WhatsApp. Using the WhatsApp application was easier to send the questionnaire and families were able to respond quickly as they have smartphones and can access the research instrument in this study. There were 100 returned questionnaires, which were ready for statistical analysis as described in the next section.

After collecting the returned, answered questionnaires, data were recorded and tabulated with the assistance of SPSS for Windows 17.0 to identify the correlated relationships of variables concerning using the socio-psychological adaptation scale. Different statistical methods were used to achieve the main objectives of the present investigation. These methods included descriptive statistics, independent sample t-test, and analysis of variance (ANOVA). Descriptive statistics, including mean scores, standard deviation, and frequencies, were computed to summarize the responses of families of persons with disabilities according to their social and psychological adaptation after the spread of COVID-19 concerning age and level of disability.

An independent sample t-test is a statistical method employed to evaluate the difference between the mean scores of two groups of a variable. In the current study, this statistical method was used to identify the significant differences in the responses of families of persons with disabilities in the Kingdom of Saudi Arabia on the socio-psychological adaptation scale. An analysis of variance (ANOVA) is a method of statistical analysis used to determine differences among the means of more than two groups of a variable (Corbin & Strauss, 2014). In the present study, this statistical method was used to determine the impact of the spread of COVID-19 on the social and psychological adaptation of families of persons with disabilities in the Kingdom of Saudi Arabia in terms of the age of the disabled and the level of disability.