A socioecological approach to understanding and positively affecting the intersectionality between disability, race and ethnicity, climate change, and rehabilitation outcomes: A scoping review

Background

Health care outcomes for people with disability may be disproportionately affected by climate change through multiple interlinked factors, which are not well understood.

Objective

With use of scoping review methodology, this study aimed to model this intersectionality using socioecological (SE) levels to connect person-level rehabilitation diagnoses with systems/policy-level climate change and use this model to identify multilevel factors, rehabilitation outcomes, and responsive strategies from literature.

Methods

A scoping review of literature was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews methodology from three databases (PubMed Medline, Ovid Medline, CINAHL) using combinations of keywords (climate change), (rehabilitation), (disability), and (race). Logic and SE models were combined to model this intersectionality and create review forms that were used to abstract data. Common themes were collated (results), and additional experiential insight was added to provide contextual relevance (discussion).

Results

Of 32 deduplicated articles, 11 met inclusion criteria for qualitative analysis. Rehabilitation outcomes included physical, economic, mental, cognitive, and mortality (person level); rehabilitation services disruption, medical supply delay, emergency capacity overwhelmed (organizational level); and disabled environment (community level). Responsive strategies included education, backup supplies, planning, social support/utility registration (person level); competency assessment/training, physical medicine and rehabilitation physicians (PM&R) assisting patient in planning, providing pre-/postevent services, and establishing cross-coverage (interpersonal level); telerehabilitation, energy/resources conservation, PM&R inclusion in disaster mitigation planning (organization level); building accessible/resilient infrastructure, evidence-based practice guidelines through professional organizations (community level); and research funding, utility companies prioritizing power, and patients/providers included in planning (system/policy level).

Discussion

Climate change impact on rehabilitation diagnoses such as spinal cord injury and limb loss, as well as intersectionality with rehabilitation outcomes and identified responsive strategies, has been comprehensively modeled using SE levels. Race is not a commonly identified factor.