Supporting disability-inclusive knowledge translation and patient access to knowledge: A synthesis of select special education theories

Abstract

Equitable access to knowledge and knowledge translation that is inclusive to marginalized patients—including those whose health conditions have resulted in lifelong disability—may be supportive of health equity. In enhancing the evidence base of what constitutes disability-inclusive knowledge translation, patients may be better supported in their health literacy, self-management, or autonomy in making health-related decisions. To identify potential guiding principles from the discipline of special education that has been invested in providing equitable access to knowledge for patients living with disabilities across all age groups. Qualitative synthesis of existing theories, models, and frameworks (TMFs) in special education is performed to identify constructs which may guide disability-inclusive knowledge translation. A search methodology adapted from PRISMA-ScR was conducted in Web of Science and Scopus to identify review-type studies in special education scholarship. A total of 69 unique review-type studies were retrieved in the English language, resulting in 21 meeting the inclusion criteria of presenting a special education TMF with potential to inform knowledge translation. Ten themes emerged through data charting of theoretical constructs, as well as open coding of five studies. Findings that may promote disability-inclusive knowledge translation are presented in a synthesized framework with 25 considerations. Special education TMFs are diverse in focus; this first-steps study illustrates significant potential of special education TMFs in informing disability-inclusive knowledge translation. Future studies that engage with a more expansive set of special education TMFs will bring value to implementation science.

This paper reviews 21 special education theories, models, and frameworks papers towards identifying potential guidelines to support equitable access to knowledge and knowledge translation for patients living with disabilities.

Implications.

Practice: Knowledge translation specialists may consider disability-inclusive guidelines drawn from special education as a discipline to help reduce barriers in accessing knowledge for patients living with disabilities (PLWD).

Policy: Policymakers who wish to support health literacy of patients may consider PLWD as uniquely marginalized and simultaneously diverse group—who may benefit from specialized policies towards the aim of health equity.

Research: Future research in health equity or implementation science may consider interdisciplinary scholarship around disability studies and rehabilitation to identify transferable guidelines that are grounded in the lived experience of disability.

Introduction

Knowledge translation (KT) that is inclusive to patients living with disabilities (PLWD) has significant potential to contribute to health equity [1, 2], and this paper aims to build upon seminal work, which assesses implementation science from an inclusivity lens that promotes minority health and diversity in health [3]. Knowledge generated by health research, with or without direct connection to disabilities, may have the potential to contribute to the health of those living with disabilities [4]. While KT is increasingly inclusive in terms of race, gender, indigenous experience, and geography [5], research suggests that members of these populations who simultaneously live with disabilities may face additional barriers [6]. Persistent disparities in terms of access to education [7], as well as access to information [8] may undermine inclusive KT efforts.

This paper emphasizes KT, which provides equitable access to research-based information for marginalized populations. While considerable research exists on KT efforts engaging PLWD as sources of information, there is value in delineating between two directions within what is conceptualized as integrated knowledge translation [9, 10]. Patients living with disabilities, with lived experience of managing chronic functional impairments, have significant knowledge base to inform policy and practice [11]. At the same time, KT efforts intending to mobilize this knowledge base do not necessarily contribute to access-to-information for PLWD [12]. To maintain an apt scope of discussion, the following discussions emphasize inclusive KT as facilitating access-to-information. The operational definition of disability-inclusive KT for this study is providing research results in ways that are feasible and accessible to PLWD, acknowledging this population as a valid audience to access research-based knowledge if they wish to.

Notably, certain forms of KT are intended for practitioners or policymakers towards the development of new treatments or policies—which diverges from KT with direct applied value to PLWD [13]. At the same time, allowing PLWD to access information intended for practitioners or policymakers may contribute to more equitable health outcomes. First, it is possible that access to research-based health information can facilitate dialogue towards the identification of collaborative health solutions [14]. Second, when provided with access to practitioner-level and policy-level knowledge, PLWD may be supported to contribute as future practitioners or policymakers [15].

Within communities of individuals who live with disabilities, research suggests notable diversity. Individuals may live with two or more simultaneous disabilities or impairments [16]. Individuals with the same disability may experience a wide range of medical and lived experiences, leading to reconceptualization of conditions as spectrum disorders [17]. Additionally, individuals may live with invisible disabilities, leading to additional stigma and barriers in social participation [18]. For individuals with socioeconomic marginalization and difficulties in accessing care, scholarship notes increased risk of undiagnosed disabilities affecting everyday interactions [19]. In combination, the diversity of the disability lived experience suggests value in broad, interdisciplinary exploration of disability theories to enhance KT as situated in the discipline of implementation science.

The following discussions mobilize the International Classification of Functioning’s definition of disability, which intently notes the disability “results from the interaction between individuals with a health condition… with personal and environmental factors including negative attitudes, inaccessible transportation and public buildings, and limited social support” [20]. The inherent links between disability and clinical health are expanded to consider socioenvironmental factors that create disabling effects [21], highlighting the role of both clinical therapies, behavioral medicine and changes in social or environmental structures to reduce lived experience of disability. Notably, patients who live with clinical conditions, including chronic illnesses, may also experience a range of disabilities when interacting with social and environmental structures around them. The following discussions aim to assess the role of education and information as two forms of leverage points to reduce lived experience of disability, with KT being inclusive of both communication of clinical health research [22] and broader research aligned with the social determinants of health [23].

Rationale

This research builds upon a prior study assessing knowledge gaps in inclusive KT [12], with the following key findings summarized below. First, a Center on Knowledge Translation for Disability and Rehabilitation Research presents a database of disability-KT publications, which were systematically reviewed [24] to show that knowledge translation models are often not generated by PLWD themselves nor offer significant disability focus. Additionally, there often exists significant overlap with process models, which may result in inadvertent backgrounding of what specific best practices or considerations may support inclusion of PLWD. These gaps suggest potential value in exploring a disability-specific focus in KT, with the aim of optimizing a lens informed by the ICF in the objective of making research knowledge accessible to more members of society.

Based on the interdisciplinarity of disability studies, this paper posits that special education research can help inform the development of disability-inclusive KT. As a discipline, special education has long been centered on meeting the information needs of PLWD. There exists the possibility that the body of literature on special education has amassed a considerable number of best practices and theories, models, and frameworks (TMFs) to inform KT. Operating on special education as a disability-centric discipline may help establish a baseline level of information tailoring towards enhancing the uptake and usability of information that is made accessible to PLWD [25, 26]. Searches across the databases used in this study did not retrieve past work that considers KT practices through the lens of special education. The following sections describe a rapid review of special education TMFs, performed to collate considerations that may enhance the disability-inclusivity of KT practices.

Objective

To perform a synthesis of special education TMFs that are present in existing review-style studies and identify theoretically grounded considerations that may contribute to new perspectives in disability-inclusive KT. The overarching objective is to promote greater access to research-based information for PLWD, as a leverage point to promote more equitable health outcomes for populations experiencing social marginalization.

Method

This paper employs an adapted review strategy based on PRISMA-ScR. In order to identify special education TMFs for synthesis, the following search process and eligibility criteria were applied. As a first-steps study, this synthesis focuses on special education TMFs, which are present in existing review-type studies. The rationale for this is to identify existing efforts in synthesizing or comparing special education TMFs, and build upon synthesis efforts performed previously by special education scholars. All review-type studies in Scopus and Web of Science published in the English language between database inception and 20 February 2024 were included for abstract screening. Non-English sources were excluded for this study given limited capacity in data analysis. The rapid search strategy employed to identify existing syntheses of special education TMFs is represented in Table 1:

Table 1.

Rapid search strategy for retrieving special education TMFs in Web of Science and Scopus

Article title, abstract, keyword (topic)	“Special education”
Article title	Theor* OR model* OR framework*
Limits	review-type study English language

Between two databases, the search strategy retrieved 47 reviews in Scopus and 43 reviews in Web of Science. Duplicate screening removed 31 titles for a total of 69 reviews included for further screening. Selection of sources of evidence was performed by full-text screening; sources that did not present a special education TMF were excluded. All studies that included discussion, or direct presentation, of at least one special education TMF were included for selection in the next stage.

In determining special education TMFs that have the capacity to inform disability-inclusive KT, two specific types of TMF emerged with limited relevance. First, special education TMFs, which focused entirely on organizational structures within educational systems towards the delivery of special education were removed. Second, TMFs, which help guide teacher’s diagnoses of potential learning disabilities were also removed from consideration. The final included TMFs were represented by 21 studies.

Data charting process of TMFs categorized the 21 studies into 4 types (Table 2). The first type of study compared and contrasted multiple TMFs with distinct constructs in special education and did not attempt to perform synthesis towards an integrated TMF. Notably, this study does not attempt to philosophically distinguish between TMFs, and refers to all recommendations of considerations present in TMFs as constructs for brevity. The second type of study compared and contrasted multiple TMFs, but involved extensive discussion in place of presenting distinct constructs. These studies required further data analysis to identify key concepts within the special education TMFs represented.

Table 2.

Categorization of TMF reviews by dual criteria

	Multiple TMFs	Single or Integrated TMF
Distinct constructs	Type I	Type III
Extended qualitative engagement	Type II	Type IV

The third type of study either presented one specific special education TMF, or synthesized prior scholarship into an integrated TMF. Type III studies also present distinct constructs within the singular TMF. Lastly, review studies, which involved extensive qualitative discussion on a single special education TMF were also retrieved and analyzed separately in its own category.

Data items collected from the Type I and Type III studies were defined by the constructs presented under each TMF. For Type II and Type IV studies in which a TMF was not cleanly represented by distinct constructs, open coding [27] was performed to identify key findings. Critical appraisal of the quality of sources was not conducted, as the study objective was not to assess whether TMFs had validity towards the discipline of special education. For synthesis of results, all data items collected from four types of studies were collated. Constructs and codes were then compared to identify recurring themes. Data items that were exclusively relevant to optimizing organizational structure of special education were removed, though other elements within the same TMF were retained given their potential to inform disability-inclusive KT. No constructs relevant to diagnosis of disability emerged in the data analysis stage.

Results

Twenty total studies out of 69 unique titles retrieved were included for synthesis. Two studies by the same lead author used the same theory; these were combined during the data charting phase according to PRISMA-ScR. With regard to the aforementioned categorization of studies, Table 3 outlines 20 studies, noting the number of TMFs presented, focus of TMF, and number of total constructs from TMFs, if specified. Notably, two articles by Tlili et al. retrieved mobilized identical TMFs and are collated in the following discussions.

Table 3.

Four categorizations of twenty studies retrieved through rapid search strategy

Type	Study	Number of TMFs	Focus	Number of constructs
I	Rao	3	Universal learning	8 + 3 + 8
	Farmer et al.	2	Intervention components	16 + 39
II	Price & Patton	Qualitative*	Biological, social, psychological, and integrated frameworks	Qualitative
	Trent et al.	Qualitative*	Deficit to social constructivism	Qualitative
	Abbeduto & Boudreau	Qualitative*	Mental retardation	Qualitative
III	Biggs et al.	1	Partner instruction	12
	Bross et al.	1	Video modeling	1
	Tlili et al. and Tlili et al.	1	Activity theory	7
	Odom & Wolery	1	Unified theory of practice	28
	Frederick et al.	1	Role of parents and behavior analysts	28
	Anderson	1	Optimal resource theory	7
	Wehmeyer	1	Causal agency theory	17
	Ronksley-Pavia	1	Learning	10
	Johnson et al.	1	Self-regulation in learning	23
	Hastings	1	Service provider influences	7
	Skarbek et al.	1	Prevention of abuse	12
	Rainforth	1	Teams in learning	8
IV	Fisher et al.	1	DisCrit	Qualitative
	Bal et al.	1	Cultural historical activity theory	Qualitative

This synthesis retrieved only one duplicate in TMFs presented—suggesting considerable diversity within special education TMFs. This diversity emerges as particularly expansive when comparing the theme of TMFs. Special education TMFs presented vastly divergent foci. This diversity persisted even after removing TMFs, which were relevant to the organizational structure of special education systems and the diagnosis for special learning needs.

Discussion

Open coding [27] was employed to identify key themes among TMF constructs presented in the studies retrieved. A snapshot of the data charting process, resulting in the identification of 10 recurring themes in special education TMFs intending to equalize access to information for PLWD (Table 4) with clarifying points in Appendix 1. Notably, one of the nine themes identified: role of family members and service providers was later split into two diverging themes after the coding process. The final data extraction also expanded beyond the 20 studies retrieved to assess additional TMFs referenced or nested within the twenty studies.

Table 4.

Twenty-five considerations for disability-inclusive knowledge translation, as informed by special education TMFs

	Theme	Practice
1	Environment	• KT is conducted in a welcoming, inclusive environment • KT mobilizes technology to create virtual environments that are welcoming and inclusive for PLWD to engage with information
2	Interactivity	• KT employs multimodal communications so that PLWD can access multiple ways to interact with information towards new ways of acquiring information
3	Promotional Role of Family & Service Providers	• KT acknowledges the role of family members and service providers as: ◦ Individuals who may have specific, profound knowledge about the PLWD engaged ◦ Individuals who could be engaged in KT as mediators of information towards successful access to knowledge • KT considers a family-centered approach, which can be mobilized to complement a PLWD-centered approach
4	Hindering Role of Family & Service Providers	• KT considers nuance in engaging service providers, given existing research on power imbalances and documented cases of abuse affecting equitable access-to-information for PLWD • KT aims to empower PLWD as equally valid recipients of knowledge compared to their service providers
5	Emotion	• KT acknowledges emotions as a natural response to authentic engagement with information • KT is aware of how emotions can emerge from service providers to impact access-to-information for PLWD • KT aims to assist in the process of regulating emotion towards sustained engagement with information
6	Modeling	• KT considers demonstrating modeled behaviors as a means to facilitate knowledge-to-action
7	Technology	• KT employs assistive technologies to maximize access-to-information for PLWD, while noting potential needs for accommodations in technology as well as potential limits to in-home technology that PLWD can realistically access • KT explores environment-induced learning and interaction-based learning via new technologies such as video, serious games, and artificial intelligence
8	Diversity & Individualization	• KT embraces multiple ways to communicate information • KT provides multiple ways for PLWD to respond to and engage with information • KT acknowledges that certain information will require adaptation for improved relevance to the PLWD experience • KT recognizes individual strengths of PLWD, and adopts a strength-based approach to learning
9	Social Determinants of Health	• KT acknowledges history of marginalization of PLWD intersecting with other social determinants of health such as gender and race • KT acknowledges modern forms of inequitable outcomes, which often emerge for PLWD living with multiple statuses of marginalization • KT empowers PLWD towards overcoming historic, cultural, and intersectional experiences of inequalities
10	Goal-Setting, Self-Reflection, and Advocacy	• KT clearly presents a goal, with rationale, to be accomplished with new information • KT supports PLWD in developing personal goals • KT facilitates self-reflection towards learning • KT promotes self-advocacy efforts of PLWD

The following sections summarize key findings that emerged after data analysis. Synthesis of results is performed by comparison of TMF constructs and codes. Ten finalized themes are outlined below: environmental contributions; interactivity; promotional role of family & service providers; hindering role of family and service providers; acknowledging role of emotions; utilizing modeling; utilizing technology; mobilizing diverse & individualized methods; acknowledging the social determinants of health; and supporting goal-setting, self-reflection, and advocacy.

Environmental contributions

Thirteen TMFs [28–40] emphasize the role of the environment on learning and acquisition of new information. Learning new information is facilitated by a welcoming, caring climate [28, 29, 35], which fosters a sense of safety or belonging [33] in addition to positive engagement [37]. Participation in one’s environment can happen in terms of group engagement [30] to facilitate learning [41]. Additionally, modes of communicating information that acknowledges environmental contexts—including that forming the background knowledge of the learners [32]—can help facilitate successful outcomes. Impacts from the environment may include organizational factors, including culture of service providers and other stakeholders around the learner [34].

Notably, the context in which KT occurs is not always under the control of implementation scientists. At the same time, various special education TMFs indicate that learning happens via the environment, therefore positioning environmental contributions as central to the task of acquiring information [38]. For example, individuals are noted to learn through “acting on and observing their environment” [30], with both the community and the home as spaces that impart knowledge [42]. Incremental learning is sometimes facilitated via environmental transitions [43, 44]. New environments can both encourage and hinder learning, as adaptation to new environmental contexts may require PLWD to switch their preexisting learning strategies [33]. Learning of new information is often successful when situated “in the context of everyday activities and routines” [36]. In addition to self-awareness, environmental contributions are positioned by some theories as one of two critical factors that foster learning—as learning is noted to be “triggered by external events” [45, 46].

Interactivity

Rao et al.’s comparison of three TMFs of universal learning all suggests the value of interaction in facilitating learning [28, 29, 47, 48]. Feedback from the information source is noted as a recurring aspect fostering interactivity [28, 29, 49]. Increased interaction in diverse modes of engagement [29] is positioned as conducive to overall learning, specifically when traditional modes of learning often do not always provide opportunity for PLWD to respond [37]. Beyond feedback, interactivity can take other forms such as discussion or roleplay [49]. To address the diversity in lived experiences of disability, there is value in simultaneously exploring “multiple means of engagement” [48].

Akin to aforementioned theoretical constructs related to the contributions of the environment, interactivity itself is positioned as not just a factor in special education, but central to the act of both human development [50] and learning [51]. Social-interactionist theories in special education suggest that learning is motivated by desire to participate and interact with others [52, 53]. The centrality of interactivity is also seen in theories of responsive interaction [54, 55] and social constructivism [56]. Vygotsky’s theory of special education also notes mediation—and interaction with mediators of knowledge—as one of three key principles [57, 58]. Interactivity forms the foundations of Tlili et al.’s review on game-based environments for students with disabilities [59]. While Tlili et al.’s review only presents one TMF [60], there is value in considering how KT products in themselves can create or become interactive environments. With increasing research mobilizing serious games, virtual reality, and augmented reality for the purpose of KT [61], implementation scientists may find greater leverage in creating interactive environments that foster acquisition of information for PLWD.

Promotional role of family and service providers

A number of TMFs retrieved were centered on the role of parents and service providers in special education [34, 35, 49, 62]. There is value in drawing from family-centered practices [63], family-centered planning [64], parent-implemented milieu teaching approaches [65], and parent-education programs to support special education [66]. A critical rationale for engaging parents in the KT process is that parents may have direct knowledge to inform processes that are suited to their children living with disability [67]. For individuals living with more severe disabilities, the role of parents may continue into adulthood [68]. Family members may largely determine environmental contexts in which PLWD will access and utilize knowledge [67]. Learning, which successfully happens outside of a home context, does not necessarily carry into the home environment [62]; modifications to the home environment may be required in order to foster sustained learning [28].

In addition to suggesting value in engaging family members, TMFs note value in exploring community and division of labor as two aspects of the special education experience [69, 70]. Behavioral analysts, occupational therapists, and a number of other institutional actors can play a role in successful learning [37, 62]. The actions and attitudes of service providers can also directly determine if learning or other behaviors take place [34]. In general, parents and service providers in the lives of PLWD are positioned as “agents of change” [65]. Existing TMFs suggest value in considering whether KT to family members and service providers can serve as critical leverage points to mediate research-based information.

Hindering role of family and service providers

TMFs retrieved from this study also highlight the necessity of nuance in considering mediators in special education. Service providers often may not recognize PLWD “as full members and key decision-makers” [36]. Three studies out of 20 are centered on the power imbalances that PLWD may experience to hinder learning and their access to information. Hastings [34] provides a framework to assess how behaviors deemed detrimental to PLWD’s own learning may stem from stress responses to the behaviors of service providers. Service providers were noted to sometimes experience considerable stress and negative emotions under current social structures; these, in turn, tend to negatively impact the learning of PLWD. Skarbek et al.’s [35] framework is centered upon responding to the well-observed phenomenon of sexual abuse of PLWD by service providers [71, 72]. Disabilities that hinder PLWD’s ability to communicate often facilitate opportunities for sustained abuse, which not only undermines learning but also exacerbates inequitable experiences in life [73–75].

Fisher’s review study emphasized the role of DisCrit theory [76] in response to exclusionary discipline practices targeting marginalized PLWD [77]. Existing scholarship evidence suggests value in acknowledging historical inequalities, under which PLWD were positioned by deficit-thinking theories as individuals needing to be “saved” by mainstream society [78], or, requiring “social control” [79]. Towards identifying alternatives, Farmer’s framework suggests the monitoring of social hierarchies, which often emerge to undermine successful learning [37]. With multiple TMFs created with the objective of fostering collaborative, equitable relationships between PLWD, family members, and service providers, existing evidence suggests that future KT efforts will benefit from a lens of potential power imbalances impacting access-to-information for PLWD. Implications for future research suggest value in exploring how to support family members and service providers in their caregiving responsibilities so that inadvertent negative effects on PLWD and their information-access processes can be minimized. This paper does not posit that all family members and caregivers should be assessed for their potential negative contributions to an equitable KT process; rather, given social and structural barriers that present various unmet needs for families living with disabilities [80], PLWD may have diverse interpersonal relationships that are worth continued scholarly investigation. In combination, potential conflicts may be acknowledged towards the objective of resolution, and the implications of resolution on KT may be significant enough to warrant increased relational perspectives in KT scholarship.

Acknowledging role of emotions

Three studies retrieved emphasize the role of emotions in special education [33, 34, 37]. Johnson et al.’s integrated special education framework [33] highlights the fact that authentic learning can induce emotion as a response. Additionally, emotions and feelings are integral to learning as a behavior. Information, including curriculum, can impact and elicit emotions of recipients-of-knowledge, which in turn may lead to varying behaviors to support or hinder learning. For disabilities that inherently impact Johnson et al.’s consideration of emotional regulation, a curriculum that acknowledges such conditions can help foster more successful engagement. In combination, the framework positions thoughts, feelings, and behaviors within a collective context of awareness as a central aspect of learning. Hastings [34] emphasizes the potential for emotions to hinder learning and highlights the role of emotions, which may be present in the learning environment via service providers. Stress, negative reactions to learners, coping mechanisms, and self-efficacy of service providers all emerge as key constructs to impact learning. Farmer [37] specifically notes the value of “emotionally & behaviorally supportive relationships” in contributing to successful learning outcomes, which underscores Johnson et al.’s interconnectedness of emotion and behavior. In combination, the TMFs suggest that sustained learning as a behavior can be confounded by emotions of PLWD—as well as the emotions of service providers and other individuals in the learning setting. In combination, these three TMFs suggest value in KT that acknowledges the validity and the impacts of emotions towards supporting authentic and sustained engagements with information.

Utilizing modeling

Bross et al.’s study is focused entirely on the theory of video modeling [59], through which learning is facilitated by viewing videos of promoted behavior performed by a role model. Biggs et al. [49] likewise suggest the value of demonstrating or modeling in a learning context, noted to help promote the learning of mediators such as parents [62]. Learning-via-modeling is extended by the aforementioned construct of roleplaying, in which the learner can also engage in modeling that is interactive [49]. Farmer’s [37] framework suggests that modeling does not only promote learning of content but can also be employed to overcome barriers arising from emotion and social hierarchy in the learning context. Trent et al. [79] detail Vygotsky’s theory of social constructivism, which suggests that learning is “acquired through apprenticeships in applied settings.” Rolemodels or “more knowledgeable members” help transform knowledge into action, which aligns with existing frameworks in implementation science like knowledge-to-action [81]. The benefit of modeling is described to be reducing the demands on the learner, who no longer needs to piece together how information needs to be integrated towards a functional outcome [82].

Utilizing technology

In relation to interactivity, modeling, and roleplaying, technology emerges as a recurring construct in various TMFs. Three studies suggest the inherent value of technologies in both facilitating learning and reducing barriers arising from a disability, particularly in the form of assistive technologies [28, 29, 69]. Technologies represented in the reviews include videos [59, 62], serious games [70], artificial intelligence [69], and virtual learning platforms [62].

Beyond a capacity to create virtual environments that facilitate learning, technology also supports the aforementioned goal of equalizing power relations between individuals. Frederick [62] notes the value of technology in facilitating inclusive, consistent communications between occupational therapists, speech-language pathologists, behavior analysis, behavior interventionists, teachers, case managers, other special service providers, and parents. The framework describes the value of technologies towards “rapport building,” especially in terms of helping to facilitate distance-based relationships.

Echoing concerns raised by Burgstahler et al. [28], Frederick also notes that PLWD may not benefit from commercial technologies in the same way. Accommodations in technology may be required, and service providers may help take on the role of providing technology support to families. Additionally, Frederick highlights that “technology at home” for PLWD should be assumed to be at the same level as that in schools and other service contexts. The evidence suggests value in acknowledging potential inequalities in access to technology for PLWD, which echoes existing research on the digital divide [83].

Mobilizing diverse and individualized methods

TMFs retrieved help add nuance in disentangling what diversity in the disability experience entails. Diversity exists in terms of learning styles, abilities, ways of knowing, previous experience, and background knowledge [29]. Evidence suggests value in platforms that allow for multiple means of representing knowledge, acting upon knowledge, expression, and engagement with knowledge [48]. There exists the possibility that knowledge will need to be reinterpreted within the context of disabilities to facilitate optimal outcomes, which includes individualized or personalized learning that can happen both for “individuals and small group(s)” [32]. Beyond diversity, which reflects the lived experiences of disabilities, TMFs also suggest that diversity emerges from factors including the inherent complexity of human development [31]; the multidisciplinary nature of teamwork in a learning context [35]; and the social construction of being delayed versus being different [38]. Price & Patton [84] explore various integrative models of adult development, which in combination emphasize that adults can become “far too complex to put into one theoretical box.” Learning that acknowledges the “rich experiential base that all adults bring into the learning environment,” and learning that does not attempt to negate uniqueness may help facilitate successful outcomes [45, 85, 86]

Acknowledging the social determinants of health

Echoing the considerable body of literature on health inequalities and social determinants of health, various TMFs also highlight how the act of providing learning has historically contributed to reinforcing social inequalities [87]. Trent et al. [79] dedicates considerable discussion to historical realities of deficit-thinking in special education theories. First, the child-saving theory is discussed to illustrate how PLWD have been, by default, positioned as inferior to normative members of society who must remove their differences [78, 88]. Second, the social control theory paradoxically highlights how disabilities have been mobilized with the goal of segregating specific races from White, mainstream society [89]. The attachment of the label of a disability, particularly for marginalized groups, can lead to persistent experiences of inequality [90].

The dominance of these perspectives in special education is not entirely historical, as Fisher’s review [77] notes a 2014 study finding 24% of Black students with disability labels being suspended versus 9% of White students with disability labels in the USA [91]. Towards resisting deficit-thinking in special education TMFs, Vygotsky’s theory of social constructivism emphasizes how learning cannot be separated from cultural and historical contexts [57, 58, 79]. Price & Patton [84] also consider how learning is “shaped by societal/cultural norms and expectations” [92]. Odom [30] proposes that an objective of special education is social integration and inclusivity [93], both of which have been noted in the scholarship to contribute to health equity [94, 95]. In combination, the evidence suggests value in considering culturally sensitive efforts [96]; understanding the intersectional experiences of PLWD for different genders and races [97–100]; as well as positioning KT as an opportunity for PLWD to be engaged in empowering discourse [57]. Knowledge translation, therefore, can be mobilized towards advancing equitable outcomes under the social determinants of health.

Supporting goal-setting, self-reflection, and advocacy

A number of TMFs consider the value of goal-setting and self-reflection towards special education [31, 32, 36, 49, 84, 101]. Learning opportunities that are explicit in its goals, with clear rationale, are noted to be conducive to learning for PLWD [49]. Additionally, there are also benefits associated with supporting PLWD in self-determined goal-setting, towards effective acquisition of new information [36]. Goal-setting helps to achieve incremental, reasonable outcomes [31] and is interconnected with the reflective practices of self-analysis and self-monitoring in learning [101]. Self-reflection is commonly associated with evaluating successful learning [32, 49, 84] and can also support other goals in special education. Self-reflection can create a foundation for self-advocacy so that PLWD can better access what is necessary for effective learning [33] and communicate often-silenced forms of abuse in service settings [35]. These forms of reflective practice have significant potential to “shape personal identity” [102, 103], towards the “reframing of negative identities” associated with the disability experience [37].

Implications for practice

The following synthesized framework collates findings from existing special education TMFs retrieved for this study towards informing disability-inclusive KT practice. There is value in noting that the TMFs collated, though inclusive of different types of disabilities, do not reflect diverse cultural contexts nor present a specific lens on Indigenous health. As KT needs and health literacy needs for people living with disabilities from diverse Indigenous, immigrant, and refugee groups may vary, the following framework should be viewed as largely limited given the review strategy’s inclusion of English-language publications only. Future studies that complement the linguistic focus will bring significant value to the cross-cultural applied value of the framework.

Limitations

This study focuses on the synthesis of TMFs present in review-type special education literature. As a first-steps study aiming to define manageable scope, the study is limited in its investigation and does not replace future efforts involving scoping or systematic review methodologies to understand special education TMFs. Sustained investigation engaging with other databases and expansive search strategies will bring value to the state of evidence.

TMFs, which were focused on the delivery and organizational structures associated with education systems, were removed, in addition to TMFs aiming to support teachers in identifying or diagnosing learning disabilities. Further analysis of these two categories of TMFs may reveal new relevance to information KT practice.

This study builds upon an adapted PRISMA-ScR framework and notably does not involve quality assessment of retrieved resources. The search strategy, which includes only review-type studies aims to identify special education TMFs that were (1) noted as generating sufficient research warranting review-type methodologies; (2) seeing a level of usage in the special education discipline for comparison with other TMFs; or (3) deemed by researchers as important to inform and become components of new, integrated TMFs. These targets, however, do not suggest that all studies are of uniform quality. Given the focus of TMFs, this review study does not include analyses of special education concepts, strategies, or best practices that may have value towards enhancing inclusive KT but have not yet been systematically conceptualized into a TMF.

The exclusion of non-English language studies may result in the omission of important perspectives to inform inclusive KT, particularly given the intersectional nature of disabilities with race and geography [77, 104]. This is a particularly notable limitation given the fact that the notable TMFs from other geographic regions and cultural contexts may add to the lens on special education, with value to support PLWD from diverse immigrant or refugee backgrounds. While publication bias is largely limited to those that present a concrete special education TMF, language bias is largely the result of research capacity—and not an intentional deprioritization of diverse cultural perspectives that have long been noted to present value to the study of behavioral medicine. These biases are explicitly acknowledged here as a means to disclose limitations in overall generalizability and support continued investigations towards a holistic view of inclusivity.

Conclusion

Theories, models, and frameworks in special education are broad in scope and represent a longstanding discipline that have promoted access-to-information for PLWD. As such, special education literature has the potential to inform disability-inclusive KT practice and may help promote inclusivity of other marginalized groups—such as racialized minorities—given the intersectional nature of disabilities. Notably, special education TMFs may help enhance the accessibility of diverse forms of research for PLWD, including research that aims to communicate clinical information, enhance health literacy, or help address the social determinants of health via broader considerations as proposed by the ICF [20]. Twenty studies that presented over 30 special education TMFs resulted in a synthesized framework in this study. Future testing of the synthesized framework through direct engagement with PLWD will help enhance the utility of the framework in KT practice.

Future studies including perspectives from diverse global communities of PLWD will significantly help inform disability-inclusive KT. As key directions for continued research, involving special education TMFs published in non-English languages will enrich the diversity of perspectives in inclusive KT. Additionally, continued review of the evidence base on special education practices and strategies that have not yet been conceptualized into a TMF will also add significant breadth.

With regard to practical application, this paper has not yet engaged with direct application as part of the review methodology. Potential studies which may be considered include (1) participatory action research in which PLWD are engaged in testing the efficacy of KT considerations proposed; (2) implementation case studies to investigate utility in clinical, rehabilitation, or community health context; or (3) health literacy initiatives designed for PWLD, which by nature integrate an information-access component to the dissemination of clinical research. Future research collaborations that employ the conceptual framework will bring significant value.

Appendix 1. Clarifying examples and preliminary definitions of themes in framework

	Theme	Definition	Example
1	Environment	The physical and digital context in which knowledge translation takes place	Ie. a social media platform through which PLWD access information
2	Interactivity	Elements of KT which invite engagement, feedback, and participation in ways that are inclusive to PLWD	Ie. employment of serious games, which has been notably mobilized in both graduate and professional formal education
3	Promotional Role of Family & Service Providers	Contributions to the objective of equitable access-to-information for PLWD	Ie. translation services offered by family members, which may expand cultural reach of KT
4	Hindering Role of Family & Service Providers	Potential hindrances, including conflicts and divergent interests are worth acknowledging to ensure a human-centered approach for KT that is made accessible to PLWD	Ie. acknowledgement of research on service providers who may present experiences of ableism towards the exacerbation of marginalizing experiences of PLWD
5	Emotion	Elements of KT that acknowledge psychosocial well-being and mental health of PLWD as valid—even in KT initiatives	Ie. support services that help PLWD resolve emotional barriers that prevent access, absorption, or application of knowledge received
6	Modeling	KT, which mobilizes direct examples to encourage or illustrate specific pieces of information	Ie. documentary of success stories created and shared by other PLWD who have benefited from a previous KT initiative
7	Technology	Diverse digital and assistive devices, including software such as digital media, which may advance the accessibility of KT	Ie. digital media such as film, graphic novels, series, animations, and other storytelling or narrative features that make information more contextualized, immersive, and emotionally relevant
8	Diversity & Individualization	Acknowledgement of the disability experience as inherently heterogeneous and potentially intersecting with other forms of social marginalizations—towards clarifying tailored KT approaches	Ie. ensuring audio-based engagements for PLWD who live with vision impairments
9	Social Determinants of Health	Following the World Health Organization’s definition, nonmedical model elements, which may impact health of individuals can also directly impact access to information - such as transportation barriers to education	Ie. presenting information on housing or transportation as two nonmedical model elements that nonetheless can pose significant impacts to the long-term health of PLWD
10	Goal-Setting, Self-Reflection, and Advocacy	Elements of KT that support gradual empowerment so that PLWD experience greater health equity in addition to general outcomes relevant to social justice	Ie. supporting PLWD beyond the access of information to the successful application of knowledge—and positioning them as valid agents of social change

Funding Sources

This study was funded in part by the Social Science and Humanities Research Council of Canada. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Human Rights

This article does not contain any studies with human participants performed by any of the authors.

Informed Consent

This study does not involve human participants, and informed consent was therefore not required.

Transparency Statement

This study was not formally registered. The analysis plan was not formally preregistered. De-identified data from this study are not available in a public archive. De-identified data from this study will be made available (as allowable according to institutional IRB standards) by emailing the corresponding author. Analytic code used to conduct the analyses presented in this study is not available in a public archive. They may be available by emailing the corresponding author. Materials used to conduct the study are not publicly available. They may be available by emailing the corresponding author.