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. Author manuscript; available in PMC: 2025 Nov 26.
Published in final edited form as: J Vocat Rehabil. 2024;61(2):1–18. doi: 10.3233/jvr-240032

Updated trends in disability, diversity, and corporate social responsibility

Courtney Mullin 1, Robert Gould 1,*, Sarah Parker Harris 1, Robin Jones 1
PMCID: PMC12645482  NIHMSID: NIHMS2085524  PMID: 41306761

Abstract

BACKGROUND:

Disability holds a unique position in employment, including corporate social responsibility (CSR) and diversity, equity and inclusion efforts. Furthermore, contextual shifts in employment, such as the COVID-19 pandemic, make it critical to explore how disability is considered within company strategies.

OBJECTIVE:

Authors reviewed 2020/2021 CSR reports to observe organizational disability inclusion practices and shifts in company approaches to workplace and community initiatives. This analysis helps illuminate what disability inclusion strategies businesses publicize and prioritize, contributing to the growing knowledge of disability inclusion.

METHODS:

Building from a previous analysis completed in 2018 (Gould et al., 2020), the current review involved content analysis of 129 CSR reports from companies recognized for their disability inclusion efforts.

RESULTS:

Results showed a substantial increase in organizations that participated in disability inclusion activities and illuminated potential contextual changes. Additional findings highlight primary disability inclusion strategies as well as emerging practices.

CONCLUSION:

Although there is an increasing interest in including disability within business efforts, there continues to be distinct challenges to advancing disability inclusion overall. By providing insights into disability inclusion approaches, the current study sets a foundation for future research to explore the efficacy and long-term impacts of inclusive practices to enhance disability employment outcomes.

Keywords: Organizational culture; equal opportunity; corporate social responsibility; diversity, equity, and inclusion; disability inclusion

1. Introduction

Over the past few years, the landscape of work has drastically changed in a myriad of ways, including approaches to supporting employees with disabilities. The purpose of this paper is to explore some of these changes through a review of corporate social responsibility (CSR) reports that analyzes how these reports publicly promote the inclusion of disability within organizational settings.

The current review builds from a previous analysis of CSR reports that was conducted in 2018, which identified key strategies to advance inclusion of people with disabilities within the workplace and community (Gould et al., 2020). Reviewing CSR reports is a useful vantage point to observe organizational practices and how companies approach workplace and community initiatives, such as disability inclusion. CSR reports are often published on a standardized timeline and provide visibility into business actions for company stakeholders, which can help illuminate how companies openly demonstrate their priorities (Sheehy, 2015). Building an understanding of company practices can be beneficial for vocational rehabilitation professionals and other disability employment advocates to better interact with and support businesses in developing disability inclusion initiatives. As a five year follow up to the previous review, the research team was able to observe shifts over time, which is important as there has been a significant evolution in how companies drive and communicate CSR and disability inclusion efforts.

Considerable changes have occurred that prompted this review and make it timely, such as the COVID-19 pandemic as well as the momentum of the Black Lives Matter (BLM) movement and increased focus on racial equity. While the COVID-19 pandemic impacted how all people lived and worked, people with disabilities had distinct experiences (Schur et al., 2020; Tang, 2021). During the same time that the pandemic was shifting the way people work, the emphasis of the BLM movement concurrently influenced company approaches to racial equality and diversity, equity, and inclusion (DEI) efforts (Johnson, 2021). One demonstration comes from an article published in the Guardian (Farah, 2022) which found that three times as many employers formalized their DEI efforts during the year 2020, which was the height of both the pandemic and the movement for racial justice, compared to the year prior.

Given these significant contextual shifts, the research team conducted a review of CSR reports to help contribute to the growing literature and understanding of disability inclusion within business practices. The updated review provides insight into what strategies have remained important, the growth of disability inclusion in businesses, and identification of potentially emerging strategies. The next section will situate the current study through an overview of the existing literature.

1.2. Literature review

1.2.1. Corporate social responsibility, disability and diversity

There are several key concepts that are critical to understanding corporate approaches to DEI reporting. For example, CSR is a wide and complex category that captures many different aspects of how a company conducts business (Sheehy, 2015). Most simply worded, CSR refers to the positive impact that companies have in society, the environment, and for their employees (Fenwick & Bierema, 2008). A foundational concept of CSR is that companies have a responsibility to the communities and environments in which they operate (Sheehy, 2015). CSR reports can help illuminate how organizations approach a variety of strategies designed to have a positive impact on internal workplaces as well as external communities. Given the structure and content of CSR reports, analysis of these documents can provide an opportunity to further examine how disability is framed within company initiatives and can benefit disability employment advocates in making connections with potential employers.

CSR has been growing in popularity and increasingly becoming a core business strategy in recent years. According to an article posted by the Harvard Business School, there has been a growth in companies that develop and share CSR reports. In fact, this article further describes that of businesses listed on the S& P 500 index, only 20% issued a CSR report in 2011 compared to over 90% in 2019 (Stobierski, 2021). One potential reason for this increase is the well-documented support from consumers and customer bases for CSR. For example, a majority (55%) of surveyed adults in the U.S. indicated that they would be willing to spend more on products from companies that have a CSR mission (Stobierski, 2021). Additionally, in a different survey, 93% of participants reported that companies should be purpose driven overall (Abiaka, 2021).

While CSR as a business concept has been evolving for decades, one of the more recent impacts on approaches to CSR has been the development and growth of global initiatives to promote socially responsible acts from companies. Global perspectives for CSR are increasingly important as companies find themselves operating cross-nationally (Asmussen & Fosfuri, 2019). For example, the publication of the United Nations Sustainable Development Goals (UN SDGs) which act as guidance as well as a “call to action” for UN member states to make a positive impact in the world (United Nations, n.d.) have been used as a framework for businesses to leverage when sharing out their CSR work (Latapí Agudelo et al., 2019). The UN SDGs are especially noteworthy for this study as they specifically identify people with disabilities as part of these endeavors. The inclusion of the disability community further emphasizes the potential impact on organizational strategies towards disability inclusion within CSR efforts.

In addition to the inclusion of disability within the UN SDGs, there has also been some exploration into disability inclusion as an initiative within CSR overall. For example, recruiting and hiring people with disabilities has been found to be a useful point of view to identify key characteristics of CSR and corporate social innovation (Tabares, 2022). Additionally, Gould et al. (2020) identified key strategies that organizations utilize to promote disability inclusion that were publicized within CSR reports. While this provides an understanding of what some businesses are doing, previous research indicates that disability remains largely excluded from much of the existing literature on CSR as well as part of publicly marketed company values (Castelnovo, 2022).

DEI strategies are tangential and related to CSR. Companies often enhance equity and social justice within their company and communities through DEI efforts. DEI initiatives capture multiple activities that encompass how businesses support employees from a variety of backgrounds and cultures and can include internal workplaces as well as engaging with external consumers and philanthropic endeavors (Yadav & Lenka, 2020). DEI is increasingly becoming a central component of CSR, as a way for companies to publicly demonstrate their commitment to advancing DEI both inside and outside of the organization (Laskin & Kresic, 2021). Over time there has been additional recognition of how companies can embed social considerations, such as DEI and social justice, within their CSR efforts. Although there is an increase in companies considering CSR and DEI and engaging strategies to enhance opportunities for marginalized communities, previous research shows that disability has traditionally been isolated from and left out of existing frameworks (Miethlich, 2019).

1.2.2. Corporate public values and disability employment

CSR and DEI strategies influence how organizations work internally as well as how consumers and society perceive organizations and their business objectives (Ramesh et al., 2019; Zepponi, 2022). Reviewing what CSR strategies and initiatives companies publicize can shed light on how organizations signal their values, priorities, and investment of resources.

CSR reports are becoming increasingly utilized and even embraced by companies as a way to publicly share what is important to them and how they are working to make a positive impact in their communities (Jonsen et al., 2021). In other words, this is how organizations market their CSR planning to influence stakeholder perspectives. During the COVID-19 pandemic, investing in CSR was found to be a potentially successful strategy for maintaining firm and brand value (Qiu et al., 2021). Furthermore, as previously mentioned, there has been an expansion of companies publishing CSR reports and referencing DEI strategies as a response to the renewed emphasis on social and racial justice (Davis, 2022; Farah, 2022). In fact, companies are progressively using DEI as a branding technique to showcase company practices (Jonsen et al., 2021). Some research has shown that DEI is becoming a common aspect of business and including DEI in public facing materials helps support the recruitment of potential employees and company reputation with consumers and investors (White et al., 2019).

While these efforts may be demonstrative of what strategies businesses are engaging in, there are concerns that there may be a disconnect between what companies are publicizing versus what is done in practice, especially in relation to disability inclusion (Marcinko, 2020). Further, there are specific concerns that companies publicly support disability inclusion to enhance how they appear to consumers and investors, and the named practices are not yielding positive impacts for people with disabilities within their companies and communities (Segovia-san-juan et al., 2017).

Understanding that CSR and DEI are part of marketing and building company reputations adds nuance to the position of disability inclusion. Hiring employees with disabilities and embracing disability inclusion has often been seen as risky for business due to potential stigma or lack of acceptance from customers (Dwertmann et al., 2021; Houtenville & Kalargyrou, 2015). This is a long-standing concern that is steeped in ableist perceptions and disability stigma. While research has shown that customers do not hold a negative bias towards employees with disabilities (Dwertmann et al., 2021), these points highlight potential tension between the importance of CSR and DEI in external communications and disability inclusion.

1.2.3. Advancing disability employment

Although disability inclusion may be somewhat precarious in DEI and CSR initiatives, there has been considerable growth in understanding disability inclusive strategies. Over the years, literature regarding workplace disability inclusion has identified a number of practices. Examples include aspects that are related to workplace cultures, such as flexible management and top-level leadership buy-in (Broughton & Strebler, 2008; Erickson et al., 2014; Gilbride et al., 2003). Other practices have been a part of overarching DEI efforts such as employee resource groups and offering trainings on disability inclusion (Gould et al., 2021; Meena & Vanka, 2017; Phillips et al., 2016). Discreet disability inclusion practices have also been identified in supporting inclusive workplace cultures, such as provision of workplace accommodations and opportunities for employees to share their disability status with their employers, also known as self-identification campaigns (Gould et al., 2021; Karpur et al., 2014; Schur et al., 2014). Many self-identification campaigns serve multiple purposes, though are often implemented as part of compliance for organizations to maintain their federal contractor status within the U.S. This is done as part of the Section 503 of the Rehabilitation Act of 1973, which prohibits discrimination of employees with disabilities and was amended in 2014 to require organizations to proactively recruit and hire employees with disabilities (U.S. Department of Labor, n.d.b).

Reasons for companies to invest resources in disability inclusion varies widely. Historically companies have fostered inclusive strategies to comply with disability policies as disability has been viewed as a legal or human resources concern rather than a part of DEI initiatives (Moore et al., 2017). More recently there is growing recognition that disability inclusion practices not only advance disability employment as many have been shown to improve workplaces overall and for all employees, not just for employees with disabilities (Chan et al., 2010; Kalargyrou, 2014; Schur et al., 2014; Solovieva et al., 2011). Because of the multiple benefits for organizations and employees across various identity dimensions, several of these strategies have become a part of DEI frameworks.

How companies become aware of disability inclusion practices is likely multi-faceted and may reflect evolving, cultural understandings of people with disabilities as well as the result of concerted efforts by disability inclusion advocates. One noteworthy example of awareness efforts include the National Disability Employment Awareness Month campaigns sponsored by the Office of Disability Employment Policy in the U.S. (U.S. Department of Labor, n.d.a). Examples of past campaign slogans include “Disability: Part of the Equity Equation” and “Advancing Access & Equity”. This language is aligned to DEI activities, which may further reflect how disability could be incorporated into these efforts.

Perceptions of disability and people with disabilities within DEI frameworks has shifted over time (Mullin et al., 2023). For example, one study explored how perspectives of people with disabilities have transitioned from being recipients of charity, in need of help and support, to being viewed as organizational stakeholders (Choudhury-Kaul, 2017). This is further exemplified by disability management itself becoming a noted strategy for CSR (Castelnovo, 2022). Although inclusion in some CSR frameworks, such as the UN SDGs, may still place the disability community as a “vulnerable” population, there is growing recognition of disability as a notable demographic group within sustainability goals and DEI approaches (Gould et al., 2020).

1.2.4. Impacts of COVID-19

As described above, workplace strategies have a distinct impact on the inclusion of people with disabilities, as have major contextual events such as the COVID-19 pandemic. The COVID-19 pandemic deeply impacted all people around the world, including the way people work. Changes to how people approached work include physical locations of jobs, interactions with coworkers, the technology and tools needed to complete job duties, and several other aspects of the workplace (Schur et al., 2020). In the wake of the COVID-19 pandemic, other research found that companies altered how they engaged and supported their employees. For example, some businesses increased their investment in and emphasis on mental health supports as well as creating flexibility in the workplace (Mullin et al., 2023).

As companies had to adapt to the changing world, individuals were also profoundly impacted by the pandemic. However, not all groups of people experienced the pandemic in the same way. In fact, different demographic groups had distinct challenges and experiences through the pandemic, including people with disabilities. For example, Carey et al. (2021) found that people with intellectual disabilities experienced changes in key elements of daily living, including shifts in employment procedures and concerns about employment futures. Others reported how people with visual impairments and blindness experienced unintentional consequences in daily living as regularly provided accommodations were no longer available due to pandemic related guidance and policies (Rizzo et al., 2021).

Within employment specifically, workers with disabilities had unique experiences given the massive transition to virtual and remote work settings (Tang, 2021). While there has been discussion that remote settings allow workers with disabilities to access work opportunities that may not otherwise have been available or accessible, there continues to be debate about whether these changes will have a lasting positive impact for people with disabilities (Jesus et al., 2021; Koon et al., 2022; Schur et al., 2020). In fact, people with disabilities experienced disparate impacts of the pandemic compared to people without disabilities. Some of these negative outcomes include: higher rates of reduced work hours, increased rates of unemployment, and greater feelings of job insecurity and financial stress (Emerson et al., 2021; Houtenville et al., 2021; Maroto et al., 2021).

The dramatic changes to the workplace due to the COVID-19 pandemic adds further nuance and additional layers of complexity, emphasizing the need to re-examine public facing disability inclusion strategies. Given the pandemic and other important factors, like the renewed priority of racial and social justice and increased publication of CSR reports, there is a need to investigate and explore strategies that organizations publicly share to advance disability inclusion.

1.2.5. Introduction to the study

To further explore how the context of work has changed and contribute to research regarding organizational disability inclusion, the research team conducted an updated content analysis of 2020/2021 CSR reports from organizations recognized for their disability inclusive practices. This analytical process mirrored that of previous research, which included collecting and preparing data for analysis, organizing data within broader categories, and reporting data in an organized format (Elo & Kyngäs, 2008; Lieblich et al., 1998). The analysis utilized findings from a previous article, Gould et al. (2020), which acted as a framework for deductive analysis to identify specific strategies connected to the inclusion of people with disabilities that were publicly shared within CSR reports. This analysis also included iterative coding to identify emergent themes and issues that are new to the more recent reports. The current review reflects how strategies may have changed over time and is especially relevant given the massive macro-level and contextual changes that may have influenced the ways companies publicize their disability inclusion efforts.

The current analysis was completed to answer the following research questions: (1) What strategies do organizations use to promote disability inclusion within their CSR reports? (2) What strategies remained prominent in 2020/2021 CSR reports from organizations known for their disability inclusion efforts? (3) How have disability inclusion strategies included in the CSR reports evolved since 2015/16?

2. Materials and methods

To answer the above research questions, 2020/2021 CSR reports were collected from organizations that received 100% on the 2021 Disability:IN Disability Equality Index, of which a list of 186 companies was published on the Disability:IN website. Disability:IN is a global membership-based organization that supports businesses that invest resources towards advancing disability inclusion in the workplace. The Disability:IN Disability Equality Index is a benchmarking tool that is intended to help companies assess their existing policies and practices to identify opportunities to promote greater inclusion of the disability community (American Association of People with Disabilities & Disability:IN, 2022). Organizations that scored 100% on the Disability:IN Disability Equality Index were selected as the sample as the tool provides a framing of practices that are publicly perceived as innovative with respect to disability inclusion, in alignment with the research questions and intended purpose of the study.

CSR reports were collected from January 1 through March 31, 2022, by web searching company names and phrases such as a “corporate social responsibility report.” These reports are often published on an annual or bi-annual basis and are completed for the previous year as a look back in time. While the included organizations were recognized for disability inclusion, they represented a multitude of industries and were mostly from large organizations with over 1000 employees and listed on the Fortune 1000. To see a summary of included company industries, please see Table 1.

Table 1.

Included company industries corporate social responsibility reports

Industry Frequency Percentage
Technology 21 16%
Banking & Finance 20 16%
Insurance 15 12%
Pharmaceuticals 10 8%
Aerospace & Defense 8 6%
Telecommunications 8 6%
Utilities (Energy) 7 5%
Healthcare 6 5%
Professional Services 6 5%
Retail 5 4%
Manufacturing 4 3%
Chemical 3 2%
Food, Beverages, & Tobacco 3 2%
Household Products 3 2%
Hotels, Restaurants and Leisure 2 2%
Medical Equipment 2 2%
Motor Vehicle & Parts 2 2%
Real Estate 2 2%
Entertainment 1 1%
Publishing 1 1%

To be included in this review, CSR reports had to meet the following criteria: published by one of the companies listed as receiving 100% on the Disability:IN Disability Equality Index, publication detailing 2020 or 2021 company CSR efforts, downloadable format, and include the word “disability” or variation (such as “disabilities”) at least once. The current study only included reports from companies that received a 100% on the Disability Equality Index to narrow the focus to recognized leaders in the disability inclusion space, enhance feasibility of the study by limiting the project scope, as well as to align with original review (Gould et al., 2020). The timeframe of the reports was determined based on the massive changes in the world and workplace, particularly the COVID-19 pandemic and racial and social justice movement. While this study does not specifically evaluate the pandemic, social justice movement, or related policies, these changes to the workplace provide important context for how companies demonstrated their commitment to and strategies for disability inclusion. Only publications that were downloadable (e.g., PDF format) were included to maintain the integrity of the data as the research team returned to the reports for continued analysis. Finally, the word disability (or variation) needed to be included to ensure the report had relevant information regarding disability inclusion for the review.

With these criteria, the research team identified 129 reports to be included. This is a significant increase from the previous review, where the research team included only 34 reports. This represents both an increase in organizations that had public facing, downloadable reports as well as growth in the number of businesses that participated in the Disability Equality Index. Some of the organizations indicated that their reports were inaugural, meaning that it was the first time the company had created a public facing CSR publication. Other businesses differentiated themselves by clearly stating how long they had been dedicating resources and investing in CSR as well as diversity and disability inclusion. Similar to the previous study, many of the reports had various names, like impact report or environmental, social, and governance report. One distinction from the prior study was that the research team did not include specific diversity, equity, and inclusion reports unless directly linked or referenced in the CSR report. As the field has evolved, it was important to align towards CSR as a way to narrow the scope of the project and confirm greater comparison across the included data.

Once the CSR reports were collected, the research team prepared to engage in content analysis. The review involved an iterative process where key narratives were named and coded thematically (Elo & Kyngäs, 2008; Kyngäs, 2020). To support the analysis, the research team developed a database of disability inclusion related strategies on Microsoft Excel. The research team deductively categorized key practices within the database using the strategies listed in Gould et al. (2020) as a framework which was important as it helped provide clear definitions of key themes for the research team to build on, contributing to the overall validity of the study. Following this framework, the research team read through the published reports then copied relevant text related to each strategy thus maintaining integrity of the data throughout analysis. To enhance reliability, the research team continually reviewed strategy and theme descriptions used to create the framework and ensured the copied text from included reports were reflective of these practices. For disability-related practices that did not align with previously identified practices, the research team created a separate category and further identified potential themes using an iterative process. Throughout analysis the research team met three separate times to discuss the strategies and ensure consensus on overarching themes and categories identified in the data. The following section will detail the results of the systematic process described above.

3. Results

This study provides an overview of disability inclusion strategies and initiatives that are publicized by organizations recognized for their disability inclusion efforts in their publicly available 2020/2021 CSR reports. By investigating practices published by known leaders in disability inclusion, we are able to contribute to the understanding of how companies include people with disabilities within their workplaces and communities. Mapping these strategies may help support and enhance recognition of potential best practices and provide a foundation for future research.

The most commonly observed practice within the current study was including disability as part of a diversity section or statement alongside other facets of identity, which was viewed in a majority of the reports (106/129; 82%). Relatedly, another common strategy described in over half of the included reports (76/129; 59%) was highlighting external awards or recognitions regarding disability inclusion. Providing details about a disability-based employee resource group or similarly identified affinity group was also found in 57% (73/129) of the included reports. For this strategy, it’s important to note that companies may have a disability-based ERG even if not listed, as this categorization was assigned if the ERG was a part of the CSR report, demonstrating the ERG as a CSR initiative. Another common strategy was including disability within supplier diversity statements (66/129; 51%), which was most often done by including disability and service-disabled veteran-owned business enterprises within the long list of different types of suppliers such as women-owned business enterprises, veteran-owned business enterprises, etc.

The following strategies appeared in less than half of the included reports, but still highlight potentially important avenues for advancing disability inclusion. One fairly common strategy put forth in the reports was community partnerships with disability-related organizations (53/129; 41%). This included ways that companies strategically collaborated with groups to progress business objectives, such as access to talent pipelines or support in education and awareness. Similarly, a smaller number of CSR reports (47/129; 37%) shared details about philanthropic giving or charitable donations to disability-related organizations. Some of the strategies that were identified in fewer reports include targeted recruitment efforts to hire people with disabilities, disability-related employee benefits, accommodation resources or programs for employees and customers, disability-related trainings for employees, and capturing and/or reporting data about the number of employees with disabilities. For a complete overview of identified strategies, see Table 2. The next section details some of the most prominent strategies and provides context regarding emerging practices within corporate settings.

Table 2.

Frequency of strategies found in corporate social responsibility reports

Identified strategies Percentage Frequency
Disability included in diversity section/statement 82% 106
Disability-based ERG 57% 73
Highlighting disability inclusion awards 59% 76
Supplier diversity included disability-owned 51% 66
Community partnerships with disability related organizations 41% 53
Philanthropic giving 37% 47
Targeted recruitment and hiring of people with disabilities 36% 46
Disability (short-and/or long-term) employee benefits packages 34% 44
Disability related training (awareness raising) for employees 29% 38
Outreach and/or accommodation for customers with disabilities 29% 37
Accommodations resources for employees 29% 37
Metrics related to number of employees with disabilities 27% 35

3.1. Most common disability inclusion strategies

3.1.1. Diversity section or statement that expressly included people with disabilities

The most prevalent disability inclusion practice was having a diversity section that expressly included people with disabilities. Through this strategy, the reviewed organizations appeared to consider disability as a key demographic group, similar to that of other diversity dimensions like race/ethnicity, gender, and sexual orientation. The widespread use of this practice also highlighted the growing number of organizations embedding DEI within their CSR reports and frameworks overall.

There were various ways that organizations promoted disability as a central dimension of diversity. To frame DEI efforts in the CSR reports, many of the companies detailed how they defined diversity and what diversity meant within their organizations. Capturing the wide breadth of DEI, many organizations listed a number of demographic groups, such as Edison International (2020, p. 22) which stated, “We embrace all forms of diversity, including age, disability, race, ethnicity, gender, LGBTQ+[Lesbian, gay, bisexual, trans, questioning, and others], religion, veteran status and diversity of thought, and continue to seek opportunities to support all our employees, partners, and our community.” By directly naming disability as part of “diversity” there was a distinct representation of disability as a diversity dimension and identity.

Some companies included additional sections about specific aspects of diversity. Within some of these reports, there were designated text sections detailing disability inclusion efforts, such as General Motor’s (2020, p. 150) report with the section titled, “Equity for People with Disabilities.” This approach appeared to be thorough, describing a myriad of strategies the company took to support the disability community, mapped as other practices throughout the paper. By offering full sections on disability inclusion efforts, companies showcased their commitment to and recognition of supporting the disability community as part of their CSR efforts.

Another approach within the CSR reports related to disability as part of diversity was highlighting awards received regarding disability inclusion (76/129; 59%). A majority of referenced awards were related to the Disability:IN Disability Equality Index, which was unsurprising as companies had to receive 100% to be included in this study. Other examples included being featured in magazines or other benchmarking tools related to disability inclusion. Similar to that of diversity statements, many disability inclusion related awards were listed in conjunction with that of other company recognitions within the CSR reports.. These recognitions may be additionally notable as many of them required resource investment, such as completing lengthy benchmark surveys and paying participation fees, on behalf of the organization.

Overall, including disability as part of diversity sections and statements was the most common strategy and potentially demonstrated acknowledgement of disability as a diversity category. This represents a continued evolving recognition and understanding of disability as part of both overarching CSR and DEI initiatives.

3.1.2. Disability-specific employee resource group

Another major strategy publicized within the CSR reports was having a disability-specific employee resource group (ERG). As previously mentioned, ERGs are becoming an increasingly influential and important aspect of the DEI strategies (Gould et al., 2021; Welbourne & McLaughlin, 2013). The inclusion of these groups in a majority of reports further demonstrated how ERGs are becoming mainstream within CSR and DEI efforts. Although this was a slight decrease in percentage from the original study, the increase in the sAltmple size emphasizes the widespread use and importance of ERGs.

While these groups may be known by different names, such as resource councils, employee networks, affinity groups, as well as business resource groups, most of them serve a similar purpose of providing community for employees centered on a specific affinity and helps employees give input on overarching business activities to enhance DEI (Welbourne & McLaughlin, 2013). Many of the ERG descriptions within the CSR reports included a running list or other overview of all ERGs, which usually aligned with various demographic groups thus reinforcing disability as a dimension of diversity.

Other common summaries of the disability-specific ERGs included descriptions of members and key initiatives of the groups. One example comes from Verizon (2020, p. 88), “We work with our ADVANCE (Advocates for Disability, Accessibility, Neurodiversity and Caregiver Empowerment) ERG, as well as industry partners, to remain informed about accessibility issues and to improve user experiences.” This brief statement highlighted the broad connections across the disability community involved in the ERG as well as how the ERG engaged in DEI efforts to advance access for both internal and external stakeholders. Descriptions in other reports also included how disability-based ERGs raised awareness about disability by “educating” employee bases and “advocating” for people with disabilities. Similar to Verizon’s ERG descriptions, these efforts were often aligned with enhancing accessibility.

In addition to the qualitative descriptions of the ERGs, some of the reports quantified aspects of these groups providing overviews of the number of ERG members, number of chapters across various regions as well as the number of events held and/or other types of ERG activities, like philanthropic giving. For example, Dell Technologies (2021, p. 18), which described their ERG with the following text, “Our True Ability ERG provides support and advocacy for those with disabilities . . . .They have 5,458 members across 41 global chapters and experienced 44% growth in 2020.” This example highlighted how ERGs may demonstrate impact and presence within the company. Additionally, the significant increase in membership seen at Dell may showcase how disability inclusion strategies may have matured or grown in prevalence over the years.

Overall, descriptions of disability-based ERGs highlighted the role they play in overarching DEI initiatives and shed light on disability inclusive practices companies may be doing as well as how disability was understood within broader DEI efforts.

3.1.3. Community partnerships

Partnerships with external organizations was another common strategy observed in the CSR reports. This was a notable advancement in the practice mapping as there was an opportunity for greater distinction within this study compared to the previous review, particularly around the types of partnerships companies engaged. Given the greater availability of data and the larger sample size, the research team was able to differentiate between what is being described as community partnerships and philanthropic giving. Community partnerships referred to connections with other organizations or groups that supported specific business objectives such as connection to benchmarking tools, thought leader insights, recruitment opportunities, and connection to diverse suppliers. Within this review, strategic partnerships appeared to serve important roles in overarching DEI strategiesproviding connection to demographic groups and offering research backed tools and information. One organization described a disability inclusion partner as a way to provide “sponsorshipsfordevelopment programs,” (MetLife Inc., 2020, p. 26). Others framed partnerships as an opportunity to gain tools to “… embed disability inclusion in the business leadership agenda” (Lenovo Group Limited, 2021, p. 47). These descriptions highlighted how community partnerships may help align business activities in ways that advance disability inclusion broadly.

Another example of how organizations described community partnerships comes from Regions (2020, p. 59) where the company detailed, “Regions further publicly demonstrated our commitment to inclusion by joining the Valuable 500. This global community of CEOs has committed to improving disability inclusion through business leadership and a collective voice.” This statement exemplified how companies may utilize partnership opportunities as a demonstration of their investment and priorities toward disability inclusion. In this way, partnerships may also help provide legitimacy to business efforts as companies may be seemingly endorsed by well-recognized community partners and leaders.

The described partnerships appeared to connect companies to the disability community and emphasized business commitments toward disability and diversity, equity, and inclusion. Descriptions of these community partnerships highlighted how organizations may be leveraging these connections to advance overarching DEI strategies, such as gaining top-leader buy-in, employee recruitment and retention, and education and awareness.

3.1.4. Philanthropic giving

Another type of external stakeholder engagement found within some of the CSR reports were descriptions of philanthropic or charitable giving as part of disability inclusion efforts. These activities were characterized by descriptions of employee volunteer activities as well as financial giving to designated nonprofits. Another distinction between these engagements or activities was that they were not done to solely advance business objectives and instead appeared to be more focused on supporting underserved communities through charity.

Philanthropic endeavors have been a traditional aspect of CSR and have evolved as companies seek ways to publicly connect company values to external stakeholders. Connection to the disability community was included in a number of the reviewed organizations’ charitable efforts, such as HP Inc. (2020, p. 71) which shared, “In Japan, 74 HP employees volunteered more than 400 hours over three months to help create audio books for children with limited vision, in partnership with Disability Impact Network.”

Through this brief statement, HP quantified their potential community impact and showcased how businesses may collaborate with charities to support broad disability inclusion efforts Throughout the review, philanthropic endeavors appeared to provide opportunities for businesses to connect their activities with the disability community and external stakeholders.

3.2. Emerging trends

3.2.1. Reporting number of employees with disabilities

Another notable change from the previous review was the increased use of capturing and reporting quantitative data regarding the representation of employees with disabilities. As highlighted in other research self-identification campaigns, which are communication strategies to encourage employees to share their disability status with employers, can help garner support for disability inclusion efforts within a company as well as support compliance with U.S. federal policies, such as Section 503 of the Rehabilitation Act of 1973 (Gould et al., 2021; Karpur et al., 2014; Schur et al., 2014). The increase in companies sharing data about the number or percentage of employees with disabilities may demonstrate the maturity of disability inclusion activities within some organizations, show outcomes of disability inclusion efforts, and support compliance with public policies.

Some organizations explicitly detailed their workforce demographics, including disability status. One example comes from Bayer (2021, p. 62), which described, “Based on voluntary statements by employees, we employ some 2,150 people with disabilities, 45% of whom are women and 55% men. That represents around 2.1% of our total workforce.” This text exemplified how some organizations explicitly stated the number of employees with disabilities within their organizations. Although this is a seemingly simple strategy, this represented a fairly significant shift in how disability is understood within DEI and CSR initiatives. Aligned with other practices, this also demonstrated how disability is a key demographic group and further helped measure outcomes related to disability inclusion efforts. As demonstrated in Bayer’s statement, many companies qualified statistics on disability representation with phrasing around voluntary statements or self-reporting by employees, tying representation data with that of self-identification efforts.

Another common aspect of capturing and reporting data related to employee disability representation included expressed goals with associated metrics. This strategy illustrated how companies appeared to monitor and assess progress and success of diversity and disability inclusion efforts. For example, Grant Thornton LLP (2021, p. 22) detailed their goals related to diversity recruitment, “[By 2025]50% increase across the firm of our representation of veterans, military spouses and individuals with disabilities, from fiscal year 2020 … ” The quote further described other metrics related to leadership roles and specific positions within the company, also involving disability representation. In fact, a number of the reports incorporated disability as part of overarching diversity slate, where disability was listed in conjunction with other underrepresented groups. The descriptions of goals with metrics highlighted the recognition of disability inclusion and detailed expected outcomes of DEI efforts. This practice may provide insight into how companies utilize transparency in employee data as an approach to enhancing accountability toward DEI goals.

As touched on earlier, a related emerging trend was the description of self-identification campaigns, which sought to encourage employees to share aspects of their identity, notably disability status, veteran status, and sexual orientation with employers. These campaigns help to advance disability inclusion efforts by creating awareness as well as recognizing the importance of measuring outcomes. Organizations described these initiatives as opportunities to “gain greater visibility” about the diversity of employee bases through “voluntary and confidential” efforts. These campaigns were described as an approach to better understand the needs of the employees with disabilities, with added recognition that many disabilities are non-visible nor apparent.

3.2.2. Mental health

Although not quantified in a similar way as the other strategies, as it was not a key theme of prior analyses, mental health supports were another strategy identified through this review that provided further context of disability inclusion efforts within the CSR reports. Some descriptions of mental health strategies were not directly connected to disability inclusion, but instead were a part of a separate initiative. However, other descriptions within the reviewed reports did align mental health with disability inclusion broadly such as that from Lockheed Martin Corporation (2020, p. 29) which shared how the organization sought “ … to raise awareness for mental health and well-being during the COVID-19 pandemic [through the] Able & Allies [disability-based ERG] launch [of the] the Mind Matters campaign in the U.S.” This text highlighted how mental health supports may be incorporated into existing disability inclusion strategies, like the disability-based ERG.

Many of the mental health efforts shared in the reports appeared to be responses to the pandemic and rising mental health needs of employees. In fact, mental health supports has been an increasingly important business practice as noted by other researchers and continuing through the COVID-19 pandemic (Held, 2017; Mullin et al., 2023). The references to mental health within the included reports reaffirms this topic as an emerging and evolving disability inclusion strategy.

3.3. Contextual influences on the corporate social responsibility reports

3.3.1. Compliance

Other aspects that provided important context were related to the role of compliance and legislation in advancing disability inclusion. Companies referenced various laws as ways to qualify or describe their disability inclusion efforts. Some of these included the definition of disability and workplace accommodations and other supports based on regional disability policies and civil rights laws. For example, the report by Sony Corporation of America (2021, p. 79) described, “Sony employs and supports individuals with disabilities in compliance with the laws, regulations, and rules of the countries and regions in which it operates…” This description highlighted how legal obligations framed disability inclusion efforts and may act as a foundation for inclusion of employees with disabilities. Other organizations also detailed processes or other strategies to address “legal requirements” that support disability inclusion for both employees as well as customers with disabilities. This further demonstrated how compliance may play a unique role within disability inclusion efforts and CSR initiatives.

Additionally, a number of organizations referenced the UN SDGs as a framework to report CSR efforts. Some of the organizations listed the UN SDGs as part of their publication, clearly connecting company efforts to the UN SDG framework. One example can be found in Dominion Energy Inc.’s (2020, p. 53) report, in which the organization provided a “mapping of Dominion Energy’s sustainability initiatives to the applicable UN SDGs.” The inclusion of disability within the UN SDGs provided insight into how disability was recognized within some CSR initiatives, further contextualizing the other named practices identified in this study. Within the reviewed reports, disability inclusion was both framed as part of compliance as well as a part of DEI and CSR efforts.

3.3.2. Pandemic and racial justice

The pandemic and racial justice movement also contextualized company DEI efforts and CSR strategies in the reviewed organizational reports. Multiple reports indicated that it was the first time an organization had developed this kind of publication. One example comes from M& T Bank (2020, p. 7), which stated, “We are proud to publish our inaugural ESG Report, to help tell the story of the work that’s already underway[and] set a firm ground on which to further build our ESG efforts in 2021 and beyond.” This statement highlighted the importance of 2020 and the impact that the aforementioned COVID-19 pandemic and racial and social justice movement had on business practices.

Several of the organizations described how their CSR and DEI efforts changed in response to the pandemic and increased calls for social justice. Many reports cited the “unprecedented” experiences of 2020 and how it influenced their approaches to supporting stakeholders both internally and externally. One example comes from Novant Health (2020, p. 2) which described how they took a “relentless pursuit of diversity, inclusion, and equity, in the age of COVID-19 and social justice.” Another company, BAE Systems Inc. (2020, p. 47), began a description of their DEI efforts with the statement, “In response to heightened tensions regarding racial injustice in the U.S. in 2020.” Discover Financial Services (2020, p. 7) also provided a summary of the impact of the pandemic and calls for greater social justice on CSR and DEI strategies within their report, “Corporate social responsibility has taken on a new meaning as we work through the worst global pandemic since 1918 and widespread social unrest resulting from centuries of racism in this country [the U.S.].” These texts highlighted how the pandemic and the social and racial justice movement deeply influenced how companies crafted their CSR and DEI efforts.

The context of the pandemic and the increased emphasis on racial justice appeared to further reinforce the prioritization of DEI within CSR efforts as core business strategies as well as shape how companies shared their practices publicly.

4. Discussion

This study provides unique insights into what strategies and practices employers publicize to promote disability inclusion. As a 5 year follow up to a previous review, the current paper provides a synthesis of observed changes through an analysis of 2020/2021 CSR reports from organizations that received 100% on the Disability:IN Disability Equality Index. This study adds to the understanding of disability inclusion efforts by mapping, reviewing, and analyzing strategies published in 2020/2021 CSR reports and examining emerging trends and contextual influences. Some of the primary strategies identified include incorporating disability within diversity sections, having a disability-specific employee resource group, establishing community partnerships, and philanthropic giving.

One of the most notable changes found through this review was the sheer growth in the number of included reports. In the first study conducted in 2018, there were only 34 included reports, whereas in the current review there were 129 reports that met the inclusion criteria. This aligns with other literature reporting the growth of diversity, equity, and inclusion (DEI) efforts in the workplace generally (Yadav & Lenka, 2020). The increase in companies that participated in the Disability:IN benchmarking tool as well as have published CSR reports may also be reflective of what others have indicated in that companies are increasingly using DEI as a branding technique to showcase company practices to external stakeholders (Jonsen et al., 2021). Additionally, this growth also aligns with noted increases in DEI efforts following the most recent movement for racial and social justice (Davis, 2022; Farah, 2022).

In addition to the increased number of reports that met the inclusion criteria, the research team provided an overview of some of the most prevalent practices. The most common identified strategy was having diversity sections or statements that expressly included disability. Businesses took different approaches for incorporating disability as a part of their understanding of ‘diversity.’ For example, organizations listed disability alongside other identity dimensions, noted awards or recognitions received for disability inclusive practices, and dedicated report sections to the disability community or disability inclusive strategies.

The prevalence of diversity or DEI sections within the CSR report may be reflective of previous research demonstrating how DEI is becoming a mainstream practice and is increasingly a part of publicly shared company values (Jonsen et al., 2021; White et al., 2019). This may be important as showcasing how companies utilize DEI efforts may contribute to business outcomes such as attracting talent, connecting with consumers, and more (White et al., 2019). However, given the historical mis/understanding of disability and stigma related to hiring people with disabilities (Dwertmann et al., 2021; Houtenville & Kalargyrou, 2015), including disability in the diversity statements or sections may represent a shift in how companies more commonly recognize and include disability in overarching DEI and CSR efforts.

The inclusion of disability as part of diversity sections in the CSR reports appeared to be illustrative of other research about the growing interest in disability inclusion and awareness of disability as a facet of identity (Gould et al., 2021). Further research could also look to how the awareness and communication campaign efforts, like that of National Disability Employment Awareness Month from the Office of Disability Employment Policy, may be influencing the nuances of disability inclusion within the workplace. The transition and potential evolution of disability inclusion highlights the need for more research about what companies are doing in practice in addition to what companies are promoting within their public outlets. This is especially true given the identified concerns about how disability inclusion efforts may be marketing motivated and not producing meaningful outcomes (Segovia-san-juan et al., 2017).

The second most common strategy identified in this study was having a disability-specific employee resource group (ERG). ERGs are formal groups of employees centered around a particular affinity, identity, or mission often acting as a source of engagement for employees and resources for businesses to create more inclusive workplaces (Welbourne & McLaughlin, 2013). ERGs are becoming an increasingly influential and important aspect of the DEI strategies (Gould et al., 2021; Green, 2018; Welbourne & McLaughlin, 2013), which appeared to align in the current study where many ERG descriptions were embedded within the CSR reports.

Details about disability-specific ERGs included the types of activities the groups did to advance disability inclusion, such as “educating” employee bases about disability and accessibility, “advocating” for people with disabilities (both internal and external stakeholders), philanthropic endeavors, as well as assisting with accessibility concerns. These descriptions mirrored other research about the role of ERGs within overarching diversity strategies as well as disability inclusion efforts (Gould et al., 2021; Green, 2018; Mullin et al., 2023). Members of these groups are often inclusion champions, driving key initiatives and may act as experts or consultants for companies seeking to advance inclusion strategies (Colgan, 2011; Gould et al., 2021; Green, 2018; Mullin et al., 2023).

Although there has been some research about the potential impact of ERGs as vehicles for disability inclusion, the prevalence of disability-based ERGs in the current study emphasizes the need for further investigation into how these groups are evolving and the identification of best practices. Future research may be helpful to support companies as they seek to create disability inclusive workplaces and disability-based ERGs.

Another prevalent finding in this study was the publication of strategic, community partnerships as an initiative to promote disability inclusion. This finding is a development from the foundational review as the increased sample size and availability of data allowed the research team to differentiate between types of partnerships companies engaged. Community partnerships in this context were characterized by how companies collaborated with community organizations or experts in the disability inclusion field to advance specific efforts towards greater inclusion of people with disabilities. Some examples of these efforts included thought leadership and consultation, connections to talent pipelines and diverse suppliers, and benchmarking tools.

In addition to the aforementioned resources provided by community partners, these collaborations may also have offered companies opportunities for marketing and added legitimacy to their disability inclusion efforts, given the positive recognition of the community partners within the disability community and beyond. This connects to prior research where DEI initiatives are part of larger branding efforts to showcase company practices (Jonsen et al., 2021). While these partnerships appeared to do both, connect companies to needed resources as well as offer marketing opportunities, there may be a need for future research to evaluate the actual impact of these efforts and what practices may contribute to intended outcomes.

Philanthropic giving was another prevalent strategy found to promote disability inclusion, though identified in only 37% of the included reports. For this review, philanthropic giving referred to descriptions of employee volunteer activities and charitable giving to designated nonprofits. By including elements of philanthropic giving in the CSR reports, companies may be demonstrating how they are purpose driven, which can support consumer expectations and further market CSR efforts to stakeholders (Abiaka, 2021).

While philanthropic giving is an expected element of CSR initiatives, it is somewhat surprising that disability-related philanthropy was listed in less than half of the included reports, given how people with disabilities have been traditionally associated with charity (Longmore, 2016). Historically, disability and people with disabilities have been viewed as tragic, in need of charitable support and pity. The low percentage of reports that reference disability-related philanthropic efforts may be indicative of growing recognition of people with disabilities as organizational stakeholders rather than people in need of help (Choudhury-Kaul, 2017). However, more research is needed on the implementation of these strategies to more fully understand perceptions of disability within CSR and philanthropic efforts.

In addition to the increased understanding of known strategies, emerging practices also came to light through this analysis. One of these developing strategies was the increased use of disability representation data. This strategy was implemented within the CSR reports through different ways, including the publication of percentages of employees with disabilities within workforce populations as well as including disability within goals that have designated metrics. For the reporting of actual data points or percentages of employees with disabilities, companies often qualified and described these outcomes in association with descriptions of self-identification campaigns. These campaigns and related activities were described as helping to “inform” metrics and “track” DEI strategies within the included reports.

The use of representation data, especially for the disability community, is nuanced. As previously mentioned, disability disclosure can be complex for individuals given the historical stigma associated with disability (Lindsay et al., 2018; von Schrader et al., 2014). Given the apparent increased use of self-identification campaigns and publication of representation data, this emerging trend may show a change in how organizations consider disability statuses and monitor impacts of disability and diversity inclusion strategies. This aligns with other research about how organizations may sustain disability inclusion efforts by developing measurements for long-term outcomes (Gould et al., 2021). Furthermore, future research should explore self-identification campaigns and approaches to disability-related representation data to contribute to the understanding of this emerging practice and inform approaches companies can take to advance their disability inclusion initiatives.

Another emerging trend found in this review was mental health supports for employees. Descriptions of mental health efforts included raising awareness of existing employee programs as well as the establishment of mental health campaigns or other initiatives in relation to disability inclusion efforts. Many of the companies that included references to mental health connected these strategies to the needs of employees due to the COVID-19 pandemic. The identification of mental health efforts within the CSR reports aligns with previous research noting the growth and widespread use of mental health supports as a benefit for employees and recognized business practices (Held, 2017). Additionally, mental health strategies appeared to be related to the COVID-19 pandemic as companies described their mental health supports as a response to changing needs of employees. Given the short time since the pandemic, there may be a need to further explore how these strategies continue to evolve and the long-term impact of the pandemic on workplace mental health, especially within the context of disability and diversity inclusion.

While the identified strategies contribute to an understanding of disability inclusion, the research team also recognized key contexts that added to the overarching knowledge of how organizations considered and promoted their disability inclusion efforts. One of these contextual factors was the “legal requirements” that support disability inclusion, which companies referenced when detailing their disability inclusion initiatives. As noted in the previous section, several of the CSR reports qualified their disability inclusion efforts by describing them as being “in compliance withlaws, regulations, and rules.” This reflects other research where disability inclusion has been viewed as a legal obligation or human resources issue (Moore et al., 2017). The regulatory-based qualifications within the reviewed CSR reports may offer some insight into how disability inclusion is contextualized and related to compliance efforts.

Additionally, the use of UN SDGs within company efforts to highlight and frame CSR accomplishments ensured that disability was included within these publications as disability is a key dimension within the goals. It is important to note that the UN SDGs are not compliance-based and instead act as guidelines for organizations to voluntarily align themselves with the established initiatives. As compliance plays a unique role within disability inclusion (Saleh & Bruyère, 2018), and there are discrepancies in the effectiveness of laws on disability inclusion outcomes, especially in employment (Ameri et al., 2018; Bell & Heitmueller, 2009; Kruse & Schur, 2003; Maroto & Pettinicchio, 2015), future research may benefit from investigating how framing disability inclusion efforts to match global frameworks, like the UN SDGs, may influence the implementation and effectiveness of disability inclusion practices.

The other major contextual factor identified in this review was the confluence of the COVID-19 pandemic and the calls for racial and social justice. Many of the reports shared that they were initial or “inaugural,” reflecting recent research about how companies took on DEI initiatives and commitments in the wake of the pandemic and social justice movement (Davis, 2022; Farah, 2022). While these major changes in the world may have contributed to the growth in DEI or catalyzed company actions, the sustainability and outcomes of these activities are still unknown. Continued review and analysis are needed in order to better understand the long-term impacts on disability and diversity inclusion efforts.

4.1. Limitations

As with all studies, this review is not without limitations. First, through the sampling method, some of the reports may have been missed based on the web search terms. However, this sampling method remained the valid option for identifying reports given the emphasis on public-facing aspects of CSR as well as aligning with the previous review.

Another primary limitation of this study is that through our review, we are not able to evaluate the effectiveness or efficacy of the identified practices but can only name publicized strategies. Relatedly, this review only identified what companies published and may not be fully reflective nor indicative of what companies are doing in practice (Marcinko, 2020; Segovia-san-juan et al., 2017). Along with this, social desirability bias may also influence what companies publish (Kaye et al., 2011), and there may be some concern that companies are overstating their disability inclusion and compliance efforts in public forums (Gould et al., 2015).

While the current study helps to provide a foundation of what disability inclusion practices may be relevant for companies, these limitations highlight the need for future research that investigates what practices companies are actually implementing and what outcomes these practices yield.

5. Conclusion

Drastic changes to the world and the workplace have impacted how businesses engage with their employees, external stakeholders, and conduct business overall. Calls to action for greater emphasis on social and racial justice and the changed ways of working due to the COVID-19 pandemic are important contextual shifts that deeply influenced how companies operate. In conjunction with policies and other resources that have been used to help guide CSR efforts, there has been significant evolution of how companies approach CSR and DEI reporting in recent years. Through this review, there has been an apparent increase in the interest and recognition of disability inclusion as part of CSR and DEI initiatives. Companies have sought to publicize their DEI and CSR strategies as a way to drive marketing and employer branding, and disability inclusion appears to be a growing consideration in many of these efforts. Despite the known benefits of embracing best practices for disability inclusion and the increasing awareness and interest of including disability within DEI and CSR, disability remains unique due to stigma and contextual nuances. This study provides key insights into what organizations are sharing publicly regarding their disability inclusion efforts as part of their CSR initiatives and can be used to help inform future practices and strategies. However, there needs to be more research to better understand the efficacy of these strategies in order to truly address the discrepancies and disparities the disability community faces within the realm of employment.

Acknowledgments

The authors have no other acknowledgments.

Funding

This research was conducted under a grant funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) (grant number 90DP0091). NIDILRR is a Center within the U.S. Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this manuscript do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.

Footnotes

Conflict of interest

The authors do not have any conflicts of interest to disclose.

Ethics statement

This study was reviewed and approved by the Institutional Review Board at the University of Illinois at Chicago (Protocol number 2022–0123).

Informed consent

Verbal informed consent waobtained from all participants in this study.

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