Abstract
The current study examined how employment conditions (competitive employment, work center employment, unemployment) are associated with the quality of life (QoL) for individuals with intellectual or developmental disabilities. Using the Comprehensive Quality of Life Scale – Intellectual/Cognitive Disability (5th Edition; ComQoL‐I5; Cummins, 1997a) to measure objective QoL factors, and the PWI‐ID (Personal Wellbeing Index – Intellectual Disability, 3rd Edition; Cummins & Lau, 2005b) to measure subjective well‐being, participants answered self‐reporting questions regarding the seven QoL domains. Kruskal–Wallis H for Oneway Analysis of Variance was used to determine statistical significance between comparison work conditions. Results indicate significant findings in the objective QoL domains of Material Well‐Being, Productivity, and Safety between the work conditions for individuals with intellectual and developmental disabilities, with participants in the competitive‐employment group reporting the highest QoL objective scores in these areas. Implications of these findings for practice and research are discussed.
Keywords: competitive employment, intellectual or developmental disability, quality of life, work center
1. INTRODUCTION
Most researchers agree that the universal concept of “Quality of Life” (QoL) is a multidimensional construct, which signifies outcomes across significant areas of life (Cummins et al., 2010; Felce, 1997; Felce & Perry, 2007). Research on QoL and individuals with intellectual or developmental disability have been occurring since the movement toward deinstitutionalization occurred during the 1980s. While there has been difficulty with researchers agreeing on common terminology and how best to measure QoL (Cummins et al., 2010; Diener, 2006), generally QoL is thought of as what is important to people (Cummins, 1997b; Felce, 1997; Schalock, 2000; Schalock et al., 2010; Schalock & Verdugo, 2002). QoL is measured by assessing the outcomes of important life domains, which typically include emotional well‐being, interpersonal relations, material well‐being, personal development, physical well‐being, self‐determination, social inclusion, and rights (Felce & Perry, 2007; Schalock et al., 2010). QoL has been accepted as a valuable outcome for health and social policies and practices, in which theory and applied research should consider (Schalock et al., 2002). As a result, the established QoL domains are often used as dependent variables when examining the association different life factors (e.g., employment, housing, supports; Claes et al., 2012; Tait et al., 2020) have on the well‐being of individuals with intellectual and developmental disabilities. To accurately determine an individual's QoL, life conditions must be examined both objectively and subjectively (Cummins et al., 2010; Schalock & Felce, 2004).
QoL comprises the easily measurable objective aspect, and the more challenging measurable subjective aspect (Cummins et al., 2010; Schalock, 2000). Life conditions are the objective description of an individual and their unique circumstances (Felce, 1997). Questions to determine well‐being in physical, material, social, productive, emotional, and civic domains are typically used to measure life conditions of an individual objectively (e.g., “What is your yearly income?”). Subjective wellbeing involves an individual's personal satisfaction with their unique life conditions (Cummins, 1996; Felce, 1997). Since individuals find value, enjoyment, and importance in different areas of their lives, it is essential that individual perspectives are reflected in overall QoL scores. The subjective aspect of QoL involves individuals rating importance to the objective life conditions and their personal satisfaction with those life conditions. Resulting scores from the objective and subjective QoL measures may be related or as is often the case, quite independent of each other, however, both are necessary to fully understand an individual's QoL (Cummins et al., 2010; Schalock et al., 2002).
Research regarding the association of various life factors (e.g., supports, housing, self‐determination, health, etc.) on the QoL of individuals with intellectual and developmental disabilities has been published (Buntinx & Schalock, 2010; Verdugo et al., 2012; Wehmeyer & Schwartz, 1998). Additionally, the role of employment on QoL has been the focus of many previously published studies. One such study completed in the Netherlands by Claes et al. (2012), found that QoL outcomes were significantly associated with availability of supports, living arrangement, and status of employment and level of intellectual disability. Participants who lived independently or in apartments had significantly higher QoL scores than those living in 24‐h supervised settings. They also found that participants who maintained paid employment had significantly higher mean QoL scores than those engaged in day activities, or volunteer work. Claes et al. (2012) used a self‐report measure to obtain subjective QoL aspects and a proxy‐report to measure objective QoL aspects. A more recent Australian study conducted by Tait et al. (2020), used a QoL measure developed by Schalock and Keith (2004). Approximately, 17% of the participants completed the measure as a self‐report, 43% were assisted by a carer, and 36% were completed by a proxy respondent. The authors found that the employment status (employed vs. non‐employed) was significantly associated with QoL scores in the domains of Satisfaction, Productivity, Empowerment/Independence, and Social Belonging/Community Integration for individuals with intellectual and developmental disabilities. Results were not differentiated between subjective and objective QoL aspects. The authors did not investigate if there was any association between sheltered work center employment and QoL for individuals with intellectual and developmental disabilities.
Understanding the associations that various employment settings may have on QoL is of importance for several reasons. While only 19% of individuals with intellectual and developmental disabilities within the United States reported having community‐based employment in the most recent National Core Indicators (NCI) In‐Person Survey on Work (2018–2019), it is important to determine how different employment settings are associated with QoL. Individuals with intellectual and developmental disabilities typically hold one of four types of employment, including: (a) competitive employment with no public funds (31%), (b) competitive employment with public funds (41%), (c) employment with a group (e.g., work crew) with or without public funds (24%), and (d) paid employment in a community business that primarily hires people with disabilities (11%; National Core Indicators, 2018). Competitive employment is typically defined as: (a) a job within the community, (b) receive pay at or above minimum wage, and (c) work within a body of co‐workers who are mostly non‐disabled (Migliore et al., 2007). Work‐center employment can be defined as places of employment that are geared toward those with disabilities that: (a) provide easy and often repetitive employment tasks, (b) are typically paid below minimum wage, and (c) are always both lower ranking than and dependent on other staff members (those without disabilities; Migliore et al., 2007).
Many studies focused one examining objective and subjective QoL and their association with employment conditions have been conducted. One such study by Beyer et al. (2010) out of South Wales, found that both objective and subjective overall QoL scores were higher for those individuals with intellectual and developmental disabilities in competitive employment than those in other supported employment settings. A study (Blick et al., 2016) conducted in the United States used a programmatic‐created measure with both self‐ and proxy‐reporting to measure both objective and subjective QoL aspects. Researchers found that individuals with intellectual and developmental disabilities who were employed competitively reported a greater sense of community integration and financial autonomy in comparison to those employed at sheltered work centers, or who attended adult day care programs. Interestingly, the study found that individuals with intellectual and developmental disabilities did not report differences in overall satisfaction regardless of employment status (e.g., competitive employment or sheltered work center). These findings are similar to an international (i.e., Canada, Spain, USA, etc.) review of 13 studies examining job satisfaction (subjective QoL) for individuals with intellectual and developmental disability (Akkerman et al., 2016). Researchers found that while individuals with intellectual and developmental disabilities from both integrated and sheltered employment settings reported satisfaction with their jobs, those in integrated employment settings reported higher levels of satisfaction. Akkerman et al. (2016) suggested that more self‐report measures for satisfaction focused research (subjective QoL) be used in future studies.
A study by Verdugo et al. (2006) conducted in Spain used both self‐ and proxy‐reporting to find that workers in both supported settings and sheltered work center settings showed similar levels of QoL, however, the authors reported the more typical (i.e., “Typicalness, the degree to which job characteristics are the same as those co‐workers without a disability in the same company”; Verdugo et al., 2006, p. 309) the employment, the higher the quality of life. While the authors conceptualised QoL into four components (competence/productivity, self‐determination/independence, satisfaction and social belonging/integration into the community), they did not specify subjective or objective QoL. An Australian study by Kober and Eggleton (2005) using a self‐ or proxy‐reporting measure found that level of functional work ability also is associated with constructs and overall QoL as well as the employment setting. Individuals with intellectual and developmental disabilities who had “high functional work ability” employed in competitive settings scored significantly higher in the domains of Empowerment/Independence, Social Belonging/Community Integration, and overall QoL scores than those in sheltered work centers. The researchers did not specify the QoL components as subjective or objective, however, the domains measured included objective and subjective aspects (e.g., productivity and satisfaction).
A small‐scale study done in the UK focusing on measuring subjective QoL used proxy and self‐report measures (Beadle‐Brown et al., 2009). The researchers found that while not statistically significant, proxies typically perceived individuals with intellectual and developmental disabilities as less satisfied on overall subjective QoL than the individuals themselves. Beadle‐Brown et al. (2009) postulate that when using proxy‐reporting, proxies may have difficultly separating what is important to them from what is important to the individual. As a result, caution should be used when using proxy‐reports for subjective QoL measures. Interestingly, an international (i.e., The United Kingdom, Taiwan, Ireland, etc.) review of QoL research on individuals with intellectual and developmental disabilities found that most of the studies used proxy reporters, and that none of the reviewed studies used 100% self‐reported data (Francis et al., 2014). A primary purpose of the review was to identify what household variables influenced QoL outcomes (objective or subjective aspects were not specified). The review also found that of the included studies none reported results for the QoL domains of Material Well‐Being and Rights, and that only one study reported on the Emotional Well‐Being domain. Francis et al. (2014) called for further research into these understudied QoL domains.
The purpose of the current study is based on various gaps found in the existing literature. Both objective and subjective QoL domains (Cummins et al., 2010; Schalock et al., 2002) need be examined to determine how various employment settings may be associated with understudied QoL domains (Francis et al., 2014). The use of self‐report QoL measures is also important, as there are concerns with the use of proxies in regard to subjective QoL (Akkerman et al., 2016; Beadle‐Brown et al., 2009; Francis et al., 2014). Using self‐report measures, the current study proposes to: (1) explore both objective and subjective quality of life among individuals with intellectual and developmental disabilities across three employment conditions (e.g., competitive employment, work center, or unemployment); and (2) determine to what extent specific types of employment conditions are associated with the quality of life for individuals with intellectual and developmental disabilities.
2. METHODS
2.1. Participants and setting
Upon attaining IRB and ethical approval from the university and the research ethics committees of the participating service provider, potential participants were read the approved study invitation and consent form by staff members of the non‐profit center. The center provides various services for over 1500 individuals (birth through seniors) with intellectual disabilities and/or chronic health conditions. Services provided by the center are numerous, but include employment and housing supports, as well as day and work programs. Those individuals wishing to participate then signed the consent form to allow their personal information to be provided to the authors. To be eligible, individuals had to be receiving services of the organisation, have an intellectual or developmental disability, and the ability to communicate with the lead researcher. Individuals who provided consent were then contacted and interviews were scheduled. Participants included 27 adults with intellectual and developmental disabilities, 14 were employed at the community work center (i.e., sheltered work center; WC), eight had competitive employment (CE) jobs, and five were unemployed (UE). The mean age of participants was 45.08 years (range of 24–76 years). Fifty‐nine percent (n = 16) of the participants indicated their race as White, while 41% (n = 11) indicated they were Black or African American. Regarding gender, 13 (48%) of the participants were male, 13 (48%) were female, and one (4%) identified as non‐binary. Eleven (41%) participants lived in group homes, eight (30%) rented apartments, six (22%) lived with family, and two (7%) participants lived independent renting a house. Participant demographics separated by employment status can be found in Table 1.
TABLE 1.
Participant demographics
| Unemployed (n = 5) | Work‐center employment (n = 14) | Competitive employment (n = 8) | Total (N = 27) | |
|---|---|---|---|---|
| Gender | ||||
| Male | 2 (40%) | 10 (71%) | 1 (13%) | 13 (48%) |
| Female | 3 (60%) | 4 (19%) | 6 (75%) | 13 (48%) |
| Non‐binary | 1 (13%) | 1 (4%) | ||
| Age | ||||
| Mean (range) | 39.8 (24–54) | 54.57 (26–76) | 40.88 (27–53) | 45.08 (24–76) |
| Race | ||||
| Black or African Amer. | 1 (20%) | 3 (21%) | 7 (88%) | 11 (41%) |
| White | 4 (80%) | 11 (79%) | 1 (13%) | 16 (59%) |
| Residential designation | ||||
| Group home | 2 (40%) | 7 (50%) | 2 (25%) | 11 (41%) |
| Apartment | 4 (29%) | 4 (50%) | 8 (30%) | |
| With family | 1 (20%) | 3 (21%) | 2 (25%) | 6 (22%) |
| House | 2 (40%) | 2 (7%) | ||
2.2. Experimental design
A descriptive correlational quantitative design using surveys and interviews was implemented to better understand the QoL of individuals with intellectual and developmental disabilities across a variety of employment conditions and to determine the relationship between those conditions and QoL. The purpose of a correlational design is to allow researchers the ability to explore the degree to which two or more variables are associated or related (Creswell & Guetterman, 2018). Additionally, correlational research can be used to explore differences between groups on variables of interest (Cook & Cook, 2008).
2.3. Dependent measures
Researchers created an employment indicators survey based on the questions from the National Core Indicators (NCI) 2018–2019 In‐Person Survey on Work (National Core Indicators, 2018). Questions focused on current employment status (type, length of employment, bi‐weekly hours, wages, paid time off, etc.) as well as a few additional questions regarding career preparation and alternative activities (volunteering or day programs). All questions included can be found in Table 2.
TABLE 2.
Employment factors
| Competitive employment (n = 8) M (SD); range | Work center employment (n = 14) M (SD); range | Unemployed (n = 5) | |
|---|---|---|---|
| Type of Paid Community Job |
Individual job without publicly funded supports (n = 7) Individual job with publicly funded supports (n = 1) |
Sheltered workshop (work center) (n = 14) | |
| Bi‐weekly hours |
39 (16.4) Range: 11–60 |
50(0) Range: 50 |
|
| Average hourly wage |
$9.51 ($1.37) Range: $7.25–$11.00 |
$1.16 ($0.65) Range: $0.18–$2.00 a |
|
| Length of employment at current job |
14.75 months (19.2 months) Range: 1.5–60 months |
59.3 months (72 months) Range: 1.5–192 months b |
|
| Receives paid time off at community job | 3 (38%) | 14 (100%) | |
| Job Industry |
Food preparation or service (n = 5; 63%) Retail (n = 1; 13%) Cleaning (n = 1; 13%) Other (n = 1; 13%) |
Assembly, manufacturing, or packaging (n = 14; 100%) | |
| Has Community Employment as a Goal in Service Plan | 8 (100%) | 14 (100%) | 5 (100%) |
| Takes Classes, Training, or Does Something to Get a Job or Do Better at Current Job | 1 (13%) | 6 (43%) | 1 (20%) |
| Attends a Day Program or Workshop | 1 (13%) | 14 (100%) | 1 (20%) |
| Volunteers | 2 (25%) | 0 (0%) | 1 (20%) |
Eight out of 14 participants indicated their wages.
Twelve participants indicated their total months or years at their current employment.
To measure objective quality of life (QoL) factors, the Comprehensive Quality of Life Scale – Intellectual/Cognitive Disability (5th Edition; ComQoL‐I5; Cummins, 1997a) was administered to participants. The ComQoL‐I5 was designed for use with individuals with intellectual disability or other cognitive impairments (Cummins, 1997a), and contains an objective and subjective measure, however, in the current study only the objective measure was used, as the subjective measure has been found to have psychometric flaws (Cummins, 2005). The ComQoL‐I5 divides QoL into seven domains: material well‐being, health, productivity, intimacy, safety, place in community and emotional well‐being (Cummins, 1996, 1997b). The objective scale contains three questions for each of the seven domains (21 questions total), with most questions requiring a Likert‐type response. The material well‐being domain includes questions on living environment, income, and personal possessions. The health domain includes questions on trips to the doctors, medical conditions or disabilities, and regular medications taken daily. Productivity domain questions focus on hours spent at work, education, or on childcare, as well as how often they have nothing much to do, and how much time spent watching TV. The intimacy domain includes questions on frequency of talking to friends, having someone who shows care or concern, and frequency of social interactions. The safety domain includes questions on quality of sleep, feelings of safe at home, and frequency of being worried or anxious during the day. The place in the community domain includes questions on monthly leisure activities, belonging to a club, group, or society, and frequency of people outside of the home asking for advice. The emotional wellbeing domain includes questions on frequency of doing things, frequency of wanting to stay in bed all day, and frequency of wishes not coming true. The ComQoL‐I5 is psychometrically sound, and has been found to be reliable, stable, valid, and sensitive, using sub‐score alphas of between 0.3 and 0.7 (Cummins et al., 1994). Additionally, Cummins (1996) refers to the ‘gold‐standard’ score of 75 ± 2 SM for satisfaction.
To measure subjective well‐being, the PWI‐ID (Personal Wellbeing Index – Intellectual Disability, 3rd Edition) measure developed by Cummins and Lau (2005) was utilised. The PWI‐ID measures subjective QoL via the satisfaction sub‐scale (Cummins & Lau, 2005). The PWI‐ID contains eight items, with each one corresponding to a QoL domain (i.e., material well‐being domain: “How happy do you feel about the things you have? Like the money you have the things you own?”; health domain: “How happy do you feel about how healthy you are?”; productivity domain: “How happy do you feel about the things you make or the things you learn?”; intimacy domain: “How happy do you feel about getting on with the people you know?”; place in the community domain: “How happy do you feel about doing things outside your home?”; physical well‐being domain: “How happy do you feel about how safe you are?”; and emotional well‐being domain: “How happy do you feel about how things will be later on in your life?”). The PWI‐ID contains a pre‐testing protocol to determine if and to what level of complexity scale the respondents should be given. Likert‐type responses options include either a 1–10 scale, or a reduced‐choice format with two, three, or five choices. The PWI has demonstrated good psychometric properties in its reliability (Cronbach α 0.70), validity, and sensitivity (Lau et al., 2005). For both measures, individual domain and total QoL scores range from 0 to 100, with higher scores indicating increased QoL.
2.4. Procedures
During the fall of 2021 and early winter of 2022, individual interviews for those in the CE and UE groups were conducted at the participants home or through virtual means (FaceTime, Zoom, Teams, etc.), depending on participant preference. Three days were arranged for individual interviews for the WC group and were conducted in a large conference room at the work center. The dependent measures were then read to the participant, and responses were written down by the first author as well as captured by audio recording and then reviewed by the researchers to ensure accuracy of participant responses. For the subjective portion of the PWI‐ID, different sized manipulative cubes were used (following the directions in the manual) along with a print‐out of steps of importance (2, 3, and 5) for the importance questions. Additionally, the Likert scale face chart that the PWI‐ID uses was also provided for participant use for the happiness subjective questions. Interviews ranged from 20 to 78 min, with the average interview length of 38 min. Participants received a $30 gift card to a retailer or restaurant of their choice for participating in the study.
2.5. Data analysis
Using IBM SPSS Statistics for Windows, Version 21.0, ComQoL‐I5 and PWI‐ID data was explored using a nonparametric analysis. Kruskal–Wallis H for Oneway Analysis of Variance (ANOVA) analysis were conducted to determine statistical significance between comparison groups (CE vs. WC, CE vs. UE, and WC vs. EU). Due to uneven group sizes (e.g., CE n = 8, WC n = 14, UE n = 5), a parametric ANOVA would not be appropriate due to violations of homogeneity (MacFarland & Yates, 2016). However, the Kruskal–Wallis Test, as a nonparametric test analysis is best to identify any statistical significance when there are considerable differences in the number of subjects in each comparative group (MacFarland & Yates, 2016). This analysis was followed by pairwise comparisons of group, using the Dunn‐Bonferroni correction for multiple tests to control for Type 1 error (Lee & Lee, 2018). Probability values of less than 0.05 were considered evidence of statistical significance.
The data pertaining to the ComQoL‐I5 and the PWI‐ID were both scored according to the guidelines of the manuals (Cummins, 1997a; Cummins & Lau, 2005). The ComQoL‐I5 was interpreted using the formula described by Cummins (1997a) to find the scale maximum for each participant in each objective domain: % of scale maximum = (4 − 1) × 100/(5 − 1). Any resulting scores of 75 ± 2.5% indicate a score of “satisfaction” (Cummins, 1996). Objective scores of Importance and Satisfaction were also calculated with the formula specified by Cummins and Lau (2005), by first converting all PWI scores to the standard 0%–100% SM. For the Importance scale, possible scores are between 0 and 10, making the conversion easily by simply shifting the decimal point to the right (Cummins & Lau, 2005, e.g., 7.5 = 75%). For the Satisfaction scale, possible scores are between 0 and 5, the values are converted to the standard 0%–100%SM (standard mean) and the decimal point is again shifted to the right (e.g., score of 4 − 0[minimum score]/5[maximum score] − 0 [minimum score] × 100; (4 – 0)/(5 – 0) × 100 = 80%). Totals for individuals and groups are then averaged and aggregated.
3. RESULTS
3.1. Descriptive statistics
3.1.1. Employment indicators measure
Study participants were asked 12 questions based on the NCI (2018) In‐Person on Work survey regarding their current employment condition. Participants in competitive employment work on average 39 h bi‐weekly, with a range of 11–60 h. All participants employed at the work center work on average 50 h bi‐weekly. Competitive employment participants made an average of $9.51/h (SD = $1.37), while those employed at the work center were paid a piece rate and averaged $1.16/h (SD = $0.65). Length of employment ranged from one‐and‐a‐half months to 60 months for those in competitive employment settings, and from one‐and‐a‐half months to 192 months for participants employed at the work center. Three (38%) participants who are competitively employed receive paid time off, whereas 14 (100%) of those employed at the work center receive paid time off. All participants (N = 27; 100%), regardless of current employment status have community employment as a goal in their individual service plan. One (13%) participant in competitive employment, six (43%) participants employed at the work center, and one (20%) participant who is unemployed take classes or training to improve skills at their current job or for a different job. All employment factors are provided in Table 2.
3.1.2. Comprehensive Quality of Life Scale: Intellectual/cognitive disability
Objective QoL scores
Using the formula described by Cummins (1997a) and Cummins and Lau (2005) and within the measures section, percentage of scale maximums were calculated for each participant in each domain for both the objective and subjective scales. Results on both QoL scales were averaged and aggregated to formulate Domain and QoL scores for individual participants, different employment condition groups, and the total sample. All Com‐QoL‐I5 and PWI‐ID domain results can be found in Table 3. Any resulting scores of 75 ± 2.5% indicates a score of “satisfaction” (Cummins, 1996). Only the objective domain of safety was rated as satisfactory by participants in the WC and CE groups respectively (M = 76.79% and M = 78.13%). All other objective domains were rated with scores less than 72.5%. Of particular note, lowest scale maximums for total participants were in the objective domains of Material Well Being (M = 25.12%), Productivity (M = 32.01%), and Place in Community (M = 15.74%). The total average QoL objective score for all participants was 43.97%.
TABLE 3.
COM QoL objective and subjective domain data table
| QoL domains | Percent of scale maximum | |||
|---|---|---|---|---|
| Unemployed (n = 5) | Work center employment (n = 14) | Competitive employment (n = 8) | Total average (N = 27) | |
| Objective scale | ||||
| Material well‐being | 28.33 | 13.69 | 33.33 | 25.12 |
| Health | 58.33 | 51.79 | 56.25 | 55.46 |
| Productivity | 10 | 38.10 | 47.92 | 32.01 |
| Intimacy | 65 | 67.86 | 66.67 | 66.51 |
| Safety | 46.67 | 76.79 a | 78.13 a | 67.20 |
| Place in community | 14.67 | 12.98 | 19.58 | 15.74 |
| Emotional well‐being | 55 | 51.79 | 51.04 | 52.61 |
| Total score | 39.71 | 41.78 | 50.42 | 43.97 |
| Subjective scale | ||||
| Material well‐being | 91 | 91.79 | 94.06 | 92.28 |
| Health | 90 | 89.96 | 76.56 | 84.51 |
| Productivity | 89 | 80.36 | 67.19 | 78.85 |
| Intimacy | 95 | 78.93 | 74.69 | 82.87 |
| Safety | 84 | 83.93 | 77.5 | 81.81 |
| Place in community | 73.5 | 76.79 | 56.25 | 68.85 |
| Emotional well‐being | 96 | 86.25 | 92.5 | 91.58 |
| Total | 88.36 | 83.57 | 76.96 | 82.96 |
Score of 75 ± 2.5% indicates a score of “satisfaction” (Cummins, 1996).
Subjective QoL scores
Participants in the UE group scored an average total subjective score of 88.36%, with the lowest subjective score in the domain of Place in Community (M = 73.5%) and the highest score in Emotional Well‐Being (M = 96%). Participants in the WC group scored an average total subjective score of 83.57%, with the lowest subjective score in the domain of Place in Community (M = 76.79%) and the highest score in Material Well‐Being (M = 91.79%). Participants in the CE group scored an average total subjective score of 76.96%, with the lowest subjective score in the domain of Place in Community (M = 56.25%) and the highest score in Material Well‐Being (M = 94.06%). Participants' responses in all three groups were aggregated and averaged on subjective questions, which resulted in all domains receiving a score of 68.85% or higher. The lowest average subjective scores were in the domains of Place in Community (M = 68.85%) and Productivity (M = 78.85%). The highest average subjective scale scores were in the areas of Material Well‐Being (M = 92.28%) and Emotional Well‐Being (M = 91.58%). The total average QoL score on the subjective portion for all participants was 82.96%. Table 3 contains all ComQoL‐I5 objective and subjective data results.
Using participants aggregated raw data scores for each QoL domain (e.g., Material Well Being, Health, etc.) Kruskal–Wallis H tests were conducted to determine whether there was an effect of work status on the quality of life for individuals with intellectual and developmental disabilities, with follow‐up Dunn‐Bonferroni post hoc tests for comparison of any significant pairs. A Kruskal–Wallis H test showed a statistically significant difference between employment groups in Objective Material Well‐Being scores, H(2) = 14.152, p = <.001, with mean rank scores for CE group of 21.81, WC group of 9.11, and UE group of 15.20. A pairwise post‐hoc Dunn test with Bonferroni adjustments was only significant for CE vs. WC employment groups (p = .001). A Kruskal–Wallis H test showed that there was a statistically significant difference between employment groups in Objective Productivity scores, H(2) = 12.839, p = .021, with mean rank scores for CE group of 18.94, WC group of 14.96, and UE group of 3.40. A pairwise post‐hoc Dunn test with Bonferroni adjustments was only significant for CE versus UE employment groups (p = .001) and WC versus UE employment groups (p = .012). A Kruskal–Wallis H test showed that there was a statistically significant difference between employment groups in Objective Safety scores, H(2) = 8.274, p = .016, with mean rank scores for CE group of 16.38, WC group of 15.89, and UE group of 4.90. A pairwise post‐hoc Dunn test with Bonferroni adjustments was only significant for CE versus UE employment groups (p = .031) and WC versus UE employment groups (p = .021). The Kruskal–Wallis tests for the PWI‐ID subjective scores resulted in no statistical significance. Full results can be found in Tables 4 and 5.
TABLE 4.
Kruskal–Wallis test results for com‐QoL‐I5 & PWI‐ID
| Mean rank by employment status | Kruskal–Wallis H (df) | Asymptotic sig. (two‐sided test) | |||
|---|---|---|---|---|---|
| CE (n = 8) | WC (n = 14) | UE (n = 5) | |||
| Objective domain | |||||
| Material well being | 21.81 | 9.11 | 15.20 | 14.152(2) | <.001* |
| Health | 15.19 | 12.32 | 16.80 | 1.531(2) | .465 |
| Productivity | 18.94 | 14.96 | 3.40 | 12.839(2) | .002* |
| Intimacy | 13.44 | 15.07 | 11.90 | .654(2) | .721 |
| Safety | 16.38 | 15.89 | 4.90 | 8.274(2) | .016* |
| Place in community | 16.00 | 12.54 | 14.90 | 1.054(2) | .590 |
| Emotional well being | 12.75 | 14.07 | 15.80 | .467(2) | .792 |
| Overall objective score | 18.25 | 13.89 | 7.50 | 5.653(2) | .059 |
| Subjective domain | |||||
| Material well being | 15.25 | 13.82 | 12.50 | .457(2) | .796 |
| Health | 11.19 | 14.89 | 16.00 | 1.160(2) | .560 |
| Productivity | 9.31 | 15.36 | 17.70 | 4.586(2) | .101 |
| Intimacy | 12.13 | 13.04 | 19.70 | 3.072(2) | .215 |
| Safety | 13.50 | 14.25 | 14.10 | .319(2) | .853 |
| Place in community | 9.75 | 16.11 | 14.90 | 2.645(2) | .266 |
| Emotional well being | 14.38 | 13.36 | 15.20 | .328(2) | .849 |
| Overall subjective score | 9.25 | 15.36 | 17.80 | ||
Abbreviations: CE, competitive employment; UE, unemployed; WC, work‐center employment.
Statistical significance.
TABLE 5.
Pairwise comparisons with the Dunn–Bonferroni post‐hoc test
| Com‐QoL‐I5 objective domain | Employment status comparison groups | ||
|---|---|---|---|
| CE vs. WC | CE vs. UE | WC vs. UE | |
| Material well being | |||
| Test statistic | 12.705 | 6.613 | −6.093 |
| Standard error | 3.395 | 4.367 | 3.991 |
| Standard test statistic | 3.742 | 1.514 | −1.527 |
| Significance | <.001* | .130 | .127 |
| Significance with Bonferroni adjustment | .001* | .390 | .381 |
| Productivity | |||
| Test statistic | 3.973 | 15.538 | 11.564 |
| Standard error | 3.432 | 4.414 | 4.034 |
| Standard test statistic | 1.158 | 3.520 | 2.867 |
| Significance | .247 | <.001* | .004* |
| Significance with Bonferroni adjustment | .741 | .001* | .012* |
| Safety | |||
| Test statistic | .482 | 11.475 | 10.993 |
| Standard error | 3.477 | 4.473 | 4.088 |
| Standard test statistic | .139 | 2.565 | 2.689 |
| Significance | .890 | .010* | .007* |
| Significance with Bonferroni adjustment | 1.000 | .031* | .021* |
Abbreviations: CE, competitive employment; UE, unemployed; WC, work‐center employment.
Statistical significance.
4. DISCUSSION
The current study explored quality of life among individuals with intellectual and developmental disabilities across three employment conditions (e.g., competitive employment, work center, or unemployment). As discussed previously QoL is a multifaceted construct, making it important to consider both objective scores and subjective scores when determining QoL (Cummins, 1996; Felce, 1997). Previous research has set the standard of 75% ± 2.5% to indicate a score of “satisfaction” (Cummins, 1996). Using the objective scale, only the domain of Safety resulted in satisfaction for both employed groups. No other domains resulted in scores of satisfaction for objective QoL. Across the three employment conditions, objective QoL scores for the domains of Health, Intimacy, Place in Community, and Emotional Well‐Being were all similar. However, it is important to point out that the overall objective QoL for all participants was less than 75%, regardless of employment condition. These findings indicate that no participants' overall objective QoL score met the standard of “satisfaction” (Cummins, 1996). Beyer et al. (2010) reported similar findings, where overall objective QoL scores for employment conditions (supportive and work center) did not score over 71.5%. However, in the current study and the Beyer et al. (2010) study, individuals with intellectual and developmental disabilities in competitive employment settings did report higher overall objective QoL than their peers in other employment settings.
Subjective scale domain scores were much higher for all participants regardless of employment conditions. All domains, apart from Place in Community, were scored as satisfactory (e.g., 75%), average scores for subjective score domains ranged from 68.85% to 92.28% across all three employment conditions. These subjective domain scores imply that participants felt greater satisfaction with their current situation than what their actual objective score indicated. Verdugo et al. (2006) reported similar findings of no significant differences in satisfaction (subjective) QoL between competitive employment and work center employment. A review by Akkerman et al. (2016) found several studies that yielded similar results regarding job satisfaction (subjective QoL) scores being comparable between participants in competitive and work center‐based employment settings. Beyer et al. (2010) also found that while the competitive employment group scored the highest on overall subjective QoL, all groups' subjective QoL scores were higher than their objective QoL scores (with the exception of the non‐disabled comparison group). One suggestion for the discrepancy between objective and subjective QoL is that individuals with intellectual and developmental disability may assess their satisfaction against different reference populations (e.g., competitive employment against other individuals with disabilities in work‐center employment; Beyer et al., 2010). The current study's findings demonstrate Beyer et al. (2010) hypothesis, as our participants in the competitive employment reported the highest subjective QoL scores, followed by the work‐center participants, with the unemployed participants reporting the lowest overall subjective QoL scores. Akkerman et al. (2016) posits that a better understanding of how different variables (e.g., personal, cognitive, and situational characteristics) interact with reported job satisfaction scores and their relationship among each other are needed in order to discern the “satisfaction” concept.
The QoL score for the domain of Place in Community revealed noteworthy findings. Some may argue that while work center employment may not be as financially beneficial for those with intellectual and developmental disabilities, work center employment does provide other services (e.g., outings, trainings, day services) that competitive employment may not offer. Overall, Place in Community QoL domain scores were extremely low across all employment conditions. Place in Community questions focus on how many different outings (e.g., trips to restaurants, movies, sporting events) within the community an individual has taken during a month's time, as well as belonging to any clubs or societies, and how often others ask them for advice. The current study found that those employed in the work center condition reported lower objective scores in Place in Community QoL domain in comparison to those competitively employed, which is also in line with previous research (Blick et al., 2016; Kober & Eggleton, 2005). This finding is significant in that while those employed in work centers may spend more time completing employment tasks, they objectively report less time and energy spent on community activities (e.g., attending church, restaurants, visiting family and friends). During the interviews, participants, regardless of work‐condition, repeatedly shared that they did not do much if anything outside of their employment setting. However, participants' subjective scores in the same domain resulted in scores of near 75%, indicating participants' satisfaction with their Place in Community. Interestingly, participants in the competitive‐employment condition reported the lowest subjective scores in the domain Place in Community. These findings indicate that overall participants who are in the unemployed and work center employment conditions were satisfied with their Place in Community, while those participants who are competitively employed feel that it is important to have a place in their community but are not satisfied with their current place in their community.
The second purpose of the current study was to determine to what extent employment condition is associated with the quality of life for individuals with intellectual and developmental disabilities. Findings were mixed and have led to several considerations for future research. The first consideration is if the consistent employment and socialisation that work center employment provides is as valuable or equal to the material well‐being to those competitively employed. Participants who were employed in work center conditions reported overall higher objective scores in the domains of Intimacy and Emotional Well‐Being than those competitively employed. Participants who were employed at the work center stated numerous times that their favourite part of employment at the work center was getting to talk and see friends, which could be a reason for the increased scores in these QoL domains. Participants employed in the work center setting sit with peers, as well as have the same break and lunch times, thus having opportunity for increased socialisation. Not surprisingly, findings also revealed that competitive employment was significant at increasing the objective QoL score in the Material Well Being domain, which is also similar to previous research (Claes et al., 2012). Like previous research (Almalky, 2020; Tait et al., 2020), work center employment yielded lower QoL objective scores in most areas in comparison to competitive employment scores.
The current study's data was collected near the end of the COVID pandemic and restrictions. As a result of this timing, it is important to recognise and consider the effect that COVID and pandemic restrictions may have on this population in particular its effect on QoL. Emerging research (Abbeduto, 2020; Lake et al., 2021; Author) into this population and the effects of COVID and resulting restrictions could in part be responsible for the relatively low quality of life (e.g., increased mental health illness, interruptions to community programs). Current findings support this, as the center implemented new regulations to prevent and protect their more vulnerable population from contracting COVID‐19 had restricted most community outings and events (e.g., instead of going to eat in restaurants, clients would order through the drive‐thru and take their meal to their own home). As a result, it is very possible that these restrictions due to COVID‐19 regulations are in part responsible for the decrease in quality of life in the area of Place in Community for the current study's participants.
5. LIMITATIONS
The following limitations should be considered when interpreting the findings of this study. First, our population was small with only 27 total participants. A larger sample would provide increased statistical power. Another potential limitation is that we did not pursue participants from different providers, or geographic locations. As a result, findings from this study apply specifically to this population, provider, and geographic location (i.e., southeastern United States). Different countries may provide varying opportunities and/or levels of support, therefore affecting objective or subjective QoL differently than the current study. While only two ethnicities were represented in the sample (i.e., Caucasian and African American), this is representative of the overall population of both the center and geographic location. Participants were not all interviewed through the same format (e.g., virtual, at their residence, or place of employment). The different locations or methods may be a potential limitation, as participants may have answered differently depending on their location at the time of the interview. A last limitation was that all measures were self‐report. As a result, not all responses may accurately reflect actual behaviour or complete information (Cook & Cook, 2008).
6. IMPLICATIONS FOR PRACTICE
Results from this study add to the body of research available regarding individuals with intellectual and developmental disabilities, employment conditions, and QoL. Current study results should help inform current practice and encourage further research. The domain of Place in Community was the lowest for all participants, regardless of work condition. Program coordinators, administrators, and families need to ensure that opportunities for involvement within the community (e.g., eating out, going to a place of worship, being part of a club) for individuals with intellectual and developmental disabilities is increased. Programs also need to identify ways to increase social interaction for individuals with intellectual and developmental disabilities who may either be competitively employed or unemployed. Programming should continue to examine ways to increase pay for those employed in work centers. Most participants in work center employment settings mentioned being paid a low wage, and this conclusion was supported by the low QoL score in the Material Well‐Being domain.
7. FUTURE RESEARCH
Future research on evaluating and increasing QoL scores for individuals with intellectual and developmental disabilities should continue in several ways. First, researchers conducting studies on the concept of QoL need to specify if data gathered is objective or subjective (Cummins et al., 2010; Schalock et al., 2002). Specifying objective or subjective QoL will help researchers synthesise findings and further understand QoL for individuals with intellectual and developmental disabilities. Additional research should be conducted using the self‐reported Com‐QoL‐I5 (Cummins, 1997a) and the proxy‐reported Com‐QoL‐I5 (Cummins, 1997a) to ensure that all information provided is accurate, and to gauge how unanswered or incorrectly self‐reported surveys may affect QoL scores. To determine if there are any connections between employment condition placement, intelligent quotient scores, and adaptive behaviour scores follow‐up research should be conducted. Another path that future research should follow is to compare living arrangements (e.g., group home, apartment), to QoL domains (e.g., Safety, Intimacy, Emotional Well‐Being), and employment conditions. Also, examining the employment placements histories of individuals with intellectual and developmental disabilities could be beneficial to understand personal variables (e.g., skills, adaptive, social skills) that may have impacted assigned employment condition. The resulting information could potentially be helpful in identifying services and supports necessary to help those who are employed in work‐center settings gain competitive employment. Additionally, a larger sample would help to identify if any interactions between employment condition and other variables (e.g., age, living arrangements, ethnicity, etc.) may exist. As Akkerman et al. (2016) postulates that satisfaction (e.g., jobs satisfaction, subjective QoL) is determined by the interaction among many variables and psychological processes, future research incorporating other study instruments aimed at measuring self‐determination, cognitive processing, problem solving, etc., would be beneficial to understanding the discrepancy between objective and subjective QoL scores. As the data for this study were collected 2 years after the start of the COVID pandemic, additional research needs to be conducted once life for participants have returned to maximum normalcy, to help determine the effect that COVID and resulting restrictions may have had on their QoL.
8. CONCLUSION
Findings from this study show that the included participants, regardless of employment status, reported overall satisfactory subjective QoL scores, but overall unsatisfactory objective QoL scores, indicating that while participants' life conditions are less than satisfactory, they are content with their life conditions. Employment status, whether competitive and work center settings both resulted in increases to overall objective QoL scores for participants. As such, every effort should be made by government bodies, disability organisations, and carers to provide individuals with intellectual and developmental disabilities the option of employment. However, as both objective and subjective QoL scores were highest for those in competitive employment, government and disability organisations should focus on increasing opportunities for these types of job placements in particular. Families and program administrators need to ensure that opportunities for social and community actions are integral parts of every program. Additionally, as we move into the living‐with‐COVID world, while continuing to protect vulnerable individuals within different settings, government and disability organisations should give careful consideration and frequently evaluate restrictions and corresponding modifications that allow for increased community participation. Low objective QoL scores may be the result of pandemic‐related restrictions, however, participants should be reassessed to determine if post‐pandemic life positively increases participants' objective QoL scores.
CONFLICT OF INTEREST
The authors report no conflict of interest.
ACKNOWLEDGEMENTS
This publication was supported, in part, by the National Center for Advancing Translational Sciences of the National Institutes of Health under Grant Number UL1 TR001450. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Randall, K. N. , Bernard, G. , & Durah, L. (2023). Association between employment status and quality of life for individuals with intellectual or developmental disability. Journal of Applied Research in Intellectual Disabilities, 36(2), 270–280. 10.1111/jar.13053
Funding information National Center for Advancing Translational Sciences; National Institutes of Health
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.