"The Strength to Leave": Women With Disabilities Navigating Violent Relationships and Occupational Identities.

IMPORTANCE: Being in an intimate relationship is a desired occupation for many people, in particular for women living in low- and middle-income countries (LMICs), where relationships can provide material support, intimacy, and social integration and increase chances of survival. OBJECTIVE: To explore accounts of navigating intimate relationships from women with disabilities in Sierra Leone. DESIGN: A qualitative study was conducted, guided by a critical occupational approach and informed by feminist disability scholarship. Data were generated through interviews and analyzed using reflexive thematic analysis. SETTING: Community-based across four districts of Sierra Leone. PARTICIPANTS: Thirteen women with disabilities were recruited by means of snowball and purposive sampling. RESULTS: Four themes were generated that illuminated the women's experiences of intimate relationships as viewed through the lens of gender and disability dimensions. The overarching theme, "violence in intimate relationships," describes the incidences of violence and abuse they experienced. "Becoming a wife" explores the women's occupational identity wishes. "Leaving as an occupational rupture" illuminates the actions the women took to end the relationship. "Mothering as an occupational identity and resource" focuses on the women's role as mothers and transitions in their occupations. CONCLUSIONS AND RELEVANCE: Taking their unique narratives into account draws attention to how the women have met their occupational needs and resisted occupational injustices, enabled by social and structural supports, including their children, disability social benefits, and their engagement in the disability rights movement. Implications are directed at socially committed occupational therapists to address systemic issues of disability- and gender-based violence. What This Article Adds: This study adds much-needed knowledge in an area in which there is a paucity of research: the experiences of women with disabilities being in an intimate relationship as a social occupation in an LMIC. The results illuminate the importance of considering the systemic issues that affect the social occupations of women with disabilities, particularly in light of the shift within occupational therapy practice toward developing a socially transformative focus.

What is the recovery rate and risk of long-term consequences following a diagnosis of COVID-19? A harmonised, global longitudinal observational study protocol.

INTRODUCTION: Very little is known about possible clinical sequelae that may persist after resolution of acute COVID-19. A recent longitudinal cohort from Italy including 143 patients followed up after hospitalisation with COVID-19 reported that 87% had at least one ongoing symptom at 60-day follow-up. Early indications suggest that patients with COVID-19 may need even more psychological support than typical intensive care unit patients. The assessment of risk factors for longer term consequences requires a longitudinal study linked to data on pre-existing conditions and care received during the acute phase of illness. The primary aim of this study is to characterise physical and psychosocial sequelae in patients post-COVID-19 hospital discharge. METHODS AND ANALYSIS: This is an international open-access prospective, observational multisite study. This protocol is linked with the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) and the WHO's Clinical Characterisation Protocol, which includes patients with suspected or confirmed COVID-19 during hospitalisation. This protocol will follow-up a subset of patients with confirmed COVID-19 using standardised surveys to measure longer term physical and psychosocial sequelae. The data will be linked with the acute phase data. Statistical analyses will be undertaken to characterise groups most likely to be affected by sequelae of COVID-19. The open-access follow-up survey can be used as a data collection tool by other follow-up studies, to facilitate data harmonisation and to identify subsets of patients for further in-depth follow-up. The outcomes of this study will inform strategies to prevent long-term consequences; inform clinical management, interventional studies, rehabilitation and public health management to reduce overall morbidity; and improve long-term outcomes of COVID-19. ETHICS AND DISSEMINATION: The protocol and survey are open access to enable low-resourced sites to join the study to facilitate global standardised, longitudinal data collection. Ethical approval has been given by sites in Colombia, Ghana, Italy, Norway, Russia, the UK and South Africa. New sites are welcome to join this collaborative study at any time. Sites interested in adopting the protocol as it is or in an adapted version are responsible for ensuring that local sponsorship and ethical approvals in place as appropriate. The tools are available on the ISARIC website (www.isaric.org). PROTOCOL REGISTRATION NUMBER: osf.io/c5rw3/ PROTOCOL VERSION: 3 August 2020 EUROQOL ID: 37035.