In the 2014 review 13 qualitative studies were included that reached the 70% threshold for the quality assessment. For this review, the full texts of these 13 studies were independently rescreened for eligibility based on the four criteria in the Methods section. Of these 13 studies one [19] was excluded because the data were not reported from the perspective of workers with DD themselves, but from the perspective of employers.
The additional database searches for qualitative studies on the subject from 2013 to 2021 yielded 1114 studies, 377 of which were duplicates. 737 were qualified for independent screening and were imported into Rayyan Systematic Review Software. After independent screening of title and abstract 701 studies were excluded. The remaining 36 studies required full text scrutiny: 27 had insufficient information in the title and abstract to warrant inclusion or exclusion, and 9 seemed to be eligible. These 36 studies were independently screened on the four criteria from the Methods section. Of the 27 studies with too little information in the title and abstract, 26 were excluded and 1 was included. Of the nine studies that seemed to be eligible, three were excluded and six were included. Thus the final total was 19 studies (see Fig. 2).
Selection of eligible studies
Quality assessment
The nine criteria for quality reported by Mays and Pope [14] were used to assess the quality of the studies. Each study was assessed based on each criterion and assigned ‘ + = present’, ‘- = not present’ or ‘ ± = insufficiently described’. The threshold for inclusion in this review was at least six ‘ + ’ and one ‘ ± ’. The studies were sorted by number of plusses; those with an equal number of plusses were sorted further by publication year and alphabetical order (see Table 1). Interrater reliability at the level of the criteria independently scored by the two reviewers was measured. For that purpose a Cohen’s Kappa was calculated: 0,79, which is substantial [20].
Main characteristics of the studies
Table 2 displays the main characteristics of each included study: aim of the study, country, characteristics of participants, setting/discipline, data collection method, data analysis method and main findings.
The aims of these studies correspond with their qualitative character: they report the experiences, understandings, and impact of DD on the work of workers with DD in general, but sometimes also in specific contexts like nursing, medicine, physiotherapy, education, or transportation. One study [33] explored how technology can be supportive in the workplace, one [35] examined the impact of learning disabilities on young women’s career development, one [38] explored the intersection of dyslexia, paid work, and mothering, and one [25] explored the differences between US and Canadian workplaces for adults with learning disabilities after protective legislation was introduced.
Studies were performed in various countries, and some studies included participants from more than one country. Nine were (partially) performed in the UK [22, 24, 30,31,32, 36,37,38,39], seven in the US [21, 23, 25, 26, 29, 33, 35], three in Canada [23, 25, 34], two in Finland [24, 27] and one in the Netherlands [28]. These countries all have legislation barring discrimination of disabled people in the workplace.
The number of participants ranged from 3 to 27, with one outlier of 49 [25]. The total number of participants was 258 with an average of 13.5. One study did not specify the distribution of gender [39]; the remaining 18 studies included 123 male (50.4%) and 121 female (49.6%) participants [21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38].
The average range in ages was 24.8 – 45.4 years and three studies had narrow age ranges (28–29; 19–21; 23–31 years) [29, 35, 37]. The participants’ age at diagnosis varied considerably: in ten studies they were at least partially diagnosed during the school period [21, 23, 25, 29, 31,32,33, 35,36,37], in six studies they were at least partially diagnosed in adulthood [27, 31,32,33, 36, 39], in one study the diagnosis was self-identified [26], in another study the age at diagnosis varied considerably [28] and in five studies the age at diagnosis was not specified [22, 24, 30, 34, 38].
The participants in these studies worked in many occupations: eight studies reported on a wide range of occupations [21, 23, 25, 28, 33,34,35,36], four were rooted in education [24, 26, 27, 29], five involved people in medical occupations (two about doctors [37, 39], two about nurses [31, 32], one about physiotherapists [22]), one looked at people in the transportation industry [30], and one study reported no occupational details to preserve anonymity [38]. The existence of clusters, such as education or health, underlied the decision to read the studies in those clusters as a block to preserve the meaning of the factors in context.
Data collection methods varied: 13 studies relied on semi-structured in-depth (face-to-face or telephone) interviews [21, 22, 25, 26, 28, 29, 31,32,33,34,35, 37, 39], three used life-story interviews [23, 36, 38], two used narrative interviews [24, 27] and one used a focus group [30].
Data analysis methods also varied. Seven studies used thematic analysis [22, 27, 33, 34, 37,38,39], four used a constant comparative method [21, 25, 28, 29], three used narrative analysis [23, 26, 36], another three used template analysis [30,31,32], one used a two-step process [35] and one took a categorical content approach [24].
Extraction of factors
Additional File 2 contains the Excel spreadsheet mentioned above and describes how the factors extracted from the studies fit into the ICF scheme, in the category order shown in Fig. 1. For this paper, the findings were scaled to the second level of the ICF categories. On the first level, the ICF divides the main domains into chapters that are itemized at a second level. These second-level items are further specified into factors, mentioned in the studies. Where the word ‘ factors’ is mentioned in the text, it should be read to include both the second-level items and these more detailed factors. 374 factors were found. The number of factors per study varied from 39 [32, 35] to 94 [33].
In the category of Functions and Structures all factors but one were scored in the chapter of ‘Mental functions’. This chapter contains a diversity of second-level functions, six of which are relevant: Dispositions and intrapersonal functions; Temperament and personality functions; Memory functions; Emotional functions; Higher-level cognitive functions; and Experience of self and time functions. Under Temperament and personality functions Confidence was scored eight times [22, 23, 26, 28, 30, 31, 33, 38], always with a negative connotation like uncertainty or insecurity. Under Emotional functions, the connotations of the factors Fear and Feelings were also negative: fear of being stigmatized or laughed at [22, 28, 30, 36], fear of failure or exposure [20, 24, 25, 28, 30], feeling different [25, 28, 29, 34], inadequate or inferior [21, 25, 28, 34] or presenting a false impression [34, 37].
In the category of Activities, factors from three chapters are scored: ‘Learning and applying knowledge’ includes the negative factors Speed of reading [21, 27, 33, 34, 37,38,39] and Speed of writing [21, 24, 27, 31,32,33, 38, 39] which are consistent over the years. The two other chapters were ‘General tasks and demands’ and ‘Communication’. In the latter, the item Speaking had opposite connotations: speaking is challenging for some workers [30, 32, 37, 39], while it is a strength for others [31, 38].
In the category of Participation only two chapters were covered. The first is ‘Interpersonal interactions and relationships’ in which the item Formal relationships was exclusively used in the context of work (with colleagues [27, 30, 31, 34], supervisors [26, 30] or clients [29, 33]). The second was ‘Major life areas’ which contained two important items: Acquiring, keeping and terminating a job and Remunerative employment. In the latter the factor Job performance was mentioned seven times [22, 23, 25, 30, 33, 35, 39]. But context is important to this factor: DD can affect job performance very little or very much. Changes in the organization [30], timed tasks [39], or timed job demands [34, 37] can negatively influence job performance, but accommodations on the job and assistive technology [33] can enhance it. Stable job performance is an indicator of focused career development [35].
The category of Work-related environmental factors covers the first four chapters mentioned in Fig. 1. Under ‘Terms of employment’, the factor Promotion/Job advancement is an issue in which context is important: some workers being demoted because of their learning disability [30], while others do not seek promotion because of problems with some skills [30, 31, 38] and a need for extra time [31, 38]. These issues might restrict employment promotion. Some workers are promoted, with or without support from their supervisor, but job advancement often leads to more responsibilities [21, 25, 39] and hence more stress [23, 25, 28, 33, 34, 37, 38].
In the chapter of ‘Social relationships at work’, in the item People in position of authority, the factor Role of employer-supervisor needs some clarification. If a worker’s DD is disclosed, the employer/supervisor is a vital partner in achieving workplace success or failure [21, 36, 38]. Some workers hint at the positive role their employer/supervisor plays in making reasonable adjustments available [35], being willing to create a flexible schedule [38], or supporting them for a promotion [30]. The employer/supervisor also plays an important role in the factor Reactions of co-workers in the chapter of ‘Attitudes’ which includes explicit negative reactions, like bullying [22, 37], laughing behind the worker’s back [24, 29, 33], or disbelief [36]. Workers may fear stigmatization or criticism from colleagues [36] and compare themselves constantly to their colleagues, which may lead workers with DD to feel inadequate [21, 25] or give the false impression that they are less intelligent [23]. But when a worker with DD really trusts a colleague, disclosure will follow and then collaborative work and other types of support [27]. The chapters of ‘Task content’ and ‘Working conditions’ contain clear items and factors.
In the category of Personal factors the chapter of ‘General ‘mental’ personal factors’ with 27 items is mentioned in all included studies [21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39]. The item Learning/Coping strategies is remarkable: it contains 68 different types of strategies of which only the factor Asking for help reaches the seven-study threshold [21, 25, 28, 30, 31, 34, 37]. The item Self-disclosure (to colleagues or supervisors) often reflects a dilemma about whether to disclose DD [21, 22, 25,26,27,28,29,30,31, 34, 36, 37]. Personal and environmental factors play a role in that decision.
In the chapter of ‘Health-related personal factors ‘ the item Impact of LD/dyslexia has a vast scope [22, 25, 26, 28, 29, 31,32,33,34, 36]: DD can have a positive impact by helping the worker become a better and stronger person (self-perception). But the impact is mostly seen as negative: DD is experienced as a definite disability that affects everyday personal and family life, schooling, work, career, and practice, social isolation, and emotional health. Interestingly, nurses [31, 32] and doctors [37, 39] who work for the NHS in the UK stated that DD has little impact on their ability to do their jobs.
This Results section has described a selection of the factors from Additional File 2 that appear in seven (35%) or more of the included studies. Table 3 presents all 51 factors without specifying in which studies they appear. That information can be found in Additional File 2.