Exploring the Experiences of People with Disabilities during the First Year of COVID-19 Restrictions in the Province of Quebec, Canada

Round 1

Reviewer 1 Report

Dear authors,

I thoroughly enjoyed reading the article on the experiences of PwD in Quebec during the first year of the COVID-19 pandemic. The article is very interesting, well-written, and methodologically-sound. I particularly liked the part of the results, where the voices of PwD could be heard. 

I have only some minor comments that I believe could enhance even further the quality of the article:

·       Page 1, line 39: could you pls add the percentage of the total population that this 6,2 million represents?

·       Last part of the Introduction: could you pls add more information on the importance of your study? That is, is it the only one on this topic in Quebec? Does it include people with all types of disabilities vs. other existing studies that included only certain disabilities? Basically, as you mention that there are various studies on the topic, it would be useful to understand the additional, ‘new’ elements of you research.

·       Were any reasonable accommodations implemented during the interviews? For example, sign language interpreter for people with hearing impairment.

·       You mention three inclusion criteria for the MAVIPAN study (page 2, line 75), and then another criterion of self-identified disability. So, basically there were 4 inclusion criteria for this study? Any exclusion criteria (for both MAVIPAN and this one)?

·       Page 10, line 453: instead of ‘…Canadians with disabilities (i.e., learning disabilities)…’, I suggest ‘…Canadians with learning disabilities…’. 

Overall, a very informative article that sheds light on the experience of PwD during the pandemic.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Thank you for the opportunity to review this paper on the experiences of people living with disability in Quebec during the first year of the COVID-19 pandemic. Overall, I found it a very well written paper documenting important experiences and will be a valued contribution to the literature. A few comments that I feel are important to strengthen the paper.

In the introduction, you highlight a number of issues experienced by people with disability during the pandemic, most of this literature relates to experiences documented outside of Quebec. I feel it would actually strengthen the rationale of this paper if you make it clearer that that the broader evidence base highlights a number of potential challenges, but that it is important to document the experiences of people with disabilities in Quebec as well. I think it would also be useful to more clearly state why it is important to document these experiences. What do you hope the findings will inform? Improved policy and practice? better understanding to prepare for ongoing impact? Recommendations for particular audiences? 

In terms of how different impairments are defined, I was a bit confused about what a flexibility and dexterity impairments referred to? Perhaps review and see if you can align with more internationally used terminology, or provide an example of a condition that might fit into these categories.

You mentioned in line 312 about 'cherished' loved ones providing much needed care. Can you link this to the importance of informal supports and the need to also think about how govts can support carers and the important role they play, but for those without informal supports, life can be even more challenging?

As mentioned in line 316, participants had different experiences of telehealth, and many factors influence these experiences including access to technology, capacity to use technology in this way, access to supports to navigate technology for telehealth. Was this something that your data can shed light on and make further recommendations about? I.e. in the Australian context, many people without disabilities found it quite easy to pivot to using technology for education, work, health, but for many people with disability who have not had their technology capabilities enabled or supported, this was much much harder. In the Australian context, we also had the issue of digital poverty, where some cohorts had such poor access to technology, internet and data to begin with, that this was only compounded during the pandemic.

Under 3.5, did the authorities prioritise people with disabilities in their response? Again, in Australia there was a huge delay in recognising the need to prioritise people with disabilities in the response, but eventually with much advocacy, people with disabilities were priortised in terms of vaccinations etc

You mention a few recommendations within 3.5 re what participants felt could have been improved. I feel that these recommendations should be more strongly reflected in the discussion, alongside advocating for strategies that ensure the experiences, perspectives and recommendations of people with disabilities are able to better inform policy and practice, particularly during a pandemic. In Victoria Australia for example, the government established a taskforce of people with disabilities and other experts to ensure that people with disabilities were able to voice concerns and criitque policy and practice to ensure better inclusion. And then tied back into the broader literature about what other jurisdictions did to better support people with disabilities during the pandemic? I.e. allowing social bubbles and visits for people with disabilities to give and receive care, exclusive shopping times, telehealth appointments, provision of technology to enable online social interaction, working from home, COVID information and services tailored for people with disabilities.... 

I think your findings really highlight the heterogeneity of experiences and that this therefore requires individualised and flexible responses, yet if services and supports were not already meeting individualised needs of people with disabilities prior to the pandemic, it was difficult for services and supports to pivot to ensure appropriate responses to the pandemic. Nonetheless the pandemic provided opportunities to re-think the design and implementation of services and supports to be more flexible and inclusive, what do you think governments and services should continue to do to continue to improve services and prepare for disability inclusion in future public health/disaster responses? 

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

This study examined the experiences of people with disabilities in Quebec during the first year of the pandemic through semi-structured interviews. A few sections of the study can be improved:

1. Intro: Given the growing number of studies on people with disabilities' experiences during the pandemic, the authors need to stress why this study contributes to the existing literature. 

2. Methods: I am particularly concerned about the methods section for the following reasons: 

1. Sampling: sampling size should be justified. Is it based on data saturation? or simply a convenient number the team could reach? If the rationale is the later, then the authors should acknowledge this limitation 

2. Use of the mixed inductive-deductive methods: perhaps the biggest issue of the methods is the choice of the inductive-deductive methods. Literature on this methods have documented how deductive part of the method should be developed (often based on engagement with literature). Though the authors mentioned that the questions were developed based on the survey, it is not clear how the structure of the survey was developed. Was there a theoretical framework? Need to clarify or acknowledge in the limitations section

3. Another problem is the inter-rater reliability or trustworthiness of the inductive part of the analysis. It's not clear if the two coders came together to develop those additional codes. The authors mentioned that the two coders coded one interview together, and then coded independently. This process does not seem to allow the two coders to develop additional codes together. Significant clarifications are needed here.

4. Inter-Coder Reliability. Did the authors code for IRR? If not, acknowledge in limitations

3. Discussion: the authors may benefit from interpreting how Quebec PWD's experiences differ from other countries. What are some future emergency public health policies that are needed to ensure the rights of PWDs in Quebec? 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

The authors have sufficiently addressed my concerns.