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Electoral Participation of Electors with Disabilities: Canadian Practices in a Comparative Context

3. Literature Review

On the topic of people with disabilities and electoral participation, the literature reviewed for this study contains different kinds of evidence. A small number of works are philosophical in nature, exploring the concepts and arguments surrounding personhood and individual capacity to make decisions and thus to vote (Applebaum, Bonnie and Karlawish 2005; Vorhaus 2005). Other works are anecdotal accounts or individual cases of experiences, often captured in newspaper stories, while others report results from interviews, focus groups or surveys, and a few studies are comparative analyses of legislation and policy measures. Section 6.3 of this report offers further discussion on the methodological features of the literature under review.

The literature also differs according to which impairment or group of impairments is addressed. Many studies, according to Redley (2008), concentrate on people with physical impairments, whether spinal cord injuries (Schur 1998), visual impairments and blindness (Harrington 1999) or other mobility and sensory limitations (Scope 2010a). There are, however, a number of works that examine people with various cognitive impairments, such as Alzheimer's disease and dementia, and intellectual or developmental disabilities. One illustration of this stream of writing, which dates back to the 1970s, centres on people with learning disabilities the voting behaviour of those living in institutions; their political values and levels of political knowledge; issues of getting to polling stations and overcoming barriers to participation; and measuring the level of voter registration and turnout, noting their relative under-representation at the polls (Bell, McKay and Phillips 2001; Keeley et al. 2008).

Reports on the accessibility of electoral processes and polling stations for voters with disabilities are produced by some electoral commissions and, in the UK, by a network of disability organizations in England, Northern Ireland, Scotland and Wales. Across these studies an array of common barriers and more specific challenges emerge as obstacles to electoral participation, which will be discussed in more detail below. Although there is a strong emphasis on documenting barriers, some studies also consider solutions and identify promising practices for boosting civic engagement by electors with disabilities.

3.1  Voter Turnout and Attitudes Toward the Electoral Process

Most empirical research on the voting turnout of electors with disabilities, and how those rates compare with the general voting-age population, has been undertaken in the US over the past 15 to 20 years by a handful of scholars. There are also some studies of voter turnout by people with disabilities in the UK as well as a few of electoral participation in other nations, for instance Canada (McColl 2006). Accordingly, the discussion that follows draws primarily from the research from the US, unless otherwise noted.

Academic works on the topic of attitudes, disability and electoral participation have two orientations. One is to examine the viewpoint of people with disabilities toward their disability, their lives, peer groups, and toward democracy, policy issues and politics more generally. The second focus is on the beliefs and judgments of caregivers and other significant actors like electoral officials toward adults with disabilities. In both cases "attitudes towards capacity are important because they reflect our views on citizenship" (Redley, Hughes and Holland 2010, 341).

3.1.1 The International Experience

In broad terms, research shows that compared with the general population of eligible voters, adults with disabilities are:

  • less likely to be registered to vote, although the extent of the gap may well vary across jurisdictions and elections (Keeley et al. 2008; Redley 2008; US Census Bureau 2011);
  • less likely to vote, even with similar demographic characteristics (Schur and Kruse 2000; Schur et al. 2002);
  • more likely to vote by absentee ballot (Schur et al. 2002, 176);
  • more likely to report some difficulties in getting to the polls, using a ballot and voting (Schur et al. 2002); and
  • under-represented at the polls and have "comparatively low political involvement" (Schur et al. 2002, 168).

In a review of five studies of voter turnout rates among people with disabilities, in three different election years in the US, the turnout rate of electors with a physical or mental disability was 14 to 21 percentage points lower than that of electors without disabilities who otherwise have comparable demographic qualities (Schur et al. 2002; see also Prince 2009).

Within the overall disability population in a jurisdiction or nation, voter turnout rates among electors with disabilities can differ. In their national survey, Schur and associates (2002) found great variation in electoral participation among the 700 people with disabilities they surveyed.4 Specifically, they found that a lower turnout is concentrated among people with disabilities who are not employed, who are age 65 or older, who have difficulty going outside alone, who have a mental impairment that impacts memory and concentration, and who have a recent onset of a significant disability. The relation between age and voting turnout among adults with and without disabilities is worth noting here. Schur and associates found from their analysis that:

While voter turnout rises strongly with age in the general population, it rises only weakly with age in the disability population, and begins decreasing at about age 55. The result is that voter turnout is only slightly depressed among young people with disabilities, and more strongly depressed among older people with disabilities (2002, 172).

In fact, these researchers remark that voter turnout for people with disabilities "drops dramatically" over age 65 (Schur et al. 2002, 180). This finding certainly qualifies the usual view in election studies and in conventional wisdom that voter turnout increases with increases in age.5

Data from the US election in November 2010 reveal the following on reported voting and registration among American citizens by disability status. Among citizens who reported voter registration, the rate was 65.3 percent for those with no disability and 64.1 percent for those with one or more disability. Of those who voted in the 2010 elections, 45.9 percent were citizens with no disability, while 42.8 percent were citizens with a disability. Among those with a disability who voted, the highest turnout rate was by people with hearing difficulties (50.0 percent) and the lowest voter rate (29.6 percent) was by people with cognitive difficulties; that is, individuals with serious trouble concentrating, remembering or making decisions because of a physical, mental or emotional condition (US Census Bureau 2011, Table 6).

Some studies that examine voter turnout provide information on more specific dynamics at play in electoral participation among people with disabilities. Research in the UK reveals that adults with a learning disability are more likely to vote if they live in a private household than in a supported accommodation facility; and are more likely to vote if they live in a place where another adult voted, in other words, "living in close proximity to at least one other active voter" (Redley 2008, 380). United Response, a national charity in the UK for people with learning disabilities, mental health needs and physical disabilities, reports that only 16 percent of the people they support used their vote in the 2005 general election, compared with a national average turnout of 59 percent for the general population. United Response concluded that approximately 500,000 people with learning disabilities who were eligible to vote failed to do so (Sayer 2010; United Response 2010).

An American study of people with spinal cord injuries found that those who were highly politically active among this group were more likely to be married, to have a college or university degree and be currently employed (Schur 1998). A study of patients with dementia who voted in the 2000 US presidential election found that "a substantial portion of patients with mild to moderate dementia voted on their own at a voting booth. Patients cared for by spouses were more likely to vote than patients cared for by adult children" (Karlawish et al. 2002, 1100; see also Henderson and Drachman 2002; Ott, Heindel and Papandonatos 2003). And some of those who voted had severe dementia. On the finding that patients cared for by spouses were more likely to vote than patients cared for by adult children, the researchers suggest that:

Differences in the relationship may explain this finding. A spouse's relationship with the person who has dementia is long-standing and intimate. Moreover, unlike an adult child, spousal caregivers are likely to have fewer commitments to other people such as children and to other tasks such as a job. As a result, they may be more likely to understand their spouse's wishes and have the time to assist him or her in fulfilling those wishes (Karlawish et al. 2002, 1102).

The American study of people with spinal cord injuries by Schur (1998), mentioned above, also examines the psychology of political participation among people who are political activists and non-activists.6 More specifically, the study explores "the connections among political involvement, locus of control, personal efficacy, experiences of stigma and discrimination, and views of disability" (Schur 1998, 4). The study found that among the non-activists, factors discouraging political participation, including the act of voting, were isolation, decreased resources, efforts to "normalize" oneself and be distant from others with disabilities, and a focus on self-help following the spinal cord injury (SCI). In contrast, political activists had "lived with their injuries for a longer time on average" and therefore "had more opportunity to come to terms with SCI, join disability groups, learn about disability issues, and go through a gradual process of politicization" (Schur 1998, 4). Moreover, in part because of this political work:

Activists are more likely to perceive discrimination and stigma and to express a greater sense of political control and efficacy. Their experiences show that social context and circumstances are important in who becomes politically active, indicating that outreach policies of disability organizations can play a larger role in creating conditions that encourage political participation (Schur 1998, 4).

Thus, certain conditions appear to discourage electoral participation, and other conditions support participation. Schur concludes that "while disability adds new constraints [for people who acquire an impairment other than at birth], many people who have never participated in politics could become active if given the opportunity, information, and social context that encourage political engagement" (1998, 26). For many social movements, electoral participation is the leading expression of democratic citizenship and thus, for the disability community, an exemplar of inclusion and social belonging more generally.

A British article on people with learning disabilities and voting participation states that in schools, children with learning disabilities rarely receive civic education and political knowledge on voting and training in "mock" elections, as would other students (Bell, McKay and Phillips 2001).7 The same study observes that "It may also be said by some that people with learning disabilities 'show no interest' in politics. This can also be said of a large section of the population yet we still educate and inform people in general of their right to vote" (Bell, McKay and Phillips 2001, 126). In a similar fashion, an American study points out that "Restrictions on access to the ballot box also send disenfranchised citizens a message about the limited value given to their opinions by the broader society" (Karlawish et al. 2008, 66).

Attitudes toward people with disabilities in general, and more specifically toward an individual with a particular impairment, are widely noted in the literature as a barrier to the registration and participation of electors with disabilities. "The practice of voting by people with learning disabilities may be restricted more by the attitudes of the care staff who may hold the view that those with learning disabilities could not understand the issues, and therefore, should not be allowed to make a choice" (Bell, McKay and Phillips 2001, 126). In the UK, with respect to voting by people with a disability, research on general elections in the 1990s showed "that inaccurate information is often held by hospital staff about the rights and processes of voting for those with mental health problems or learning disabilities" (Bell, McKay and Phillips 2001, 125).

A study of municipal elections in Philadelphia and the participation by residents in nursing homes and assisted living settings revealed that staff in these facilities exercised substantial control over voter rights, registration and access to a polling place by residents aged 65 years or older with cognitive and/or physical disabilities (Karlawish et al. 2008).8 The researchers concluded that "in a city with no guidelines for voting in long-term care, election officials played a limited role, and access to the polls is largely determined by the policies, practices, and attitudes of the long-term care staff, typically social workers or activities directors" (Karlawish et al. 2008, 7374). Another study cautions that the elderly "are also at particular risk of being excluded from voting due to insensitivity by caregivers or electoral officials who may assume incorrectly that elderly voters with disabilities are uninterested in voting or incapable of doing so" (Karlawish and Bonnie 2007, 882).

3.1.2 The Canadian Experience

In one of the few empirical Canadian studies, Mary Ann McColl (2006) compares the electoral participation of disabled people with the population as a whole, using data from the 1997 Canadian Election Survey. Though somewhat dated, this survey is superior to more recent ones, according to McColl, because it included a disability filter question and offered a more representative disabled sample. The survey contacted participants twice, once during the federal election campaign that year, and then a second time, eight weeks after the election. In her report, McColl examines three topics: how disabled people in Canada participate in the electoral process; how they differ from the balance of the electorate on specific issues; and what factors affect their electoral participation.

On how disabled people in Canada participate in the electoral process, McColl's analysis found that those who identified themselves as having a long-term disability or handicap expressed a relatively higher level of intention to vote (82 vs. 76 percent) than the non-disabled comparison group, and then of actually voting in that federal general election (90 vs. 82 percent). It should be noted that all these response rates are well above the actual voting turnout for that federal election. Intriguingly, McColl also found that disabled electors were less satisfied with the working of Canadian democracy. On how disabled electors differ from, or compare with the balance of the electorate on a series of specific issues, it was found that keeping election promises and reducing the federal government's deficit were about equally important to both groups. At the same time, protecting social programs and fighting crime were significantly more important for disabled voters than non-disabled voters. In the words of McColl: "Both these issues suggest that people with disabilities live with a high degree of awareness of their vulnerability in both a private and a public way. They are aware that they are potentially vulnerable in their private lives to victimization at the hands of criminals, and that they are vulnerable in a more public way to changes in the social safety net that would leave them without needed services" (2006, 238).

The third topic McColl examined was factors affecting the electoral participation of citizens with and without disabilities. More specifically, she addressed what reasons people gave for why they had not voted in the 1997 federal election. Perhaps not surprisingly, far more disabled citizens than non-disabled citizens said they failed to vote due to illness (19.4 vs. 4.0 percent). Relatively more disabled citizens also said they did not vote because they did not know who to vote for, compared with non-disabled citizens (16.1 vs. 11.8 percent). On the other hand, for non-disabled citizens, notable reasons given for not voting at that federal election were cynicism about the electoral process or candidates (24.0 vs. 6.5 percent) and being too busy (14.6 vs. 6.5 percent). Among other points, McColl concluded that "there is a role for disability organizations in enhancing the democratic participation of their members, and actualizing the disability vote on important issues" (2006, 238).

The National Youth Survey (Malatest and Associates 2011) commissioned by Elections Canada provides research findings on voting behaviour by Canadian youth aged 18 to 34.9 The study includes information on youth in general as well as profiles on five subgroups, one of which is youth with disabilities.10

In terms of electoral participation since becoming eligible to vote, of the youth in the national sample, about 46 percent said they were habitual voters, while 20 percent were frequent voters, 21 percent were occasional voters and 13 percent were habitual non-voters. Close to three-quarters (74 percent) said they had voted in the May 2011 general election, well above the overall turnout rate of 61.4 percent for voters of all ages. As the survey report indicates, however, "surveys consistently overestimate participation when compared to data on voter turnout" (Malatest 2011, 1). Participation in the 2011 election by youth with disabilities, at 55 percent, was less than the overall voting rate reported in the national random sample. Thus, youth with a disability are less likely to vote than youth without disabilities in Canada.

Factors associated with voting in the 2011 federal election were found to be education, older age, increased motivation, increased political knowledge and what the report calls increased exposure to "political influencers" that is, influence by family members, friends and peers; the media, especially TV; and direct contact with a political party or candidate. Reasons for voting by youth with disabilities included the general attitudes that it is important to vote; it is a civic duty to vote; and it is a person's right. In addition, in terms of an interest in politics, youth with disabilities most likely indicated that they voted in order to support or oppose a political party rather than a specific candidate or certain issues. This pattern of reasons is generally comparable to other youth subgroups.

When compared with the national random sample, in which 70 percent of youth said they were satisfied or very satisfied with the way democracy works in Canada, only 54 percent of youth with disabilities were satisfied or very satisfied. Again, other subgroups, notably Aboriginal and unemployed youth, similarly hold less positive views toward politics and democracy than the overall youth population. Ethno-cultural and rural youth hold relatively more positive attitudes toward politics, close to the national average.

Noteworthy predictors of youth not voting in the general election were low income, lack of interest in the election, and feeling you would not be welcome at the polling station. For youth with disabilities, characteristics of low participation included being less knowledgeable about politics, not receiving a Voter Information Card (VIC), a personal lack of interest in politics and less influence by family. Compared with the national random sample of youth, fewer youth with disabilities (64 vs. 78 percent) said they talked about politics and government at home when growing up. Youth with disabilities, along with Aboriginal youth and unemployed youth, were also most likely among the subgroups, and compared with the national sample, to believe they would feel unwelcome at a polling station. This fits with the less positive view of Canadian politics and democracy held by youth in these subgroups.

3.2 Barriers Faced by Electors with Disabilities

Five types of barriers confront people with disabilities who could or want to vote in elections. By characteristics, these barriers, in no implied order of importance for electors, are architectural and physical; attitudinal and cultural; informational and communication; legal and policy; and those rooted in the socio-economic status of many people living with disabilities. All these barriers can be regarded as societal aspects of exclusions, which have the effect of marking people with disabilities off from other electors, marginalizing them as a social group and rendering many as "absent citizens" (Prince 2009).

Architectural and physical barriers in the built environment remain a topic of concern among academics, disability organizations and electoral commissions (Ward, Baker and Moon 2009). In the May 2010 general election in the UK, visits to over a thousand different polling stations in almost 400 parliamentary constituencies throughout England, Scotland, Wales and Northern Ireland found "that 67 percent of polling stations had one or more significant access barriers to disabled voters. This represents just a 1 percentage point improvement from the last General Election (68 percent) and 2 percentage points from the General Election of 2001 (69 percent)" (Scope 2010a, 8). A theme in the literature is that access barriers vary by type of impairment. As a British politician observes, "While physical access for those of us in wheelchairs has been improving over recent years (I accept it is not yet perfect everywhere), it is still difficult for people with a visual impairment, learning disability or motor limitations" (Scope 2010a, 5).

Attitudinal and cultural barriers refer most frequently to the beliefs, assumptions and actions or inactions of election officials when dealing with people with disabilities (Harrington 1999; Redley, Hughes and Holland 2010; Schriner and Batavia 2001). They relate to what Ward, Blake and Moon (2009, 84) call "the actions or socio-psychological environment provided by polling and election officials and election workers." These academics add, "For this reason, attention has begun to turn to the sorts of problems people with disabilities encounter in their interactions with poll workers and other local election officials" (Ward, Blake and Moon 2009, 80).11

Restrictive attitudes about the voting capacity and rights of people with disabilities as held by family members, caregivers or professional staff in supported living settings has already been noted. The Speaker of the House of Commons in Britain identifies some of the effects of these prejudicial attitudes as follows: "Many [disabled people] are left with a feeling of being disenfranchised because of the various barriers they face in exercising their right to vote. This, together with the under-representation of disabled people in all areas of public and political life, sends a clear message that progress must be accelerated" (Scope 2010a, 4).

Informational and communication barriers include such problems as citizens not knowing where to register to vote or the location of polling places, the instructions that accompany a ballot being "confusing and complicated" and mail-in ballots for postal voting being difficult to mark and fold into the envelopes provided. As a British report observes, these problems derive from the fact that "Our electoral system was not designed with disabled people in mind and in this inherently inaccessible system few alternative ways of casting the ballot are offered" (Scope 2010a, 8). Another topical report in Britain on people with learning disabilities identified three key barriers to the democratic process: the low awareness of the rights of people with learning disabilities to vote; the complexity of the electoral system; and the lack of easy-to-understand information about candidates and party platforms on policies (United Response 2010). Other reports and articles reach similar conclusions in the UK (Bell, McKay and Phillips 2001; Redley 2008) and the US (Harrington 1999; Ward, Baker and Moon 2009). The result produced by such barriers is a form of civic illiteracy (Milner 2002).

Legal and policy-based and procedural barriers are another type of stumbling block electors with disabilities face in democratic nations (Bell, McKay and Phillips 2001; Redley 2008). Current research by disability organizations in Britain finds that:

Whilst legislation [the Mental Capacity Act 2005, and Electoral Administration Act 2006] and guidance have created the impetus for significant improvement, more recent experience shows that the implementation and enforcement of this on the ground falls short. This resulted in many disabled people, in 2010, being unable to cast their vote without assistance and in secret. For some it meant that they were unable to vote at all or could not verify that their vote had been cast and counted (Scope 2010a, 8).

Related to issues of implementation and enforcement is the matter of constrained public budgets for electoral services, stretching staff and reducing the ability to respond in a timely manner to voters' needs (Scope 2010a). Literature in the US examines the legislative measures enacted to promote the equal enfranchisement of adults with disabilities, including national voting rights laws in the 1980s and 1990s, voting accessibility for the elderly and the handicapped in the 1980s, and the Americans with Disabilities Act of 1990 and amended in 2008. The impact of this series of legislation as policy, as summarized by three American scholars, emphasizes difficulties in implementation.

By 2000, the end of a century in which Congress and the Supreme Court had taken decisive measures to curtail voting discrimination because of race, sex and class, the federal government had taken only beginning steps toward eliminating barriers to voting by people with disabilities.

... despite legislation designed to curtail both overt and implicit discrimination against people with disabilities, a number of legislative and policy issues regarding voting have persisted into the early 21st century. In part, some issues remain because disability legislation has not consistently, and affirmatively, addressed voting practices. ... Other issues remain because of the inability or unwillingness of local governments to carry out federal mandates (Ward, Baker and Moon 2009, 8081; see also Schriner and Batavia 2001; Schriner, Ochs and Shields 2000).

Barriers rooted in the socio-economic status of many people living with disabilities refer to economic forms of inequality and disadvantage. These material barriers are demonstrated by the substantially disproportionate rates of unemployment, lower levels of educational attainment, low income and risks of poverty of people with disabilities compared with people without disabilities in all these countries. Persistent and extensive unemployment, widespread dependence on welfare and frequently experienced stigma and social exclusion are serious obstacles to encourage electoral participation. Research in the US indicates that "the voter turnout of employed working-age people with disabilities is almost identical to that of otherwise similar people without disabilities" (Schur et al. 2002, 180).

Another theme related to barriers, but far less examined in the literature, concerns the barriers faced by family members, caregivers or professional staff in supported living settings the difficulties or hindrances they face in supporting individuals with significant disabilities in exercising their democratic citizenship. Joan O'Sullivan (2001) offers some insights in her study of nursing home residents and administrators:

Administrators must follow extensive regulatory guidelines for running the nursing home, and often do not have the time to ensure that residents have the opportunity to vote. Providing good quality care, keeping front line workers fully staffed, and managing the many tasks involved in running a quality nursing home may put voting low on the list of priorities (2001, 345).

What made a difference in the nursing homes and assisted living centres surveyed by O'Sullivan was the initiative of local election officials, and teams of local volunteers, in providing information packets to the administrators with advice on helping residents to vote in an election.12

Two additional issues discussed in the literature on disability and electoral participation deserve brief mention. One issue concerns the question of voting and the mental capacity of people with cognitive impairments and, the wider trend, of "voting by aging citizens who face some level of cognitive impairment or other brain impairment" (Sabatino and Spurgeon 2007, 843). There are numerous articles about voting and people with Alzheimer's disease, people with intellectual or learning disabilities and people with other cognitive impairments, such as multiple sclerosis, strokes, traumatic brain injury, Parkinson's disease and Huntington's disease. Most of these writings come from the US (Appelbaum 2000; Appelbaum, Bonnie and Karlawish 2005; Henderson and Drachman 2002; Hurme and Appelbaum 2007; Karlawish et al. 2002; Karlawish et al. 2004; Karlawish et al. 2008; Ott, Heindel and Papandotos 2003; Schriner and Ochs 2000) and the UK (Bell, McKay and Phillips 2001; Keeley et al. 2008; Redley 2008; Redley, Hughes and Holland 2010; Vorhaus 2005). Some of this work is philosophical in nature; other work focuses on political rights (much is clinical in orientation) and tests assessment tools of electoral capacity by measuring, for example, appreciation and reasoning about voting choices. Karlawish and Bonnie (2007) offer a comparative discussion on Australia, Germany and Canada which is touched on later.

Of the countries reviewed for this report, Australia, New Zealand, the US, and the UK have some form of mental capacity exclusions, although the legal restrictions in the UK were notably eased with the passage of legislation in 2005 (Redley et al. 2010). Canada stands out at the national level as not having explicit legislative restrictions on voting with respect to mental capacity.

Most remarkable is Canada's absence of any exclusion on mental incapacity. Incapacity does not appear to be a controversial issue in Canada, perhaps because those lacking capacity simply tend not to vote, and perhaps because of the greater attention paid to providing information, education, and accessibility services to persons who have cognitive or physical disabilities, persons with limited reading and writing skill, and persons living in transitional situations (Sabatino and Spurgeon 2007, 848).13

Sabatino and Spurgeon, American specialists in law and aging, add that "the Canadian experience may suggest that minimizing, and even eliminating, the exclusion from voting based on incapacity may indeed be a viable option for consideration" (2007, 848).

A second issue concerns the role of disability organizations in political socialization, recruitment and engagement; in this context, in asking persons with disabilities to join a group or political party, to register to vote, to learn about public issues, to volunteer in a campaign, to run as a candidate and to vote in elections (Schriner and Shields 1998; Ward et al. 2009). In her study of people with spinal cord injuries, Schur (1998, 4) showed "that outreach policies of disability organizations can play a large role in creating conditions that encourage political participation." A related article by Schriner and Shields (1998) observes that most disability activism in US has tended to target specific public policy issues and current elected representatives, rather than cultural attitudes about people with disabilities or increasing voter participation. This observation may not be so true today in the way disability activism operates in Canada and perhaps other nations.

Schur and associates (2002) likewise note that disability service agencies and advocacy groups can serve as "recruitment networks" for people with disabilities to become politically aware and active in elections and other forms of democratic citizenship. Ward and others (2009, 82) support the belief "that disability service providers can act as effective advocates for people with disabilities. Such providers are capable of educating election and poll officials and the public and identifying barriers to polling places and supporting efforts to overcome them."

4 To statistically examine disability and voter turnout, the quantitative data for this study come from a nationally representative and random household telephone survey of 1,240 people, following the November 1998 elections in the US. Of the sample surveyed, 540 were people without disabilities and 700 were people with disabilities, an oversample the result of a stratified sample. The authors of this study note that regressions included weights to adjust for the oversampling to ensure that coefficients represented the best estimates of how variables are related to voting in the general population.

5 Data on electoral participation rates in 2004 for Australia, Canada, Germany and the US show "that voting participation in all [these] countries increases with age until about age seventy-five and begins to decline thereafter. In general, political engagement of older voters appears to be a cross-national phenomenon" (Karlawish and Bonnie 2007, 906).

6 This article is distinguished methodologically by the mixture of quantitative and qualitative research methods employed. Schur (1998) explores 64 people with spinal cord injury using in-depth qualitative interviews supplemented with questionnaire data from most of the people interviewed. This is an illustration of an empirically based exploratory study in voting studies. In analyzing the collected data, the study also draws on concepts and theoretical models found in the political science and disability studies literature.

7 The authors of this study are a clinical psychologist, a solicitor and a health care official, all based in the UK. The article cites a few research studies, by others, on the attitudes and knowledge of hospital staff about the voting rights for people with mental health conditions or learning disabilities, following the 1992 general election in the UK. The main purpose of the article, however, is to clarify the authorized and rightful situation of people with learning disabilities who wish to vote. In this regard, drawing on their own professional experience, the authors apply a legal analysis to the topic, examining the legislation, procedures and rules governing elections, paying close attention to the statutory, social, environmental and informational barriers to electoral participation for this group of disabled people.

8 This is among the more rigorous studies reviewed. Of a possible 84 eligible long-term care facilities caring for people 65 years or older in this American city, 51 facilities participated in a telephone survey (61 percent response rate) immediately after the city municipal elections of November 2003. Of the participating facilities, 31 were nursing homes and 20 were assisted living residences; overall, two-thirds were not-for-profit agencies, the others were business enterprises. The survey solicited information on both interviewee and site characteristics. No significant differences were found between the profit and not-for-profit sites. Numeric data were analyzed using summary descriptive statistics and Fisher's exact test of significance for specific associations between variables.

9 The study consisted of a telephone survey of a national random sample of 1,372 youth, with an estimated response rate of 34 percent. An additional 1,293 interviews were done with youth from subgroups recruited through purposive methods. As sampling for the subgroups was not randomly selected, the youth interviewed are not necessarily representative of youth in these subgroups.

10 The other subgroups are Aboriginal youth, ethno-cultural youth, unemployed youth not in school and youth residing in rural areas.

11 This study by Ward and associates (2009) is primarily an overview of literature on issues that affect how people with disabilities vote. Specifically, the article surveys issues of legislation and policy, disability activism, implementation of laws, court decisions, electronic voting methods, and data on voters with disabilities in the US

12 O'Sullivan (2001) surveyed long-term care facilities in two jurisdictions in the American state of Maryland. In each jurisdiction, 42 residents were interviewed; each interview lasted about 10 minutes. Those chosen for interviews could make their own health decisions and were not under guardianship. Also, interviews were held with staff at the nursing homes who administer elections. One of the jurisdictions used the Board of Elections procedure and the other did not. Nursing homes selected included those in poorer neighbourhoods as well as in upscale areas. The article provides information on the socio-economic status of the respondents as well as the interview questions used. While descriptive statistics are reported, there is no elaborate quantitative analysis of the data. The article does include a review of federal laws and policies, and case law, in regards to the right to vote by Americans with disabilities.

13 While this may be true, it should not be ignored that before 1992 the Canada Elections Act was preventing those with a mental disability to vote. The Act was amended further due to court cases based on the Charter and following recommendations from the Royal Commission on Electoral Reform and Party Financing.