Introduction

Disability is a complex, multidimensional, dynamic, and contested issue.1 According to the World Health Organization (WHO) and the United Nations Convention on the Rights of Persons with Disabilities (CRPD), disability results from the interaction between individuals with a health condition that causes physical, mental, intellectual or sensory impairments and personal and environmental factors such as negative attitudes, inaccessible transportation and buildings, and limited social support, thus hindering their full and effective participation in society on an equal basis with those without disabilities.2-4

In line with the above, the International Classification of Functioning, Disability and Health (ICF) also defines disability as an interaction between individuals suffering from health conditions that affect bodily functions and structures (in terms of impairment), the performance of activities (in terms of limitation), participation in society (in terms of restriction), and environmental and personal factors.5

Health conditions that may result in disability are varied and heterogeneous, and may be temporary, episodic, chronic, or progressive. Furthermore, the concept of disability cannot be described simply using the dichotomy of normal/abnormal, as it encompasses a continuum of limitations ranging from minor functional restrictions to complete dependence to perform all activities of daily living.6 Therefore, disability transcends individual health, as it involves relationships with the family and society in general.7,8

On the other hand, persons with disabilities (PWDs) have historically been segregated and marginalized based on the paradigms of normalcy,9,10 thus contributing to a systematic violation of their rights, their infantilization, and limitations on their access to education, work, and recreational activities.11-13

According to the WHO, as of 2023, 1.3 billion people had a significant disability (i.e., 16% of the world’s population),2 and some PWDs may have a life expectancy that is 20 years shorter than that of non-disabled individuals.2,14 Disability figures in the United States and Europe are similar, as it has been established in both territories that 1 in 4 adults (27%) have some form of disability.15,16

In Latin America and the Caribbean, according to the World Bank, there were at least 85 million PWDs in 2021.17 However, some countries in the region have recent data on the number of PWDs in their territories. For example, in Argentina, according to the National Study on the Profile of Persons with Disabilities, there were 3 571 983 people (10.2% of the total population) with some form of disability in 2018;18 in Brazil, based on the 2019 National Health Survey, it was estimated that 17.3 million people (8.4% of the population) had at least one disability;19 in Mexico, according to the 2020 Housing Population Census, 6.2 million people (4.9% of the population) had some disability;20 and in Colombia, according to the Localization and Characterization of Persons with Disabilities Registry, 1.3 million people (2.6% of the population) have some kind of disability.21

Given this scenario, it is clear that the proper identification and characterization of PWDs and the issuance of disability certificates or similar disability acknowledgement documents are fundamental aspects for political, social, health, and cultural decision making. Nevertheless, there are still gaps in knowledge on this subject and differences between countries regarding the processes of identification, characterization, and acknowledgement of this population, as well as in the issuance of disability certificates and their utilization.

Consequently, the objective of this scoping review was to analyze the information available in the literature about the disability certification process, whether it is referred to as certificate, recognition, credential, or any other homologous document. We also aimed to identify the different names of this document around the world, as well as the variations in the disability certification process (approval and issuance of the document) and the uses/benefits it offers.

Materials and methods

Design

A scoping review was conducted since this type of study allows answering multiple research questions through a broad set of information sources.22 This research was developed following the Joanna Briggs Institute Manual23,24 and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).25 In general terms, we took the following steps to perform a proper scope review:26 1) delimiting one or several research questions; 2) preliminarily identification of the literature; 3) selecting, 4) mapping, 5) synthesizing the studies and data, and 6) development of an iterative process of inquiry with experts. In addition, as a good practice point, the review protocol was registered in OSF (DOI code: 10.17605/OSF.IO/AHRB7).27

Research questions

A.What is understood by disability certificate or equivalent document (definition and legal framework)?

B.What is the definition of disability being used?

C.What is the current process, steps, or methodology for obtaining a disability certificate or equivalent document (instruments)?

D.Who issues the disability certificate or equivalent document?

E.What are the uses/benefits of obtaining a disability certificate or equivalent document (benefits or subsidies)?

Study selection criteria

The population, concept, and context (PCC) strategy was used in accordance with the Joanna Briggs Institute guidelines.23,24

Population/participants: general population. All individuals and groups.

Concept: process (mechanisms, steps, procedures, or similar actions) for the approval and issuance of the disability certificate or equivalent document.

Context: a differential context was considered based on the need to obtain more in-depth information on Latin American countries and/or countries belonging to the Organization for Economic Cooperation and Development (OECD).28

Study types

The following study types were considered eligible: epidemiological studies, implementation guidelines for disability certification processes/procedures, methodological documents, manuals, technical annexes, regulations (laws, resolutions, etc.), official reports, reflections, and qualitative studies.

Search strategy

Database searches

On August 21, 2023, an advanced search was conducted in Medline (PubMed), EMBASE, SCOPUS, LILACS (VHL regional portal) and Web of Science using the following search strategy: language of publication: English, Spanish, and Portuguese; period of publication: from December 13, 2006 (publication of the CRPD)3 to August 21, 2023; search terms and equations: “disability” OR “handicap” for disability and “accreditation” OR “credential” OR “card” OR “recognition” OR “certificate” for the certification process.

Additional searches were also performed in Google Scholar (first 5 pages) and in gray literature sources such as Open Grey. The search algorithms and results are available in Annex 1.

Searches in regulatory agencies and international entities

As described in the “Context” subsection, additional searches were carried out on the websites of government agencies and institutions and international entities of the OECD member countries (Canada, Chile, Colombia, Costa Rica, United States, Mexico, Korea, Israel, Japan, Germany, Belgium, Denmark, Spain, France, Italy, Netherlands, Portugal, United Kingdom, Sweden, Australia and New Zealand) and of the other non-OECD Latin American countries (Argentina, Bolivia, Brazil, Cuba, Ecuador, El Salvador, Guatemala, Honduras, Panama, Paraguay, Peru, Uruguay, and Venezuela). The search algorithms and results by differential context can be found in Annex 2.

Selection of studies and documents

Once duplicates were eliminated, two reviewers (JMC and LFI) independently evaluated and selected potentially relevant studies for the review based on the title and abstract. Subsequently, and after reading the full text, compliance with the selection criteria was verified. Disagreements between the two reviewers regarding the inclusion of articles were discussed and resolved by the other investigators. The study selection process was carried out using the Rayyan QCRI software.29 As for the selection derived from the searches on the web pages of institutional agencies, the same two reviewers independently selected the web pages or documents and the reports or technical annexes that, according to their title, they considered might have relevant information for review purposes; disagreements on the selection of these documents were resolved by consensus.

Bias risk assessment

Due to the exhaustive and complex nature of scoping reviews and understanding that their objective is to present the largest amount of information in order to comprehensively understand a topic, risk of bias assessment is not mandatory for this type of review, so it was omitted.22-24,26

Data extraction

Data extraction was performed independently by three researchers (JMC, LFI, and JMAS): the first two were in charge of directly extracting the results and the third of cross-checking the data. The following information was extracted for each study or document: authors, year, country, study design or document type, sample, language, definition of disability, name of the disability certificate or equivalent document, characteristics of the disability certificate or equivalent document and of the approval and issuance process, entities involved in the approval and issuance of the certificate, and benefits of the disability certificate or equivalent document. Information was entered into and organized in a predesigned form in Microsoft Excel.

Data synthesis/presentation

The results are presented in a descriptive-narrative manner with a meta-aggregate approach to the information. Descriptive-quantitative level was analyzed using the R software version 4.2.3.30

Results

Results of searches in databases and other sources of gray literature

The search and study selection process is presented in Figure 1. The searches yielded 23 612 records; once duplicates were removed, 10 585 were screened after reading the title and abstract, and 10 262 of them were excluded because they were not relevant to the objective of the study. Of 323 studies that were fully read, 46 were finally included in the review. The general characteristics of the selected studies are presented in Table 1.

Figure 1. Flowchart describing the search and selection process for studies and documents.OECD: Organization for Economic Cooperation and Development.

Table 1. General characteristics of the included studies.

#	Authors - Year of publication	Country	Study design	Population	Language
1	Robins et al. 200631	India	Cross-sectional	233 individuals with disabilities	English
2	Conti-Becker et al. 200732	Canada	Mixed methods	104 disability concepts	English
3	Saloojee et al. 200733	South Africa	Cross-sectional	156 children with disabilities	English
4	Pastrán-Alfonso et al. 200834	Colombia	Cross-sectional	253 individuals with disabilities	Spanish
5	Ghosh et al. 200835	India	Cross-sectional	155 visually impaired individuals	English
6	Martínez 200836	Colombia	Cross-sectional	173 587 records of population with disabilities	Spanish
7	Vicente-Herrero et al. 201037	Spain	Reflection	Not applicable	Spanish
8	Di Nubila et al. 201138	Brazil	Reflection	Not applicable	English
9	Kareemsab et al. 201139	India	Cross-sectional	272 individuals with disabilities	English
10	Kashyap et al. 201240	India	Cross-sectional	1 794 mentally retarded individuals and 285 mentally ill individuals	English
11	Kausto et al. 201241	Finland	Cohort	1 047 subjects on partial sick leave (treatment group) and 28,380 subjects on full sick leave (control group).	English
12	Mishra et al. 201242	India	Reflection	Not applicable	English
13	Balhara et al. 201343	India	Cross-sectional	169 individuals with disabilities	English
14	Cortés-Reyes et al. 201344	Colombia	Reflection	Not applicable	Spanish
15	Franzoi et al. 201345	Brazil	Qualitative	25 focus groups, 214 individuals with impairments	Portuguese
16	Guzmán-Suárez 201346	Colombia	Reflection	Not applicable	Spanish
17	Leahy et al. 201347	United States	Cross-sectional	394 certified rehabilitation counselors	English
18	Moreno-Angarita et al. 201348	Colombia	Mixed methods	44 documents and 168 representatives with disabilities	Spanish
19	Bourkiza et al. 201449	United Kingdom	Cohort	Cohort 1: 78 patients with certifiable vision. Cohort 2: 24 patients with no perception of light	English
20	Laaksonen et al. 201450	Finland	Cross-sectional	502 819 randomly selected individuals (representing 20% of the Finnish population aged 25-62), of whom 22 130 retired due to disability.	English
21	Raggi et al. 201451	Italy	Cross-sectional	552 adults applying for disability certification	English
22	Ministerio de Salud del Peru 201652	Peru	Standard / Law	Not applicable	Spanish
23	Bandyopadhya et al. 201853	India	Cross-sectional	2 472 eyes of 1 236 patients with visual impairment	English
24	Van Dijck 201854	Multiple countries	Reflection	Not applicable	English
25	Ambastha et al. 201955	India	Cross-sectional	203 people who applied for a blindness certificate	English
26	Bahk et al. 201956	South Korea	Cross-sectional	33 221 916 individuals with disabilities	English
27	Banks et al. 201957	Nepal	Mixed methods	Quantitative study: 418 individuals (209 cases and 209 controls). Qualitative study: 35 individuals with disabilities	English
28	Basavarajapapa & Angothu 201958	Multiple countries	Narrative review	8 countries	English
29	Balakrishnan et al. 201959	India	Reflection	Not applicable	English
30	Mont et al. 201960	Multiple countries	Reflection	Not applicable	English
31	Puga et al. 201961	Argentina	Cohort	726 patients under 18 years of age who applied for the Unique Certificate of Disability	English
32	Puri et al. 201962	India	Reflection	Not applicable	English
33	Nagarajan et al. 202063	India	Cohort	258 disability certificates	English
34	Mishra & Sharma 202064	India	Cross-sectional	Not applicable	English
35	Jadhav et al. 202165	India	Cross-sectional	2 376 individuals with disabilities	English
36	Jadhav et al. 202166	India	Cross-sectional	516 individuals with disabilities	English
37	Kaiser et al. 202167	Germany	Reflection	Not applicable	English
38	Kishore et al. 202168	India	Cross-sectional	Not applicable	English
39	Sen et al. 202169	India	Cross-sectional	356 individuals with disabilities	English
40	Vasudeva et al. 202170	India	Reflection	Not applicable	English
41	Dhabarde et al. 202271	India	Cross-sectional	600 individuals with disabilities	English
42	Ministerio de Salud del Peru72	Peru	Standard / Law	Not applicable	Spanish
43	Nieradko-Iwanicka et al. 202273	Poland	Cross-sectional	76 581 disability certificates	English
44	Schiariti 202274	Argentina	Editorial	Not applicable	Spanish
45	Subramanyam et al. 202275	India	Cross-sectional	Not applicable	English
46	Prassana et al. 202376	India	Mixed methods	200 individuals with mental illnesses	English

General characteristics of the selected studies

Most studies were conducted and/or published in India (n=20, 43.47%); the remainder were published in Colombia (n=5, 10.86%), multiple countries (n=3, 6.52%), Argentina, Brazil, Finland, Peru (each with 2; 17.36%), Germany, Canada, South Korea, Spain, United States, Italy, Nepal, Poland, United Kingdom, and South Africa (each with 1; 21.79%). The most common publication year was 2019 with 8 studies (17.39%), followed by 2013 and 2021 with 6 studies each (13.04%).

With respect to how the studies refer to PWDs, we identified the use of terms such as “persons with disabilities” (n=20, 43.47%), “adults with disabilities” (n=4, 8.69%) or “persons with impairments” (n=2, 4. 34%), as well as specific designations such as “persons with mental disabilities” (n=9, 19.56%), “persons with visual impairment” (n=7, 15.21%), “children and/or youth with disabilities” (n=2, 4.34%), “limited person” (n=1, 2.17%), and “person with a handicap” (n=1, 2.17%).

In terms of study types, cross-sectional studies were the most frequent (n=22, 47.82%), followed by reflection articles (n=11, 23.91%), cohort studies, and mixed methods studies (each with 4; 17.39%).

Results of searches on government agencies and institutions’ websites

Figure 1 illustrates the document search and selection process. The searches were carried out on the web pages of international organizations and institutional agencies of the OECD member countries and the Latin American countries mentioned in the methodology section (n=34). However, initial searches did not detect data for 12 countries, namely Belgium, Denmark, the Netherlands, Sweden, Australia, New Zealand, Cuba, El Salvador, Guatemala, Honduras, Panama, and Paraguay.

As for the searches in the agencies of the remaining countries, 1 526 records were identified, which were screened based on title, abstracts, or information report. Subsequently, 27 records were selected for full-text reading, and 25 references were finally included.

Countries reporting information available through agencies and institutional entities were Argentina, Bolivia, Brazil, Canada, Colombia, Costa Rica, Ecuador, Germany, Israel, Italy, Japan, Mexico, Peru, Portugal, South Korea, Spain, United Kingdom, United States, and Venezuela, each with one document, and Chile, France and Uruguay with two documents each.

Certification of disability

Concerning the certification of disability, given that this certificate or homologous documents can be considered at the international level as a recognition of PWDs, an overview of the evidence collected in the present scoping review is reported by country. This includes information extracted from studies retrieved from database searches and sources of gray literature (Table 1), as well as from documents obtained from searches on the websites of agencies and institutional organizations of OECD member countries and other non-member Latin American countries.

The main characteristics of the disability certificate or homologous documents (designation, characteristics, benefits) in the various countries with information on this topic on government agency and institution websites are presented in Table 2.

Table 2. Data on disability certificate or similar documents by country.

#	Country	Institution involved	Name	Characteristics of the certificate	Uses/benefits	References (Including studies and agency reports)
1	Argentina	Agencia Nacional de Discapacidad (National Disability Agency)	Certificado Único de Discapacidad - CUD (Unique Certificate of Disability)	- Paper and digital (must be registered in the Mi Argentina platform)	- Free rides, discount on car purchases, and preferential parking use - Family allowance (basic benefit system) - Tax discount	61,74,77
2	Germany	Social Welfare Office	Identification card for persons with severe disabilities	- It determines the degree of disability - The issuance process starts at the Supply or Citizenship Office - It enables the issuance of the European Disability Card	- Free rides on public transportation - Tax discount	67,78
3	Bolivia	Servicio Departamental de Salud - SEDES (Departmental Health Service) Comité Departamental de la Persona con Discapacidad – Conalpedis (Departmental Committee for Persons with Disabilities)	Disability card	An updated medical report is required to verify the type of disability - A layout of the place of residence is required	- Free medical care - Commutes with discount (50%) on public transportation - Admission to the Public University Program	79
4	Brazil	Instituto Nacional de Seguro Social (National Institute of Social Security)	Certificate of person with disability	- Service for the issuance of the document certifying the disability - Identification and health documents required	- Monthly pension payment - Reduced fares on public transportation	38,45,80
5	Canada	Canada Revenue Agency – CRA	Disability tax credit - DTC *	- Persons with a severe and prolonged physical or intellectual impairment may apply for a disability benefit	- Tax discount - Annual tax reduction for vehicle purchases	32,81
6	Chile	National Service for Persons with Disabilities / Ministry of Social Development and Family Services (Servicio Nacional de la Discapacidad / Ministerio de Desarrollo Social y familia)	Disability credential	- There are 3 steps: 1) functional biomedical report, 2) social and support network report, and 3) community performance assessment report - Registration in the National Registry of Disability is required	- Priority access to health services - Admission to labor inclusion programs - Housing subsidies - Vehicle restriction exemption - Tax discount	82,83
7	Colombia	Departmental or district health departments	Certificate of disability	- Three components are evaluated: 1) body structure deficits, 2) limitations in activities, and 3) restrictions related to participation - The person is registered in the Localization and Characterization of Persons with Disabilities Registry (RLCPD for its Spanish acronym)	- Access to the Care System’s services - Priority medical care - Health Service fee waiver - Family allowance	34,36,44,46,48,84
8	South Korea	National Pension Service office	Disability registration card	- Assessment by a medical specialist required - The National Pension Service office reviews the application - Results are delivered to the local community center	- Discounts at local stores - Preferential service (e.g. banks) - Priority medical care	56,85
9	Costa Rica	National Council for Persons with Disabilities (Concejo Nacional de Personas con Discapacidad)	Certificate of disability	Requirements: - Application duly completed (signed or stamped by the applicant or by their caregiver or legal guardian) - Medical certificate, certificate or discharge summary issued by the Costa Rican Social Security Fund or the National Insurance Institute with an issue date no older than one year. -Copy of the identity document (of the applicant or their legal guardian)	- Unrestricted car use - Preferential use of parking lots - Admission to labor inclusion programs	86
10	Ecuador	Ministry of Public Health	Certificate of disability	Three modalities: - Certificate of qualification or requalification of persons with disabilities at the health care facility - Certificate of qualification or requalification at home of persons with disability - Certificate to persons with impairments or temporary disabling conditions	- Tax discount - Basic utilities payment discount (e.g. water supply) - Discount (50%) for access to theaters, cinemas, and circuses - Commute with discount (50%) on public transport	87
11	Spain	Ministry of Social Rights, Consumer Affairs, and 2030 Agenda / Regional Ministry of Social Affairs (Ministerio de Derechos Sociales, Consumo y Agenda 2030 / Consejería de Asuntos Sociales)	Certificate of disability	- Official document certifying the legal status of the person with a disability	- Admission to labor inclusion programs - Early retirement - Access to educational resources and support - Tax discount	37,88
12	United States	Social Security Administration (SSA)	Disability determination *	- Applicant’s medical records are required and processed in accordance with each state’s regulations	- Access to Supplemental Security Income (family allowance)	47,89
13	France	Departmental Centres for Disabled People	Mobility inclusion card	- There are 3 types of cards: parking lot, priority, and invalidity - Cards are granted for a permanent disability rate ≥80% and if the person is disabled by 3rd category (receives disability pension)	- Priority medical care - Tax discount - Reduced fares on public transportation	90,91
14	Israel	Commission for Equal Rights of Persons with Disabilities	Certificate of disability	- The certificate bears the name and identification number of the disabled person, without a photograph. - It has a digital version	- Family allowance - Priority medical care - Special service assignment (e.g. caregivers)	92
15	Italy	National Social Security Institute	Civil disability and health assessment	- The service makes it possible to verify all the necessary requirements for the acknowledgement of legal disability, legal blindness, deafness, invalidity, and disability - An entry medical certificate is required	- Family allowance - Tax discount	51,93
16	Japan	Ministry of Health, Labor, and Welfare	Certificate of disability	Including: a physical disability certificate, a rehabilitation notebook, and a mental disability health and wellness notebook	- Family allowance - Tax discount - Reduced fares on public transportation	94
17	Mexico	Sistema Nacional para el Desarrollo Integral de la Familia (National System for the Comprehensive Development of Families)	National Credential for Persons with Disabilities	Requirements: - Birth certificate - Permanent disability certificate - Current proof of address - Unique Population Registry Code (CURP by its Spanish acronym)	- Reduced fares on public transportation - Discounts for sporting and tourist activities - Priority access to educational programs	95
18	Peru	Ministerio de Salud / Consejo Nacional para la Integración de la Persona con Discapacidad (CONADIS) (Ministry of Health / National Council for the Integration of Persons with Disabilities (CONADIS))	- Certificate of disability - Disability card	- Application to the health care institution certifying the disability - A physical examination and complementary tests must be performed.	- Admission to labor inclusion programs - Early retirement - Reduced fares on public transportation - Discounts for sporting and tourist activities	52,72,96
19	Portugal	National Health Service	Multipurpose Medical Certificate of Disability	- Intended for persons with a disability or with a severe clinical condition. - Issued based on the National Table of Disabilities	- Tax discount - Health service fee waiver	97
20	United Kingdom	Local City Hall	- Registration Card - Voluntary registrations	- Identification documents required - Medical certificate required	- Family allowance - Admission to labor inclusion programs	49,98
21	Uruguay	Secretaría Nacional de Cuidados y Discapacidad (National Care and Disability Department)	National Registry of Persons with Disabilities	- intended for persons 15 years of age and older - Health record required - Specific information on visual, motor, intellectual, auditory, visceral, and psychosocial health required	- Admission to labor inclusion programs - Reduced fares on public transportation - Tax discount	99,100
22	Venezuela	National Council for Persons with Disabilities (Concejo Nacional de Personas con Discapacidad - CONAPDIS)	- Certificate of disability - Disability card	- Individual assessment carried out for the purpose of identifying the condition, type, kind, degree, and characteristics of the disability - The process begins in the municipalities and then moves to central institutions in charge of evaluating and issuing the certificate	- Tax discount - Priority access to educational programs - Admission to labor inclusion programs - Preferential service in public and private establishments	101

* Not a certificate but implies recognition.

Definitions of disability found

In general, it was found that 19 of the 22 countries for which information was available cited the definition of disability provided by the WHO, which characterizes it as a complex, dynamic, multidimensional, and contested concept.14 The term also encompasses multiple impairments, activity limitations and participation restrictions, related health conditions, and environmental factors.102 This statement is in line with the definitions of the CRPD and the ICF and establishes that disability results from the interaction between persons with impairments and the barriers (attitudinal and environmental) that hinder their full and effective participation in society on an equal basis with persons without disabilities.3,5

Name and characteristics of the disability certificate or homologous documents

Regarding the name given to the document that certifies and/or recognizes the disability, it was found that the most commonly used term in the 22 countries where information was found was “disability certificate” (n=13, 59.09%), followed by card/registration/credential (n=9, 40.90%). There were also accompanying or adjoining terms used in some countries, namely: Care Dependency Grant, Disability Grant, Multipurpose Disability Medical Attestation, Legal Disability and Health Assessment, Medical Certificate, Disability Determination, and Disability Tax Credit (n=8; 36.36%) (Table 2).

Process of evaluation, issuance, and registration of disability certification or similar documents

Concerning the approval of the certification of disability, in 21 (95.45%) of the 22 countries where documents on this matter are available, this process is based on the evidence of a medical diagnosis, which includes, according to the established protocol, the review of medical records or the assessment of the individual by a medical board. Moreover, in all countries, in order to issue this document and as the first step of the process, the PWDs must have a valid identity document; for minors, the legal guardian/caregiver’s valid identity document must also be presented.

Competent authorities in charge of the process

According to the documents reviewed, the issuance and registration of disability certificates or similar documents in the different countries are the responsibility of public institutions such as ministries and state agencies (Table 2). With respect to the disability assessment, this process is carried out by interdisciplinary health boards, teams or commissions made up mainly of physicians specialized in physical medicine and rehabilitation or disability, psychiatrists, speech therapists, physical therapists, psychologists, and occupational therapists; in addition, in some countries (Peru, Argentina, Canada, Chile, Colombia, Spain, France, Venezuela) audiologists, nurses, optometrists, lawyers, and social workers often take part in these boards as well.72,77,81,82,84,88,91,101

Uses/benefits of a disability certificate or similar documents

The most frequently identified uses or benefits of the disability certificate or homologous documents in the 22 countries where information was found were tax discounts (semi-annual or annual depending on the country) (n=11, 50%), discounts on public transportation fares via tickets or direct fare discounts (n=8, 36. 36%), access to labor inclusion programs (e.g. employment exchange or jobs with activity modifications) (n=7, 31.81%), and family allowances and priority/differential access to health care services (n=6, 27.27%, each) (Table 2).

Discussion

The approval and issuance process for the disability certificate or similar documents, as well as their effective use to access different programs, services or benefits, prompts the analysis of the articulation of disability certification with multiple aspects such as the recognition of disability and PWDs, economic situation, employability or employment situation, and social protection mechanisms, access to health and rehabilitation services.

Recognition of disability and PWDs

Our study identified two relevant issues to discuss on this topic. First, most studies and agencies cite the definition of disability proposed by the WHO, the CRPD and the ICF,3,5 clearly outlining the interaction between persons with disabilities and barriers (attitudinal and environmental) that hinder their full and effective participation in society on an equal footing with those without disabilities. It should be noted that these interactions (related to social, geopolitical, health, governmental structures, population models, among others) may have contributed to missing or incomplete information in this review, which provides an opportunity for further study or in-depth analysis.

The second issue concerns the disability certificate or similar documents, as it is evident that their issuance is based on the recognition of the condition and on a series of processes that are not only administrative, but also social in nature. With respect to the 22 Latin American or OECD member countries with information available on government agency websites, the disability certificate was the most frequently used term to refer to this document (59.09%), followed by common and/or similar terms such as card/registration/credential. Other terms used were more related to the determination of a state of health or dependency and the need for an economic subsidy, such as “Dependency Grant” or “Disability Grant”. These results seem to be in line with the international literature, which describes these documents or forms of identification as a response to the invisibility and violation of rights to which this population has traditionally been subjected.103,104

The need for a disability certificate as it relates to economic status

The relationship between poverty and disability has been described above.105 This report highlights how disability perpetuates the cycle of poverty, that is, it replicates generational transgression and the difficulties/barriers that maintain this socioeconomic condition, such as low employability, low levels of education, difficult access to health services, among others.34,105-107

While the results of our study do not show the impact of the disability certificate on poverty levels among PWDs, they do show how this document is used to try to solve some socioeconomic barriers encountered by this population, such as tax and public transportation discounts and the provision of economic subsidies. This undoubtedly reinforces the relationship of this document with socioeconomic aspects that must be addressed; in this sense, further studies should discuss the real impact of these and other benefits on the population and, of course, on overcoming poverty.

Certification of disability and employability or employment status

As mentioned above, it is well known that PWDs have lower employability rates, which is the result of deeper gaps such as limitations in access to education, social imaginary, or limitations in transportation in cities that are not prepared for this population to move around and live in.108,109 In this regard, another benefit of the disability certificate identified in this review is related to access to labor inclusion programs that allow PWDs to participate in employment exchanges that provide jobs with accommodations (e.g., flexible schedules) or jobs with specific activities (e.g., focused on personal skills).

The disability certificate in relation to social protection, health, and rehabilitation

The results of this review reveal an articulation between the state, its institutions, health personnel, and stakeholders on two levels: 1) identification documents as the first step to obtain a disability certificate and documentation related to health status, including a diagnostic process and medical care as starting points for proper certification, and 2) the inclusion of authorities and health professionals as guarantors of the certification process, assessing aspects as diverse as cognitive abilities, the body, occupation, context-environment, social activities, among others.

Multiple policies, programs, interventions and actions have been developed worldwide with the aim of encouraging the participation of PWDs in the labor market110-112 since this population is at greater risk of multidimensional poverty, malnutrition, comorbidities, and even mortality compared to people without any form of disability.102

Future prospects

Reflecting on the disability certificate or similar documents

Disability certification processes are dynamic tools that allow, first, to identify and assess impairments and, second, to recognize barriers that result in restrictions to the participation of PWDs in various social and economic activities. Currently, these processes are the subject of debate in different sectors of society, as they make us reflect on the need or not of certification mechanisms and lead us to ask questions such as: what are the reasons for requesting a disability certificate? or, if we had universal and not targeted policies, would there be a need to generate disability certificates?

These questions can be partially solved by understanding that the disability landscape is still poorly understood; however, given that it is necessary to consider the protection of so-called “vulnerable” groups, we strongly believe in the need to escalate the debate to a global level and propose common global strategies for the recognition of PWDs.

Access to the disability certificate and its uses/benefits

The disability certificate has become a legitimate and practical tool that, once granted, makes it easier for PWDs to demand their rights and access services/benefits, but also allows the State to identify the individual needs of these people and refer them to the most appropriate inclusion programs. The problem is that, based on the results of the present review, some questions arise, such as: how much the population with disabilities and their families know about this certificate; what they think about its uses/benefits; and whether they are aware of the steps to access it.

In this sense, it is necessary to reflect on the most effective, current and future mechanisms for certifying disability and accessing the certification process. Thus, forthcoming studies should reflect on what the most effective mechanisms are for certifying disability and increasing access to such a process, and how to expand and improve the benefits offered by such a document. Moreover, from the administrative point of view, the installed capacity, available human resources, and the logistical and economic needs of the agencies or institutions in charge of the certification process must be analyzed.

As a research group, we believe that future studies should not only focus on PWDs without a disability certificate, but also on those who already have the document, addressing aspects such as the meaning of such dynamics for them and the real impact of having this document on the living conditions of individuals, families, and communities.

Finally, according to the evidence gathered, it is possible to state that the disability certification process faces multiple challenges in the 22 OECD and Latin American countries for which information was found.

Strengths and limitations

The main strength of this scope review lies in the possibility of addressing a topic of current importance such as disability by focusing on the disability certification process and the disability certificate, a document that, in addition to recognizing the disability, allows PWDs to access different benefits. For this purpose, a set of documents and information on the disability certificate or homologous documents from an international perspective (OECD member countries and other Latin American countries) was compiled. It also highlights the application of a rigorous and systematic search methodology that made it possible to identify documents that reflect the current situation of the disability certification process. The search for information was also conducted on the websites of government agencies and institutions in these countries, allowing us to obtain a broader and more comprehensive overview of this issue in those countries.

On the other hand, the main limitation of this study is related to the broad scope of the topic addressed and, therefore, its presentation, since, due to the descriptive approach with a specific level of synthesis, several aspects that we would have liked to discuss in depth were omitted. Moreover, despite our efforts to cover various databases and governmental entities, it is likely that additional information or documents exist beyond those presented in this review, attributable to the vast gray literature, linguistic limitations, and the precision of search engines.

Another limitation is related to the quality of the studies and information collected, since no evaluation of quality or evidence was performed in this review. On this point, it should be borne in mind that even though scoping reviews, due to their nature, should not assess quality, it is necessary to interpret the results presented here with caution.

Conclusions

This scoping review identified documents and thematic information from various sources on disability certification or similar documents. In the 22 OECD and Latin American countries for which documents on disability certification were found, this process is based on the globally accepted concept of disability, is regulated by government agencies, and in most cases is based on a medical diagnosis (medical history review or evaluation by a medical board). In addition, the issuance and granting of this document results in access to multiple individual and social benefits. Finally, it is necessary that further studies address the coverage, impact, and social relevance of this document.

Conflicts of interest

None stated by the authors.

Funding

This research was funded under the research services contract - Invitation 007-2023 between the Corporación para el Desarrollo de la Seguridad Social (CODESS) and the Universidad Nacional de Colombia.

Acknowledgments

None stated by the authors.

References

1.Samuel R, Jacob KS. Empowering People with Disabilities. Indian J Psychol Med. 2018;40(4):381-4. https://doi.org/nxb3.

2.World Health Organization (WHO). Disability [Internet]. Geneva: WHO; 2024 [cited 2024 Dec 22]. Available from: https://bit.ly/4gNdcmC.

3.United Nations (UN). Convention on the Rights of Persons with Disabilities [Internet]. New York: UN; 2006 [cited 2024 Dec 22]. Available from: https://bit.ly/4hawliP.

4.Madans JH, Loeb ME, Altman BM. Measuring disability and monitoring the UN Convention on the Rights of Persons with Disabilities: the work of the Washington Group on Disability Statistics. BMC Public Health. 2011;11(Suppl 4):S4. https://doi.org/cgrtcq.

5.World Health Organization (WHO). International Classification of Functioning, Disability and Health (ICF) [Internet]. Geneva: WHO; 2001 [cited 2024 Dec 22]. Available from: https://bit.ly/3PcWUYt.

6.O’Young B, Gosney J, Ahn C. The concept and epidemiology of disability. Phys Med Rehabil Clin. 2019;30(4):697-707. https://doi.org/nxb4.

7.Peñas Felizzola OL. Referentes conceptuales para la comprensión de la discapacidad. Rev. Fac. Med. 2013;61(2):202-12.

8.Lalvani P. Disability, Stigma and Otherness: Perspectives of Parents and Teachers. Int J Disabil Dev Educ. 2015;62(4):379-93. https://doi.org/f8tm.

9.Milner P, Kelly B. Community participation and inclusion: People with disabilities defining their place. Disability & Society. 2009;24(1):47-62. https://doi.org/bbg8gh.

10.Thompson JR, Wehmeyer ML, Shogren KA, Seo H. The Supports Paradigm and Intellectual and Developmental Disabilities. In: Shogren KA, Wehmeyer ML, Singh NN, editors. Handbook of Positive Psychology in Intellectual and Developmental Disabilities. Cham: Springer International Publishing; 2017. https://doi.org/nxb6.

11.Robey KL, Beckley L, Kirschner M. Implicit infantilizing attitudes about disability. J Dev Phys Disabil. 2006;18:441-53. https://doi.org/dm3mrr.

12.Schur L, Han K, Kim A, Ameri M, Blanck P, Kruse D. Disability at Work: A Look Back and Forward. J Occup Rehabil. 2017; 27(4):482-97. https://doi.org/nxb9.

13.Aron L, Loprest P. Disability and the Education System. Futur Child. 2012;22(1):97-122. https://doi.org/f3xdz2.

14.World Health Organization (WHO). Global report on health equity for persons with disabilities [Internet]. Geneva: WHO; 2022 [cited 2024 Dec 22]. Available from: https://bit.ly/4gnic1z.

15.United States of America. Centers for Disease Control and Prevention (CDC). Disability [Internet]. Atlante: CDC; 2024 [cited 2024 Dec 19]. Available from: https://bit.ly/4fzlCNx.

16.European Council. Council of the European Union. Disability in the EU: facts and figures [Internet]. Brussel: European Council; 2024 [cited 2024 Dec 19]. Available from: https://bit.ly/4fzdgoX.

17.Garcia-Mora ME, Schwartz.Orellana S, Freire G. Disability inclusion in Latin America and the Caribbean: A path to sustainable development [Internet]. Washington D.C.: World Bank; 2021 [cited 2024 Dec 19]. Available from: https://bit.ly/4iUeRZC.

18.Argentina. Instituto Nacional de Estadística y Censos (INDEC). Estudio Nacional sobre el Perfil de las Personas con Discapacidad. Resultados definitivos 2018 [Internet]. Buenos Aires: INDEC; 2018 [cited 2024 Dec 22]. Available from: https://bit.ly/4iPFOO3.

19.Brasil. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa nacional de saúde 2019 Ciclos de vida [Internet]. Rio de Janeiro: IBGE; 2021 [cited 2021 Dec 19]. Available from: https://bit.ly/3DxwoXi.

20.México. Instituto Nacional de Estadística y Geografía (INEGI). Principales resultados del Censo de Población y Vivienda 2020 [Internet]. Ciudad de México: INEGI; 2022 [cited 2024 Dec 19]. Available from: https://bit.ly/49WefhT.

21.Colombia. Ministerio de Salud y Protección Social (Minsalud). Boletines Poblacionales: Personas con Discapacidad I-2020 [Internet]. Bogotá D.C.: Minsalud; 2020 [cited 2024 Dec 19]. Available from: https://bit.ly/4gsQQav.

22.Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):143. https://doi.org/gfq8w2.

23.Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc. 2015;13(3):141-6. https://doi.org/gdkzzq.

24.Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping Reviews. JBI Manual for Evidence Synthesis. 2020. https://doi.org/nxxb.

25.Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-73. https://doi.org/gfd8vk.

26.Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. https://doi.org/bqnqnb.

27.Moreno-Chaparro J, Ibarra LF, Suárez OBG, Ferro FER. Disability certification process: Protocol of a scoping review. OSF Registries [Preprint]. 2023. https://doi.org/nxxc.

28.Organisation for Economic Co-operation and Development (OECD). Who we are [Internet]. OECD; 2023 [cited 2024 Dec 22]. Available from: https://bit.ly/49SciTy.

29.Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5:1-10. https://doi.org/gfkdzd.

30.R Core Team. R: A language and environment for statistical computing. R version 4.2.3. [Software]. Vienna, Austria; 2023. Available from: https://www.r-project.org/.

31.Robins R, Martin D, Raj KD, Raju MS. Awareness about the persons with disability act among leprosy patients and other disabled persons. Indian J Lepr. 2006;78(3):217-29.

32.Conti-Becker A, Doralp S, Fayed N, Kean C, Lencucha R, Leyshon R, et al. A comparison of the International Classification of Functioning, Disability, and Health to the disability tax credit. Can J Occup Ther. 2007;74(Spec No):281-7. https://doi.org/nxkd.

33.Saloojee G, Phohole M, Saloojee H, IJsselmuiden C. Unmet health, welfare and educational needs of disabled children in an impoverished South African peri-urban township. Child Care Health Dev. 2007;33(3):230-5. https://doi.org/cz8chg.

34.Pastrán-Alfonso O, Céspedes-Nieves G, Ruiz-Latriglia M, Silva-Preciado S. Caracterización de personas con discapacidad del municipio de Sopó, Cundinamarca, Colombia. Rev Colomb Rehabil. 2008;7(1):15-44. https://doi.org/nxkf.

35.Ghosh S, Mukhopadhyay S, Sarkar K, Bandyopadhyay M, Maji D, Bhaduri G. Evaluation of registered visually disabled individuals in a district of west bengal, India. Indian J community Med Off Publ Indian Assoc Prev Soc Med. 2008;33(3):168-71. https://doi.org/fk4gbd.

36.Martínez FL. Inequidad social y discapacidad. Investig segur soc salud. 2008;10:45-71.

37.Vicente-Herrero MT, Terradillos-García MJ, Capdevila-García LM, Ramírez-Iñiguez de la Torre MV, Aguilar-Jiménez E, López-Gozález AA. Minusvalía, discapacidad e incapacidad. Una revisión desde la legislación española. Semer-Med Fam. 2010;36(8):456-61. https://doi.org/bxh42j.

38.Di Nubila H, de Paula AR, Marcelino MA, Maior I. “Evaluating the model of classification and valuation of disabilities used in Brazil and defining the elaboration and adoption of a unique model for all the country”: Brazilian Interministerial Workgroup Task. BMC Public Health. 2011;11(Suppl 4):S10. https://doi.org/dtgm2t.

39.Kareemsab D, Rachaiah NM, Balasubramanya. The prevalence of the leading causes of certification fo r blindness and partial sight in the Hassan district of Karnataka, India. J Clin Diagn Res. 2011;5(8):1624-6.

40.Kashyap K, Thunga R, Rao A, Balamurali NP. Trends of utilization of government disability benefits among chronic mentally ill. Indian J Psychiatry. 2012;54(1):54-8. https://doi.org/nxkg.

41.Kausto J, Solovieva S, Virta LJ, Viikari-Juntura E. Partial sick leave associated with disability pension: propensity score approach in a register-based cohort study. BMJ Open. 2012;2(6):e001752. https://doi.org/gb3tn3.

42.Mishra NN, Parker LS, Nimgaonkar VL, Deshpande SN. Disability certificates in India: a challenge to health privacy. Indian J Med Ethics. 2012;9(1):43-5. https://doi.org/nxkh.

43.Balhara YP, Verma R, Deshpande SN. A study of profile of disability certificate seeking patients with schizophrenia over a 5 year period. Indian J Psychol Med. 2013;35(2):127-34. https://doi.org/nxkp.

44.Cortés-Reyes E, Riveros LT, Pineda-Ortiz GA. Clasificación internacional del funcionamiento, la discapacidad y certificación de discapacidad en Colombia. Rev Salud Pública. 2013;15(1):129-37.

45.Franzoi AC, Xerez DR, Blanco M, Amaral T, Costa AJ, Khan P, et al. Etapas da elaboração do instrumento de classificação do grau de funcionalidade de pessoas com deficiência para cidadãos brasileiros: Índice de Funcionalidade Brasileiro - IF-Br. Acta Fisiátrica. 2013;20(3):164-70. https://doi.org/nxkw.

46.Guzmán-Suárez OB. Certificación de discapacidad como herramienta para la accesibilidad a derechos e inclusión social. Rev Salud Pública. 2013;15(1):149-57.

47.Leahy MJ, Chan F, Iwanaga K, Umucu E, Sung C, Bishop M, et al. Empirically Derived Test Specifications for the Certified Rehabilitation Counselor Examination: Revisiting the Essential Competencies of Rehabilitation Counselors. Rehabil Couns Bull. 2013;63(1):35-49. https://doi.org/ghtzmt.

48.Moreno-Angarita M, Cortés-Reyes E, Cárdenas-Jiménez A, Mena-Ortíz LZ, Giraldo-Rátiva Z. Construcción de una herramienta para certificar la discapacidad en Colombia. Rev Salud Pública. 2013;15(1):566-78.

49.Bourkiza R, Subash M, Qatarneh D, Dacosta J, Bunce C, Peto T. Barriers to sight impairment certification in the UK: the example of a population with diabetes in East London. BMC Ophthalmol. 2014;14:99. https://doi.org/gb5jzs.

50.Laaksonen M, Gould R. The effect of municipality characteristics on disability retirement. Eur J Public Health. 2014;24:116-21. https://doi.org/gpcdjq.

51.Raggi A, Covelli V, Pagani M, Meucci P, Martinuzzi A, Buffoni M, et al. Sociodemographic features and diagnoses as predictors of severe disability in a sample of adults applying for disability certification. Int J Rehabil Res. 2014;37(2):180-6. https://doi.org/f54rzd.

52.Perú. Ministerio de Salud. Resolución 981 de 2016 (marzo 9): Norma Técnica de Salud para la evaluación, calificación y certificación de la persona con discapacidad [Internet]. Lima; 2016 [cited 2024 Dec 20]. Available from: https://bit.ly/3ZLCdb1.

53.Bandyopadhyay S, Bandyopadhyay SK, Biswas J, Saha Dutta Chowdhury M, Dey AK, Chakrabarti A. Visual Impairment Registry of Patients from North Kolkata, Eastern India: A Hospital-based Study. J Ophthalmic Vis Res. 2018;13(1):50-4. https://doi.org/gcxvwk.

54.Van Dijck C. Case Study—The European Disability Card. In: Co-Production and Co-Creation [Internet]. New York: Routledge; 2018 [cited 2024 Dec 23]. pp. 145-147. Available from: https://bit.ly/3BE0NTf.

55.Ambastha A, Kusumesh R, Sinha S, Sinha BP, Bhasker G. Causes of visual impairment in applications for blindness certificates in a tertiary center of Bihar and its role in health planning. Indian J Ophthalmol. 2019;67(2):204-8. https://doi.org/gqph25.

56.Bahk J, Kang HY, Khang YH. The Life Expectancy Gap between Registered Disabled and Non-Disabled People in Korea from 2004 to 2017. Int J Environ Res Public Health. 2019;16(14):2593. https://doi.org/nxrv.

57.Banks LM, Walsham M, Neupane S, Neupane S, Pradhananga Y, Maharjan M, et al. Access to social protection among people with disabilities: Mixed methods research from Tanahun, Nepal. Eur J Dev Res. 2019;31:929-56. https://doi.org/ghvd96.

58.Basavarajappa C, Angothu H. Certification of Disability Due to Mental Illness: India and Other Countries. J Psychosoc Rehabil Ment Health. 2019;6:43-7. https://doi.org/nxrw.

59.Balakrishnan A, Kulkarni K, Moirangthem S, Kumar CN, Math SB, Murthy P. The rights of persons with disabilities Act 2016: Mental health implications. Indian J Psychol Med. 2019;41(2):119-25. https://doi.org/nxrz.

60.Mont D, Palmer M, Mitra S, Groce N. Disability identification cards: Issues in effective design. Development. 2019;62:96-102. https://doi.org/nxsc.

61.Puga C, Pagotto V, Giunta D, Vicens J, Leist M, Vaucheret Paz E, et al. Prevalence and incidence of disability based on the Unique Certificate of Disability at a teaching hospital in the Metropolitan Area of Buenos Aires. Arch Argent Pediatr. 2019;117(3):183-7. https://doi.org/nxsd.

62.Puri I, Singh G, Acharya RK, Goswami D. Critical appraisal of guidelines for evaluation and certification of specified neurological disabilities. Ann Indian Acad Neurol. 2019;22(4):373-6. https://doi.org/nxsf.

63.Nagarajan P, Bharadwaj B, Kattimani S. Five-year trend in issuing disability certificates from a general hospital psychiatric unit in South India. Indian J Psychol Med. 2020;42(5):451-5. https://doi.org/nxsg.

64.Mishra S, Sharma R. Proposed method for evaluation and categorization of functional capacity of children, adolescents, and adults with cardiac diseases to bring them in existing social justice system by creating the cardiac disability criteria. Indian J Thorac Cardiovasc Surg. 2020;36(3):207-25. https://doi.org/nxsm.

65.Jadhav P, Sivakumar T, Gupta A. Sociodemographic and Clinical Profile of Patients Receiving Disability Certificates as per Rights of Persons with Disabilities Act 2016 for Psychiatric, Neurological, and Neurosurgical Disorders at Tertiary Care Centre. J Psychosoc Rehabil Ment Heal. 2021;8:29-34. https://doi.org/nxsn.

66.Jadhav P, Sivakumar T, Gupta A. Duration of Illness at the Time of Disability Certification for Mental Illness and Neurological Disorders. Indian J Psychol Med. 2021;43(5):459-61. https://doi.org/nxsp.

67.Kaiser A. Legal Benefits for the Severely Disabled: The Process for Filing an Eligibility Claim with the Pension and Benefits Office. In: Bahm J, editor. Movement Disorders of the Upper Extremities in Children. Cham: Springer International Publishing; 2021. p. 319-322. https://doi.org/nxsq.

68.Kishore MT, Maru R, Seshadri SP, Kumar D, Vijay Sagar JK, Jacob P, et al. Specific learning disability in the context of current diagnostic systems and policies in India: Implications for assessment and certification. Asian J Psychiatr. 2021;55:102506. https://doi.org/gmxg3d.

69.Sen MS, Deep R, Nair V, Chadda RK. Audit of requests for disability certification of adults received at a tertiary care general hospital psychiatry unit. Indian J Psychiatry. 2021;63:495-9. https://doi.org/nxss.

70.Vasudeva A, Sheikh NA, Sahu S. Digitization of disability certification using technology to curtail infringement of dignity. J Fam Med Prim Care. 2021;10(11):3948-50. https://doi.org/nxsw.

71.Dhabarde KA, Wankhade AB, Doble PM, Rahul NV, Kende RP. A Descriptive Analysis of Unique Disability Identification Card (UDID)-Certified Visually Disabled Patients at a Tertiary Eye Care Center in Central India. Cureus. 2022;14(11):e31106. https://doi.org/nxsz.

72.Perú. Ministerio de Salud (Minsalud). Evaluación, calificación y certificación de la persona con discapacidad: Discapacidad 2020 [Internet]. Lima: Minsalud; 2022 [cited 2024 Dec 23]. Available from: https://bit.ly/3Pa7tM4.

73.Nieradko-Iwanicka B, Witkowska-Zimny M, Iwanicki JA. Musculoskeletal diseases as the basis for disability certificates in Lublin (Poland) in 2006-2021. Reumatologia. 2022;60(6):376-83. https://doi.org/nxs4.

74.Schiariti V. Rol del certificado único de discapacidad en Argentina: ¿enfoque biopsicosocial en la definición de discapacidad o certificado de accesibilidad? Rev Fac Cien Med Univ Nac Cordoba. 2022;79(3):215-6. https://doi.org/nxs5.

75.Subramanyam AA, Thanapal S, Kirpekar V, Deshpande S, John T. Disability Certification in Psychiatry. Indian J Psychiatry. 2022;64(Suppl 1):S185-95. https://doi.org/nxs6.

76.Prasanna CK, Sam JM. Social Security Measures for Persons with Mental Illness: Access and Utilisation in Rural India. J Psychosoc Rehabil Ment Heal. 2023;10:55-65. https://doi.org/nxs7.

77.Argentina. Ministerio de Salud. Cómo obtener el Certificado Único de Discapacidad (CUD) [Internet]. Buenos Aires: Agencia Nacional de Discapacidad; 2023 [cited 2024 Dec 23]. Available from: https://bit.ly/3ZPoEHE.

78.Bundesrepublik Deutschland. Bundesministerium für Arbeit und Soziales. Wie beantrage ich einen Schwer­behinderten­ausweis? [Internet]. Berlin: Bundesministerium für Arbeit und Soziales; [cited 2024 Dec 23]. Available from: https://bit.ly/3ZNvz45.

79.Bolivia. Ministerio de Salud y Deportes. Conozca los requisitos para acceder a la certificación de persona con discapacidad [Internet]. La Paz: Ministerio de Salud y Deportes; 2017 [cited 2024 Dec 23]. Available from: https://bit.ly/49OOW1j.

80.Brasil. Serviços e Informações do Brasil. Emitir Certificado da Pessoa com Deficiência [Internet]. Serviços e Informações do Brasil [cited 2024 Dec 23]. Available from: https://bit.ly/41UYvJU.

81.Canada. Canada Revenue Agency (CRA). Disability tax credit [Internet]. Ottawa: CRA; [cited 2024 Dec 23]. Available from: https://bit.ly/4gMy9OE.

82.Chile. Chile Atiende. Credencial de discapacidad [Internet]. Santiago de Chile: Chile Atiende; 2024 [cited 2024 Dec 23]. Available from: https://bit.ly/4gqgvAv.

83.Chile. Ministerio de Desarrollo Social y Familia. Servicio Nacional de la Discapacidad (SENADIS). Beneficios del RND. Santiago de Chile: SENADIS; 2022 [cited 2024 Dec 23]. Available from: https://bit.ly/49SzKjG.

84.Colombia. Ministerio de Salud y Protección Social (Minsalud). Certificación de discapacidad [Internet]. Bogota D.C.: Minsalud; [cited 2024 Dec 23]. Available from: https://bit.ly/3VSgdKq.

85.Kim M, Jung W, Kim SY, Park JH, Shin DW. The Korea National Disability Registration System. Epidemiol Health. 2023;45:e2023053. https://doi.org/nxtw.

86.Costa Rica. Consejo Nacional de Personas con Discapacidad (Conapdis). Servicio de Certificación Discapacidad [Internet]. Santo Domingo: Conapdis; 2023 [cited 2024 Dec 23]. Available from: https://bit.ly/3DGkHNR.

87.Ecuador. Ministerio de Salud Pública (Minsalud). Calificación o recalificación de personas con discapacidad o condición discapacitante [Internet]. Quito: Minsalud; 2023 [cited 2024 Dec 23]. Available from: https://bit.ly/4iRSYu0.

88.España. Ministerio de Derechos Sociales, Consumo y Agenda 2030. Grado de discapacidad [Internet]. Madrid: Instituto de Mayores y Servicios Sociales; 2023 [cited 2023 Dec 23]. Available from: https://bit.ly/3ZNC5b3.

89.United States of America. Social Security Administration (SSA). Disability Benefits [Internet]. Woodlawn: SSA; 2022 [cited 2024 Dec 23]. Available from: https://bit.ly/49VAwfR.

90.Française. Service-Public. Carte mobilité inclusion (CMI). Paris: Direction de l’information légale et administrative; 2023 [cited 2023 Dec 23]. Available from: https://bit.ly/49ZbnAT.

91.Française. Service-Public. La carte d’invalidité est-elle toujours délivrée? [Internet]. Paris: Direction de l’information légale et administrative; 2023 [cited 2023 Dec 23]. Available from: https://bit.ly/4gLjfbm.

92.Israel. Ministerio de Justicia. Comisión para la Igualdad de Derechos de las Personas con Discapacidad [Internet]. Jerusalén; 2023 [cited 2024 Dec 23]. Available from: https://bit.ly/4gv00TE.

93.Italia. L’Istituto Nazionale della Previdenza Sociale (INPS). Domanda invalidità civile e accertamento sanitario [Internet]. Roma: INPS; 2022 [cited 2024 Dec 23]. Available from: https://bit.ly/4fy6NKU.

94.Japan. Ministry of Health Labor and Social Welfare. Disability certificate [Internet]. Tokio: Ministry of Health Labor and Social Welfare; 2022 [cited 2024 Dec 23]. Available from: https://bit.ly/3BIulz0.

95.México. Sistema Nacional para el Desarrollo Integral de la Familia (DIF). Credencial Nacional para Personas con Discapacidad [Internet]. México D.F.: DIF; 2019 [cited 2024 Dec 23]. Available from: https://bit.ly/49QFQRy.

96.Perú. Ministerio de Trabajo y Promoción del Empleo (Mintrabajo). Cómo se acredita la discapacidad [Internet]. Lima: Mintrabajo; 2023 [cited 2024 Dec 23]. Available from: https://bit.ly/49TjW06.

97.Portugal. Serviço Nacional de Saúde. Atestado Médico de Incapacidade Multiuso [Internet]. Governo da República Portuguesa; 2023 [cited 2024 Dec 23]. Available from: https://bit.ly/4gOI85Z.

98.United Kingdom. House of Commons. Registering as disabled in England [Internet]. UK Parliament; 2023 [cited 2024 Dec 24]. Available from: https://bit.ly/4fxT9HN.

99.Uruguay. Dirección Nacional de Impresiones y Publicaciones Oficiales (IMPO). En Uruguay existe una ley que protege a las personas con discapacidad [Internet]. Montevideo: IMPO; 2023 [cited 2024 Dec 24]. Available from: https://bit.ly/3Ds9Nvl.

100.Uruguay. Ministerio de Desarrollo Social - Secretaría Nacional de Cuidados y Discapacidad. Registro Nacional de personas con discapacidad [Internet]. Montervideo: gub.uy; 2023 [cited 2024 Dec 24]. Available from: https://bit.ly/41PVAlV.

101.Venezuela. Ministerio del Poder Popular para la Salud. Dirección Clasificación y Calificación [Internet]. Caracas: Dirección General de Salud Integral para las Personas con Discapacidad; 2023 [cited 2024 Dec 24]. Available from: https://bit.ly/4gSdl8p.

102.World Health Organization (WHO), World Bank. World report on disability 2011 [Internet]. Geneva: WHO; 2011 [cited 2024 Dec 24]. Available from: https://bit.ly/4h8m1Yj.

103.Zárate-Rueda R, RodríguezQuinónez DA. Los derechos de las personas en situación de discapacidad: Una respuesta desde la responsabilidad social. Revista Eleuthera. 2014;10:38-57.

104.Chin NM. Centering disability justice. Syracuse L Rev. 2021;71:683. https://doi.org/nxw9.

105.Banks LM, Kuper H, Polack S. Poverty and disability in low-and middle-income countries: A systematic review. PLoS One. 2017;12(12):e0189996. https://doi.org/gcrk9d.

106.Pinilla-Roncancio M. The reality of disability: Multidimensional poverty of people with disability and their families in Latin America. Disabil Health J. 2018;11(3):398-404. https://doi.org/gdt97s.

107.Pinilla-Roncancio M. Disability and poverty: two related conditions. A review of the literature. Rev. Fac. Med. 2015;63(Suppl 1):S113-23. https://doi.org/km8x.

108.Alkorta AB. Economía social e inserción laboral de las personas con discapacidad. R.V.A.P. 2014;529-47. https://doi.org/nx2f.

109.Fernández-Gutiérrez CR. La Economía Social y las personas con discapacidad. CIRIEC-España, Revista de Economía pública, Social y Cooperativa. 2003;(47):119-24.

110.Wong J, Kallish N, Crown D, Capraro P, Trierweiler R, Wafford QE, et al. Job Accommodations, Return to Work and Job Retention of People with Physical Disabilities: A Systematic Review. J Occup Rehabil. 2021;31(3):474-90. https://doi.org/gmmbsr.

111.Smith DL, Atmatzidis K, Capogreco M, Lloyd-Randolfi D, Seman V. Evidence-Based Interventions for Increasing Work Participation for Persons With Various Disabilities: A Systematic Review. OTJR Occup Ther J Res. 2016;37(Suppl 2):3S-13S. https://doi.org/f9ntsr.

112.Derbyshire DW, Jeanes E, Khedmati Morasae E, Reh S, Rogers M. Employer-focused interventions targeting disability employment: A systematic review. Soc Sci Med. 2024;347:116742. https://doi.org/nx2g.

Annex 1. Search algorithms and results by databases.

Search Report #1
Database	MEDLINE
Platform	PubMed
Date range	2006-2023
Language restrictions	Spanish, Portuguese, and English
Date search	21/08/2023
Search	1. Disability[Title/Abstract] (205 968) 2. Handicap[Title/Abstract] (12 409) 3. #1 OR #2 (216 453) 4. Register[Title/Abstract] (82 761) 5. Credential[Title/Abstract] (630) 6. Accreditation[Title/Abstract] (19 014) 7. Card[Title/Abstract] (21 033) 8. Certification[Title/Abstract] (20 179) 9. #4 OR #5 OR #6 OR #7 OR #8 (141 754) 10. #3 AND #9 (3 830) 11. Filters: from 2006-2023 (3 198)
Results	3 198

Search Report #2
Database	EMBASE
Platform	EMBASE
Date range	2006-2023
Language restrictions	Spanish, Portuguese, and English
Date search	21/08/2023
Search	1. ‘disability’:ab,ti (288 688) 2. ‘register’:ab,ti (107 314) 3. ‘accreditation’:ab,ti (25 392) 4. ‘certification’:ab,ti (25 798) 5. #2 OR #3 OR #4 (156 539) 6. #1 AND #5 (4 556) 7. #6 [2006-2023]/py (3 988)
Results	3 988

Search Report #3
Database	SCOPUS
Platform	SCOPUS
Date range	2006-2023
Language restrictions	Spanish, Portuguese, and English
Date search	21/08/2023
Search	(TITLE-ABS-KEY (“Disability” OR “Handicap”)) AND (TITLE-ABS-KEY (“Register” OR “Credential” OR “Card” OR “Certification”)) AND PUBYEAR > 2005 AND PUBYEAR < 2024
Results	7 846

Search Report #4
Database	LILACS
Platform	LILACS
Date range	2006-2023
Language restrictions	Spanish, Portuguese, and English
Date search	21/08/2023
Search	(disability OR handicap) AND (register OR credential OR accreditation OR card OR certification) AND ( db:(“LILACS”)) AND (year_cluster:[2006 TO 2023])
Results	92

Search Report #5
Database	Web of Science
Platform	Web of Science (Core collection)
Date range	2006-2023
Language restrictions	Spanish, Portuguese, and English
Date search	21/08/2023
Search	(“Disability” OR “Handicap”) AND (“Register” OR “Credential” OR “Card” OR “Certification”) Timespan: 2006-01-01 to 2023-08-21
Results	7 732

Annex 2. Search algorithms and results by differential approach.

Search Report
Platform			Google
Date range			2006-2023
Language restrictions			Spanish, Portuguese, and English
Date search			21/08/2023
ID	Country	Institution or organization	Search	#
1	Argentina	Ministerio de Salud	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.argentina.gob.ar/salud	35
		Ministerio de Desarrollo Social	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.argentina.gob.ar/desarrollosocial	6
2	Australia	Australian Government Department of Health	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.health.gov.au/	68
		Australian Institute of Health and Welfare	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.aihw.gov.au/	75
3	Belgium	Belgian Health Care Knowledge Centre	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://kce.fgov.be/en	23
		The Federal Public Service (FPS) Health, Food Chain Safety and Environment	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.health.belgium.be/en	27
4	Bolivia	Ministerio de Salud y Deportes	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.minsalud.gob.bo/	7
		Ministerio de Planificación del Desarrollo	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: http://www.planificacion.gob.bo/	3
5	Brazil	Ministério da Saúde	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.gov.br/saude/pt-br	94
		Ministerio da Cidadanía	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://antigo.cidadania.gov.br/	0
6	Canada	Health Canada	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.canada.ca/en/health-canada.html	11
		Public Health Agency	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.canada.ca/en/public-health.html	10
7	Chile	Ministerio de Salud	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.minsal.cl/	112
		Ministerio de desarrollo social y Familia	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.senadis.gob.cl/	12
8	Colombia	Ministerio de Salud y Protección Social	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site:https://www.minsalud.gov	359
9	Costa Rica	Ministerio de Salud	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.ministeriodesalud.go.cr/	24
		Instituto Mixto de Ayuda Social	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.imas.go.cr/	7
10	Cuba	Ministerio de Salud Publica	Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://salud.msp.gob.cu/	8
		Ministerio de trabajo y protección social	Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.mtss.gob.cu/	3
11	Denmark	Minister for the Interior and Health of Denmark	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site:https://sum.dk/english	3
12	Ecuador	Ministerio de Salud Pública	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site:https://www.salud.gob.ec/	39
		Ministerio de inclusión economica y social	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.inclusion.gob.ec/	25
13	El Salvador	Ministerio de Salud	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site:https://www.salud.gob.sv/	3
		Ministerio de Desarrollo Local	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.mindel.gob.sv/	0
14	France	Haute Autorité en Santé	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site:https://www.has-sante.fr/	20
		Ministère des Solidarités et de la Santé	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site:https://solidarites-sante.gouv.fr/	37
15	Germany	Federal Ministry of Health	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site:https://www.bundesgesundheitsministerium.de	27
		Federal Ministry of Labour and Social Affairs	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.bmas.de/EN/Home/home.html	1
16	Guatemala	Ministerio de Salud Pública y Asistencia Social de Guatemala	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site:https://www.mspas.gob.gt/	5
		Ministerio de Desarrollo Social	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.mides.gob.gt/	0
17	Honduras	Secretaría de Desarrollo e Inclusión Social	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://sedesol.gob.hn/	0
		Secretaria de Salud	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.salud.gob.hn/sshome/	0
18	Israel	Ministry of Health	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site:https://www.health.gov.il/English/Pages/HomePage.aspx	1
		The Ministry of Welfare and Social Affairs	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.gov.il/en/departments/molsa/govil-landing-page	52
19	Italy	Ministry of Health - Ministero della Salute	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.salute.gov.it/portale/	58
		Italian Ministry of Labour and Social Policies	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.minori.gov.it/	3
20	Japan	Ministry of Health, Labour and Welfare	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.mhlw.go.jp/english/	52
21	Mexico	Secretaría de Salud	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.gob.mx/salud/en	1
		Secretaria del Bienestar	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.gob.mx/bienestar	7
22	Netherlands	Ministry of Health, Welfare and Sport	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.government.nl/ministries	16
23	New Zealand	Ministry of Social Development	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.msd.govt.nz/	13
		Ministry of Health	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.health.govt.nz/	10
24	Panama	Ministerio de salud de la Republica de Pánama	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.minsa.gob.pa/	2
		Ministerio de Desarrollo Social	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.mides.gob.pa/	1
25	Paraguay	Ministerio de Salud pública y bienestar	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.mspbs.gov.py/index.php	0
		Ministerio de Desarrollo Social	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.mds.gov.py/	2
26	Peru	Ministerio de Salud	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.gob.pe/minsa	2
		Ministerio de Desarrollo e Inclusión Social	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.gob.pe/midis	0
27	Portugal	Directorate-General of Health (DGS)	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.dgs.pt/directorate-general-of-health/about-us.aspx	66
		The Ministry of Labour, Solidarity and Social Security	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.portugal.gov.pt/pt/gc21/area-de-governo/trabalho-solidariedade-e-seguranca-social	33
28	South Korea	Ministry of Health and Welfare	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site:https://www.mohw.go.kr	41
29	Spain	Ministerio de Sanidad, Consumo y Bienestar Social	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site:https://www.mscbs.gob.es	5
		Ministerio de Derechos Sociales y Agenda 2030	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.mdsocialesa2030.gob.es/	10
30	Sweden	Federal Office of Public Health	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.bag.admin.ch/bag/en/home.html	2
		Federal Social Insurance Office	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.government.se	0
31	United Kingdom	Department of Health and Social Care	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.gov.uk/government/organisations/department-of-health-and-social-care	23
		National Institute for Health and Clinical Excellence - NICE	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.nice.org.uk/	36
32	United States	U.S. Department of Health and Human Services (HHS)	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site:https://www.hhs.gov/	26
33	Uruguay	Ministerio de Salud Pública	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.gub.uy/ministerio-salud-publica/home	1
		Ministerio de Desarrollo Social	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: https://www.gub.uy/ministerio-desarrollo-social/	9
34	Venezuela	Ministerio del Poder Popular para la Salud	(Disability OR Handicap) AND (Register OR Credential OR Card OR Certification) site: http://mpps.gob.ve/	10