Definitions of team effectiveness core processes.
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“Teams are pervasive in today’s world” [1]—and they are needed. Collaboration and teamwork are required, more so today than in the past, to handle today’s complex problems [2]. Today’s complexity comes from dramatic structural changes to organizations and governments such as globalization, global competition, workforce diversity, and continual innovations [3]. Also, deMattos et al. [3] highlighted the information revolution and the creation and destruction of organizations as contributors to this complexity.
Within the complexity literature, complexity results from the “inter-relationship, inter-action, and inter-connectivity of elements within a system” [3], among elements that make up the system (micro-level), and among different systems (macro-level). In the organizational science’s literature, organizations are viewed as being complex adaptive systems (CAS) that are a composite of the “interconnected whole” [4]. West [2] identified the growth of this complexity due to, in part; the digital revolution, the increasing diversity as a result of interconnectedness and globalization, the interconnectedness within and across entities, the need for inclusion, and a growing demand in the need to belong amongst these interconnections [2]. Aghina et al. [5] highlighted advances in technology and connectivity as reasons why organizations needed to create “new forms of engagement within and across organizational boundaries” (The evolving organizational challenge). Also, organizations must learn to become competitive in these new “rapidly emerging ‘ecosystems’” that involve multiple organizations and business sectors.
Driving and managing these interconnections are collaborative entities, teams and small groups. In today’s workplace, teams have become the common collaborative entity. West [2] highlighted this point by stating that “teamwork is ubiquitous in modern organizations”. Keller and Meaney [6] reported that research conducted by McKinsey & Company showed executives were “five times more productive when working in one [high-performing team] than they are in an average one [team]”.
In placing teams as CAS [7, 8] that manage and operate in these emerging ecosystems, teams become one of the antecedents or predictors to an organization’s survival. To provide successful high-performing teams, organizations must be able to facilitate the factors that lead to a team’s effectiveness. These factors are known as the 9-Cs in which team conflict is one of these factors. These concepts are important to understand when managing and facilitating teams, especially when it comes to managing team conflict. This chapter is divided into four sections. The first section discusses teams, what they are, what are the 9-Cs of team effectiveness, team transitions, team failure mechanisms, and team leadership. The second section looks at CAS and how teams and small groups are considered CAS and what this means to the organization and the larger emerging ecosystem. Also, team conflict will be positioned within these CAS as a key factor that should be considered in any team and organizational system. Next, this chapter reviews traditional organizational conflict models from the literature. Following, the discussion moves to reviewing the literature on traditional intragroup conflict and newer, emerging, intragroup conflict types. Next, this chapter previews different conflict management models and techniques that could be used for managing teams and, more specifically, team conflict. In conclusion, this chapter introduces adaptive leadership as one potential leadership style to implement when dealing with complex adaptive systems and intragroup conflict in today’s complex and global environment.
Cohen and Bailey [9] defined teams in the following manner:
Cohen and Bailey [9] used the terms team and group interchangeably, noting that the field of management typically refers to teams, whereas academic literature typically uses the term group. We will consider teams and small groups as being synonymous to one another for this book chapter.
Kozlowski and Ilgen [10] defined teams as: “Complex dynamic systems that exist in a context, develop as members interact over time, and evolve and adapt as situational demands unfold”. Gibson [11] described a group as a social aggregation with meaning, with a limited number of interacting people, and with shared objectives. Relating to the shared objectives, Cohen and Bailey [9] noted that some groups have different degrees of
Teams are composed of individuals working on interdependent tasks which contribute to the overall task objective of the collective. The first identifier of a team is the interdependency of individual members working toward a common goal. Second, team members are required to interact to combine each team member’s interdependent portion of the overall task. In combining each individual effort into a composite representative of the team’s output, team members must interact with one another. This interaction involves shared responsibilities in which authentic communication [12] is a requirement. Finally, a team must also be adaptive as indicated by Cohen and Bailey [9]. Today’s knowledge economy presents complex dynamic problems to which teams need to adapt. Although adaptability may not be an initial requirement for a team, if a team is to remain successful in a “dynamic, shifting, and complex environment” [10], it must learn to be adaptive.
The literature on team performance or team effectiveness has grown into essentially 9 core processes (Figure 1). One example of this expansion is in the addition of conflict to this list of core processes. Weaver et al. [13] did not include conflict in their list of core processes whereas Dinh and Salas [14] and Salas et al. [1] included conflict. All-in-all the current literature presents a total of nine core processes that need to be considered when participating in, or managing, highly effective teams: coaching, cognition, cohesion, collective efficacy, collective identify, communication, conflict, cooperation, and coordination. Definitions for each of these processes are provided in Table 1.
Teamwork processes.
Factor | Definition | Source |
---|---|---|
Emerging States | ||
Coaching | Direct interaction with a team intended to help members make coordinated and task-appropriate use of their collective resources in accomplishing the team’s work. | Weaver et al. [13], p. 15; see also Hackman and Wageman [80] |
An enactment of leadership behaviors to establish goals and set direction towards the successful accomplishment thereof. | Dinh and Salas [14], p. 23; see also Fleishman et al. [77] | |
The host of activities performed by both individuals and teams for the sake of team effectiveness. | Dinh and Salas [14], p. 23; see also Hackman and Wageman [80] | |
Cognition | A foundational component of effective team processes, as it allows teams to enter performance episodes with a mutual baseline understanding of how to engage in the task at hand. | Dinh and Salas [14], p. 24; see also Salas et al. [1] |
Detecting and recognize[ing] pertinent cues, make decisions, problem solving, storing and remembering relevant information, planning, and seeking and acquiring necessary knowledge. | Weaver et al. [13], p. 15; see also Orasanu [90] | |
Shared cognition: The collective understanding among team members regarding team member interactions and team tasks. | Hinsz and Ladbury [81]; see also Turner et al. [92] | |
Team cognition: The organized understanding of collective knowledge among team members. | Mohammed and Dumville [85]; see also Turner et al. [92] | |
Cohesion | Affective attraction to the team, team goals, and desire to remain part of the team. | Weaver et al. [13], p. 15; see also Zaccaro and Lowe [93]; Beal et al. [73] |
The degree to which team members desire to remain in the team and are committed to the team goal. | Forsyth [78] | |
The feeling of belonging to a group, liking the tasks a group performs, and having an identity with a group. | Turner [91] | |
The process of keeping team members together and united. | Dion [74]; see also Turner [91] | |
Collective Efficacy | Team efficacy: The perception that the team is capable of performing well at a given task. | Levi [88], p. 65 |
The collective sense of competence or perceived empowerment to control the team’s performance or environment. | Dinh and Salas [14], p. 18; see also Katz-Navon and Erez [86]; Mahieu, Gilson, and Ruddy [89]; Zaccaro et al. [87] | |
The belief, shared among a substantial portion of the group members, that the group is capable of organizing and executing the actions required to attain the group’s goals and successfully complete its tasks. | Forsyth [78], p. 138 | |
Collective Identity | Perceptions of oneness with a particular group. | Weaver et al. [13], p. 15; see also Ashford and Mael [72] |
One’s sense of individuality is replaced by a shared sense of unity. | Forsyth [78], p. 138 | |
Communication | Exchange of information that teams use to perform such tasks as negotiating their goals, making decisions, and providing one another task status information. | Weaver et al. [13], p. 15; see also Fussell et al. [79] |
The process by which a person or group sends some type of information to another person or group…. Three basic parts of communication: sender, receiver, message. | Levi [88], p. 102 | |
A transactional process, in which communicators can send and receive information simultaneously and influence these pathways. | Dinh and Salas [14], pp. 21–22 | |
Conflict* | The perceived incompatibility in interests, beliefs, or views held by one or more team members. | Dinh and Salas [14], p. 23; see also Jehn [82] |
Differences or incompatibilities in interests, values, power, perception and goals. | Yasmi et al. [31]; see also Turner [44] | |
Being either a set of incompatibilities or an awareness of being threatened or frustrated or perceived to be threatened. | Turner [44], p. 151 | |
Cooperation | Motivation and desire to engage in coordinative and adaptive behavior. | Weaver et al. [13], p. 15; see also Fiore et al. [76] |
A performance situation that is structured in such a way that the success of any one member of the group improves the chances of other members’ succeeding. | Forsyth [78], p. 436 | |
Coordination | The enactment of behavioral and cognitive mechanisms necessary to perform a task and transform team resources into outcomes. | Salas et al. [1], p. 603; Dinh and Salas [14] |
The process of orchestrating the sequence and timing of interdependent actions. | Marks et al. [15], pp. 367–368 | |
Coordination activity: Processes aimed at managing dependence through collaboration, coordination, negotiation, and feedback. | Drach-Zahavy and Somech, [75], p. 149 | |
Influencing conditions | ||
Context | Situational characteristics or events that influence the occurrence and meaning of behavior, as well as the manner and degree to which various factors (e.g., team member characteristics, team behaviors processes) impact team outcomes. | Salas et al. [1], p. 611 |
Situational opportunities and constraints that affect the occurrence and meaning of organizational behavior as well as functional relationships between variables. | Johns [83], p. 386 | |
Composition | Team building: Making sure the team has common goals and that members can work together to achieve them. | Levi [88], p. 328 |
The mix of knowledge, skills, abilities, and other characteristics (KSAOs) of team members. | Mathieu et al. [84], pp. 522–523 | |
Culture | Team culture: The shared perception of how the team should operate to accomplish its goals. Team norms, member roles, and patterns of interaction are included in the team culture. | Levi [88], p. 265 |
The assumptions people hold about relationships with each other and the environment that are shared among an identifiable group of people (e.g., team, organization, nation) and manifest in individuals’ values, beliefs, norms for social behavior, and artifacts. | Salas et al. [1], p. 613 |
Definitions of team effectiveness core processes.
More complete definitions of the different types of conflict will be provided in later sections of this chapter.
Among these core processes, Dinh and Salas [14] differentiated between internal and external dynamics. Internal dynamics include a team’s core processes, or emerging states, whereas external dynamics are composed of influencing conditions. Emerging states include the processes of coaching, cognition, communication, conflict, cooperation, and coordination [1, 14]. Influencing conditions (Figure 2) include context, composition, and culture. Definitions for these influencing conditions are also provided in Table 1. Within these six emerging states, Dinh and Salas [14] and Salas et al. [1] included the processes of collective efficacy and collective identity as part of the cooperation process.
Influencing conditions.
For this chapter, we will maintain that there are nine emerging states (coaching, cognition, cohesion, collective efficacy, collective identify, communication, conflict, cooperation, and coordination) and three influencing factors (context, composition, and culture).
The overall team processes are presented as a taxonomy by Marks et al. [15] with three categories: transition phase processes, action phase processes, and the interpersonal processes. These processes are categorized around three phases in which the transition phase mostly occurs during the beginning stages of team formation, the action phases take place after team formation and during team task work, and the interpersonal processes occur throughout the entire time up to the point that the team completes its goal. Figure 3 provides a diagram showing these different phases of the team transition processes.
Team transition processes.
During the transition phases team members primarily concentrate on distributing tasks, scheduling of activities, and allocation of resources. These transition phases aid the team in accomplishing their goal or objective [15]. LePine et al. [16] described these transition phases as: “Actions that teams execute between performance episodes”. Among the transition phases, Marks et al. [15] identified three processes: mission analysis, goal specification, and strategy formation and planning. Mission analysis involves team member’s interpretation and evaluation of the team’s mission, identification of the team’s goal and its environment, and assessing resources required compared to resources available [15]. Goal specification relates to prioritizing goals of the team as well as associating these goals with the organization. Strategy formulation and planning identifies decisions that need to be made to achieve the team’s goal, the team’s expectations, assignment of duties, lines of communication, along with setting priorities and deadlines. Stout et al. [17] identified that teams high in planning (e.g., strategy formulation and planning phase) are more effective at communicating with team members at critical times, when needed the most.
Action phases relate to the team’s activities aimed specifically toward goal accomplishment [15]. This phase concentrates on team activities that lead toward goal attainment. The action phases have four processes: monitoring progress toward goals, systems monitoring, team monitoring and backup responses, and coordination activities [15]. The first process, monitoring progress toward goals, relates to team members paying attention to, interpreting, and communicating information that allows team members to assess and provide feedback to the team’s progress. The second process, systems monitoring, tracks a team’s resources and environment. Team monitoring and backup responses, the third process, provides support services for team members. This process gives team members individual feedback, coaching/mentoring, assistance in task completion, etc.… The last process, coordination activities, related to “the process of orchestrating the sequence and timing of interdependent actions” [15]. This process is conducted by individual members as a shared-leadership role, and by the team’s leader/manager if one is assigned.
The interpersonal phases relate to those team activities that are primarily concentrated toward managing relationships, internal and external. Interpersonal phases are different from the transition and action phases in that they are mostly present throughout the duration that the team is formed. The interpersonal processes involve three processes: conflict management, motivating/confidence building, and affect management [15]. Conflict management is geared toward managing conflict so that constructive conflict is facilitated and destructive conflict is diminished. Understanding conflict in small group settings requires viewing conflict from the individual’s perspective as well as from the perspective of the collective. Conflict is prevalent throughout a team’s formation, a further discussion of conflict that takes place in small group settings, intragroup conflict, will be provided in the next section. Conflict management focuses on identifying areas of agreement and disagreement among team members, identifying any barriers relating to task accomplishment, to better identify intragroup conflict. Conflict management then optimizes collaborative efforts around conflict by collectively selecting the best course of action in resolving conflicting issues. The second process in the interpersonal processes, motivating/confidence building, involves “activities that develop and maintain members’ motivation and confidence with regard to the team accomplishing its goals and objectives” [16]. The last process, affect management, facilitates emotional balance among team members. This last process monitors members’ emotions, social cohesion, team member frustrations and excitement, as well as examining team morale [16].
The taxonomy of team processes presented by Mathieu et al. [18] incorporates transition phase processes that evaluate past achievements and plan future achievements with action phase processes that involve activities dedicated to goal accomplishment. Throughout the transition and action phase processes, interpersonal processes are continually being managed. Mathieu et al. [18] identified: “Some processes are more likely to occur during transition periods, whereas others are more likely to occur during action periods. Interpersonal processes are expected to occur throughout transition and action phases”. Of these interpersonal processes, conflict is a key determinant that is not only prevalent in all small group settings, but it has the potential to be destructive to the point of preventing a team from accomplishing its stated goals. This chapter further identifies these different intragroup conflicts and addresses how best to manage these conflicts.
Just as organizations are viewed as being complex adaptive systems (CAS) [19, 20], teams are also viewed as being CAS. We utilize the definition provided by Uhl-Bien et al. [21] for CAS:
In this definition of CAS, neural-like networks represent teams while the interacting and interdependent agents represent individual team members. As one of the characteristics of a team involves having a common goal, this definition fits well for teamwork settings. The overlapping hierarchies represent components of shared leadership that takes place in teams, no one team member leads the whole team through all tasks. It is advantageous for teams to use the skills, experiences, and resources available to them when deciding who will lead the team during each stage of the team’s goal. It could be that multiple team members take an individual leadership role before the team meets its stated goal, resulting in a self-organizing shared leadership function. Teams are dynamic in nature in that each individual member is working independently as well as interdependently on their own task as an effort to contribute to the collective’s main objective.
Complex adaptive systems consist of six primary functions: they operate in open systems, they are self-organizing, they operate on the
Systems theory and systems thinking operate in closed systems, a change in one part of the system results in an expected and predictable change in another part of the system. Closed systems provide a level of predictability and are partially sheltered from external forces. In contrast, complexity theory or complexity thinking operates in open systems. Open systems are non-linear, unpredictable, in which changes in one part of the system could lead to predictable results just as easy as unpredictable results.
Operating in open systems requires self-organizing systems compared to directed systems. Systems that are controlled, or directed every step of the way, are less able to react to multiple threats from the environment (external of the system). Systems that are capable of self-organizing and reorganize as needed, are better able to operate in open systems more effectively compared to controlled systems. This key characteristic, the ability to self-organize, is defined by Varga [22] as: “self-organization occurs through the dynamics, interactions and feedbacks of heterogeneous components”.
The
Being able to adapt to external forces is one requirement when operating in open systems. For a system to self-organize, then alter its course and reorganize, it must be adaptable. Adaptive systems “have a high degree of awareness to its local context as well as a high capability to change internally” [23]. This adaptability characteristics includes a team and its members to adapt to both internal and external forces. One example of internal forces could be intragroup conflict, with intergroup conflict being an example of external forces.
Interactions are identified as being representative of “causal processes at the lower levels” [24], and can represent structural or behavioral processes. In viewing behavioral processes in a team setting, facilitation constructive conflict as opposed to destructive conflict will aid in a team’s interactions, thus becoming more effective and adaptive. In complexity terms, facilitating interactions aids emergence.
Complex adaptive systems operate from the bottom-up in a dynamic manner that facilitates interactions among the system’s agents (e.g., individual team members) with the potential of producing emergent, new, structures [22]. Beck and Plowman [19] identified emergence as “new structures and new forms of behavior in open systems far from equilibrium”, whereas Campbell-Hunt [25] identified it as “new structures around which organizational activity is reassembled”.
Operating in complex and open systems, teams must be free to self-organize as they adapt to external and internal forces, allowing team members to interact accordingly until the team emerges as a new entity to address the current environment. This process identifying teams as complex adaptive systems is described best by Beck and Plowman [19]:
Groups are best represented as being complex adaptive systems (CAS). McGrath et al. [7] highlighted this point by describing groups as: “complex entities embedded in a hierarchy of levels and characterized by multiple, bidirectional, and nonlinear causal relations”. McGrath et al. [7] identified groups as “complex entities embedded in a hierarchy of levels and characterized by multiple, bidirectional, and nonlinear causal relations”. Ramos-Villagrasa et al. [8] proposed that viewing teams as CAS was more than just a metaphor anymore, it has become a “change in the epistemology of teams”. Ramos-Villagrasa et al. [8] highlighted this new epistemology as providing researchers to: “(a) adopt a different logic of inquiry, (b) to deal with temporal issues, (c) to raise the level of theoretical sophistication, and (d) thus to lead to better practical applications”. One example of this is in [26] complex adaptive team systems model that utilizes naturally occurring team processes (see TELDE model [27]) to drive organizational interventions.
Conflict models can be classified as being either descriptive or normative in design. Lewicki et al. [28] identified the key identifier in differentiating between descriptive and normative conflict models as their origin of analysis. Descriptive conflict models tend to be built down from human behavior theories, mainly from academia [28]. In contrast, Lewicki et al. [28] differentiated normative conflict models as those that are built up from direct experience by practitioners.
Six general approaches to conflict were identified by Lewicki et al. [28]: the micro-level approach, the macro-level approach, economic analysis, labor relations approach, bargaining and negotiation, and third party dispute resolution. These different approaches to conflict have been derived from both academia and practitioners, have evolved to address specific needs, have emerged to accompany specific industries, and have originated due to excessive frequency of usage [28].
The micro-level approach best fits with the purpose of this review to identify cognitive conflicts in team settings. The micro-level approach is based in psychological theory concentrating on conflict within and between participants while looking at small group behavior, inter- and intra-personal interactions [28]. A review of the conflict theories from the Lewicki et al.’s [28] manuscript will be concentrated on those classified as being descriptive conflict models from the micro-level approach.
The predominant paradigm within the micro-level approach is presented as being [29] organizational conflict model. Additional models within the micro-level approach that are descriptive had been identified as: [30]
Three conceptual models were presented by Pondy [29] in his seminal article: the bargaining model, the bureaucratic model, and the systems model. These conceptual models deal with interdepartmental conflict (bargaining model), vertical hierarchy conflict (bureaucratic model), and lateral conflict (systems model). Although Pondy’s conceptual models were identified to conceptually represent conflict in organizations, both the bureaucratic and systems models could be utilized to represent conflict in a team setting. The bureaucratic model could be associated with conflict between team leadership and team members, whereas the systems model could be representative of team member to team member conflict. Pondy [29] identified common threads for each of these three conceptual models. These commonalities are summarized below with the original emphasis changed from organization to team:
Each conflict relationship is composed of a sequence of interlocking conflict episodes.
Conflict may be functional as well as dysfunctional for the individual and the team.
Conflict is intimately dependent upon the stability of the team [29].
To further elaborate on the characteristics of conflict, Pondy [29] identified five conflict episodes: “1) latent conflict (conditions), 2) perceived conflict (cognition), 3) felt conflict (affect), 4) manifest conflict (behavior), and 5) conflict aftermath (conditions)”. This systematic organization has been helpful to provide a framework for evaluating the type of conflict team members have experienced or thought they have experienced.
Latent conflict is driven by conflict related to scarce resources, autonomy, and divergence of goals. Role sets within teams is one example of latent conflict, with this latent conflict possibly generated between the team members. Pondy [29] identified latent conflict to occur when “the focal person receives incompatible role demands or expectations from the persons in his role set”.
With a focus on teams, conflict could occur when a team member receives incoherent task assignments or expectations from other team members. Although there might be no conditions for latent conflict in the team, perceived conflict in a team setting is likely to occur when one team member misunderstands the positions of the other team members. To manage conflict within the team, Pondy indicated that a suppression mechanism and an attention-focus mechanism can be present during a perceived conflict episode. When a team member blocked a conflict, the suppression mechanism was applied to team member conflict. In contrast, Pondy explained that the activation of the attention-focus mechanism was applied where team members focused on conflict related more to behaviors within the team organization rather than the personal values of the team members.
Felt conflict refers to the “personalization of conflict” [29]. This conflict could be present in situations where inconsistent demands on team members are made or when a team member feels anxiety through the personalization of conflict [29]. The amount of conflict felt by team members has been observed to be at different levels; there is the possibility that one person might feel conflict with another team member of which that team member has no idea there is any conflict. The level of anxiety felt is personalized.
Manifest conflict represents the levels of behavior that one may take due to the conflict. A team member may react hostile toward a perceived or threatening conflict, which could result in a disruption of other team members. A key element noted within manifest conflict was the intention to create, hence manifest, a conflict situation to frustrate a team member and result in non-cooperative behavior.
Lastly, Pondy [29] explained two possible outcomes for the episode of conflict aftermath; not all conflict has the impact of limiting the achievement of goals within the team. If conflict has a positive effect on both the team members and their performance, then the conflict aftermath would be positive and the team members would be more receptive and experienced controlling future conflict situations. Alternatively, if the conflict had a suppression effect, then team members may react unfavorably during the next conflict episode, or even worse, team members could unleash unresolved issues from a past conflict episode, eventually resulting in poor team cohesion and performance.
Three levels of conflict were introduced by Rapaport [30]: fight, game, and debate. At the first level, fight conflict, responses to conflict are automatic responses, which are manifested by chains of events rather than by rational choice [30]. Within the fight conflict, Rapaport [30] explained that there were both positive and negative feedback loops that account for either the stability or instability of the system. The essence of the fight level is the basic fight or flight responses that are embedded into our psychological make-up. To move beyond these basic animalistic responses, one incorporates cognitive senses as a component of conflict, transforming one from the fight level to the game level of conflict. Rapaport [30] further identified various types of games including zero-sum games where both players eventually lose something, the non-zero sum game where the win of one player does not necessarily mean the loss of the second player, and the three-person coalition game where the final outcome is ultimately decided by the social norm or the majority rule. Within the third aspect, Rapaport [30] described the debate level of conflict as one in which the opponent needs to be convinced of the outcome. As an attempt to persuade someone to listen to an alternate position one often needs to offer new insights that are not threatening [30]. The debate level of conflict offers a situation in which each side has an opportunity to present their position while the other side listens, and vice versa. By providing both sides a position, and allowing each alternative side to listen to opposing views, a better resolution or decision could be made.
Of the three levels of conflict presented by Rapaport [30] the debate level of conflict would be the best level of conflict to model in a team setting. The exchange of information is critical to resolve the team’s conflict. This exchange of information allows team members to consider other points of view, which can lead to productive resolution. This is supported by Rapaport [30]: “a shift in the outlook of the other can take place only together with a shift in one’s own outlook”.
Escalation theory is presented by Yasmi et al. [31] to represent the escalation of a conflict when nothing is done to address the conflict or if the conflict is not addressed in a timely manner. Escalation theory within conflict in teams is “based on inter-individuals’ conflicts within organizational settings” [31]. The model presented by Yasmi et al. [31] is based on Glasl’s (as cited in Thomas [31]) stage model of conflict escalation which involved nine stages of escalation: (1) hardening, (2) debate, polemics, (3) actions, not words, (4) image and coalition, (5) loss of face, (6) strategies of threat, (7) limited destructive blows, (8) fragmentation of enemy, and (9) together into the abyss.
The first stage of conflict, hardening, takes place when a typical disagreement in opinion or policy occurs between two parties. As each party attempts to resolve the conflict, both sides become more fixed in their positions, hence the descriptive term, hardening, used for this stage. Thomas [33] explained that progression to stage two occurs when either side loses faith in resolving the conflict: “When straight argumentation is abandoned in favour of tactical and manipulative argumentative tricks, the conflict slips into stage 2”. During the second stage of debate, the two parties continue to hold onto their fixed position, furthering their diverging positions. Thomas identified that rational interactions escalate into emotional and power issues during this stage. At this point mistrust becomes an issue and one or both parties begin to act without consulting the other side [33]. This leads us to the third stage, actions, not words. During the actions stage, each party views the other as a competitor in which verbal communication is diminished due to a lack of trust between the parties [33]. Both parties begin to feel a sense of helplessness in that neither side can resolve the conflict.
Once the conflict becomes a matter of either victory or defeat for both parties, as Thomas [33] pointed out, the conflict has entered into the fourth stage, images and coalitions. During this fourth stage, each party suppresses the opinions and suggestions presented from the other party resulting in in-action. Attacks become more prevalent and take a form that borders acceptable norms for the two parties involved. Thomas identified these attacks as dealing through “insinuation, ambiguous comments, irony and body language” (stage 4). Once these attacks expand beyond the acceptable norms for the two parties then the conflict has entered into stage 5, loss of face. Thomas [33] identified attacks during this fifth stage to be directed toward a person’s status within the group or organization, a person’s ‘face’. Once the conflict escalates to where one or both parties begin to make ultimatums or threats, Thomas indicated that the escalation has entered into stage 6, strategies of threats. Beyond this sixth stage, those stages of limited destructive blows, fragmentation of the enemy, and together into the abyss, are present in rare cases [33]. In most cases, conflict within a team setting will be of the stages between hardening (stage 1) and loss of face (stage 5).
Escalation can take one of two forms according to Pruitt [32]. Escalation where one party becomes increasingly resistant while the second party remains open to discussion is what Pruitt termed
Dual concerns have been identified in the literature to represent the dual nature of ‘concern for oneself’ and ‘concern for others’ [34, 35, 36]. The interaction of the concern for self and concern for others occurs on a diagonal where low concern for self and a low concern for others results in a team experience that attempts to avoid the conflict. As the level of concern increases along the diagonal, the level of positive strategy for conflict resolution in implemented. The highest concern for self and for others on the diagonal represents a compromise situation for team members. Although the level of concern seemingly provides for positive outcomes related to conflict resolution, team members with little or no experiences have been observed to have difficulty integrating conflict resolution strategies for long-term solutions in team conflict situations [35]. It is expected that team members who experience the stages of conflict and are novices to conflict, would have difficulty achieving positive outcomes.
Conflict in group settings (e.g., teams, department, task group) has been described as being a dynamic process consisting of a series of conflict episodes [29]. Greer et al. [37] supported this description by indicating that “conflict is dynamic”. Likewise, Pondy [29] proposed: “Conflict can be more readily understood if it is considered a dynamic process”. Since Pondy’s [29] stages of conflict, the field of intragroup conflict has expanded into a multidimensional model. Balkundi et al. [38] indicated that team conflict could have multiple effects including distracting team members, undermining relationships, and reducing the team’s ability to function (similar to those effects outlined by Pondy’s conflict episodes). Team conflict is synonymous with intragroup conflict or within group conflict. Intragroup conflict can be formally defined as: “Perceived incompatibilities or perceptions by the parties involved that they hold discrepant views or have interpersonal incompatibilities” [39].
Traditionally, intragroup conflict has been described as being a multidimensional construct [40] consisting of task, relationship, and process conflict. Intragroup conflict originated with Jehn [39] in which task and relationship conflict were first combined into one larger concept - intragroup conflict. Further expansion of intragroup conflict began with the introduction of process conflict [40, 41, 42, 43]. At this point, intragroup conflict was identified as consisting of the “trio of task, relationship, and process conflict” [44]. Jehn and Chatment [41] highlighted the point that the three intragroup conflict types were interrelated and each one should be included in any research effort that looks at intragroup conflict (Figure 4).
Intragroup conflict.
Task conflict is associated to task related functions and the judgement differences that arise when completing specific tasks [44]. Jehn [39] identified that high levels of task conflict could be associated with “tension, antagonism, and unhappiness among group members and an unwillingness to work together in the future”. Also, task conflict relates to differences in opinions or viewpoints about the team’s task, including task awareness, disagreement of work issues, and disagreements surrounding the work being conducted [37, 40, 44, 45]. Increasing task conflict has been associated to increasing team performance [46], up to a point. Like most things, too much results in negative consequences.
Relationship relates to interpersonal conflict: “Interpersonal animosity, tension, or annoyance” [45]; also cited in Turner [44] between team members. Whereas disagreements related to task work fall under the task conflict arena; disagreements about non-task work issues are identified as being relationship conflict. Relationship conflict has been identified as being negatively associated with group performance [37]. Also, relationship conflict is potentially the most detrimental conflict type that must be managed effectively. Greer et al. [37] highlighted relationship conflict as having a lasting effect on a team’s performance when not managed properly.
The coordination of activities, scheduling of task work, and allocation of resources make up process conflict. Process conflict has been identified as disagreements about assignments of duties and resources [43], conflict over logistics [37], controversies relating to task accomplishment [42], to simple disagreements over procedures [40, 41]. Process conflict has been shown to negatively impact team performance [46]. As confusion about how to accomplish a task grows, or when resources become unavailable for task completion, tensions grow, resulting in process conflict. Managing process conflict early on during the team’s initial formation pays dividends, especially when process conflict has the potential to lead to relationship conflict and status conflict, ultimately resulting in a snowball effect being counter-productive to team performance.
Once intragroup conflict had been generally accepted by the field, some extensions to the original trio had been proposed. These extensions had extended process conflict into two separate sub-components, logistical conflict and contribution conflict [44, 47]. Logistical and contribution conflict were derived as extensions of process conflict primarily due to the lack of process conflict being able to differentiate itself from task and relationship conflict, resulting in most studies dropping process conflict and only using task and relationship conflict [47]. Reasons for this were highlighted in Behfar et al.’s [47] research: “Process conflict has been difficult to distinguish empirically from task conflict and is often highly correlated with relationship conflict”. Also, process conflict has been confused with task and relationship conflict due to the inconsistencies in their definitions [47]. Logistic conflict relates to allocation of resources for task accomplishment, whereas contribution conflict identifies with coordination of these activities: “Logistical conflict is about task-related differences, but contribution conflict is about people related differences” [47]. From their studies, high levels of logistical conflict can lead to poor group performance and the presence of contribution conflict negatively affected group satisfaction and other team processes [47].
Much in the same manner that process conflict was confused with other types of intragroup conflict due to inconsistent definitions within the literature, so too was cognition conflict misrepresented. A number of studies would identify cognition conflict by name, and use the definition for task conflict (see [44]). Missing from the trio of conflict was the cognitive aspect, representing the team member’s representation of knowledge and understanding and the representation of the team’s shared knowledge. From the literature relating to team mental models (TMM) and shared mental models (SMM), Turner [44] introduced the construct of cognition conflict to the trio of intragroup conflict. Cognition conflict represents “team member cognitive states (overlapping cognitive representation of team member knowledge, team member representation of tasks, equipment, working relationships, and situations)”. Here, cognition conflict was represented by two sub-categories: elicitation and representation. Elicitation represents the team’s accuracy of knowledge and representation represents similarity in team member structures [44].
More recently, Bendersky and Hays [48] introduced status conflict to the intragroup conflict conversation. Status conflict relates to conflicts that arise due to hierarchical structures within the group [48]. Bendersky and Hays [48] defined status conflict as: “Disputes over people’s relative status positions in their group’s social hierarchy”. In their research, they [48] identified status conflict to be negatively associated with information sharing, and highly impactful to group performance (negatively associated).
Much research has been conducted on conflict management. This section defines what conflict management is and how it encompasses conflict resolution and dispute resolution. Three conflict management approaches: Robbins [49] levels for conflict; Lan’s [50] individual perspective; and Rahim and Magner’s [51] and Thomas’ [52] concern for others are presented as broad strategies on how to think about conflict management. Also, ten techniques: problem solving [45, 53]; collaboration [54, 55, 56]; avoidance [51, 52]; competition [51, 52, 54]; accommodation [51, 52]; compromise [51, 52, 57]; authoritative command [49, 57]; altering structure variables [45, 53]; altering human variable [45, 53]; and expanding resources [49] are provided as tactics for implementing conflict management.
Research on conflict management is extensive. Conflict management is widely studied in a range of disciplines such as sociology, psychology, economics and organizational development [50]. Maybe this is because conflict is always present and occurs in families, political parties, religious groups, businesses, and many other situations [50, 58]. Managers can invest substantial resources in managing conflict [49, 50].
Conflict management, conflict resolution, and dispute resolution are sometimes used synonymously in the literature, but they are not necessarily the same [45, 49, 59]. Just as there are formal conflict (typically associated with settings of defined laws and policies) and informal conflict (typically associated in settings of unwritten communication norms between individuals and groups) types, there are formal and informal conflict management methods [53]. Dispute resolution is often associated with formal work policies, governance, courts, and political situations [60, 61]. Conflict resolution is often associated with the informal interactions between family, team members, colleges, and groups [62, 63, 64]. Both terms can be used for formal and informal interactions.
The evolution from dispute and conflict resolution to conflict management includes disputes but is broader — representing stress, tensions, and strains that may or may not have surfaced or been expressed. Management includes resolution, but also includes prevention and containment [45, 59]. Conflict resolution is often seen as a sequence of post-conflict events intended to end hostility [58]. Whereas, conflict management is more. Management recognizes that not only can conflict be too high, but it also can be too low. Conflict management asks the question, what is the desired level of conflict necessary for success at the interpersonal, group, or intergroup level [49]. Thus, conflict management not only recognizes that conflict can hinder progress, it embraces the idea that conflict enables new ideas, better decision making, and creativity itself [49, 58, 65].
Approaches and techniques for conflict management vary greatly from conversations, to third-party involvement, to violent acts [58, 62, 66]. This section will focus on resolving and stimulating conflict through nonviolent constructive approaches and techniques. As with strategies and tactics, approaches, like strategies, tend to be broad in nature - ideas and guides to thinking. On the other hand, techniques are more like tactics that are more specific and actionable. This section will be spent focusing on techniques. However, approaches are identified as a basis for explaining how the techniques developed.
One approach outlined by Robbins [49] focused on the desired level for conflict. This approach defines conflict as an opposition between two parties. It recognizes that conflict can occur at the interpersonal, group, or intergroup level. This approach considers the traditionalists, behaviorist, and the interactionist view of conflict management. With both the traditionalists and the behaviorist, the approach is to eliminate conflict. But, the interactionist encourages conflict. Through this approach, conflict enables change. Therefore, conflict management is not just the resolution of conflict, but also the stimulation to foster improvement. Eight different conflict management techniques are identified [49].
Another approach outlined by Lan [50] considers the individual status of the conflicting parties. This approach to conflict takes a U.S. centric view. In this approach, the distinct conflict players are the conflicting parties, the observers or onlookers and conflict resolvers. There are three authority related values systems: managerial, political, and legal. The managerial system values efficiency and effectiveness and views the individual as an impersonal objective case. The political system values representation and views the individual as a member of a group. The last system, the legal system, values constitutional integrity; it views the individual as having equal rights. Conflict management is evaluated, stimulated and resolved through one or a combination of these systems. Three primary conflict management techniques are presented with additional alternative techniques [50].
Within the last approach, proposed by Thomas [52] and by Rahim and Magner [51], each consider the concern for others (cooperativeness) and concern for self (assertiveness) as key predictors in how individuals will manage conflict. These researchers used a two by two matrix to predict conflict management styles based on the strength of each consideration—ranging from high concern for both self and others to low concern for self and others. Five conflict management techniques are identified [51, 52] and are presented in the following section.
The following conflict management techniques have been highlighted in the research approaches mentioned above and from related research on conflict management approaches, techniques, and skills. Techniques are not mutually exclusive and may have some overlapping concepts. Different techniques may be more appropriate based on conflict type (task, process, or relational), outcomes, timing, and the power position of interacting parties [44, 45, 54].
Problem solving is the most direct technique. Problem solving is often associated with managing task related conflict [44, 45].Through this tactic, parties involved in the conflict interact to define, assess, and solve the problem [49, 50]. Interactions to arrive at problem definition among conflicting parties, observers and/or conflict resolvers may involve debate and discussion of ideas [45]. Through communications and direct interactions to confront the problem and related parties, information can be gained to move forward [57, 66]. Problem-solving can be executed through individual interaction, workshops, and third-party mediation [50, 58].
Collaboration is often seen as the most desired technique [54]. Through the collaboration tactic, one focuses on both high concern for others (cooperativeness) and high concern for self (assertiveness) in conflict management [51, 52]. The collaborative technique can be described as integrative and cooperative because it constructively searches for information that can be used to develop mutually satisfactory agreements [55, 56]. Collaboration can also be described as smoothing, which focuses on common interest between parties and deemphasize differences [49, 57, 67]. In some situations, cooperation has to evolve and grow over time allowing for small victories to build trust while enabling flexibility and learning [68].
This is the opposite technique to collaboration. Avoidance is often practiced when there is a low regard for self and the opposing position in a conflict [51, 52]. Withdrawal, ignoring, suppression, and not addressing issues represent this technique [46, 50, 58, 68].
With the competition technique, one focuses on high regard for self (assertion) and low regard for the opposing position (low cooperation) in managing conflict [52, 53]. This technique can also be labeled as dominating and is often used when there is a perceived power imbalance favoring the dominant party [51, 54].
The opposite tactic to the competitive technique is accommodation. With this technique, one focuses on a low regard for self and a high regard for the opposing position [51, 52]. This technique is also referred to as obliging and can result in quick resolve and being viewed favorably by the opposition [51].
Compromise is similar to collaboration. The difference is that there is a high regard for self and opposing positions in the short-term, but not necessarily in the long-term [51, 52]. Compromise can also be termed bargaining or negotiating; [57, 67, 68]. It is often facilitated through an exchange and giving up one demand to secure another [49].
Through this technique a formal authority dictates the solution [49]. Authoritative command can be viewed as forcing [57, 67] a win-lose scenario. This technique can be implemented by a leader, manager, group vote, arbitrator, court or other party [45, 49, 50].
Changing structure may be reflected in different group dynamics, roles, responsibilities, coordination tactics, new boundaries, or systems [45, 49]. This technique is closely associated with managing process related conflict [44, 45]. To execute this technique, a third-party may enable the change for better process or structure utilizing negotiations, arbitration, or mediation [58, 68].
This technique is closely associated with relational conflict management [44, 45]. It involves using education, awareness, training, and other constructive means to change the attitudes of one or more conflicting parries, but may be the hardest to implement [49, 66]. Cognitive analysis, posited by [67], is part of this technique. Cognitive analysis recognizes that conflict resolution is based on human judgement, which can be inaccurate and inconsistent. Conclusions about an outcome on the surface can have deeper implications that are both different than what is expressed on the surface and hard to explain. This cognitive difference can be a source of team conflict through elicitation and representation [44, 67]. Cognitive analysis outlines a system to communicate and clarify differences in cognition [67].
Expansion of resources may be the easiest technique to implement. If resources and means are available, making more of the scarce resource, that is causing the conflict, available to the parties involved enables a high sense of satisfaction to everyone [49].
Hempel et al. [69] highlighted research indicating that inter-group (external) and intra-group (internal) conflict are highly related. If a team is unable to manage inter-group conflict they are also less likely to manage intra-group relations, including intra-group conflict. Hempel et al. [69] pointed this out by stating “within-team processes can influence between-team processes”. In fact, they went as far as to identify competition between groups often results in lower within group performance. This would seem counterproductive to typical motivational techniques that believe that competition yields a greater aggregate compared to no competition among groups. However, when viewing teams as CAS these research results make sense. In CAS, changes in one part of the system results in changes in the whole system. If the change in one system causes a large enough dissonance among other parts of the system this could potentially result in the whole system emerging as a different entity. In the case of managing a team’s internal processes, including intra-group conflict, each team must be able to operate effectively internally prior to successfully operating among other teams, thus contributing to the whole organization. If one team is unable to manage its internal processes successfully, this could have drastic effects on other teams and, ultimately, the whole system—the organization.
Complex adaptive systems work both ways, small changes in one system (or sub-system) can affect the larger system just as well as changes in the environment or the larger organization can affect lower level systems. As Hempel et al. [69] indicated: “The way teams within the organization manage conflict with other teams influence how they manage their internal conflicts”. Here, it is critical that managers provide the resources, tools, and freedom for teams to operate independently enough to manage their internal processes as well as providing the mechanisms that allow teams to manage among one another within the organization. Managers need to be aware of the modes of operation within and among teams and small groups to allow the overall system or organization to self-correct, to be adaptive.
Adaptive organizations are not heavily managed. If they were, they would not be able to react to external changes quickly enough. Adaptive leadership provides mechanisms for organizations to react quickly to external changes, offering a prescriptive approach for leaders to help their followers confront and manage conflict issues in complex and changing environments [70]. Adaptive leadership “focuses on the strategies and behaviors that encourage learning, creativity, and adaptation in complex organizational systems” [71]. Northouse [71] presented six behaviors for adaptive leadership:
Get on the balcony: a metaphor for adaptive leaders to step away from the fray to gain a bigger perspective;
Identify adaptive challenges: adaptive leaders focus on the problems that they alone cannot solve and require collaboration with others;
Regulate distress: adaptive leaders monitor the stress that people are experiencing during times of uncertainty while helping them to recognize the need for change but not to be overwhelmed by it;
Maintain disciplined attention: adaptive leaders influence others to remain focused with the task at hand despite the difficult nature of the work or the tendency to avoid it;
Give the work back to the people: adaptive leaders empower others to take ownership of their work by allowing them to solve their own problems and take responsibility for both positive and negative outcomes;
Protect leadership voices from below: adaptive leaders listen and are open to ideas from those who are in the minority in order to avoid group-think.
The authors identify adaptive leadership as one potential leadership style to better manage in today’s complex environment. However, there are other leadership styles that may work just as well (e.g., complexity leadership theory, shared leadership). More research is needed to identify which types of leadership styles work best in complex environments, adaptive leadership is only identified here as one potential style.
Complex adaptive systems are a composite of the interconnected whole that empowers teams and leaders to understand and address intragroup conflict in complex and adaptive situations. Future research relating to the five different intragroup conflict strategies presented in the current chapter is recommended. Currently, there is no study or instrument incorporating all five intragroup conflict constructs in the same study (task, relationship, process, cognition, status). This line of research could benefit the literature relating to small group and organizational behavior research in two key areas. First, a comprehensive instrument on intragroup conflict would be composed and validated. Second, this instrument would be utilized in future research efforts to better identify the effects of intragroup conflict on team performance as well as identify the impact that different leadership styles might have on intragroup conflict.
The taxonomy of team processes presented in the current chapter from Marks et al. [15] provides probably one of the best temporal models for teams. This model identifies the team transition, action, and interpersonal phases as a team works toward goal attainment. However, this model is essentially a linear model and does not address complexity and emergence. Future team process models are recommended to be developed using complexity theory to position the construct of emergence as a key outcome of team processes caused by the interactions facilitated by organizational leaders or managers. This is important to address because today’s teams are more self-directed and achieve their outcome once emergence has surfaced. Current team process models are just beginning to incorporate emergence as a key team process. Better understanding of the antecedents to this emergence (e.g., interactions) will provide better utility for teams and organizations in the future.
Sexuality and disability is a comparatively new issue of concern with pertinent research on the topic originating in the 1970s [1]. It was during this era that we witnessed increased focus on principles of normalization as a basis for service delivery for people with disabilities [2]. It was also during the 70s that the
Best professional practices dictate that healthcare providers refrain from coercing clients to discuss sexuality needs or concerns. However, questions pertaining to this significant aspect of human functioning are basic to holistic assessment and treatment. Clients should feel as if the door to discussing these matters is open throughout the tenure of care or service and that sexuality is a natural topic for discussion. Conscientious providers are aware of their limitations and promptly refer out when a sexual concern extends beyond their scope of practice. According to Nosek [5], “disability is a complex phenomenon, but psychosocial and social factors make all the difference in the outcomes” (p. 121). In the following section we will explore psychosocial factors that should be considered when sexuality and disability present as a rehabilitation concern.
The goal of the conscientious provider is to increase protective psychosocial factors and to decrease or eliminate psychosocial factors that foster risk or harm. These factors can be addressed by a single provider or an interprofessional team [6]. According to Mah and Binik [7], sexuality involves more than physical performance or physical factors. Positive attention to psychosocial factors tend to correlate more with healthy sexuality. Table 1 depicts psychosocial factors impacting sexuality.
Protective factors | Risk factors |
---|---|
Healthy, functional, supportive family-of- origin | Dysfunctional family-of-origin |
High level of self-confidence, self-esteem | Low self-confidence, poor self-esteem |
Appropriate sex education (e.g., age level, cognitive level, etc.) | No formal sex education |
Body image acceptance (rejection of dominant, ableist, heteronormative notions about beauty, sex) | Poor body acceptance (internalization of dominant, ableist, heteronormative notions about beauty, sex) |
Positive social network | No (or insufficient) social network |
Healthy, positive coping ability | Poor coping ability |
Internal locus of control | External locus of control |
No history of sexual abuse, exploitation | History of sexual abuse, exploitation |
Acceptance or positive adaptation to disability | Low acceptance or poor adaptation to disability |
General sense of optimism | General sense of pessimistic |
Service agency or provider adheres to a social-environmental model of care | Service agency or provider adheres to a medical model of care |
A holistic assessment tool should capture information or invite discussion in all of the areas above. This information can easily be converted into a needs assessment. Agencies adhering to the medical model of disability versus the social-environmental model of disability may not see the value of assessing for protective and risk factors that impact sexual functioning.
Myths about disability and sexuality are pervasive in our society. According to Esmail et al. [8], stigmas and negative attitudes often result in the internalization of concepts that can adversely influence self-esteem and sexual confidence. The researchers underscored how public attitudes and perceptions are driven by education and knowledge. Personal biases and beliefs can also limit providers’ ability to engage comfortably with clients while discussing sexuality or sexual health. The ethical expectation is to do no harm; yet harm can occur when providers fail to embrace the notion that sexuality is a critical quality of life determinant. It is important that healthcare professionals be mindful of the roles they play in propagating myths and negative attitudes about sex and disability. Obtaining accurate knowledge and relaying this knowledge is the only way to eradicate broadly held destructive beliefs [10]. According to Haboubi and Lincoln [11], 90% of multi-disciplinary health professionals agreed that sexuality should be part of holistic care (
Sexuality has longed been a taboo subject because of societal, religious, and cultural norms and expectations. It is the forbiddingness of the topic that has erected barriers to addressing sexuality in healthcare settings. This taboo is associated with a lack of knowledge, inadequacies in training, and low levels of comfortability. Sexuality is a private and sensitive subject and must be approached professionally to avoid any confusion of emotions and feelings between the healthcare professional and client. Therefore, adequate knowledge of and training on how to approach and address this topic is vital to overcoming barriers and ensuring successful interventions.
Common myths are outlined below [3, 10, 13, 14]. Rehabilitation professionals, in particular, have an obligation to do what they can to debunk these myths.
People with disabilities are asexual, having no sexual desires or interests
No able-bodied person would find someone with a disability desirable
Sexual intimacy is not possible for people with disabilities
People with disabilities are not suitable marriage or sexual partners
Preventive medical procedures such as pap smears are not necessary for women with disabilities, especially those with spinal cord injuries
Sex education is not necessary for people with disabilities
It is easier for people with disabilities to adapt to sexual losses and changes
Large aggregate care institutions serving people with disabilities were closed in most western European and North American countries in the 1970s and 1980s and today, large numbers of people with disabilities are living independently. They hire personal assistants who are their employees, not their overseers. They have been empowered by the disability rights movement to demand access, support, and respect. As part of their increased independence, many are unapologetically exploring their sexuality. They are finding partners, engaging in romantic relationships and refusing to be told that a disability automatically disqualifies them from having an erotic life [15]. There is a delicate balance between the legal and ethical requirements to protect people with disabilities from harm, including sexual exploitation and abuse, while at the same time protecting their rights to express sexuality in a healthy way [16]. Honest, accurate information about sexuality changes lives, especially for individuals with disabilities. It dismantles stereotypes and assumptions, builds self-acceptance and self-esteem, fosters healthy relationships, improves decision-making, and has the potential to save lives. However, because the topic of sexuality and disability is often surrounded by controversy and stigma, it is important for healthcare providers to remain ethical and professional when dealing with such issues.
There is a delicate balance between the legal and ethical requirements to protect people with disabilities from harm, while at the same time protecting their rights to sexual expression. Traditionally, parents, professionals, and the law have erred on the side of protection from harm, consequently limiting sexual expression of people with disabilities, e.g., the same laws that were designed to protect people with disabilities from harm prevented them from engaging in normal sexual activities [16]. What appears to be concern for the welfare of people with disabilities therefore could, in reality, be masking an anti-sexual bias. Since the law protects the rights for sexual activity for and between individuals with disabilities, service providers cannot have policies prohibiting it [17]. Instead, agencies should have policies that help people with disabilities learn about and express their sexuality in healthy ways within the confines of the law and ethical principles [16, 18, 19].
Among the many barriers to healthy sexual expression for people with physical and developmental disabilities is lack of privacy [20]. Individuals have the right to privacy and to consensual sexual relations. These rights are restricted, obviously, for children, and also for those individuals who are determined to be incapable of consenting to sexual activities. However, the right to privacy is often restricted in the case of an individual who engages in severe self-injurious behavior and/or property destruction. In these cases, the individual’s service or behavior plan frequently requires ‘line-of-sight’ supervision, which challenges the individual’s right to private sexual expression. This is not a simple matter, as it exemplifies the conflict between concern for wellbeing and upholding of the rights of the individual.
Capacity to consent can vary over time. This means capacity to consent is a state rather than a trait. Sexuality education can enhance the capacity of people previously deemed incapable of making informed decisions. Thus, repeating an assessment for capacity to consent may yield different findings across time and may indicate that even individuals with intellectual or developmental disabilities who were previously deemed incapable, have developed the capacity to consent to sexual interactions. Additionally, the requirements of consent can vary based on the nature of the sexual interaction. Thus, to best help people with disabilities make informed choices, good quality ongoing sexuality education is necessary [21].
The crucial components of capacity to consent are knowledge, rationality, and voluntariness [22]. Sexual knowledge starts with the ability to label body parts, identify sexual behaviors, and understand where and when it is appropriate to engage in sexual behaviors and where and when it is not appropriate to do so. Sexual knowledge encompasses being able to state the consequences of sexual behavior, specifically pregnancy and sexually transmitted infections, and how to prevent them. Knowledge also means the person can demonstrate how to obtain and use contraception [22]. Voluntariness means the person can decide without coercion, that, and with whom he or she wants to have sex. This also means he or she is able to take necessary self-protective measures against abuse, exploitation, and other unwanted advances. Voluntariness also means that the person has the ability to say, “No,” either vocally or non-vocally, and to remove him or herself from a situation and indicate a desire to discontinue an interaction [22, 23, 24]. Rationality means the ability to evaluate and weigh the pros and cons of a sexual situation and make a rational decision. When considering someone’s ability to be rational, any neurological conditions that can impair decision-making need to be considered. Determining rationality comprises the individual’s awareness of person, place and time; his or her ability to accurately report events; and to discriminate between fantasies, lies, and truth. The individual should be able to describe the process for deciding to engage, or not, in a partnered sexual interaction, to demonstrate an understanding of mutual consent, and chose socially appropriate times and places to engage in sexual behaviors. Finally, he or she should be able to perceive and respond to the vocal and non-vocal signals of the feelings of his or her partner, specifically the desire to continue or discontinue the sexual interaction [22].
Sexuality is defined as a multidimensional construct in which the individual expresses feelings, thoughts, and cognition, such as the demonstration of intimacy, affection, love, touch, hugging, including sexual contact itself [25]. This asserts that sexuality includes many aspects of a person’s life and while it encompasses the concept of intercourse, sexuality exceeds the idea of physical sex. The ability to fully experience sexuality does not have to be hindered by a person’s or couple’s disability status. Sexuality and being sexually healthy is an important part of life. According to the World Health Organization (WHO), sexual health is defined as “a state of physical, mental and social well-being in relation to sexuality”, which “requires a positive and respectful approach to sexuality and sexual relationships, as well as pleasurable and safe sexual experiences, free of coercion, discrimination and violence” [4]. This definition indicates that sexual health is not just about physical intercourse but also about the mental and social connections involved with intimacy. People with disabilities have the right to experience this connectivity just as people without disabilities. Societal attitudes, beliefs and perceptions guide how individuals with disabilities are regarded. These attitudes, beliefs, and perceptions are also evident in healthcare settings. If an individual without a disability experiences a lack of sexual desire, he or she is diagnosed as having hypoactive or inhibited sexual desire disorder [26]. Similarly, if this person is unable to experience an orgasm, he or she is diagnosed as having an orgasmic disorder. The rendering of a diagnosis makes it possible to qualify for medical treatment and to receive assistance in achieving sexual satisfaction [26]. These disparities in medical perspectives can ultimately impact the quality of life for people with disabilities. Very often these individuals are expected to simply adjust to their disability status with no consideration or discussion about appropriate or possible interventions.
More than 15% of the world’s population have disabilities. These disabilities can be categorized as physical and sensory; developmental and intellectual; and psychosocial [27]. Society has long disregarded the sexuality and reproductive concerns, aspirations, and human rights of this sector of our population [27]. People with disabilities are often not educated related to concepts about sexuality, relationships, and intimacy. People with disabilities are often viewed as infantilized and held to be asexual (or in some cases, hypersexual). Furthermore, they are often viewed as incapable of reproduction and unsuitable as sexual or marriage partners or parents [27]. While not all disabilities impact sexuality, many of them disabilities do. The following sections discuss how physical disabilities, cognitive/intellectual disabilities, mental disabilities, and disabilities related to aging impact sexuality and levels of intimacy.
Physical disabilities are disabilities that impact the mobility of a person. Physical disabilities directly affect muscles and limbs. Physical disabilities include but are not limited to the following types of conditions: lupus, cerebral palsy, absent or reduction in limb functions, and muscular dystrophy.
Lupus
Lupus is a chronic autoimmune disease where one’s own immune system attacks many different systems within the body.
Cerebral palsy
Cerebral palsy is a group of disorders that affect a person’s ability to move and maintain both balance and posture. This disorder is characterized by stiff muscles, uncontrollable movements, and poor balance and coordination [28].
Absent limbs or reduction in limb functions
This group is related to the loss of limbs through amputation or injury in addition to the absence of limbs since birth. Additionally, this group includes individuals who lose functioning or control of their limbs over time, limiting their mobility and their ability to complete tasks
Muscular dystrophy
Physical disabilities impact sexuality in a variety of ways. The impact is based on the person, their specific condition, and the severity of their condition.
Lupus
Individuals with lupus are impacted physically and emotionally by their symptoms. Sexual dysfunctions are the result of both the physical and psychological problems [30]. The physical limitations affect individual’s ability to be intimate but psychologically their motivation and desire to engage in intimacy is impacted. Those diagnosed with lupus often experience pain during sexual activity [30]. Pain can be a significant barrier to a healthy sexual experience. With lupus, this pain can occur even with gentle movement. Pain during intercourse, vaginal dryness, and the development of ulcers in the mouth and genitals areas are manifestations of with lupus [30]. Additional side effects of lupus that such as fatigue and weight gain may also impact sexuality.
Cerebral palsy
Individuals with cerebral palsy frequently are not able to reach an orgasm and report infrequent experiences with intimacy. Individuals with cerebral palsy are limited by personal and functional characteristics that are specific to their type of cerebral palsy. Additionally, they may struggle with issues related to energy, fatigue, body image concerns, and lack of sexual confidence.
Absent limbs or reduction in limb functions
While sexual functioning is rarely structurally diminished by absent limbs or reduction in limb functions; many individuals with these disabilities experience sexual challenges [31]. They may struggle with internalized views of their sexual self or with the external views of others. Reductions in sexual interest, frequency, arousal, and difficulties pertaining to orgasm and sexual drive have specifically been reported in this group of disabilities [31].
Muscular dystrophy
Individuals with muscular dystrophy report difficulties with kissing and oral sex [32]. Both of these activities require significant muscle movement and coordination. Individuals with muscular dystrophy also report difficulties with bodily positions during sexual activities and having a negative body image in general [32]. Individuals with muscular dystrophy also report difficulty communicating with their partners about their functional limitations [32]. Some of their limitations are related to hugging and being able to caress [32]. Other manifestations may include pain during intimacy, fatigue, and erectile dysfunction [32].
Cognitive/developmental/intellectual disabilities are disabilities that impact the thinking process, adaptive development, and ability to socially connect with others. These conditions have a variety of social characteristics: impulsivity, limited attention span, difficulty understanding social ques, and perceptual limitations related to other behaviors. This group of disabilities are characterized by diagnoses such as attention deficit hyperactivity disorder (ADHD), autism spectrum disorder, and down syndrome.
Attention deficit hyperactivity disorder
ADHD is a neurodevelopmental disorder, which many recognize as a childhood disorder [33]. However, a review of the literature as well as longitudinal studies of individuals with ADHD reveals that symptoms of ADHD can persist into adulthood [34]. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5), ADHD is characterized by impulsivity, hyperactivity and inattention [35]. Overall, it is a developmental disorder that impacts social interaction and behavior patterns.
Autism spectrum disorder
According to the DSM 5, autism spectrum disorder is a neurodevelopmental disorder characterized by (1) persistent deficits in social communication and social interaction across multiple contexts and (2) restricted, repetitive patterns of behavior, interests, or activities [35]. Autism spectrum disorder may impact individuals’ ability to interact socially and make connections with others.
Intellectual disability
This is a disorder where an individual may present with limited understanding along a spectrum. These individuals may present with cognitive impairments (mild, moderate, severe or profound).
Down syndrome
Down syndrome is a genetic disorder that results in an extra chromosome 21, either partially or fully. Down syndrome symptoms exist on a spectrum from mild to severe. Individuals with Down syndrome often present with both physical and intellectual challenges.
Autism spectrum disorder and ADHD
Social connection, a large component of sexual health, is often a major obstacle for individuals diagnosed with autism spectrum disorder [4]. Individuals with autism spectrum disorder often have social deficits that influence their ability to connect with others. Sexuality is associated with an emotional and social skillset that may directly influence appropriate sexual behaviors and how human beings connect with others [4]. Similarly, to autism spectrum disorder, ADHD presents social obstacles. These social obstacles impact intimacy, experiences with connectivity, and sexual decisions.
Intellectual disability and down syndrome
Studies indicate that people with intellectual disabilities and Down syndrome face various personal and socioenvironmental barriers in their sexual lives [36]. Many of these are related to their inability to understand the dynamics of intimacy and sexual situations. Some of the barriers that negatively impact individuals with intellectual disabilities and Down syndrome include limited sexual knowledge, poor education, negative attitudes related to sex, lack of access to healthcare, lack of sexual experiences, and social isolation [36]. Each of these factors impede the development of healthy sexual behavior practices. Overall, the lack of knowledge about sexuality coupled with limited sexual experiences, language difficulties, communication problems, fear, embarrassment, low self-esteem, and poor negotiating skills can increase exposure to unsafe situations for both men and women with intellectual difficulties and/or Down syndrome [36].
There are many mental health disorders that impact sexual functioning. Some categories identified in the DSM 5 are mood disorders, anxiety disorder, psychotic disorders, and eating disorders. The prevalence of sexual dysfunctions is higher in persons with mental disorders, particularly those treated with psychotropic medications [37].
Mood disorders
This is a group of mental health conditions that is characterized by the disturbance of one’s mood contributing to feelings of dysthymia, dysphoria, euthymia and/or euphoria. Very often in this group, a person’s mood is unstable and requires medical treatment.
Anxiety disorder
This is a group of mental health conditions that are known to cause excessive and consistent fear and worry. Some individuals may experience panic attacks or have severe forms of anxiety that not only impact their perceptions and experiences socially and intimately, but also affect their physical mobility.
Psychotic disorders
This is a group of mental health conditions where perceptions and experiences are impacted by external stimuli and thoughts that may not be based on reality. Psychotic disorders are regularly treated with antipsychotic medications whose common mechanisms impact sexual experiences as well [37]. Symptoms associated with psychotic disorders may also impact the ability to meaningfully connect with others, socially and intimately.
Eating disorders
This is a group of mental health conditions relate to eating habits. Eating disorders are manifested by eating and purging, binge eating, and extreme caloric restriction. Very often individuals are ashamed of their behaviors and engage in these activities in secret. Eating Disorders can influence individuals’ ability to connect socially and intimately with others.
The rate of sexual disorders in people experiencing mental disabilities is significantly high. The use of psychotropic medications and subsequent side effects often exacerbate sexual dysfunction [37].
Mood disorders
Major depression is a common mood disorder. Decreased libido commonly accompanies an episode of major depression [37]. Depressed persons may also experience diminished ability to maintain sexual arousal or achieve orgasm. In males with severe depression, the rate of erectile dysfunction is as high as 90% [37].
Anxiety disorder
There are several types of anxiety disorders and each has symptoms that impact a person’s ability to emotionally connect with others due to stress and worry. Additionally, a loss of libido occurs frequently in people with high levels of anxiety.
Psychotic disorders
Patients suffering from psychotic disorders are prone to experience sexual dysfunction as a part of the nature of the disease [37]. Negative symptoms of the disorder, such as anhedonia, avolition, and blunted affect significantly diminishes the ability to enjoy sexual and intimate activities [37]. In addition, these individuals face difficulties in establishing relationships due to recurrent psychotic episodes, obesity, and low self-esteem [37].
Eating disorders
Clinicians have often reported that anorexia nervosa patients suffer from sexual dysfunction and immaturity, evident by low sexual interest, inhibited sexual behavior, disgust towards sex, and fear of intimacy [37].
Aging and neurological disabilities are disabilities that impact the brain and spinal cord. These disorders may also be more prominent in individuals who are older.
Alzheimer’s disease and dementia
Dementia is a disorder that encompasses conditions that affect memory, focus, communication, judgement, and perceptions. They vary in degree of severity and influence the way individuals are able to interact with and experience others. Alzheimer’s disease is a specific and common type of dementia.
Parkinson’s disease
Traumatic brain injuries
Traumatic brain injury is harm to the brain due to trauma. This can result from a forceful strike to the head or from something penetrating the head. Both injuries can result in both physical and emotional symptoms.
Spinal cord injuries
Spinal cord injuries are debilitating conditions that result from a sudden, traumatic impact on the spine that fractures or dislocates the vertebrae [39]. The severity of the injury and the location of the injury dictates the level of functional limitation. Spinal cord injuries can result in paraplegia, or tetraplegia [39]. Paraplegia is defined as the impairment of sensory or motor function of the lower extremities while tetraplegia is defined as a partial or total loss of sensory or motor function in all four limbs [39].
Alzheimer’s and dementia
Individuals diagnosed with dementia or Alzheimer’s endure mental health symptoms such as depression and anxiety that impact their motivation and ability to participate intimately with others. Physically they may experience erectile dysfunction and reduced strength and mobility due to impairment of the motor systems.
Parkinson’s
Adults with Parkinson’s report significant adverse effects on quality of life due to their symptoms [38]. They report concerns with both depression and anxiety [38]. These symptoms influence how they view themselves and how they believe others view them. They also report issues with urinary disturbances and erectile dysfunction as well as issues with pain, and sensory issues related to the reduced blood flow to and from sexual organs [38].
Traumatic brain injury
Individuals who experience traumatic brain injury report coping with changes in their sexual desires. Some report that they have decreased sexual desires and a loss in sexual interest while others report increased in sexual desires and difficulty controlling sexual desires [40]. Individuals with traumatic brain injuries report decreased sexual arousal even when they are interested in intimacy [40]. Men may experience erection difficulty, while women may present with difficulties with vaginal lubrication. Both men and women with traumatic brain injuries report trouble reaching a climax and in general they report lacking satisfaction after intimacy [40].
Spinal cord injuries
The type of injury to the spinal cord dictates the degree of sexual difficulty [41]. Sexuality concerns vary widely. There are reports of limitations with erections and ejaculatory difficulties in men [41]. In women there are reports of decreased lubrication [41]. In general, the frequency of sexual activity and intercourse appears to decline after a spinal cord injury [41]. Individuals with spasticity in the hips and thighs also experience challenges as they relate to sexual intimacy [41].
This final section of the chapter will identify how occupational therapy (OT), physical therapy (PT), and rehabilitation counseling approach the topic of sexuality with clients. All three disciplines emphasize the importance of (1) acknowledging sexuality and disability, (2) early initiation of discussions by the healthcare professionals, (3) self-awareness of the healthcare professionals’ attitudes towards sexuality and disability and as their own sexuality, and (4) counseling education.
The topic of sexuality has previously been unrecognized or disregarded by many healthcare professionals when addressing clients’ care, holistically [12, 42, 43]. Discussions concerning sex and disability have been particularly arduous. However, over the course of years, the emergence of the identification and acknowledgement that sexuality is important to all human beings has contributed to a positive shift towards acceptance. Consequently, sexuality is slowly becoming a more acceptable topic to discuss and approach in the clinical setting.
Sexuality in healthcare should be approached from an interprofessional perspective. Sexuality is a core aspect of an individual’s overall health that “encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction” ([44] , p. 5). Disciplines within the healthcare realm address these core sexuality aspects in manners specific to their disciplines. Healthcare professionals from various disciplines acknowledge that individuals with disabilities are sexual beings, and that addressing sexuality in practice is integral in providing holistic care. According to Haesler et al. [45], given the strong connection between sexuality and quality of life it is important to understand factors that influence its recognition by health professionals. Despite differences in addressing sexuality, some methods amongst providers are comparable. Furthermore, the practitioners’ “interactions should be directed toward creating an environment that promotes the client’s self-esteem, positive and appropriate sexuality, and adjustment to disability” ([46], p. 214).
Personal bias and comfortability are important elements to consider when creating an environment where sexual issues can be addressed or explored. Healthcare practitioners must be able to express empathy and understanding while maintaining appropriate personal and professional boundaries [9]. Such attributes allow practitioners to establish a therapeutic relationship in which they can build trust and confidence necessary to approach this intimate subject. Practitioners must look inward and conduct a self-assessment of their personal attitudes and beliefs, even before initiating the discussion of sexuality with their clients. Being aware of one’s own sexuality and level of comfort is an essential component when conversing about sexuality [12]. Healthcare personnel should not demand that their clients discuss concerns related to sexuality, but rather create opportunities by obtaining permission to discuss sexuality [47].
To counsel effectively, one must first feel comfortable with one\'s own sexuality and then progress to achieving comfort in discussing sexuality with others” ([48], p. 543). Addressing sexuality and disability requires a multifaceted skill-set; one that necessitates factual knowledge, awareness, and interpersonal skills. Health-care professionals’ roles can vary when providing sexuality counseling for people with disabilities [47]. Sexuality training implemented by healthcare practitioners may comprise sex health education and information on related topics and issues such as the physical and psychosocial effects of disability on sexuality, anatomy and development of sexuality, anatomical and systems-related dysfunction, sexual adaptation to functional issues, and appropriate sexual behavior [46, 47, 48]. Due to the sensitive nature of the topic of sexuality, healthcare practitioners have been encouraged to utilize the PLISSIT Model when approaching this topic with their clients.
OT is a profession in healthcare that involves “the therapeutic use of everyday life occupations with persons, groups, or populations (e.g., the client) for the purpose of enhancing or enabling participation” (c, 2020, p. 1). Occupations are identified as an aspect within the domain of practice for OT and are defined as “everyday activities that people do as individuals, in families, and with communities to occupy time and bring meaning and purpose to life” ([49], p. 7), and the therapeutic use of self is defined as the process “in which OT practitioners develop and manage their therapeutic relationship with clients by using professional reasoning, empathy, and a client-centered, collaborative approach to service delivery” ([49], p. 20). Occupations, along with the therapeutic use of self are cornerstones for this profession.
Studies have shown that “sexuality is important to clients and that occupational therapists believe that addressing clients’ sexual issues is a legitimate domain of practice that should be included in order to provide holistic treatment” ([43], p. 53). In OT, occupations are further categorized in eight broad categories within the OT practice domain: activities of daily living, instrumental activities of daily living, health management, rest and sleep, education, work, play, leisure, and social participation. It is from these broad occupations that occupational therapists approach the topic of sexuality with their clients. OT practitioners recognize sexuality as an important aspect of an individual’s activities of daily living, health management, and social participation, and acknowledge how sexuality directly impacts an individual’s self-esteem and quality of life. In fact, sexual activity, “engaging in the broad possibilities for sexual expression and experiences with self or others (e.g., hugging, kissing, foreplay, masturbation, oral sex, intercourse)” ([49], p. 30), is specifically identified as an ADL in the Occupational Therapy Practice Framework-IV (OTPF-IV). Along with an individual’s occupation, OT practitioners also recognize an individual’s sexuality as it relates to their roles and routines. Despite the inclusion of sexual activity as an occupation in the OTPF-IV and the acknowledgement of sexuality as a legitimate domain of practice, studies show OT practitioners “do not adequately address sexual activity in their clinical work” [43].
OT practitioners also address sexuality with their clients with disabilities by providing management of physical problems that may contribute to sexual dysfunction through rehabilitation of physical impairments and adaptive modifications. Some areas of physical impairment addressed by OTs include, tone, endurance, mobility, pain, sensation, anxiety, skin care, and hygiene. Occupational therapists provide education and training in the use of adaptive aids, equipment, and positioning for clients who may require special or alternative support to engage in sexual activity. Psychosocial and emotional problems related to self-esteem, body image, and perception are also addressed.
PT is a healthcare profession that works to “improve quality of life through prescribed exercise, hands-on care, and client education” [50]. PT practitioners also view the client from all aspects of health, thus including sexuality as an integral component to holistic care of their clients [42]. Physical therapists approach sexuality with their clients by addressing “basic sexual function and anatomy, as well as information regarding male and female disorders of sexual function, including the effects of psychological and social factors” [51]. Some areas of physical impairment addressed by physical therapists include muscle strength, tone, mobility, pain, sensation, and reflexes.
Along with client education, one specific area in which physical therapists address sexuality in practice is through pelvic floor physical therapy (PFPT). This type of therapy comprises various manual therapies such as neuromuscular reeducation and behavioral modifications. PFPT has been successful in treating many sexual disorders [52]. This functional retraining therapy promotes pelvic floor muscle strength, endurance, power, and relaxation in patients with pelvic floor dysfunction [53]. This treatment explores neuromusculoskeletal causes of pelvic floor disorders and how they affect sexual dysfunction. As with other PT treatments, emphasis is placed on the muscles, ligaments, and nerves to improve sexual function. PT practitioners identify that sexual dysfunction is related to disorders of the pelvic floor, whether the cause is over activity or inactivity [52]. PFPT provides an effective basis for addressing sexuality with clients using therapeutic interventions such as strengthening and stretching; trigger point and myofascial release; connective tissue manipulation; electrical nerve stimulation; cold laser therapy; and heat and cold therapy.
Rehabilitation counseling is an allied health profession in which the counseling process is used to assist individuals with disabilities in achieving personal, career, and life goals. The counseling process involves communication, goal setting, and beneficial growth or change through self-advocacy, psychological, vocational, social, and behavioral interventions [54]. Rehabilitation counselors have been identified as the health professional clients with disabilities are more likely to discuss personal issues with ([12], p. 16). Rehabilitation counselors often serve as the bridge between the individual with a disability and a self-sufficient, fully integrated life. Certified rehabilitation counselors (CRCs) are equipped to address the topic of sexuality and disability and provide counseling and education with their clients. The impact of disability on sexuality is listed as one of the core content areas for rehabilitation counseling programs ([55], 5H.2j, Section).
Typically, rehabilitation counselors adhere to two professional Codes of Ethics: The American Counseling Association (ACA) Code of Ethics and the CRC Code of Professional Ethics. However, when dealing with the issue of disability and sexuality, neither code offers specific guidelines on the topic. To remain ethical when dealing with issues of sexuality and disability, Rehabilitation Counselors should consider becoming a member of The American Association of Sexuality Educators, Counselors and Therapists (AASECT) [56]. It is also important to become acquainted with certified sexual education resources offered through programs such as Planned Parenthood and Our Whole Lives (OWL). Certified sexuality educators are trained in and adhere to specific ethical guidelines, including issues such as restrictions on genital touching and may therefore have more specific information and resources available regarding sexuality and disability [57].
A counselor’s response to a client’s sexuality concerns can have lasting effects [47]. Given their specialized training in counseling and education, CRCs guide their clients in achieving personal goals related to their sexual health. Rehabilitation counselors can be especially helpful to their clients if they use their disability-related knowledge and rehabilitation counseling skills in conjunction with PLISSIT (Permission, Limited Information, Specific Suggestion, and Intensive Therapy). This is a basic behavioral model of sexuality counseling useful with individuals with disabilities [58, 59]. PLISSIT provides a basis for exploring sexual expression and receiving relevant information on how disability may affect sexuality. The therapy also fosters specific suggestions on how to deal with the effects of disability on sexuality. Through intensive therapy, a client is assisted in coping with issues related to sexuality [58, 59].
Individuals with disabilities have the natural biological desires to express and fulfill their sexual desires. As a result, it is imperative that healthcare professionals address sexuality as a part of their intervention in the clinical settings. Although healthcare professionals from various disciplines acknowledge the need to address this intimate topic, there continues to be a disparity between acknowledgement and sexual health intervention as a part of routine care. According to Sengupta and Sakellariou [42], “inclusion of sexuality in education of health care professionals can contribute to integrating this important issue as a routine aspect of practice” (p. 101). Improving the knowledge, training, attitudes, and level of comfortability of the healthcare professional is key in tackling the taboo of sexuality and ensuring clients that it is appropriate to talk about the topic freely. Those who are committed to providing holistic care for people with disabilities will take the necessary actions to stay abreast of issues pertaining to sexuality and disability. There are a number of psychosocial factors that influence the sexuality of individuals with disabilities. In order to determine risk factors and promote protective factors conversations between people with disabilities and counselors and healthcare providers must take place. Moreover, providers have to develop relevant competences, become knowledgeable about sexuality trainings and resources, and be mindful of ethical guidelines. It is also importants for care providers to be cognizant of how certain disabilities and chronic illnesses impact sexuality.
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He has been listed among the top 2% of scientists in the world for the last three consecutive years, 2019 to 2021 as per studies conducted by the Stanford University, USA.",institutionString:"Praxis Business School",institution:null},{id:"320071",title:"Dr.",name:"Sidra",middleName:null,surname:"Mehtab",slug:"sidra-mehtab",fullName:"Sidra Mehtab",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00002v6KHoQAM/Profile_Picture_1584512086360",biography:"Sidra Mehtab has completed her BS with honors in Physics from Calcutta University, India in 2018. She has done MS in Data Science and Analytics from Maulana Abul Kalam Azad University of Technology (MAKAUT), Kolkata, India in 2020. Her research areas include Econometrics, Time Series Analysis, Machine Learning, Deep Learning, Artificial Intelligence, and Computer and Network Security with a particular focus on Cyber Security Analytics. Ms. Mehtab has published seven papers in international conferences and one of her papers has been accepted for publication in a reputable international journal. She has won the best paper awards in two prestigious international conferences – BAICONF 2019, and ICADCML 2021, organized in the Indian Institute of Management, Bangalore, India in December 2019, and SOA University, Bhubaneswar, India in January 2021. Besides, Ms. Mehtab has also published two book chapters in two books. Seven of her book chapters will be published in a volume shortly in 2021 by Cambridge Scholars’ Press, UK. Currently, she is working as the joint editor of two edited volumes on Time Series Analysis and Forecasting to be published in the first half of 2021 by an international house. Currently, she is working as a Data Scientist with an MNC in Delhi, India.",institutionString:"NSHM College of Management and Technology",institution:null},{id:"226240",title:"Dr.",name:"Andri Irfan",middleName:null,surname:"Rifai",slug:"andri-irfan-rifai",fullName:"Andri Irfan Rifai",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/226240/images/7412_n.jpg",biography:"Andri IRFAN is a Senior Lecturer of Civil Engineering and Planning. He completed the PhD at the Universitas Indonesia & Universidade do Minho with Sandwich Program Scholarship from the Directorate General of Higher Education and LPDP scholarship. He has been teaching for more than 19 years and much active to applied his knowledge in the project construction in Indonesia. His research interest ranges from pavement management system to advanced data mining techniques for transportation engineering. He has published more than 50 papers in journals and 2 books.",institutionString:null,institution:{name:"Universitas Internasional Batam",country:{name:"Indonesia"}}},{id:"314576",title:"Dr.",name:"Ibai",middleName:null,surname:"Laña",slug:"ibai-lana",fullName:"Ibai Laña",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314576/images/system/314576.jpg",biography:"Dr. Ibai Laña works at TECNALIA as a data analyst. He received his Ph.D. in Artificial Intelligence from the University of the Basque Country (UPV/EHU), Spain, in 2018. He is currently a senior researcher at TECNALIA. His research interests fall within the intersection of intelligent transportation systems, machine learning, traffic data analysis, and data science. He has dealt with urban traffic forecasting problems, applying machine learning models and evolutionary algorithms. He has experience in origin-destination matrix estimation or point of interest and trajectory detection. Working with large volumes of data has given him a good command of big data processing tools and NoSQL databases. He has also been a visiting scholar at the Knowledge Engineering and Discovery Research Institute, Auckland University of Technology.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"314575",title:"Dr.",name:"Jesus",middleName:null,surname:"L. Lobo",slug:"jesus-l.-lobo",fullName:"Jesus L. Lobo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314575/images/system/314575.png",biography:"Dr. Jesús López is currently based in Bilbao (Spain) working at TECNALIA as Artificial Intelligence Research Scientist. In most cases, a project idea or a new research line needs to be investigated to see if it is good enough to take into production or to focus on it. That is exactly what he does, diving into Machine Learning algorithms and technologies to help TECNALIA to decide whether something is great in theory or will actually impact on the product or processes of its projects. So, he is expert at framing experiments, developing hypotheses, and proving whether they’re true or not, in order to investigate fundamental problems with a longer time horizon. He is also able to design and develop PoCs and system prototypes in simulation. He has participated in several national and internacional R&D projects.\n\nAs another relevant part of his everyday research work, he usually publishes his findings in reputed scientific refereed journals and international conferences, occasionally acting as reviewer and Programme Commitee member. Concretely, since 2018 he has published 9 JCR (8 Q1) journal papers, 9 conference papers (e.g. ECML PKDD 2021), and he has co-edited a book. He is also active in popular science writing data science stories for reputed blogs (KDNuggets, TowardsDataScience, Naukas). Besides, he has recently embarked on mentoring programmes as mentor, and has also worked as data science trainer.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"103779",title:"Prof.",name:"Yalcin",middleName:null,surname:"Isler",slug:"yalcin-isler",fullName:"Yalcin Isler",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRyQ8QAK/Profile_Picture_1628834958734",biography:"Yalcin Isler (1971 - Burdur / Turkey) received the B.Sc. degree in the Department of Electrical and Electronics Engineering from Anadolu University, Eskisehir, Turkey, in 1993, the M.Sc. degree from the Department of Electronics and Communication Engineering, Suleyman Demirel University, Isparta, Turkey, in 1996, the Ph.D. degree from the Department of Electrical and Electronics Engineering, Dokuz Eylul University, Izmir, Turkey, in 2009, and the Competence of Associate Professorship from the Turkish Interuniversity Council in 2019.\n\nHe was Lecturer at Burdur Vocational School in Suleyman Demirel University (1993-2000, Burdur / Turkey), Software Engineer (2000-2002, Izmir / Turkey), Research Assistant in Bulent Ecevit University (2002-2003, Zonguldak / Turkey), Research Assistant in Dokuz Eylul University (2003-2010, Izmir / Turkey), Assistant Professor at the Department of Electrical and Electronics Engineering in Bulent Ecevit University (2010-2012, Zonguldak / Turkey), Assistant Professor at the Department of Biomedical Engineering in Izmir Katip Celebi University (2012-2019, Izmir / Turkey). He is an Associate Professor at the Department of Biomedical Engineering at Izmir Katip Celebi University, Izmir / Turkey, since 2019. In addition to academics, he has also founded Islerya Medical and Information Technologies Company, Izmir / Turkey, since 2017.\n\nHis main research interests cover biomedical signal processing, pattern recognition, medical device design, programming, and embedded systems. He has many scientific papers and participated in several projects in these study fields. He was an IEEE Student Member (2009-2011) and IEEE Member (2011-2014) and has been IEEE Senior Member since 2014.",institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"339677",title:"Dr.",name:"Mrinmoy",middleName:null,surname:"Roy",slug:"mrinmoy-roy",fullName:"Mrinmoy Roy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/339677/images/16768_n.jpg",biography:"An accomplished Sales & Marketing professional with 12 years of cross-functional experience in well-known organisations such as CIPLA, LUPIN, GLENMARK, ASTRAZENECA across different segment of Sales & Marketing, International Business, Institutional Business, Product Management, Strategic Marketing of HIV, Oncology, Derma, Respiratory, Anti-Diabetic, Nutraceutical & Stomatological Product Portfolio and Generic as well as Chronic Critical Care Portfolio. A First Class MBA in International Business & Strategic Marketing, B.Pharm, D.Pharm, Google Certified Digital Marketing Professional. Qualified PhD Candidate in Operations and Management with special focus on Artificial Intelligence and Machine Learning adoption, analysis and use in Healthcare, Hospital & Pharma Domain. Seasoned with diverse therapy area of Pharmaceutical Sales & Marketing ranging from generating revenue through generating prescriptions, launching new products, and making them big brands with continuous strategy execution at the Physician and Patients level. Moved from Sales to Marketing and Business Development for 3.5 years in South East Asian Market operating from Manila, Philippines. Came back to India and handled and developed Brands such as Gluconorm, Lupisulin, Supracal, Absolut Woman, Hemozink, Fabiflu (For COVID 19), and many more. In my previous assignment I used to develop and execute strategies on Sales & Marketing, Commercialization & Business Development for Institution and Corporate Hospital Business portfolio of Oncology Therapy Area for AstraZeneca Pharma India Ltd. Being a Research Scholar and Student of ‘Operations Research & Management: Artificial Intelligence’ I published several pioneer research papers and book chapters on the same in Internationally reputed journals and Books indexed in Scopus, Springer and Ei Compendex, Google Scholar etc. Currently, I am launching PGDM Pharmaceutical Management Program in IIHMR Bangalore and spearheading the course curriculum and structure of the same. I am interested in Collaboration for Healthcare Innovation, Pharma AI Innovation, Future trend in Marketing and Management with incubation on Healthcare, Healthcare IT startups, AI-ML Modelling and Healthcare Algorithm based training module development. I am also an affiliated member of the Institute of Management Consultant of India, looking forward to Healthcare, Healthcare IT and Innovation, Pharma and Hospital Management Consulting works.",institutionString:null,institution:{name:"Lovely Professional University",country:{name:"India"}}},{id:"310576",title:"Prof.",name:"Erick Giovani",middleName:null,surname:"Sperandio Nascimento",slug:"erick-giovani-sperandio-nascimento",fullName:"Erick Giovani Sperandio Nascimento",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y00002pDKxDQAW/ProfilePicture%202022-06-20%2019%3A57%3A24.788",biography:"Prof. Erick Sperandio is the Lead Researcher and professor of Artificial Intelligence (AI) at SENAI CIMATEC, Bahia, Brazil, also working with Computational Modeling (CM) and HPC. He holds a PhD in Environmental Engineering in the area of Atmospheric Computational Modeling, a Master in Informatics in the field of Computational Intelligence and Graduated in Computer Science from UFES. He currently coordinates, leads and participates in R&D projects in the areas of AI, computational modeling and supercomputing applied to different areas such as Oil and Gas, Health, Advanced Manufacturing, Renewable Energies and Atmospheric Sciences, advising undergraduate, master's and doctoral students. He is the Lead Researcher at SENAI CIMATEC's Reference Center on Artificial Intelligence. In addition, he is a Certified Instructor and University Ambassador of the NVIDIA Deep Learning Institute (DLI) in the areas of Deep Learning, Computer Vision, Natural Language Processing and Recommender Systems, and Principal Investigator of the NVIDIA/CIMATEC AI Joint Lab, the first in Latin America within the NVIDIA AI Technology Center (NVAITC) worldwide program. He also works as a researcher at the Supercomputing Center for Industrial Innovation (CS2i) and at the SENAI Institute of Innovation for Automation (ISI Automação), both from SENAI CIMATEC. He is a member and vice-coordinator of the Basic Board of Scientific-Technological Advice and Evaluation, in the area of Innovation, of the Foundation for Research Support of the State of Bahia (FAPESB). He serves as Technology Transfer Coordinator and one of the Principal Investigators at the National Applied Research Center in Artificial Intelligence (CPA-IA) of SENAI CIMATEC, focusing on Industry, being one of the six CPA-IA in Brazil approved by MCTI / FAPESP / CGI.br. He also participates as one of the representatives of Brazil in the BRICS Innovation Collaboration Working Group on HPC, ICT and AI. He is the coordinator of the Work Group of the Axis 5 - Workforce and Training - of the Brazilian Strategy for Artificial Intelligence (EBIA), and member of the MCTI/EMBRAPII AI Innovation Network Training Committee. He is the coordinator, by SENAI CIMATEC, of the Artificial Intelligence Reference Network of the State of Bahia (REDE BAH.IA). He leads the working group of experts representing Brazil in the Global Partnership on Artificial Intelligence (GPAI), on the theme \"AI and the Pandemic Response\".",institutionString:"Manufacturing and Technology Integrated Campus – SENAI CIMATEC",institution:null},{id:"1063",title:"Prof.",name:"Constantin",middleName:null,surname:"Volosencu",slug:"constantin-volosencu",fullName:"Constantin Volosencu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/1063/images/system/1063.png",biography:"Prof. Dr. Constantin Voloşencu graduated as an engineer from\nPolitehnica University of Timișoara, Romania, where he also\nobtained a doctorate degree. He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. He has developed automation equipment for machine tools, spooling\nmachines, high-power ultrasound processes, and more.",institutionString:"Polytechnic University of Timişoara",institution:{name:"Polytechnic University of Timişoara",country:{name:"Romania"}}},{id:"221364",title:"Dr.",name:"Eneko",middleName:null,surname:"Osaba",slug:"eneko-osaba",fullName:"Eneko Osaba",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/221364/images/system/221364.jpg",biography:"Dr. Eneko Osaba works at TECNALIA as a senior researcher. He obtained his Ph.D. in Artificial Intelligence in 2015. He has participated in more than twenty-five local and European research projects, and in the publication of more than 130 papers. He has performed several stays at universities in the United Kingdom, Italy, and Malta. Dr. Osaba has served as a program committee member in more than forty international conferences and participated in organizing activities in more than ten international conferences. He is a member of the editorial board of the International Journal of Artificial Intelligence, Data in Brief, and Journal of Advanced Transportation. He is also a guest editor for the Journal of Computational Science, Neurocomputing, Swarm, and Evolutionary Computation and IEEE ITS Magazine.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"275829",title:"Dr.",name:"Esther",middleName:null,surname:"Villar-Rodriguez",slug:"esther-villar-rodriguez",fullName:"Esther Villar-Rodriguez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/275829/images/system/275829.jpg",biography:"Dr. Esther Villar obtained a Ph.D. in Information and Communication Technologies from the University of Alcalá, Spain, in 2015. She obtained a degree in Computer Science from the University of Deusto, Spain, in 2010, and an MSc in Computer Languages and Systems from the National University of Distance Education, Spain, in 2012. Her areas of interest and knowledge include natural language processing (NLP), detection of impersonation in social networks, semantic web, and machine learning. Dr. Esther Villar made several contributions at conferences and publishing in various journals in those fields. Currently, she is working within the OPTIMA (Optimization Modeling & Analytics) business of TECNALIA’s ICT Division as a data scientist in projects related to the prediction and optimization of management and industrial processes (resource planning, energy efficiency, etc).",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49813/images/system/49813.png",biography:"Prof. Dr. Javier Del Ser received his first PhD in Telecommunication Engineering (Cum Laude) from the University of Navarra, Spain, in 2006, and a second PhD in Computational Intelligence (Summa Cum Laude) from the University of Alcala, Spain, in 2013. He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. He is a Senior Member of the IEEE, and a recipient of the Biscay Talent prize for his academic career.",institutionString:"Tecnalia Research & Innovation",institution:null},{id:"278948",title:"Dr.",name:"Carlos Pedro",middleName:null,surname:"Gonçalves",slug:"carlos-pedro-goncalves",fullName:"Carlos Pedro Gonçalves",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRcmyQAC/Profile_Picture_1564224512145",biography:'Carlos Pedro Gonçalves (PhD) is an Associate Professor at Lusophone University of Humanities and Technologies and a researcher on Complexity Sciences, Quantum Technologies, Artificial Intelligence, Strategic Studies, Studies in Intelligence and Security, FinTech and Financial Risk Modeling. He is also a progammer with programming experience in:\n\nA) Quantum Computing using Qiskit Python module and IBM Quantum Experience Platform, with software developed on the simulation of Quantum Artificial Neural Networks and Quantum Cybersecurity;\n\nB) Artificial Intelligence and Machine learning programming in Python;\n\nC) Artificial Intelligence, Multiagent Systems Modeling and System Dynamics Modeling in Netlogo, with models developed in the areas of Chaos Theory, Econophysics, Artificial Intelligence, Classical and Quantum Complex Systems Science, with the Econophysics models having been cited worldwide and incorporated in PhD programs by different Universities.\n\nReceived an Arctic Code Vault Contributor status by GitHub, due to having developed open source software preserved in the \\"Arctic Code Vault\\" for future generations (https://archiveprogram.github.com/arctic-vault/), with the Strategy Analyzer A.I. module for decision making support (based on his PhD thesis, used in his Classes on Decision Making and in Strategic Intelligence Consulting Activities) and QNeural Python Quantum Neural Network simulator also preserved in the \\"Arctic Code Vault\\", for access to these software modules see: https://github.com/cpgoncalves. He is also a peer reviewer with outsanding review status from Elsevier journals, including Physica A, Neurocomputing and Engineering Applications of Artificial Intelligence. Science CV available at: https://www.cienciavitae.pt//pt/8E1C-A8B3-78C5 and ORCID: https://orcid.org/0000-0002-0298-3974',institutionString:"University of Lisbon",institution:{name:"Universidade Lusófona",country:{name:"Portugal"}}},{id:"241400",title:"Prof.",name:"Mohammed",middleName:null,surname:"Bsiss",slug:"mohammed-bsiss",fullName:"Mohammed Bsiss",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241400/images/8062_n.jpg",biography:null,institutionString:null,institution:null},{id:"276128",title:"Dr.",name:"Hira",middleName:null,surname:"Fatima",slug:"hira-fatima",fullName:"Hira Fatima",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/276128/images/14420_n.jpg",biography:"Dr. Hira Fatima\nAssistant Professor\nDepartment of Mathematics\nInstitute of Applied Science\nMangalayatan University, Aligarh\nMobile: no : 8532041179\nhirafatima2014@gmal.com\n\nDr. Hira Fatima has received his Ph.D. degree in pure Mathematics from Aligarh Muslim University, Aligarh India. Currently working as an Assistant Professor in the Department of Mathematics, Institute of Applied Science, Mangalayatan University, Aligarh. She taught so many courses of Mathematics of UG and PG level. Her research Area of Expertise is Functional Analysis & Sequence Spaces. She has been working on Ideal Convergence of double sequence. She has published 17 research papers in National and International Journals including Cogent Mathematics, Filomat, Journal of Intelligent and Fuzzy Systems, Advances in Difference Equations, Journal of Mathematical Analysis, Journal of Mathematical & Computer Science etc. She has also reviewed few research papers for the and international journals. She is a member of Indian Mathematical Society.",institutionString:null,institution:null},{id:"414880",title:"Dr.",name:"Maryam",middleName:null,surname:"Vatankhah",slug:"maryam-vatankhah",fullName:"Maryam Vatankhah",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Borough of Manhattan Community College",country:{name:"United States of America"}}},{id:"414879",title:"Prof.",name:"Mohammad-Reza",middleName:null,surname:"Akbarzadeh-Totonchi",slug:"mohammad-reza-akbarzadeh-totonchi",fullName:"Mohammad-Reza Akbarzadeh-Totonchi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Ferdowsi University of Mashhad",country:{name:"Iran"}}},{id:"414878",title:"Prof.",name:"Reza",middleName:null,surname:"Fazel-Rezai",slug:"reza-fazel-rezai",fullName:"Reza Fazel-Rezai",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"American Public University System",country:{name:"United States of America"}}},{id:"302698",title:"Dr.",name:"Yao",middleName:null,surname:"Shan",slug:"yao-shan",fullName:"Yao Shan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Dalian University of Technology",country:{name:"China"}}},{id:"125911",title:"Prof.",name:"Jia-Ching",middleName:null,surname:"Wang",slug:"jia-ching-wang",fullName:"Jia-Ching Wang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Central University",country:{name:"Taiwan"}}},{id:"357085",title:"Mr.",name:"P. Mohan",middleName:null,surname:"Anand",slug:"p.-mohan-anand",fullName:"P. Mohan Anand",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"356696",title:"Ph.D. Student",name:"P.V.",middleName:null,surname:"Sai Charan",slug:"p.v.-sai-charan",fullName:"P.V. Sai Charan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"357086",title:"Prof.",name:"Sandeep K.",middleName:null,surname:"Shukla",slug:"sandeep-k.-shukla",fullName:"Sandeep K. Shukla",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"356823",title:"MSc.",name:"Seonghee",middleName:null,surname:"Min",slug:"seonghee-min",fullName:"Seonghee Min",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Daegu University",country:{name:"Korea, South"}}},{id:"353307",title:"Prof.",name:"Yoosoo",middleName:null,surname:"Oh",slug:"yoosoo-oh",fullName:"Yoosoo Oh",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:"Yoosoo Oh received his Bachelor's degree in the Department of Electronics and Engineering from Kyungpook National University in 2002. He obtained his Master’s degree in the Department of Information and Communications from Gwangju Institute of Science and Technology (GIST) in 2003. In 2010, he received his Ph.D. degree in the School of Information and Mechatronics from GIST. In the meantime, he was an executed team leader at Culture Technology Institute, GIST, 2010-2012. In 2011, he worked at Lancaster University, the UK as a visiting scholar. In September 2012, he joined Daegu University, where he is currently an associate professor in the School of ICT Conver, Daegu University. Also, he served as the Board of Directors of KSIIS since 2019, and HCI Korea since 2016. From 2017~2019, he worked as a center director of the Mixed Reality Convergence Research Center at Daegu University. From 2015-2017, He worked as a director in the Enterprise Supporting Office of LINC Project Group, Daegu University. His research interests include Activity Fusion & Reasoning, Machine Learning, Context-aware Middleware, Human-Computer Interaction, etc.",institutionString:null,institution:{name:"Daegu Gyeongbuk Institute of Science and Technology",country:{name:"Korea, South"}}},{id:"262719",title:"Dr.",name:"Esma",middleName:null,surname:"Ergüner Özkoç",slug:"esma-erguner-ozkoc",fullName:"Esma Ergüner Özkoç",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Başkent University",country:{name:"Turkey"}}},{id:"346530",title:"Dr.",name:"Ibrahim",middleName:null,surname:"Kaya",slug:"ibrahim-kaya",fullName:"Ibrahim Kaya",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"419199",title:"Dr.",name:"Qun",middleName:null,surname:"Yang",slug:"qun-yang",fullName:"Qun Yang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Auckland",country:{name:"New Zealand"}}}]}},subseries:{item:{id:"40",type:"subseries",title:"Ecosystems and Biodiversity",keywords:"Ecosystems, Biodiversity, Fauna, Taxonomy, Invasive species, Destruction of habitats, Overexploitation of natural resources, Pollution, Global warming, Conservation of natural spaces, Bioremediation",scope:"