Social representations of gender and their influence in Supported Employment: employment specialists’ experiences in Sweden

Abstract

Purpose

Gender differences have been found in the outcomes of vocational rehabilitation (VR) and in Supported Employment (SE), therefore, the purpose of this study was to explore employment specialists’ (ES) social representations of gender in relation to work and VR and how these social representations influence the ES’s work in the VR process according to SE.

Methods

The qualitative method of focus group discussions was employed. Ten focus groups were held with 39 ESs from four categories of SE organizations in Sweden. Topic analysis was applied to the transcribed material from the focus groups.

Results

Five themes with different social representations about gender and disability in relation to VR and working life formed in the analysis: (1) differences in personal and health factors among VR-participants, (2) gender norms in society influencing VR, (3) energy-intensive environmental issues influencing VR, (4) gender-specific interactions in VR, and (5) gendered paths in the welfare system.

Conclusion

Social representations of higher strains on women with disabilities compared to men with disabilities both in private and working life, which reflect the lived experiences of the ESs, is a possible explanation for gender differences in VR and working life for persons with disabilities.

IMPLICATIONS FOR REHABILITATION

• Gender differences in the outcomes of vocational rehabilitation (VR) interventions have been noticed worldwide. In this study, pervasive social representations about gender and disability in relation to VR were found, but also unconsciousness about gender among VR professionals. Therefore, awareness of gender is necessary in VR.

• Individualized and person-centered approaches to VR like Supported Employment, although considered best practice, might hide structures like gender, which could lead to reproducing discriminating processes and therefore not achieving gender equality in VR. Therefore, knowledge of discrimination is important in VR.

• Gender-sensitivity in vocational rehabilitation models with a person-centered and individualized approach is needed and there might also be a need to systematically tailor vocational rehabilitation models to reach gender equality in the outcomes of the interventions. Therefore, gender equality indicators are needed for VR models, to evaluate model effectiveness from a gender perspective.

Keywords:

• Disability
• vocational rehabilitation
• professionals
• social work
• topic analysis

Introduction

In all regions of the world, women with disabilities are less likely to be employed than men with disabilities and less likely to be employed than men and women without disabilities [1]. This is also the case in Sweden, even if there are small differences in employment between men and women in overall labor market participation [2]. The differences between men and women with disabilities in the labor market in Sweden have been shown to be prevalent regardless of disability group [3,4]. Moreover, there seem to be gender differences in the employment outcomes of the vocational rehabilitation (VR) services given to persons with disabilities [5] and indications of gender differences in the employment outcomes of evidence-based practices in VR such as Supported Employment [6]. These gender differences have been studied to a limited extent and further research in the field is needed. Disability research often has neglected gender issues and gender research often has neglected issues related to disability. Therefore, the intersection of gender and disability has received little attention and raising awareness and knowledge of issues concerning gender equality for women with disabilities is an important task [7]. The United Nations also has as a goal that women with disabilities should have the same rights and opportunities as men and these include VR to a well-functioning working life [7].

The situation for women with disabilities in vocational rehabilitation

A systematic review by Lindsay et al. [8], that examined the role of gender in securing and maintaining employment for people with disabilities under the age of 30, found in a majority of the included articles, that young men with disabilities had better employment outcomes than young women with disabilities. One of the reasons for this situation was differences in the vocational and training service opportunities given to men and women, where women tended to lack career development opportunities and received more gender-stereotypical training, but only a few of the articles included in the review explored this issue [8]. However, at least in the United States, there seem to be persistent gender differences in the outcomes of the VR given to persons with disabilities [9,10], where men with disabilities have better employment outcomes after participating in VR than women with disabilities. A worrisome factor from a gender equality perspective is that differences in employment outcomes and income were larger after participating in VR [9]. Differences related to gender in the employment outcomes of VR have also been identified outside of the United States [11,12].

Although studies have been performed on gender differences in VR for persons with disabilities, research in the area is still scarce. Several studies, both quantitative and qualitative, have pointed to the family situation for women, where higher demands are placed on women than men to take care of home and family [13–15]. Women also seem to be less exposed to different career options during school and the transition years from school to working life, be more restricted by traditional gender roles, and have fewer role models [16,17]. Other factors found to be barriers to women’s working are their self-perception and low self-esteem, depending on the disability and other persons’ perception of the disability; the school system’s poor performance in identifying girls with special needs; and the school system’s failure to prepare girls with disabilities for the transition years [16,17]. These reasons for why women fare worse than men in the VR are to a high degree located outside of the actual VR and training services. However, Lindstrom et al. [16] studied the training services for young women with disabilities and noted that if the professionals adopted a perspective of “broadening horizons” regarding the different possible career paths, this could be helpful for women with disabilities in establishing themselves in the labor market.

Supported Employment (SE) is one method within VR to support people with disabilities find and keep a job. SE is based on three basic principles. Persons with disabilities are individually supported by a professional employment specialist to (1) locate an appropriate job in the open labor market, (2) undergo intensive training on the job, and (3) receive permanent ongoing support during employment [18]. SE and especially the variant Individual Placement and Support (IPS) have shown better results in employment rate than other methods of VR in several systematic reviews [19–24]. Although the overall effect on the employment rate for participants in SE interventions has been established, some reviews have requested more subgroup analyses, e.g., of how SE affects different subgroups depending on gender, age or ethnicity [20,25]. A recent scoping review examining how intersecting statuses affected the employment outcomes in SE [26] found that gender, in most settings, did not seem to affect the employment rate after participating in the SE interventions. However, this study also found that significantly more men had access to SE interventions, and many reviewed studies did not report the employment rate according to gender at the outcome level in the SE interventions. Moreover, the sample sizes of many studies reporting the employment rate according to gender were too small to perform subgroup analyses. Thus, the results of the review must be interpreted with caution.

In the VR in Sweden, there are significant differences between men and women. Men with disabilities who are enrolled at the Swedish Public Employment Service receive more support in terms of wage subsidies which leads to employment, while women with disabilities are underrepresented in these types of support [5]. Despite being in the same situation, women are also less likely to be “coded” for disability than men and, therefore, miss out on support that is targeted to persons with disabilities [5].

Concerning SE and gender differences, studies performed in Sweden have mixed results. Some studies did not report the employment rate according to gender at the outcome level [27–29]. One study revealed no gender differences in the employment rate after participating in an SE intervention [30], and another study, with a much larger sample size, revealed gender differences favoring men in the employment rate after participating in an SE intervention [6].

Vocational rehabilitation professionals and their perceptions of gender

Despite reported gender differences in VR, research on the VR professionals and their perceptions and experiences of working with men and women with different disabilities is scarce. One Finnish study [31] explored the perceptions of occupational health workers of what support to provide to older workers after completion of comprehensive VR. They found that the participants in the study disagreed on whether different types of support were given to men and women. Some considered differences in support due to individual needs only, while others confirmed gender differences, e.g., women were more often referred to psychological counseling, while men were more often referred to rehabilitation programs. Differences in social support were also discussed, where women were perceived as having an advantage. A Swedish study [32] examined occupational therapists’ perceptions of gender and found that theoretical knowledge of gender was limited. The occupational therapists emphasized the individual and having a client-centered approach, but at the same time, they were “doing gender” when encountering their patients, e.g., by talking more about household and family with women and more about paid work with men. To our knowledge, no previous research has been done on the gender perceptions of employment specialists in VR overall, or particularly in SE.

The use of gender in this study

The context of this study is organizations working with VR close to the labor market, hence, Joan Acker’s theory about gendered organizations [33] is a suitable model for analysis. According to Acker, the differences between men and women in organizations, including working life, depend on three processes. First, a gender-related division is constructed between men and women in work, allowed behavior, environment, and power. Second, symbols and images are constructed that explain and express the gender-related division. Third, interactions between men and women, men and men, and women and women, and the patterns in these interactions, maintain the gender-related division. These three processes support the creation of the individual identity in relation to gender.

The theory of social representations

In the light of Joan Acker’s theory of gendered organizations [33], it could be assumed that perceptions and experiences of gender from the professionals’ point of view work as moderators in VR and influence how the professionals are working with men and women. Therefore, Serge Moscovici’s theory of social representations is a useful analytical tool. According to Moscovici [34], social representations are socially-developed – through interaction and communication – and socially-shared knowledge that shapes the way in which we view reality. As Moscovici writes, “the purpose of all representations is to make something unfamiliar, or unfamiliarity itself, familiar” [34,p.37]. These social representations provide frames for interpretation of the world around us and influence how we view ourselves and the people surrounding us and, by extension, how we act. Primary conceptions or source ideas that shape our views about other phenomena are called themata [34]. An example given by Moscovici [34] is how our views of the dichotomy of gender shape our views of men and women. Social representations vary within a society, and different groups have somewhat different social representations depending on culture and experiences; therefore, different professional groups may have different social representations of the same phenomena [34,35].

Purpose of the study

There is a lack of knowledge on how gender and disability intersect in VR, but gender differences have been noticed in VR outcomes favoring men. In order for a more gender equal VR to be realized, gender-awareness needs to be raised and knowledge needs to be obtained on how the professionals working in VR reflect upon these matters. Therefore, the purpose of this study was to explore employment specialists’ social representations of gender in relation to work and disability and how these social representations influence the employment specialists’ work in the VR process according to SE.

Materials and methods

For this qualitative study, focus group discussions were conducted. Focus group discussions can be suitable as tools for exploring socially formed and shared knowledge, such as social representations, as shared beliefs are discussed, negotiated, and developed in the dialogue in the focus groups [36].

Setting and participants

Because the social representations of gender in relation to disability and VR and working life among employment specialists in SE were to be studied, a strategic sample of groups of employment specialists in different categories of organizations working with SE in Sweden was chosen. However, strictly following the principles of SE in a Swedish context is difficult because the support systems usually divide people in the rehabilitation process into working and nonworking people. Many of the organizations working with SE in Sweden, in most cases, either work with the participant until employment is settled or begin their work when employment is about to be settled. This procedure is not in line with the SE principle that support should be given both before employment can be settled and as long as support is needed after employment is settled [18], but it is usually the only way to conduct SE interventions in the Swedish system.

Ten focus groups with employment specialists were recruited from four different categories of VR organizations:

1. Four groups working with SE in the context of daily activities for persons with intellectual disabilities, autism spectrum disorders (ASD) and to a limited extent traumatic brain injuries.

2. Three groups working with SE in a private SE organization sponsored by the publicly financed municipalities and health care services. This private SE organization work with persons with different kinds of disabilities.

3. Three SE-inspired groups in the context of Coordination Agencies financed by the publicly financed municipalities, health care services, the Swedish Public Employment Agency, and the Swedish Social Insurance Agency. The Coordination Agencies work with persons with different kinds of disabilities.

4. One employment specialist from the Sweden Public Employment Agency’s SE program took part in the study. The SE program involves persons with different kinds of disabilities. This employment specialist participated in one of the groups from the Coordination Agencies, where she had recently been employed.

In the first two of these categories of organizations, the employment specialist works together with the participant up until employment is settled; after that, the organizations have to transfer the case to the Sweden Public Employment Agency for further support for the participant. In the third category, the employment specialist, depending on the remittent, works together with the participant from up until the participant can manage work (not employment) for 10 h a week or up until employment; after that, the organizations have to transfer the case to the Sweden Public Employment Agency for further support for the participant. In the fourth category, participants who are assessed as being able to work at least 20 h a week are approved for the program, and then the employment specialist works together with the participant for a quick path to employment and follow-up support for two years.

The 10 focus groups had 2–6 participants in each group. The two groups with two participants were due to late cancellations. The participants in the different focus groups knew each other as colleagues. In total, 39 participants took part in the focus groups, 31 women and 8 men, which reflects the gender distribution in this occupation in Sweden. The employment specialists were rather evenly distributed among the focus groups given their educational background and working life background. See Table 1 for participant characteristics.

Table 1. Participant characteristics.

Group	1, P	2, CA	3, P	4, CA	5, CA	6, DA	7, P	8, DA	9, DA	10, DA	Total
Number of participants	3	6	4	5	4	2	4	2	4	5	39
Gender
Men	0	2	1	0	1	0	1	0	1	2	8
Women	3	4	3	5	3	2	3	2	3	3	31
Age (years)
30 or less									2		2
31–40		1	1			2	1	1	2	3	11
41–50	1		1	2	3		1				8
51–60	1	5		3	1		1			2	13
61 or more	1		2				1	1			5
Education^a
University exam											29^b
In Social sciences											18
In Health sciences											6
In Educational sciences											3
Other university exam											2
Vocational diploma^c											8
Unspecified upper secondary diploma											3
Years working in the field^a
+10 years SE experience											11
3–10 years SE experience											15
<3 years SE experience											8
+5 years in VR or with PWD^d											5
Working experience unknown											5

P: Private SE organization; CA: Coordination Agency; DA: Daily Activities. ^aDue to integrity reasons for the participants, education and years working in the field are only presented as totals in the whole study sample. ^bOne of the participants has double university exams in different fields, therefore the total number in education add up to 40. ^cMainly in the field of disability. ^d“+5 years in VR or with PWD (persons with disabilities)” is only provided for participants with less than 3 years of SE experience.

Data collection

The focus groups were held from March 2021 through September 2021. The first focus group was a pilot group, but because the focus group format worked out as planned, the pilot group was included in the study. Each focus group met twice with a few days between the two sessions.

The focus groups were of the type “open discussion” [36]. Two of the researchers in the project participated in each focus group as moderators. The first focus group session, which lasted approximately two hours, began with a presentation from one of the moderators on the labor market for women and men with different types of disabilities in Sweden. (Some of the participants refer to this presentation in the extracts included in the results section.) The presentation ended with the following question to the participants in the focus groups:

What are your perceptions of work and vocational rehabilitation in relation to disability and gender?

The second focus group session lasted approximately one hour and served as a continuation of the first session, where the participants had the opportunity to discuss what they had been thinking about since the first session, deepen their thoughts, or correct previous statements.

The interview technique was nondirective, where the participants, after the initial question, were released to talk freely about the theme of the focus groups. The role of the moderators consisted of asking follow-up questions to clarify statements, capturing previous topics that remained somewhat unclear or ask additional questions on topics that the participants discussed. This approach was chosen so that the participants could discuss as freely as possible without being overly controlled by the moderators to obtain the social representations in the different groups.

Due to the COVID-19 situation in Sweden at the time of the data collection, the focus groups were held digitally via Zoom or Teams and were video recorded. The video recordings were transcribed by the first author of the study. The transcriptions were kept verbatim with some careful editing to avoid losing the oral meaning in the written text. The transcriptions included nods, humming and laughter because the group interplay is important when studying how socially shared knowledge and common values are expressed [37]. The transcripts were anonymized, and names and places were changed. In the anonymization, the participants in each specific focus group were given names starting with the same letter.

Analysis

To analyze the material from the focus groups, topic analysis was used [36]. In contrast to traditional content analysis, the topic analysis builds on the notion that a unit of content, or topic, cannot be attributed to one single participant, but that topics develop through dialogue between the participants. The topic analysis was conducted in a number of steps:

1. Episode sequencing. A review of the transcribed material, to make markings for each topical episode where the focus group talked about the same thing, a topic [36,38].

2. Naming of the different episodes. This was done according to a three-component model. For each episode, the following was stated:

   1. the context for the episode (daily activities, the private life of the participants, Coordination Agency, etc.),

   2. the main subject of the episode (gender, disability, interactions in VR, etc., or combinations of different main subjects),

   3. a short close-to-the-text description of the conversation.

These first two steps in the topic analysis were performed individually by all three authors of the study, for the transcript of the first-hour recordings of one focus group. The authors compared their results and discovered consistency across the authors, and then the first author continued with the remaining episode sequencing and naming. After the entire episode sequencing and naming were completed, the two other authors reviewed the material to check the results. Some smaller adjustments were made after this.

1. Topicalization. The first author reviewed all the named episodes that were related to gender. The episodes that dealt with the same or very similar topics were identified with the same topical name.

2. Sorting the topics. The first author then sorted the topics to see how many of the focus groups talked about the same topics. The topics that appeared in at least two of the focus groups were stated as recurring topics and were included in the thematization of the topics. These recurring topics can be seen as social representations and not only a perception of an individual or a specific group [36].

3. Thematization. All authors carefully reviewed the recurring topics to see which topics related to the same aspects. The related topics could then be clustered into themes. For an illustration of steps 2 to 5, see Table 2.

4. After the thematization, the focus groups were quantitively compared with each other to examine if the same themes and topics (social representations) appeared in the focus groups or if the social representations differed between the focus groups.

Table 2. Example of the topicalization and thematization.

Episode from the transcripts		Name of episode	Topic	Theme
Moderator 1:	Do you who work in this team have any idea who they are who come to you from the Swedish Social Insurance Agency?	CA^a/VR – Gender/Interactions in VR – Need before gender, seldom thinks about whether it is a man or a woman.	Individual focus hides gender	Gender-related interactions in VR
Barry:	It depends on what you mean by the question. Those who come to us are often people who want to test their ability to work; no matter what gender you have, it’s about wanting to make a change in life and stop being as sick as you are.
Bella:	I agree. I think it’s very difficult. I also haven’t thought about whether we have the most men or women. It’s not something I’ve thought about in that way, but in general I’ve thought of women, but that’s not what I’ve focused on. As Barry says, it’s more their need for our support. I’m just checking, do I work with more men or women? I thought I’d check it right now because I’ve no idea. So, I think it’s very difficult to say.
Hanna:	But of course, there are gender differences. Well, I think so. I myself am part of the norm critical group and work to become better at seeing and preventing negative effects of stereotypical norms. But it is difficult to see your own norms when you work with 10 individuals. Then you try to see them, not their gender, but their person. But it’s good to be aware that the suggested job at a recycling center is a typical male profession. Would I have suggested it to my girls as much as to my guys?	DA^b/VR – Gender/Interactions in VR – Difficult to detect gender differences when working with a few individuals.
Helena:	It’s important to remind oneself of that. I probably don’t think as much, so I’d probably need to think more about gender than I do. This is what I think, we are so influenced in our organization by the individual approach. We start from the individual we are working with right now. The individual perspective – what the person wants, is able to do and needs, so then I easily lose this gender perspective.
Desirée:	And then also that women may generally be more "prudent" and more cautious. And we, who work with these women, then we also become more careful when trying to adapt to the individual.	CA^a/VR – Gender/Interactions in VR – Adapting to being more careful with women.	More careful with women/ Faster toward work with men
	(Doris smiles and nods.)
Desirée:	I may be a bit muddled right now, but that’s what I was thinking.
Moderator 1:	Do the rest of you recognize what Desirée is describing?
Doris:	Yes!
Gabriella:	And I also think, linked to gender, I think about whether we, or I, am quicker to talk about [employment] when it’s a guy who’s out on an internship than if it’s a girl. These are my thoughts. I don’t know.	P^c/VR – Gender/Interactions in VR – Faster toward ”job talk” with the boys, more careful with the girls.
Moderator 2:	Why do you get that idea about yourself? What’s the basis of that experience?
Gabriella:	Yes, but you know, a bit like we talked about yesterday, these girls I work with, they often have so many things going on. (Greta nods.) And just getting away from home and breaking their pattern; it’s such a big goal that it’s like “Yes! Now we’re out, and it works!” But the guys are in a different position most of the time, they are more ready and then I follow that too. I’m sitting here wondering if I perhaps do this, because the goal looks so different most of the time.

^a Coordination agencies. ^bDaily activities. ^cPrivate SE organization.

After the analysis was performed, a reference group consisting of representatives of SE organizations and disability organizations had the opportunity to comment on the results from the focus groups.

Ethics

The study design of this focus group study was approved by the Swedish Ethical Review Authority (dnr: 2019-06088 and dnr: 2021-01100). Oral and written information were given to all potential employment specialists before written informed consent was given by the employment specialists who wanted to participate in the study.

Results

The analysis revealed 448 topical episodes in the transcripts from the focus groups that touched on the subject of gender. In addition, the focus groups discussed other topics without a connection to gender. Of the topical episodes on the subject of gender, 385 (86%) could be categorized into 44 recurring topics discussed in at least two of the focus groups. The remainder of the topical episodes were discussed in one focus group each (single topics) and did not count as recurring topics; therefore, they were not included in the analysis of the topics into themes. However, quite a few of these single topics touched on the fact that the employment specialists did not see gender differences. These “no gender differences” occurred in different settings and subjects and could not form a comprehensible topic. The 14 topics that were brought up in at least half of the focus groups (the most common topics) will be paid extra attention in the results shown, whereas the rest of the recurring topics in most cases are only shown in Table 3.

Table 3. The five themes with their corresponding topics.

Theme	Differences in personal and health factors among VR participants^a	Gender norms in society influencing VR	Energy-intensive environmental issues influencing VR	Gender-related interactions in VR	Gendered paths in the welfare system
	(All groups)	(All groups)	(9 groups)	(All groups)	(5 groups)
Topics	Compliant/ Determined-Demanding 8 groups	Gender roles – men breadwinners, women mothers 7 groups	Home and family influence women’s energy 6 groups	More careful with women/ Faster toward work with men 7 groups	Different paths into VR 5 groups
	Feeling insecure/Feeling secure 7 groups	Expectations on female/male behavior versus criteria for diagnosing 5 groups	Social demands in "female" work 6 groups	Broadening horizons 6 groups	Cracks in the system influence women more 2 groups
	More mental illness/Less mental illness 6 groups	Men and women hiding disability 4 groups	Other surrounding issues taking energy from women 4 groups	Easier to find work for men than women 6 groups	More boys among school refusals? 2 groups
	Want fulfilment from work/Want income from work 5 groups	Stigma for women with ASD/Stigma for men with ID 3 groups	Disability, an aggravated trap for women 3 groups	ES’^b,c methods and values influence the VR 6 groups	Men want employment immediately, difficult with the internship system^c 2 groups
	Bigger social network/ Smaller network-Network online 4 groups	Societal norms about suitable roles for men and women 3 groups		Individual focus hides gender 6 groups
	Relations in focus/ Activities in focus 4 groups	Different ideas about men and women’s mental health 3 groups		ES^b follow societal norms and participants wishes 3 groups
	Easier to express emotions/Harder to express emotions 4 groups	Choosing the same work as your parents 3 groups		Strengthen women’s self-confidence 3 groups
	Young women want education/ Young men want to work 3 groups	Gender specific choices for work 3 groups		Skewed working material strengthens gender roles 3 groups
	Great exposure to violence/ Exposure to violence 3 groups	Workplaces more tolerant with men 3 groups		Engaged employer important, especially for women 2 groups
	Higher education/ Lower education 2 groups	Higher societal requirements on women 3 groups		Different expressions by men and women, might benefit men in VR 2 groups
	Internalizing problems/ Externalizing problems^c 2 groups	Norms for mothers to be supporting 3 groups		Women connect with men, men with men^c 2 groups
	Dependence/ Independence 2 groups	No perceived gender differences in young participants 3 groups
	Introvert at school/ Extrovert at school 2 groups

^aThe female trait is before the/. The male trait is after the/. ^bEmployment specialist. ^cEspecially in relation to women/men from other cultural settings other than the Swedish.

The 44 topics were grouped into five themes: differences in personal and health factors among VR-participants, gender norms in society influencing VR, energy-intensive environmental issues influencing VR, gender-specific interactions in VR and gendered paths in the welfare system (see Table 3.)

Differences in personal and health factors among VR-participants

This theme includes the topics where men and women in the SE interventions were perceived somewhat differently from each other on the individual level and consists of 13 topics, 4 of which were brought up in at least half of the focus groups. All focus groups perceived some sort of gender differences in personal and/or health factors among the SE participants.

Compliant/determined-demanding

The women in the interventions were perceived as more compliant and wanting to please their surroundings, including the employment specialist, more than the men. In contrast, the men were perceived as more determined about what they wanted, whether to work or not, and were more inclined to make demands on the services offered.

Barry: What you’re saying is interesting Bertil. I see the same thing, that pattern of the sexes. Men are a little more aggressive, regardless of religion, I was about to say, but…

(General laughter.)

Barry: Just the fact that women are more cautious and compliant while men are more aggressive and pushier, which is actually an advantage in relation to employers and they get an income faster than women do. I have not seen this difference between men of different nationalities, but it’s more that men are more aggressive, ask more questions, want more. The women are a little more careful.

Moderator 1: What do you think it depends on? Do the rest of you recognize this too?

Blenda: Yes, to some extent.

Bertil: Yes.

Barry: It’s probably the gender roles again. (General nodding and humming.) Men should help themselves, and women should be quiet and grateful.

(A short silence.)

(Extract from focus group 2, Coordination agency.)

Feeling insecure/feeling secure

Women in the interventions were perceived as having less confidence in themselves than the men.

Gunilla: And then I also think that with guys, they’ve got greater self-confidence.

Gabriella: Yes!

Gustaf: Mhmm.

Gunilla: The girls quite often have less confidence in their own ability, like "Yes, but I can’t handle that." While the guys go "Yes, but I’ll get a driver’s license and I’ll have at least SEK 30,000 a month."

Gustaf: Yes!

Gunilla: They do have expectations of working life and their surroundings, while the girls go “No, I don’t really know. I can’t manage that and maybe I can’t do that."

Gustaf: Yes, that’s right!

Gabriella: Mhmm.

(Extract from focus group 7, Private SE organization.)

More mental illness/less mental illness

Six of the groups mentioned that there appeared to be, in different ways, slightly more mental illness among the women than the men. This was noticed in different ways, and the focus groups mentioned different kinds of mental illness. The example below is taken from an employment specialist who mostly works with persons with ASD, and the example applies to this group of persons.

Fredrika: And we see a lot more mental illness in that group. Many with social phobia and many that compare themselves to the norm a lot. The guys do that too, but in general…

Moderator 1: When you talk about the norm, what’s that?

Fredrika: I think the prevailing norm, I have a participant who has a lot of social phobias, for example, she watches Friends and “Okay, that’s how you should be. You should be happy and talkative, and you should be like this.” And it takes a lot of energy because you’re not like everyone else socially, that it’s a bigger… it’s like this with the guys as well, but we see it more with the girls.

(Extract from focus group 6, Daily activities.)

Want fulfilment from work/want income from work

In half of the focus groups, it was brought up that men in the interventions seem to value income more than the women, who, in contrast, appear to value other things more, such as a social setting or something meaningful to do.

Moderator 1: However, you talked about motivation, are guys generally more motivated to work?

Jasmine: Now I don’t have that many guys, but my view is that maybe guys maybe have more motivation for a job, a paid job, while many girls want a meaningful occupation.

(Jeanette and Joakim nod.)

Jasmine: Their employment goals maybe, I don’t know if that’s true, but it’s just a feeling. They prefer to find a good internship where they thrive and it works and employment may be a bit secondary, while guys may have more employment focus.

Joakim: Men want income, while girls may want direct feedback that they do a good job, that they make a difference.

(Jeanette and Jasmine nod.)

(Extract from focus group 10, Daily activities.)

Gender norms in society influencing VR

This theme gathers the topics where the societal norms regarding men and women, which influence the VR process, are discussed. The theme consists of 12 topics, of which 2 topics were brought up in at least half of the focus groups. All focus groups perceived some sort of societal norms regarding men and women.

Gender roles – men are breadwinners, women are mothers

A majority of the groups discussed that men in general, to a greater extent than the women, are perceived as the ones providing for the family, while there is a greater expectation that women take care of the house and family.

Barbro: It is also about self-image and society’s expectations of the different sexes.

Birgitta: Yes, exactly, it is. There are probably many parts to it, or several at least.

Moderator 1: And what are the expectations then?

Barbro: Well, I think the expectations are greater for a man to have a job and be a breadwinner, while perhaps then there are greater expectations for the woman to be at home and take care of the children. Especially if you look back at traditional gender roles. (Nodding and humming.) And if you look at these immigrants and the idea they have of what it should be like. But I also think it applies here.

Bella: Yes!

Blenda: I think so too.

Barbro: Although the difference is smaller here than traditionally, it’s like this here too, I think.

(Extract from focus group 2, Coordination agency.)

The groups talked about how these different expectations of men and women influence how they act in VR, where men are more eager to get into/get back to work, and women can take it slightly slower.

Expectations on female/male behavior versus criteria for diagnosing

Half of the focus groups, mainly those working a lot with persons with neuropsychiatric disorders such as ADHD and ASD, had noticed that men usually had received their diagnosis earlier than women because men were noticed as having problems earlier. This gender difference in diagnosing seemed to depend on norms and expectations of behavior for men and women. The employment specialists discussed that the diagnostic criteria for diagnoses like ADHD and ASD were more connected to male coded behavior.

Clara: I’m thinking about this with girls and boys, it happens often that girls are not diagnosed because you don’t see that there’s a problem like with ADHD or autism for example.

(Carin and Cecilia nod.)

Clara: While maybe girls are often more introverted. They just float along and aren’t identified in the same way as boys. Then, I kind of think, I wonder if there’s a difference with diagnosing and so, because girls, as I said, aren’t noticed in the same way as boys who more act out. That’s an idea I had.

Carin: Yes!

Christer: There is now more knowledge. Boys were overrepresented in diagnosis before, while girls, as you say, were not noticed.

Clara: Mhmm.

Christer: But now we, both the school and relatives, have learned more about both autism and ADHD, so that we understand that we can get help.

Moderator 1: But could it still be the case that women get their diagnoses later?

Carin: Yes, I think so.

Cecilia: Mhmm. I think so too.

Christer: Mhmm.

Clara: Mhmm.

(Extract from focus group 3, Private SE organization.)

Energy-intensive environmental issues influencing VR

This theme includes the topics in which the energy-intensive environment that women in general seem to live in to a larger extent than men were discussed. The theme consists of 4 topics, 2 of which were brought up in at least half of the focus groups. All but one focus group suggested that the environment for women is more energy intensive than the environment for men and that this energy-intensive environment influences women’s ability to focus on work.

Home and family influence women’s energy

A majority of the groups discussed that women in general put in a lot of extra energy and work taking care of their home and family. This extra burden makes it difficult for women to focus enough on work, which influences VR processes.

Emma: I only thought of one thing when we saw those charts with women and men. I thought that many women stay at home with their children, and many women take care of their children. (Ellinor nods.) Maybe by themselves. They don’t live together. I can see that too. Many women are alone with their children, or the children have fathers who may not be there in that way, who also have their own disabilities in one way or another.

Moderator 1: Is it the fathers who have disabilities, or the women themselves who also have disabilities?

Emma: Both. Now I can’t speak about everyone, but about most, and since I have worked in psychiatry for so long before. But I think there’s a lot going on with children. You have children at home and then the diagnoses come with the children, and you are away from work a lot because you have to go away and it’s pediatric psychiatry and things like that. Then you can’t manage this other stuff and stay at work and maybe keep a job.

Moderator 1: Right.

Emma: I thought a bit like that when I saw those charts.

Ellinor: Erik and I said the same thing when we saw the charts and we’re on exactly the same track as you, Emma, and we support it. And if it’s the old story that’s deeply rooted that women should take care of children and men should work? I have no idea, or is it genetically different that women take care of their children? No idea, but we were thinking the same thing.

(Everyone nods.)

Elsa: I also think that it follows these traditional roles for these families also that even though both have jobs, maybe the girls have part-time jobs and are also the ones who do more of the practical chores at home and in the long run they don’t manage (Emma nods.). But they fall out of the system, become ill, are perhaps on long-term sick leave and perhaps lose their jobs and have difficulty finding new jobs.

(Ellinor nods.)

(Extract from focus group 5, Coordination agency.)

These women in VR, apart from having the burden of caring for children and trying to pursue working life, also seem to have the additional challenge of children, even adult children, with diagnoses who they need to help even more than the “typical” child. Some of the groups pointed out that some men also end up in this situation with taking care of children, so it seems to be more about the role than the person’s actual sex.

Social demands in “female” work

A majority of the focus groups reflected that women’s typical workplaces place higher social demands on the worker than typical workplaces for men.

Helena: I do think that the workplaces I’ve had contact with that are more male dominated do not place such high demands on being so communicative when there’s more male dominance, than when there’s mixed or female dominance. But I don’t have many examples, there are two workplaces I’m thinking of, so I don’t know how general it is.

(Laughter.)

Hanna: No, and I don’t really know what counts as female-dominated workplaces? Is it healthcare?

Moderator 1: I think that if you look at the workplace statistics in general, healthcare is very female-dominated, also schools, preschool is very female-dominated.

Hanna: Mhmm. Yes, and in those professions, social skills are required. To a very high degree.

Helena: Exactly.

Hanna: We also have a collaboration with a nursing home, and we’ve several people there. It was huge so we started with what you could call a "hostess" or "host" on each floor, but there were both guys and girls, but it’s required that you have an interest in nursing and like to be in the kitchen. Above all, these people have more soft skills. This older lady, she was there but it went wrong because she was too unrestrained. So, she was not allowed to stay, even though she seemed to be able to handle the tasks very well, but she commented on how other staff handled their work and it wasn’t very popular.

(Laughter.)

Moderator 1: No, and I’m thinking about that. These female-dominated workplaces have quite high demands on social skills, perhaps because the tasks themselves are about taking care of other people.

Hanna: Yes, and lots of teamwork with other staff. In the break room, I think, it’s very important that it works, as well.

Helena: Mhmm.

(Extract from focus group 8, Daily activities.)

These social demands in the workplace are in the focus groups viewed as more demanding than just having a lot to do, which is illustrated in a dialogue in one of the other focus groups:

Carin: But does it have to be more tiring than working as a scaffold builder?

Christer: Yes, in a way. Because it’s easier to set boundaries as a scaffold builder than it is when working with a dementia patient or a child.

Carin: Mhmm. (Nods.)

Christer: As a scaffold builder, you build your scaffold, and you know how to do it…

Carin: Yes.

Christer: …then it can be tiring in other ways, physical and stressful and so on, but if you work in professions where it’s difficult to set boundaries in the job, like "Now I’m done with this job".

(Extract from focus group 4, Private SE organization.)

Disability, an aggravated trap for women

In this theme, one of the smaller recurring topics might require some extra attention because it links the topic of Home and family influence women’s energy to women with disability. The topic is called Disability, an aggravated trap for women and concerns how impairment might place an extra load of energy-consuming work on women with high responsibility for the family.

Moderator 1: I’m thinking about when I had small children and when they were sick. Sometimes I was at work only half of the time. But I did work well when I was at work, and I could still manage a job.

Bella: I also think when you have, I think about impairments or mental illness, this will be a stress for people. I think they have a harder time dealing with this and being able to find strategies, I think, than we who might not have these disabilities. That’s where the problem is. This stresses a lot of people too maybe “Now I have to take care of my sick children and I can’t find solutions either.” You may not really have these strategies that we can apply. And I think they lack this network. I feel that they are very lonely, these women.

Birgitta: Yes, and the resources themselves, I think.

Bella: Yes.

Birgitta: If you have a disability of some kind, perhaps neuropsychiatric which we encounter regularly. As a parent, you may have a disability. You have children who have it. Children who need extra support at school. Maybe extra support at home. And you yourself may not really be able to support them. You may not have the resources to concentrate, or to learn. I meet a lot of parents who never, well, they dropped out of high school. It became too difficult, so they don’t have an education. So, it becomes stressful in different ways. You are not sufficient in your own resources to be able to give support and then there are probably hassles and problems with the school. Most of these children are teased or bullied. So, there are a lot of things like this that may differ from when you, Moderator 1, took care of your sick children. There may not have been the resources then. I think we forget. We may have one or two pieces that are a bit debilitating, and they may have 8 out of 10 that are debilitating and two that are nourishing and then there will be such an imbalance and then you may not even understand everything yourself. (Humming.) You don’t make such wise long-term decisions because you are here and now in your ADHD. So, I think it’s more complex than we imagine.

Blenda: Yes.

(Extract from focus group 2, Coordination agency.)

Gender-related interactions in VR

This theme gathers the topics where the interactions between the participants and the employment specialists are discussed. The topics in this theme often take a starting point in the other themes and reflect how the employment specialists view their work in the light of the perceptions described in other themes. The theme consists of 11 topics, 5 of which were brought up in at least half of the focus groups. All focus groups discussed how the interactions in relation to gender influence the VR process.

More careful with women/faster toward work with men

A majority of the groups discussed that they are more careful and cautious with women than men in the VR process, usually because the women themselves are more careful and insecure and have many other things that drain their energy. This also leads to the process of moving faster towards work with the men.

Gabriella: And I also think, linked to gender, I think about whether we, or I, am quicker to talk about [employment] when it’s a guy who’s out on an internship than if it’s a girl. These are my thoughts. I don’t know.

Moderator 2: Why do you get that idea about yourself? What is the basis of that experience?

Gabriella: Yes, but you know, a bit like we talked about yesterday, these girls I work with, they often have so many things going on. (Greta nods.) And just getting away from home and breaking their pattern; it’s such a big goal that it’s like “Yes! Now we’re out, and it works!” But the guys are in a different position most of the time, they are more ready and then I follow that too. I’m sitting here wondering if I perhaps do this, because the goal looks so different most of the time.

(Extract from focus group 7, Private SE organization.)

Broadening horizons

A majority of the focus groups talked about it being their job to broaden the horizons of job possibilities for their participants. Most of them, however, even if there were exceptions, talked about how difficult this task is in regard to the gender-segregated labor market.

Moderator 1: So, the girls want to work in hotels and restaurants and in preschools. They don’t want to work in agriculture or so?

Astrid: No.

Alice: If we look at our previous SE intervention, we started from their wishes, and these were very traditional wishes. Even though we visited different workplaces and tried to show different options, they often wanted the professions they knew someone else had, a relative or a friend, because they knew a little about it. So even though we tried to showcase other jobs and opportunities and even if we were told that there might be [employment] available, they didn’t often take the chance. They had already decided that this is how it is, and we did as they wished, so it became very traditionally male and female. Even though we tried to break this pattern, we didn’t get that far.

(Extract from focus group 1, Private SE organization.)

Easier to find work for men than women

A majority of the groups discussed the perception that it is more difficult to find work for women than for men in their VR interventions. This notion mostly seems to depend on the type of work men want and that those workplaces both have more clear-cut tasks that are of great interest for the group of people in VR but also that it seems to be easier for the employment specialist to make adaptations in the workplaces that men want.

Elsa: Well, I just thinking out loud, and that may be my preconceived notions, but I have a feeling that it’s easier for guys to enter the labor market, maybe partly because in male-dominated tasks, there may be a different kind of acceptance of people who may have some special needs because you may not make such a fuss about it. I think a bit of exclusion is more common in female-dominated professions, perhaps, not inviting people who don’t act like everyone else, don’t work the same. But I’ve no evidence for that. But I do have that experience from a previous assignment at the Swedish Public Employment Service SE-program. I got a lot of these thoughts in that assignment. It was much easier to get the guys out to the industry, to smaller companies where they really adapted and made way for the person. It was much harder and trickier to get it done in a good way for a girl who needed adjustments. I tried to search myself from time to time and wondered if it was because of how I “sold” the person to the employer, or what was the reason? I got more guys and men into work that lasted over time than I got girls. I have no idea!

(Extract from focus group 5, Coordination agency.)

Employment specialists’ methods and values influence the VR

A majority of the focus groups discussed whether they worked differently with men and women. Many focus groups thought that they unconsciously worked differently with men and women, depending on methods and values. There were many uncertainties in this topic, and some employment specialists pointed out how difficult it was to know what they truly are doing in their interactions with men and women.

Jens: I don’t believe it’s the case, but I’m thinking about how I as a coach work with a female worker versus a male. If there’s any difference? Do I treat them kind of differently?

Jeanette: Mhmm.

Jens: I have a hard time seeing myself from the outside in my job, but it would be interesting if someone else would look at it and ask "Yes, but why did you say this or did this?"

Jeanette: Yes.

Jens: It would be a bit interesting to find out too.

Jeanette: Mhmm.

(Extract from focus group 10, Daily activities.)

Individual focus hides gender

A majority of the focus groups pointed out that their focus is the individual participant and not the gender of the participant. Many also pointed out that it can be difficult to notice gender differences when working with a few people.

Felicia: Then I really have to think about it carefully because we work individually, you get so caught up in your participants. I probably don’t think like: “I do this because it…”

Fredrika: “… is a girl or a guy.”

Felicia: No, exactly.

Fredrika: I think so too.

(Extract from focus group 6, Daily activities.)

Gendered paths in the welfare system

The last theme is a smaller theme and was discussed in 5 of the focus groups. The theme concerned how men and women might take different paths through the welfare system and how these differences influence men and women in the VR process. The theme consists of 4 topics, one of which was discussed in at least half of the focus groups.

Different paths into VR

Half of the focus groups discussed this issue of the different paths that men and women seem to take into VR. A few groups had noticed that the women were remitted to them from health care services to a greater extent than men, and that the women were the majority in their interventions; therefore, the question arose whether men received help elsewhere. This was in contrast to other focus groups, mainly those belonging to daily activities, which had more men in their interventions, and therefore raised the question of whether this depended on the underdiagnosing of women.

Felicia: It’s interesting that the gender distribution in the actual participation [in SE within the framework of daily activities] never is 50/50 and that over the years there have never been more girls.

Moderator 1: Right.

Felicia: And why is it like that?

Fredrika: It’s like, where are the girls?

Moderator 1: There may be gender differences in the distribution of diagnoses, but we also know, or as we talked about yesterday, that there’s been an underdiagnosing among women.

(Felicia nods.)

Fredrika: Yes. We can see that many of the girls we’ve talked about with ASD come to us much later. They’ve been to the municipality job center; they’ve been to the coordination agency. They’ve been around many different interventions; they’ve been tested in the open but still sheltered labor market in a different way before they come to daily activities. While the boys have generally followed a straighter path – special education and then on to daily activities.

(Extract from focus group 6, Daily activities.)

When compiling the answers from all groups, men and women appeared to be in different places within the welfare system, including both healthcare and VR.

Differences between the focus groups

In terms of the general patterns in the focus groups, there were no major differences between the groups. None of the focus groups covered all 14 of the most common topics, but two groups covered 11 of them, and the group covering the least of the most common topics covered 6 of them. The largest variation among the groups was how many of the recurring topics in total they covered, ranging from 11 to 24. The total topics covered by each focus group were related to how many of the most common topics were covered by each focus group.

There were some variations in how much emphasis the different focus groups put on the different themes. The smaller theme gendered paths in the welfare system were covered by five groups, but these focus groups came from the three different larger contexts represented in this study – private SE organization, daily activities organizations and the coordination agencies. The four other themes were brought up in all other focus groups, with one exception: the theme of energy-intensive environmental issues influencing VR was not brought up in focus group 4, one of the groups from the coordination agencies. Even though all the other themes were covered by all focus groups, the groups put different emphases on the themes. Group 3, from a private SE organization, put very little emphasis on gender-related interactions in VR, while groups 8 and 9, from the daily activities organizations, put little emphasis on Differences in personal and health factors among VR-participants. These differences are difficult to interpret because they did not occur in the other groups from the private SE organization and the daily activities organizations.

Discussion

Main findings – the underlying themata of the social representations

The purpose of this study was to explore employment specialists’ social representations of gender in relation to work and disability and how these social representations influence the employment specialists’ work in the VR process according to SE. Five themes with different social representations developed in the material. In the focus group material, two patterns of gender division in relation to VR could be seen in the five themes – fragile and burdened women and men and women in different places in the system of work.

These two patterns of division can be seen as underlying themata [34] and influence the interactions in VR. Many of the employment specialists acknowledged that they worked differently with men and women. They were more careful with the women, as the women were perceived as more fragile and at least not as determined to find work as the men. To perceive woman as weaker than men, especially if they also have a disability, is common [39] and this study does not seem to be an exception. But in this case, the perception could lead to job-targeted VR efforts slowing down or not leading to employment.

The patterns also influenced the employment specialists when trying to find suitable workplaces for their participants, where they experienced it more difficult to find workplaces for women. Depending on the type of organization in the welfare system, some of the employment specialists worked with more men and some with more women. VR interventions usually take place in the intersection between healthcare and work, and gendered notions have been observed in both healthcare, where women are perceived as sensitive and emotional [40], and in the gender-segregated labour market in the Nordic countries [41]. These gendered notions may well influence the employment specialists’ work in finding suitable workplaces for both men and women.

Another pattern related to gender which might influence the VR process was that the employment specialists emphasized the difficulties in discovering gender differences when working individually with few persons and that they had difficulties knowing if they worked differently with men and women. Person-centeredness in rehabilitation, which resembles the individualized support in SE, is commonly encouraged [42], although the individualized and person-centered support might risk hiding gender differences that reproduce discriminating processes. Gender sensitivity in person-centered approaches have reached some attention in the latest years [43,44], but when it comes to VR there has been a lack of gender-sensitive approches in research and practice.

The results and the theory of gendered organizations

Four of the themes that were developed from the focus group material could quite easily be explained by the theory of gendered organizations [33]. The theme of gendered paths in the welfare system matches the process of division where men and women, depending on the gender-related division, take different paths through the welfare system and end up in different places in their working lives and in the welfare systems, and this seems to be true even though the Nordic countries have the highest gender equality in the world [45]. The theme of gender norms in society influencing VR matches the construction of symbols and images that explain and express the division between men and women. An example of this is the image of a man as the breadwinner and the image of a woman as a mother, which are in line with the earlier referred Swedish study where occupational therapists talked more about work with men and more about home and family with women [32]. Another example is that the image of a man with a disability is a man with ASD or ADHD while the image of a woman with a disability more commonly is a woman with a mental illness. This latter image might lead to men and women receiving different diagnoses and that men and women with disabilities not fitting this image will not get noticed [cf. 46,47]. The theme of gender-related interactions in VR matches the process of interactions that maintains the gender-related division. An example of this is, again, that the employment specialists express that they are more careful with the women in VR, which in turn may lead to no employment being secured, maintaining the division between men and women. Another example is yet again the employment specialists’ efforts of “broadening the horizons” for the women in VR and that these efforts often proved to be in vain, because, in the end, the women wanted to have a job according to the gender-divided labor market. Finally, the theme of differences in personal and health factors among VR-participants matches the individual identity in relation to gender, where men and women may develop different behavioral strategies depending on the gender-related division, the images and symbols expressing this division, and the interactions in which men and women take part. These four themes, which match Acker’s theory of gender, are closely intertwined, but there is still the fifth theme, energy-intensive environmental issues influencing VR, which adds another gendered dimension.

Energy-intensive environmental issues influencing VR and cognitive load

The theme of energy-intensive environmental issues influencing VR is related to the perception that women have higher demands and, therefore, greater strains in both their private and working lives. This theme could fit into Acker’s theory of gendered organizations, where the gendered divisions of men and women create these greater strains on women. However, in relation to women and men with disabilities, Acker’s gender theory does not provide sufficient understanding. The social representations of disability and gender seem to be crucial for women with disabilities faring worse than men with disabilities in the labor market because there are only small differences in labor market participation between men and women without disabilities in Sweden [2]. The greater strains on women may be possible for women without impairments to handle, but if there is an impairment, the energy-intensive environment that women seem to live in might cause an actual disability for women with impairments.

One reason for this situation that the employment specialists referred to when they talked about women in VR not having enough resources to handle all the strains, is related to the theory of cognitive load [48]. Living with an impairment may per se come with limitation. Even if the impairment can be handled, the impairment may cause extra strain on one’s cognitive systems, leaving limited resources to handle other issues. These limited resources to handle increased cognitive load have been recognized in a number of different impairments, e.g., severe mental illness [49], ASD and ADHD [50], intellectual disabilities [51], stroke survivors [52], hearing loss [53] and visual impairment [54]. The limited resources for handling increased cognitive load might be the reason that women with impairments are perceived as having greater difficulty gaining and maintaining sustainable employment than men with impairments, because women with impairments, due to the greater strains in their private and working lives, have a higher cognitive load to handle. That is, the environment makes the women disabled. Therefore, to better understand why women with disabilities fare worse than men with disabilities in the labor market, a theory or a combination of theories that explore the intersection between gender and disability is better suited than explanations based on gender theory only.

The results and previous research

Many of the results in this study are in line with previous research findings on gender differences in VR. Women have previously been shown to have greater demands placed on them than men in family life [13–15]. Women have also been perceived as having lower self-perception and lower self-esteem than men in VR and being restricted by traditional gender roles [16,17]. The topic that girls with special needs are more seldom recognized than boys by the school system was also in line with previous research [16,17]. The topic of “broadening horizons” in this study was a more complicated one than previous research suggests [16]. The employment specialists thought that “broadening horizons” was important, but they also found it difficult to implement and that gender-related divisions in the labor market are challenging to break. This could be due to the occupational gender-segragated labor market in the Scandinavian countries, even if a move to less gender segregation has been seen in recent years [41].

This study confirms, to some extent, the findings from previous studies on the perceptions of gender in professions close to VR [31,32]. In this study, there appears to be an ambivalence among the employment specialists. On the one hand, they emphasize the need to work individually with each of their participants, which is in line with the SE methodology [18], but this individual approach makes them somewhat blind to structures such as gender. On the other hand, they have noticed gender differences, which shaped the way they worked with their participants. In addition, the employment specialists express that they have to work differently with men and women to achieve the same results. They are, in some sense, “doing gender”, but they seem to have a more conscious approach to do so than previous studies have shown [31,32]. This ambivalence in both recognizing and not recognizing gender differences among the VR professionals makes the issue of raising gender awareness central. Perhaps even more important, not to put the total burden of gender equality in VR on individual VR professionals, might be to have gender sensitive working methods, which both can account for men and women’s sometimes different life circumstances and treating men and women equally. SE might offer such a method within VR, if the employment specialist can balance between adhering to the individual needs of the participant and adhering to the principles of the SE method in a gender-sensitive way. What this gender sensitivity in SE might consist of still needs further examination.

Study strengths and limitations

This study has explored the views of employment specialists from several different fields of SE, which is likely a strength of the study. It can be difficult to examine perceptions but focus groups might here be a better option than individual interviews, because in focus groups the participants have to reflect on the views of each other.

The interview technique in the focus groups was nondirective, and the moderators tried not to steer the discussions. Nevertheless, the influence of moderators on the discussions cannot be ignored. To try to diminish this influence, topics that were completely controlled by the moderators, and where the employment specialist did not contribute with any content of their own, were discarded in the analysis.

Many of the utterances from the focus groups show uncertainty regarding whether the gender differences perceived actually exist. However, because the same utterances about gender differences occurred in many of the focus groups, this strengthens the idea that these gender differences, although vague, are perceived by the employment specialists. Another concern expressed by some of the employment specialists, was that the focus on gender in the focus groups might induce gender differences that do not exist; because only topics discussed in at least two of the focus groups were included in the analysis, this might be a minor issue.

The focus groups met twice, which is a strength of this study because the discussions were deepened, and the participants had the opportunity to add or correct things said in the first session. The topic analysis does not process single utterances, which is another strength of the method because social representations must, per se, go beyond the opinion of a single person. There are also contrasts in opinions in the material, but the topic analysis, unlike more traditional content analysis [36], emphasizes similarities, not differences. Another strength of the study was the use of the reference group as a means of members checking the analysis of the material [55]. The reference group confirmed the findings of women receiving diagnoses later and the energy-intensive environment of women, but also gave new perspectives; they noticed that there was a lack of nonbinary gender perspectives in the material.

Conclusions

This study has revealed pervasive social representations about gender and disability in relation to VR and working life among employment specialists working, more or less, according to SE. The gender-related divisions of men and women influence the employment specialists’ work with their participants. The social representation of greater strain on women with disabilities compared to men with disabilities, which reflects the lived experiences of the employment specialists, is a possible explanation for the gender differences in VR and working life for persons with disabilities. This issue is not completely fruitfully analyzed with gender theory; thus, a perspective of intersectionality considering aspects such as disability in conjunction with gender is needed to better understand the gender differences in VR and working life.

Moreover, apart from recognizing gender differences, the employment specialists also, to some extent, saw themselves as blind to gender, which could lead to reproducing discriminating processes and therefore not achieving gender equality in VR.

Acknowledgements

We would like to thank the reference group of this research project for their valuable comments on the results of this study. We would also like to thank writing instructor Dr. Marinette Grimbeek for invaluable feedback on the manuscript, especially the translations of the focus group transcripts from Swedish to English. In addition, we would like to thank Dr. Lena Gunnarsson for useful input in gender theory. Last, we would also like to thank Dr. Stephen Widén for his important comments on the manuscript as a whole.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by FORTE, The Swedish Research Council for Health, Working Life and Welfare, under the grant [STYB-2019/0005].