Assessment as a matter of inclusion: A meta-ethnographic review of the assessment experiences of students with disabilities in higher education

Educational Research Review 42 (2024) 100582 Available online 12 December 2023 1747-938X/© 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Review Assessment as a matter of inclusion: A meta-ethnographic review of the assessment experiences of students with disabilities in higher education Juuso Henrik Nieminen a , b , Anabel Mori˜ na c , * , Gilda Biagiotti c a Faculty of Education, The University of Hong Kong, Hong Kong Special Administrative Region of China b Faculty of Education, Ontario Tech University, Canada c Faculty of Education, University of Seville, Spain ARTICLE INFO Keywords: Educational assessment Higher education Students with disabilities Equity Meta-ethnography ABSTRACT Assessment plays a crucial role in student learning in higher education. Until rather recently, the role of assessment in relation to inclusion has been unexplored. In this study, we conduct a research synthesis of 42 studies published between 2010 and 2022, including 868 student participants, to map the assessment experiences of students with disabilities in higher education. Specifically, we conduct a meta-ethnographic review to synthesise qualitative studies and capture the participants’ lived experiences of assessment. Our analysis considers how these experiences reflect both inclusion and exclusion. We theorise these elusive terms through the ideas of access and participation. Most of the studies considered the students’ imminent physical, perceptual and social access to assessment, such as in the cases of inaccessible examination halls or digital assessment systems. A smaller subset of the studies considered inclusion/exclusion as a matter of students’ social participation as fully accepted members of academia. In these studies, assessment was described as providing the students with opportunities to belong to academia, whereas experiences of exclusion portrayed assessment as a mechanism for social segregation and discrimination. Overall, our review shows that assessment is a primary barrier to the inclusion of students with disabilities in higher education. We propose that the predominant discourse of inclusion in assessment needs to widen from considering immediate access to assessment into considering how assessment regulates the full participation of diverse students in higher education. We discuss the implications of inaccessible assessment for all students and suggest that, ultimately, both access and participation are matters of student identity. Our review has important practical implications for the design of inclusive assessment in the current higher education contexts in which student cohorts are becoming increasingly diverse. 1. Introduction Higher education (HE) has changed as a societal institution. What used to be an essentially elitist institution has now opened its doors to historically excluded students, including students with disabilities (Tight, 2019). The move towards massification has brought HE closer to the ideal of inclusive education for all (Mori˜ na, 2017). Yet, simply providing access to HE is not sufficient to promote * Corresponding author. E-mail address: [email protected] (A. Mori˜ na). Contents lists available at ScienceDirect Educational Research Review journal homepage: www.elsevier.com/locate/edurev https://doi.org/10.1016/j.edurev.2023.100582 Received 23 March 2023; Received in revised form 4 December 2023; Accepted 4 December 2023 Educational Research Review 42 (2024) 100582 2 inclusion: inclusive learning environments and support mechanisms are needed to promote the success of the diversity of students during their studies (Mori˜ na & Biagiotti, 2022). The HE literature is indeed paying increasing attention to inclusive pedagogies (Nieminen & Pesonen, 2022). However, as Stentiford and Koutsouris (2021) noted, how ‘inclusion’ is understood in HE remains unclear. Approaches to inclusion in this field vary from market-driven ‘quick fixes’ to individual accommodations to inclusive design for all. This paper focuses on the particular role of assessment in the questions of disability inclusion. Whereas earlier reviews have successfully synthesised research on disability inclusion with respect to inclusive teaching and learning practices (e.g., Cumming & Rose, 2022; Roberts, Park, Brown, & Cook, 2011; Stentiford & Koutsouris, 2021), as well as on the experiences of students with disabilities in HE in general (e.g., Hartrey, Denieffe, & Wells, 2017; Kimball, Wells, Ostiguy, Manly, & Lauterbach, 2016; Mutanga, 2017), assessment has thus far been largely neglected in this literature. The focus on assessment is warranted in contemporary HE which is often characterised by metrics and rankings (see Peseta, Barrie, & McLean, 2017). From the student’s point of view, assessment is known to be perhaps the most influential factor in learning. This is exemplified by decades of research on how practices such as summative and formative assessment, self-assessment, peer assessment, portfolios, and so forth, could promote student learning in HE. Despite the well-known importance of assessment on student learning, only rather recently has the mainstream literature on assessment started to consider the viewpoint of student diversity (see Ajjawi, Tai, Boud, & Jorre de St Jorre, 2023). This may stem from the idea of assessment being seen as an objective measurement process of students’ skills and capabilities (Boud et al., 2018). However, in mass HE settings, it is essential to consider how assessment is connected to the processes of inclusion and belonging for historically underrepresented students (e.g., Nieminen, 2022a), particularly because assessment is known to be tightly associated with student well-being (e.g., Jones et al., 2021). In this study, we focus on students with disabilities as a crucially important example of marginalised students in HE. This is considered one of the largest equity groups in higher education and beyond (World Health Organisation (WHO), (2023)), and indeed, most HE institutions have institutionalised support mechanisms for students with disabilities in particular. Earlier studies have largely reported that students with disabilities have negative experiences of assessment (e.g., Hanafin, Shevlin, Kenny, & Neela, 2007; Ryan, 2007). The fact that students with disabilities systematically require assessment accommodations (e.g., extended time in examinations) in HE systems around the world implies that assessment is widely inaccessible and may thus provide barriers to students with disabilities to represent their actual skills in assessment. However, so far, research on assessment and student diversity has primarily focused on the matters of learning, leaving the crucial aspect of inclusion somewhat underdeveloped. We are aware of one earlier review that has focused on students with disabilities and assessment in HE (Tai, Ajjawi, & Umarova, 2021), yet this study only focused on positive examples of inclusive assessment design. How is assessment connected to the inclusion and exclusion of diverse students in HE? This study answers this question by providing a comprehensive synthesis of how students with disabilities themselves have experienced assessment based on earlier research. This quest is important for two reasons. First, as HE widens access to many historically excluded and marginalised student populations, it is vital to understand the lived experiences these students have about teaching and learning in HE. This is also true for assessment: by hearing the voices of students with disabilities themselves, we may be better equipped to develop inclusive assessment practices. Second, by hearing these voices, it is possible to theorise further how assessment might be connected to the processes of inclusion and exclusion in HE (see Ajjawi et al., 2023; Nieminen, 2023). This way, we may better understand the ethics and equity in how assessment shapes the inclusion, belonging and identities of the increasingly diverse students in HE. To fulfil these goals, we conduct a metaethnographic review of qualitative studies on the assessment experiences of students with disabilities in HE. We focus on studies published after 2010 to shed light on contemporary HE settings with the specific features of massification and diversification (Tight, 2019). Ultimately, we propose that the predominant discourse of inclusion in assessment needs to widen to consider how assessment regulates the full participation of diverse students in HE. Fig. 1. Overview of our theoretical framework of assessment. J.H. Nieminen et al. Educational Research Review 42 (2024) 100582 3 2. What does ‘inclusion’ mean in assessment? ‘Inclusion’ is an elusive term in HE settings since HE has not traditionally been considered as a site of societal inclusion (Mori˜ na, 2020). What makes the term difficult is that it not only refers to educational practices but also to ethical and moral questions about why and how diversity should be nurtured, or repelled. As Stentiford and Koutsouris (2022) noted in their review, ‘inclusive practices’ are often promoted as meeting the needs of increasingly diverse student populations, yet the notion of inclusion suffers from ‘tensions and fragmentation’ (p. 14). Defining inclusion in assessment may be particularly problematic. As the main purpose of assessment is to sort and select, it by definition excludes certain students from certain spaces (Nieminen, 2022a). We use Anette Bagger’s (2022) framework for understanding inclusion in assessment. While Bagger wrote about school-level high-stakes testing, her work provides appropriate conceptual tools for our context, too. According to Bagger’s framework, inclusion in assessment is a matter of access and participation. We supplement Bagger’s theorisation with the theory of models of disability. How inclusion is understood in assessment is a matter of how disabilities are conceptualised (Gabel & Peters, 2004). First, one might follow a medical model of disability that frames disability as a personal, medical deficit that requires care and accommodation (Liasidou, 2014). Another way to conceptualise disabledness is the social model (Riddell & Weedon, 2006; Shakespeare, 2006). This model sheds light on how environments and conditions disable students, shifting the perspective from one of personal tragedy to the social, cultural and political contexts and characteristics of disability. We provide an overview of our theoretical ideas in Fig. 1. The figure shows how the idea of participation includes accessibility; the boundary between is dashed as, in practice, these ideas cannot always be easily separated. The two spheres are separated by the ideas of inclusion/exclusion, denoting that both inclusion and exclusion can occur at the level of access and/or participation. We will explore these ideas fully in the next subsections. 2.1. Access to assessment Inclusion is often provided by ensuring access to assessment for diverse student populations (Bagger, 2022). This view derives from the idea of ‘positive discrimination’, namely, that students could (and should) be categorised based on their characteristics and that some student subgroups deserve additional services in assessment situations. Such a view, by and large, follows a medical model of disability that understands inclusion with respect to providing individual accommodations for certain subgroups of students who can be classified as having disabilities. This is the global norm in higher education for promoting inclusive assessment (Johnstone, Geller, & Thurlow, 2022; Nieminen, 2022b). Assessment accommodations, such as extended time or personal space in examinations, are administered in most HE institutions around the world, as they are often mandated by legislation alongside disability adjustments in general (e.g., J¨ arkestig Berggren, Rowan, Bergb¨ ack, & Blomberg, 2016; Ketterlin-Geller & Johnstone, 2006). This means that students’ individual characteristics are considered to ensure that all students are able to demonstrate their true skills in assessment. Access might take into account physical, perceptual and digital aspects of assessment (see, e.g., Ketterlin-Geller, 2008a, 2008b; Ketterlin-Geller, Jamgochian, Nelson-Walker, & Geller, 2012). Disabilities, mental health issues and illnesses are simultaneously understood as medicalised conditions. It is a global norm that higher education students require a diagnosis or a similar document to access disability services, assessment accommodations included. According to this view of inclusion, exclusion occurs if the access needs of students with disabilities are not met or if students with disabilities are completely excluded from an assessment situation (Schuelka, 2013). In such cases, the validity of assessment is compromised because the assessment results do not represent the true skill of the student (Russell & Kavanaugh, 2011). Accommodations have long been at the core of disability inclusion and politics, and the need for them should not be denied. Our argument is that this approach is only one way of conceptualising inclusion in assessment. That said, earlier research has pinpointed fundamental issues with focusing too much on accommodations alone (see Johnstone et al., 2022). One problem with the accommodation model is that it leaves the initial design of assessment untouched. For example, an extended time in an examination may promote access for students with disabilities, but this practice does change the fundamentally inaccessible practice of the examination itself. As such, accommodations provide an ‘afterthought’ approach to inclusion; it locates the problem in the students who cannot fit the standards of inaccessible assessment, not in inaccessible assessment design (Nieminen, 2022b). Moreover, if the medical model is overemphasised, assessment accommodations might be portrayed as ‘neutral’ practices with no social consequences. As summarised by Cohen, Gregg, and Deng (2005), ‘Accommodations, if appropriate for a student, should be viewed as simply the tools for accessing or demonstrating knowledge, no different than reading glasses’ (p. 232; our emphasis). This idea has been shown to be false because, in reality, assessment accommodations are social practices that are often loaded with stigma, shame and embarrassment – unlike reading glasses (Nieminen, 2022b). For these reasons, from this perspective, inclusion could also be promoted by designing assessment to be accessible in the first place and not as an afterthought (cf. accommodations). This idea follows the principles of Universal Design for Assessment (Johnstone et al., 2022; Ketterlin-Geller, 2008a, 2008b). According to this view, students’ access needs could be determined before an assessment situation, and these needs could then be considered while designing assessment accessible. For example, if many students – both with and without disabilities – face barriers to representing their true skills because of a strict time limit in an assessment task, the time of this assignment could be extended for all students. While the focal point in Universal Design for Assessment focuses on accessible design rather than on accommodations, both approaches reach the same goal of making assessment more accessible for students with disabilities. Yet, it should be noted that in practice, Universal Design is much more rare in assessment (Tai et al., 2022). It is also more rarely mandated in HE legislation (Johnstone et al., 2022). J.H. Nieminen et al. Educational Research Review 42 (2024) 100582 4 2.2. Participation through assessment As prevalent as the idea of accessibility is in determining inclusivity in assessment, there are other viewpoints that drastically widen this approach. According to Bagger (2022), inclusive assessment is also a matter of participation. This approach does not only consider assessment as a matter of student characteristics or instructional design but situated assessment within a wider societal perspective. Historically, assessment has contributed to excluding students with disabilities from society by restricting their life opportunities (e.g., Hamre, Morin, & Ydesen, 2018; Schuelka, 2013). This view thus understands inclusion through a socio-political lens rather than as only a matter of assessment design. We define participation through assessment as students’ inclusion as fully accepted members of academic communities (Konur, 2002; Madriaga, 2007; Mori˜ na, 2017, 2017b; Ndlovu, 2019; Nieminen & Pesonen, 2022). The participation approach recognises and dismantles ‘deeply entrenched and historical educational exclusion’ (Stentiford & Koutsouris, 2022, p. 14), shifting the focus ‘from a reductionist perspective to a systemic approach to alleviating the social and educational inequalities that impact disabled students’ lives and identities’ (Liasidou, 2014, p. 131). The viewpoint of participation thus understands inclusion as a social, cultural and political process with fundamentally ethical aspects. This approach does not decline the approach of accessibility but builds on top of it and widens it (see Fig. 1). Access is, of course, required to participation (Bagger, 2022). The participation approach acknowledges the role of assessment in both promoting and hindering the inclusion of students with disabilities (Bagger, 2022). This idea aligns with the social model of disability (Shakespeare, 2006). Whereas the medical model emphasises categorisations of students (‘who is eligible for assessment accommodations’), the social model shifts the focus on the disabling conditions in assessment. Namely, it sheds light on how assessment disables students. From this perspective, inclusion is provided by designing out the barriers to students’ full participation (see Graham, Tancredi, Willis, & McGraw, 2018). For example, it has been shown that in assessment, students with disabilities are shaped and shape themselves as ‘the others’ who cannot fit the idea of an ‘ideal’ or ‘normal’ student (Nieminen, 2022c, 2023). Fear of shame and stigma have been named as key reasons for students to refrain from using assessment accommodations, instead choosing not to disclose their (often visibly hidden) disabilities and thus underperforming when assessed (e.g., Grimes, Southgate, Scevak, & Buchanan, 2019; Kendall, 2016a,2016b; Mori˜ na, 2022). Likewise, teachers and fellow students have reportedly wondered whether students with disabilities are cheaters as they receive easements for assessment (see Nieminen & Eaton, 2023). Assessment accommodations have been claimed to offer an unfair advantage and to threaten academic standards (Sharp & Earle, 2000; Vidal Rodeiro & Macinska, 2022, pp. 1–20). These kinds of portrayals limit the fundamental right of students with disabilities to be included in HE as its fully accepted members. How could assessment, then, promote the full participation of students with disabilities? Assessment might promote students’ full participation by preparing them for future roles as professionals. There is an emerging knowledge base on how student-centred assessment practices such as self- and peer-assessment, authentic assessment and portfolios could not only foster the learning of diverse students but also foster their sense of the self and professional identities (e.g., Tai et al., 2022). As such, ideas such as Universal Design for Assessment might promote not only access but participation as well (Johnstone et al., 2022). However, the role of assessment in promoting the full participation of students with disabilities has received little explicit attention. This is exactly why we decided to conduct this review. 3. Research objective The objective of this review is to synthesise the findings of published studies that report on the assessment experience of students with disabilities in HE. To capture their full, lived experiences, we reviewed studies with qualitative methods. The outcome of our metaethnography consists of both a summary of the assessment experiences of students with disabilities in HE literature, as well as a theorisation of the role of assessment in the wider processes of inclusion and exclusion in HE. To capture the contemporary massified HE context, we reviewed studies published between 2010 and 2022. Our research questions were as follows. ● According to earlier qualitative studies, what kinds of experiences do students with disabilities have about assessment and assessment accommodations? ● How do these experiences reflect inclusion and exclusion, as understood through Bagger’s (2022) model of access and participation? 4. Methods 4.1. Meta-ethnography As the purpose of our study was to synthesise the in-depth lived experiences of students with disabilities, we conducted a metaethnographic review of qualitative research. Meta-ethnographies specialise in qualitative research synthesis (Noblit, 2019; Noblit & Hare, 1988). As noted by Timmerman and Mulvihill (2015), qualitative research may ‘[bring] to light the perspectives of persons whose voices have all-too-often been silenced’ (p. 1621). Meta-ethnographies are suitable for review studies that synthesise earlier findings and develop new insights into existing theories (Maeda, Caskurlu, Kenney, Kozan, & Richardson, 2022). According to Noblit and Hare (1988), meta-ethnography typically has seven phases, which we introduced using the reporting guidelines of France et al. (2019): (1) getting started; (2) deciding what is relevant to the initial interest; (3) reading studies; (4) determining how studies are related; (5) translating the studies into one another; (6) synthesising translations; and (7) expressing the synthesis. We also followed Maeda et al.’s (2022) six recommendations for qualitative synthesis, outlined below. J.H. Nieminen et al. Educational Research Review 42 (2024) 100582 5 4.2. Literature search First, we outline our rationale for choosing meta-ethnography (cf. Maeda et al., 2022). We have formulated our research questions above; meta-ethnographies are particularly suitable for synthesising research participants’ lived experiences. Meta-ethnography enables a reinterpretation of earlier findings in light of theories on access and participation (Bagger, 2022). As Maeda et al. (2022) noted, many other review traditions do not enable such theory-driven tools for analysis. When determining relevance to our review, our starting point was that we anticipated that many studies would not focus specifically on assessment. Instead, they would examine the HE experiences of students with disabilities more generally and then discuss assessment as one factor amongst others. Many relevant studies might not explicitly use the term ‘assessment’ in the title or abstract. Therefore, we needed to create a search protocol that would capture all relevant studies while acknowledging that we would need an extensive full-text screening phase to identify assessment-specific experiences. To find relevant sources, we started with the Scopus, Education Resources Information Center (ERIC) and Web of Science (WoS) databases. Following the recommendation of Maeda et al. (2022), we started sampling with a small number of databases to test data saturation and sufficiency. Saturation was reached with these databases, as we ended up with a sufficient amount of studies that enabled us to fully answer our research questions, which is why we ultimately did not conduct a supplementary search. Moreover, 42 studies is already a large number of studies for a rich metaethnographic synthesis (see Noblit, 2019). Following the recommendation of Maeda et al. we conducted the screening using Covidence, a web-based software for managing reviews. Table 1 summarises our search terms. The search was conducted in June 2022 and limited to the 2010–2022 period in all databases. In Scopus, the search terms were sought from title, abstract and keywords. The results were restricted to journal articles published in the subject areas of psychology and social sciences, yielding 902 hits. In ERIC (accessed through the EBSCOhost research platform), the search was similar, but the assessment-related search terms were sought with the field code ‘All Text’, meaning that the retrieved studies could include the search terms in parts of the document beyond the title, keywords and abstract. This search resulted in 428 hits. Finally, in WoS, the search terms were sought in the ‘Topic’ field, which includes the title, abstract and keywords. The WoS index category was restricted to the Social Sciences Citation Index (SSCI), yielding 1242 hits. Our search process is depicted in Fig. 2. Table 2 summarises our inclusion and exclusion criteria. The titles and abstracts were screened against the inclusion and exclusion criteria by two authors. The first author screened all of the studies, and the second and third authors each screened 50% of them. The ‘maybe’ option in Covidence was selected if the abstract did not include the relevant information for the review. The conflict cases (n =122) were checked and resolved by the first author. The remaining 163 studies were subjected to a full-text review, which was conducted in a similar way to the screening phase: the first author reviewed all of the studies, and the second and third authors each reviewed 50% of them. To identify studies that included segments on the assessment experiences of students with disabilities, we categorised the 163 studies according to the centrality of assessment. A three-way categorisation was used: (1) no mention of assessment, (2) assessment played a peripheral role (e.g., one section of the study was devoted to assessment) and (3) assessment played a central role. Studies with no mention of assessment were excluded. We conducted a quality appraisal of the studies that fit the inclusion criteria (Maeda et al., 2022) by including all articles that presented a full methods section with descriptions of participant recruitment, participants, data collection instruments and data analysis. Forty-two studies were included in the final dataset, which was checked by all three authors using the Critical Appraisal Skills Programme, 2018. 4.3. Data extraction and synthesis The third phase of meta-ethnography is reading the included studies. In practice, this phase blends together with the next phase, determining how studies are related. We started the analytical process by constructing an extraction table that included the relevant characteristics of the included studies and their contexts (France et al., 2019), as well as open-ended fields for determining students’ access and participation in assessment (Table 3). The open-ended nature of the extraction table enabled us to refine our initial ideas about inclusion and exclusion, as well as access and participation, as the main concepts that would tie the studies together (Noblit, 2019). The extraction table was tested and revised by the research team through multiple research meetings. All three authors took part in extracting the data. The first author extracted data from 50% of the studies, and the second and third authors each extracted data from 25% of the studies. Any unclear cases were discussed and resolved in research meetings. The fifth phase of meta-ethnography consists of translating the individual storylines of the studies into one another. It is ‘the process of taking concepts from one study and recognising the same concepts in another study, though they may not be expressed using identical words’ (Thomas & Harden, 2008, p. 5). We used Bagger’s (2022) theorisation of access and participation and the processes of inclusion and exclusion to which they relate as the concepts through which we ‘create[d] new interpretations from the synthesis’ (Maeda et al., 2022, p. 4). We did not expect the original studies to use these specific terms or ideas. We started the process by focusing Table 1 Search terms used for our review. The search terms in different columns of the table were connected by an AND operator. Participants Focus of the study Assessment Context disab* qualitative OR interview OR perce* OR experience assess* OR test* OR exam* OR ‘assessment accommodation’ OR ‘assessment adjustment’ OR ‘extra time’ ‘higher education’ OR university OR post-secondary OR college J.H. Nieminen et al. Educational Research Review 42 (2024) 100582 6 on reciprocal translations for ‘studies in which the storylines are commensurate’ (Noblit, 2019, p. 5), given that earlier research has mostly pointed out the difficulties and barriers that assessment evokes for students with disabilities (Nieminen, 2022c, 2023; Tai et al., 2022). Phases six and seven of meta-ethnography involve the synthesis of the translations and expressing this synthesis in a meaningful way (Noblit & Hare, 1988). We used the two translations of inclusion as access and inclusion as participation to unravel the ‘full set of translations’ with ‘potentially competing interpretations’ (Noblit, 2019, p. 5). In doing so, we intended to reveal more than what the individual studies considered about the processes of inclusion and exclusion in assessment. Specifically, we conducted a refutational synthesis focusing on ‘identifying, understanding and reconciling the contradictions, rather than developing concepts around the Fig. 2. PRISMA diagram. Table 2 Inclusion and exclusion criteria for abstract and title screening. Inclusion criteria Exclusion criteria Phenomenon ● Empirical qualitative studies. ● Studies concerning experiences of teaching and learning of students with disabilities. ● Other types of studies (e.g., quantitative and mixed methods studies). ● Studies concerning students’ experiences of other aspects of HE (e.g., health care and library services, and experiences of physical accessibility if not related to teaching and learning). ● Studies concerning other factors beyond student experiences. Role of assessment in the study ● Central. ● Peripheral. ● No mention. Type of record ● Peer-reviewed studies. ● Empirical studies. ● Journal articles. ● Studies published between 2010 and 2022. ● Studies published in English. ● Full text available. ● Non-peer-reviewed studies. ● Book chapters, conference proceedings, reports, theses. ● Secondary studies (e.g., reviews and literature analyses). ● Studies published before 2010. ● Studies in languages other than English. ● No full text available. Participants ● HE: under- and postgraduate students. ● Focus on the experiences of students with disabilities. ● Studies that focused only on students’ experiences. ● Studies whose sample also included experiences of multiple stakeholders. ● Doctoral students and graduates. ● Students at lower levels of education. ● Studies with a main focus on transition phases before or after HE. ● Studies that did not include students’ experiences (e.g., studies that focused only on teachers’ experiences). ● Focus on other equity groups. J.H. Nieminen et al. Educational Research Review 42 (2024) 100582 7 similarities’ (Sattar, Lawton, Panagioti, & Johnson, 2021, p. 10). In this way, we intended to shed light on the various potentially contradictory ways in which assessment sets up enablers of and barriers to the inclusion of students with disabilities. These findings formed the second-order interpretations of our dataset, which we introduce fully in the Findings section. In the Discussion section, we introduce a third-order interpretation that places our refutational analysis in its socio-political context. As Urrieta and Noblin (2018) noted, meta-ethnography is most useful when it ‘addresses the contexts and nature of educational knowledge’ by bringing forth ‘the history of ideas’ (p. 45). Finally, we provide a brief positionality statement, following previous recommendations (Maeda et al., 2022; Noblit, 2019). We work according to the paradigm of ‘inclusive education for all’, rather than the paradigm of ‘special education’. This means that we are devoted to making HE more accessible for all students. However, as a collective, we have training in special education and its ideas of cognitive interventions and medicalised support. 5. Findings 5.1. Brief description of the dataset In this section, we briefly describe our dataset (Appendix A). Most studies were conducted in Europe (17/42) and North America (13/42), with four studies conducted in Africa, four in Australia, three in Asia and one in the Middle East. Most studies did not take a disciplinary approach: 5/42 were conducted specifically in a STEM context, 2/42 in medical education and 2/42 in other specific disciplines. The number of participants ranged from one (Hsiao, Zeiser, Nuss, & Hatschek, 2018; Lewis & Lynn, 2018) to 139 (Nieminen, 2023), with the total number of participants in the studies being 868. The types of disabilities varied greatly from physical to cognitive and emotional disabilities, while also including conditions such as illnesses, phobias and mental health issues. The most recurrent disability type was cognitive (e.g., learning disabilities). Most of the studies used interviews (41/42), and some drew on observations (2/42) and qualitative surveys (1/42). Most datasets were analysed using an inductive, data-driven approach. Fourteen studies used a theoretical framework when analysing students’ experiences (e.g., the sociomaterial theories of Tai et al., 2023 and situated learning of Ali, Kisielewska, Subhan, & Tredwin, 2020). Four studies drew on longitudinal datasets (Madriaga & Goodley, 2010; Hewett, Douglas, McLinden, & Keil, 2017; Hewett, Douglas, McLinden, & Keil, 2020; Hewett et al., 2023). It must be emphasised that our dataset specifically concerned experiences of examinations. Most (39/42) of the studies focused extensively on students’ experiences of examinations. Experiences of accommodations were also predominantly focused on examrelated adjustments (see Appendix A). 5.2. Access: experiences of inclusion (22/42 studies) 5.2.1. Assessment accommodations provide access to examinations (20/42) In 20 studies, students reported that assessment accommodations had provided physical and/or perceptual access to examinations. These studies reported cases in which assessment accommodations enabled the students to demonstrate their true skills in assessment Table 3 Data extraction table. Fields in the extraction table Characteristics of the study Open text fields: ● Year of publication ● Country in which the study was conducted ● Discipline (e.g., mathematics, education) ● Research question(s)/objective(s) ● Main theoretical framework/idea(s) ● Data collection method(s) ● Data analysis method(s) Characteristics of the participants Open text fields: ● Number of participants in the qualitative data ● Type(s) of disabilities Key information about the context Open text field Student experiences of assessment ● Type(s) of assessment (e.g., tests, self-assessment) ● Type(s) of assessment accommodation(s) Open text fields: ● Access: experiences of inclusion ● Access: experiences of exclusion ● Participation: experiences of inclusion ● Participation: experiences of exclusion Student experiences of assessment accommodations Open text fields: ● Access: experiences of inclusion ● Access: experiences of exclusion ● Participation: experiences of inclusion ● Participation: experiences of exclusion Any other notes? Open text field J.H. Nieminen et al. Educational Research Review 42 (2024) 100582 8 (e.g., Majoko, 2018). The students truly appreciated this form of support. For example, Ali et al. (2020) reported that ‘participants across the board appreciated the adjustments for students with LDs [Learning Disabilities]’ (p. 159); Nieminen (2023) reported that almost all of the 139 participants mentioned that testing accommodations had been helpful; and Slaughter and colleagues (2020) noted that all of their 21 participants reported positive impacts of extended time accommodations during assessment. A participant in the study by Slaughter, Lindstrom, and Anderson (2022) summarised the influence of accommodations on the success of students with disabilities in examinations: Some students went as far as saying that extended time has made a profound difference in their academic career. (…) ‘I think it’s definitely one of the things in my college career that’s helped me the most’. (p. 9) Extended time accommodations, such as extended time in examinations and other course assignments, were reported to enable students’ true skills to be demonstrated during assessment. For example, a student in the study by Hadjikakou, Polycarpou, and Hadjilia (2010) gave a positive account of receiving access to examinations through extra time accommodations: There was a case of a lecturer who gave me extra time … up to 3 hours, because the module was ‘Designing Circuits’, and the lines needed to be straight and the figures well-designed. He told me that he couldn’t do otherwise, because he was aware that I knew the answers and I just needed more time. (p. 413) Similarly, separate testing rooms were described as a positive means of support. In separate testing rooms, students can complete their examinations in a distraction-free environment. Kendall (2016a, 2016b) study provides a good example of this. Kendall challenged the claim by Liasidou (2014, p. 124) that separate testing rooms are a ‘segregating and stigmatising form of provision’ by reporting students’ positive experiences. For example, I’m given a quiet room to do my exams in, obviously it is invigilated but sometimes, I am literally on my own, it’s brilliant! (Sue in Kendall, 2016a, 2016b, p. 7, p. 7) Proficient communication with staff members was described as crucial for successful accommodation processes. Many studies emphasised the importance of students’ self-advocacy in communicating their needs to their universities. For example, in Pfeifer, Reiter, Hendrickson, and Stanton (2020), Opal described how she earned a higher grade on an exam due to extra time. Opal needed to defend herself: ‘I took it [into my] own hands, because I was struggling. I went and [asked] for help and figured that out for myself, so what’s your problem with it? If you want extra time, go get tested, and go figure it out for yourself’ (p. 15). 5.2.2. Assessment accommodations provide socio-emotional access to examinations (8/42) In many cases, accommodations were reported to reduce testing anxiety (e.g., Goegan et al., 2023) by allowing students to ‘concentrate and feel less anxious when taking exams’ (Stein, 2013, p. 151). Fullarton and Duquette (2016) report the case of Elizabeth, who had poor eye-hand coordination and processing problems, and who overcame her feelings of anxiety by using assessment accommodations. This story exemplifies how assessment accommodations do not only promote access on a cognitive but also on a socio-emotional level: During her first year, Elizabeth chose not to register with the special services department and without accommodations, her marks plummeted. She realized that she was overcome with anxiety and did not do well on her exams. In second year Elizabeth made the decision to register at the special services department and received the same exam accommodations as in high school. (…) She feels she has a deep understanding of how she learns and credits the availability of services and accommodations to her completion of two degrees. (Fullarton & Duquette, 2016, p. 61, p. 61) In some cases, the mere knowledge of the existence of accommodations was described as reducing anxiety: ‘It makes me feel better knowing that I have more time even though I’m probably not going to use it’ (Slaughter et al., 2022, p. 8). In another study, Len stated: I didn’t actually use the extra time, but it was a lot of comfort knowing it was there … ‘cos I didn’t have to rush at all. I finished within all the pre-set time zones. (Len in Madriaga & Goodley, 2010, p. 124, p. 124) 5.2.3. Inclusive assessment design (2/42) In two studies, access was provided through an inclusive assessment design. Tai et al. (2022) discussed open-ended exam design from the viewpoint of accessibility. In their study, Siobhan described the open-book format of examinations: ‘[open-ended examinations] took away the mental stress that I’ve really felt in the past … of having to sit there and memorise things when I wasn’t in the mental space’ (p. 8). Nieminen and Pesonen (2019) proposed that to design the accessibility issues related to examinations, examinations might need to be eliminated altogether. They outlined an accessible self-assessment model that provided mathematics students with learning disabilities access to ongoing formative assessment. With examinations removed, the students described being able to focus their energy fully on learning. 5.3. Access: experiences of exclusion (40/42 studies) 5.3.1. Inaccessibility of examinations (32/42) Closed-book examinations were identified as ‘the most significant structural barrier’ (Lewis & Lynn, 2018, p. 14) to inclusion in J.H. Nieminen et al. Educational Research Review 42 (2024) 100582 9 many studies. The format of examinations was described as profoundly inaccessible due to the limitations of time, format and physical environment. In many studies, exam-driven assessment cultures were described as excluding students with disabilities: ‘The lack of use of alternative forms of assessments in assignments and examinations impeded the participation of SWDs in learning’ (Majoko, 2018, p. 7). Examinations were reported to produce many barriers, for example in cases of exam phobia (e.g., Brandt, 2011) and test anxiety (e. g., McManus, Dryer, & Henning, 2017). MacCullagh, Bosanquet, and Badcock (2017) discussed how participants with and without disabilities considered examinations to cause barriers to access: Almost all students, both dyslexic and non-dyslexic, indicated that they disliked high-stakes written examinations and felt that they were a poor method of assessing knowledge and skills. Many mentioned stress associated with written examinations, and some commented that this assessment method is rigid, artificial, stifles creativity and does not reflect real-life situations or abilities. (p. 14) Inaccessibility of exam halls was raised as an issue in many studies. For example, exam halls might be completely inaccessible for students who use a wheelchair (e.g., Andoh et al., 2022). One of the most striking stories about their inaccessibility was reported by Braun and Naami (2021): One day I nearly lost my life on my way to write an exam. When I go to this split metal drain cover, the front tire of my wheelchair got stuck in there and I lost my balance and fell out of my wheelchair. (…) I hurt my arm, but I couldn’t go back to the [residence] hall to rest because I had to go and write the two-and-a-half-hour exam. In fact, I wrote that exam with so much pain which lasted beyond the exam time period. (p. 108) The students described how there was a general lack of reduced-distraction testing environments. The participants in MacCullagh et al. (2017) described the noise in written exam halls caused by ‘shuffling papers, coughing, sneezing and outside construction noises’ (p. 14). Some recent studies also noted the lack of COVID-19-safe exam halls (e.g., Gin, Guerrero, Brownell, & Cooper, 2021). The written format of examinations was noted as a problem in many studies (e.g., Ali et al., 2020; Hewett et al., 2023nts with visual impairments and learning disabilities found this format inaccessible and hoped for more diverse formats of assessment. Tsvaro, a student with dyslexia, summed up the problem as follows: Assignments and examinations are presented in written form only. We are all boxed into writing. We are unique individuals. Oral presentations can be a panacea to my grammatical and spelling mistakes in my writing which are a result of dyslexia. (Tsvaro in Majoko, 2018, p. 8, p. 8) The time limitation of examinations was also mentioned as a major barrier to access. Even when given extra time, the students did not always have enough time to complete their examinations (e.g., Erten, 2011; Hadjikakou, 2010; Kunnath & Mathew, 2019; Norris, 2019; Yusof, Chan, Hillaluddin, Ahmad Ramli, & Mat Saad, 2020). Often, the students wished for opportunities to have breaks during examinations. For example, in Kourea, Christodoulidou, and Fella (2021), Anna explained: ‘I wish I could have more breaks during an exam and not have to sit still for 3 h in front of the computer … ’ (p. 117). Some students noted that the overall scheduling of examinations was not accessible because ‘examinations are all crammed into a few weeks and very little time is scheduled between them’ (Mori˜ na, Cort´ es, & Melero, 2014, p. 52). In Lewis and Lynn (2018), Dylan, a statistics student with dyscalculia, explained how time limitations provided an inauthentic barrier to access: It’s really really unfortunate to me, I think that, in mathematics, it’s not just that you understand the concept. It’s not just that you can get a correct answer, you also have to do it in a certain amount of time, which inevitably is like this really bizarre artificial constraint. Especially now that I’ve worked in industry as a data analyst. And yes, I had time constraints, I had to get a report done in this amount of time or whatnot. It’s nothing like sitting down for a test and you have 60 min to do this insane page of stuff and this huge mental dump, where these kinds of rewriting things would really become problematic, I would just flat out run out of time. (p. 14) 5.3.2. Problems accessing assessment adjustments (18/42) The ‘troublesome process’ (Goegan et al., 2023, p. 5) of accessing assessment accommodation was described as long and arduous (e. g., Milic Babic & Dowling, 2015; Redpath et al., 2013). Because the students needed to prove their disabledness by acquiring a diagnosis, the process also required economic resources. In many studies, the students described how there was a limited amount of information available about assessment adjustments (e.g., Pfeifer, Reiter, Cordero, & Stanton, 2021). One participant expressed frustration about the inaccessible process of applying for accommodations: I had to wait for two months to make a provision of scribe services available in my role book. I made three trips to the main campus of the university to get this done. I was alone and there was no help. (Kunnath & Mathew, 2019, p. 180, p. 180) Many students explained that it was not easy to contact their teachers and disability centres about their personal issues (e.g., Kourea et al., 2022). The attitudes of teachers also hindered students’ access to adjustments: Sometimes when you ask for an extension, they are a bit begrudging and ask you, do you really need one? I wouldn’t be asking if I didn’t! It’s so annoying. (Kendall, 2016a, 2016b, p. 7, p. 7) Even when assessment accommodations were officially granted, they were not always implemented appropriately. In Hewett et al. (2023), 41% of the participants (13 students) reported that they had not received the adjustments they were supposed to receive (see J.H. Nieminen et al. Educational Research Review 42 (2024) 100582 16 Study Country Discipline N Types of disabilities a Data collection methods Data analysis methods Theoretical framework used in analysis Type of assessment Type of assessment accommodations Abed and Shackelford (2020) Saudi Arabia Multiple 22 Learning disabilities and comorbid ADHD (10 students) Semi-structured interviews Phenomenography (categorisation) – Examinations and assignments Extended time for examinations and assignments, private rooms for testing Ali et al. (2020) UK Medical education 15 Dyslexia Semi-structured interviews Inductive thematic analysis Situated learning Examinations Extra time in examinations Andoh et al., 2022 Ghana Unclear 19 Physical disabilities Semi-structured interviews Thematic analysis The ubuntu theory Examinations and quizzes – Brandt, 2021 Norway Multiple 19 Dyslexia, blind/partially sighted, deaf/hard of hearing, mobility impairments, exam phobia, temporary impairment Single and focus group interviews Thematic analysis – Examinations Extra time in examinations, separate examination rooms Braun and Naami (2021) Ghana Multiple 2 Mobility disabilities Photovoice (photographs and group narrations) Thematic analysis – Examinations Room reserved for students with special needs Erten (2011) Canada Multiple 7 Learning disabilities, mobility difficulties, chronic health issues Focus group interviews Interpretive data analysis – Examinations Separate testing rooms Fullarton and Duquette (2016) Canada Multiple 4 Learning disabilities In-depth interviews Cross-case analysis through coding and categorising – Examinations Extra time in examinations, separate testing rooms Gilson and Dymond (2012) Hong Kong Multiple 5 Blind, low vision, aboveknee amputation, hearing loss Observation, semistructured interviews Content analysis – Examinations Examination accommodations Gin et al. (2021) USA STEM 66 Chronic health conditions, hearing loss, learning disabilities, mental health/ psychological disabilities, physical disabilities, vision loss Semi-structured interviews Coding – Examinations Extra time in examinations Goegan et al., 2023 Canada Multiple 6 Learning disabilities Semi-structured interviews Phenomenological analysis – Examinations Extra time in examinations Hadjikakou et al. (2010) Cyprus Multiple 10 Mobility disabilities Semi-structured interviews Coding – Examinations Extra time in examinations Hewett et al. (2017) UK Unclear 32 Visual impairment Multiple longitudinal interviews, case studies with observation Thematic analysis International Classification of Functioning, Disability and Health (ICF), Bioecological Systems Theory of Human Development Examinations Extra time in examinations, separate testing rooms Hewett et al. (2020) UK Unclear 32 Visual impairment Multiple longitudinal interviews Thematic analysis Bioecological Systems Theory of Human Development Examinations Extra time in examinations, digital assessment Hewett et al., 2023 UK Unclear 40 Visual impairment Multiple longitudinal interviews Thematic analysis Access, participation and progression in higher education Examinations Examination accommodations (continued on next page) J.H. Nieminen et al. Educational Research Review 42 (2024) 100582 17 (continued) Study Country Discipline N Types of disabilities a Data collection methods Data analysis methods Theoretical framework used in analysis Type of assessment Type of assessment accommodations Hsiao et al. (2018) USA Music 1 ADHD Single case study: multiple sources of data (e.g., psychological tests, academic assignments, interviews) Qualitative analysis, following the case study methodology – Examinations Extra time in examinations, separate testing rooms Kendall (2016a, 2016b) UK Multiple 13 Learning disabilities, chronic pain, mental health problems, arthritis, sclerosis Interviews Thematic analysis – Examinations, alternative assessment Alternative assessment formats, extra time, scribing, access to a reader and/or computer Knott and Taylor (2014) UK Unclear 4 Asperger syndrome Focus group interviews Thematic analysis – Examinations and assignments Extra time in examinations, alternative assessment formats (e.g., oral presentations) Kourea, Christodoulidou, & Fella, 2022 Cyprius Multiple 62 Cognitive and emotional difficulties (e.g., learning disabilities, anxiety disorder) Survey (N =62), of which some participated in interviews (N =9) Thematic analysis – Examinations and assignments Extra time in examinations, access to a reader Kunnath and Mathew (2019) India Multiple 42 Celebral palsy, deaf, hard of hearing Focus group interviews Grounded Theory and content analysis – Examinations Examination accommodations, scribing Lewis and Lynn (2018) USA Statistics 1 Dyscalculia Video recordings of two interviews Coding Emancipatory approach to analysis to ’push back oppressive structures’ (p. 2) Examinations Extra time in examinations MacCullagh et al. (2017) Australia Multiple (social sciences) 13 Dyslexia Semi-structured interviews Coding and thematic analysis – Examinations Examination adjustments Madriaga and Goodley (2010) UK Multiple 8 Asperger syndrome Life history interviews through a longitudinal design Grounded Theory and thematic analysis Medical and social models of disability Examinations Examination accommodations Majoko (2018) Zimbabwe Multiple 17 Variety of physical (e.g., arthritis, asthma) to cognitive disabilities (e.g., learning disabilities) Semi-structured interviews Coding and thematic analysis – Examinations Extra time in examinations and separate testing rooms McManus et al. (2017) Australia Multiple 12 Mental health disabilities Semi-structured interviews Content analysis – Examinations Extra time in examinations and separate testing rooms Milic Babic and Dowling (2015) Croatia Multiple 9 Physical disability, visual and hearing impairments In-depth interviews Content analysis – Examinations Extra time in examinations Mori˜ na et al. (2014) Spain Multiple 44 Physical disabilities, mental disabilities, sensory disabilities, health issues Biographical-narrative methodology Narrative analysis – Examinations Examination accommodations Mullins and Preyde (2013) Canada Multiple 10 Invisible disabilities (e.g., dyslexia, ADHD) In-depth semi-structured interviews Interpretative phenomenological analysis – Examinations Examination accommodations Nieminen and Pesonen, 2019 Finland Mathematics 3 Dyslexia, ADHD, autism Semi-structured interview Theory-guided content analysis, narrative analysis The Universal Design for Learning framework Digital assessment, self-assessment, rubric, peerassessment – Nieminen and Pesonen, 2019 Finland Multiple 139 Disabilities, health issues, mental health issues, others (e.g., accidents) Open-ended survey Reflexive thematic analysis Ableism and disablism Examinations and essays Examination accommodations, alternative assessment (continued on next page) J.H. Nieminen et al. Educational Research Review 42 (2024) 100582 18 (continued) Study Country Discipline N Types of disabilities a Data collection methods Data analysis methods Theoretical framework used in analysis Type of assessment Type of assessment accommodations formats, flexibility with language, supportive technology Nnama-Okechukwu et al. (2020) Nigeria Multiple 17 Learning disabilities Focus group interviews Thematic analysis – Examinations Examination accommodations Norris, Hammond, Williams, and Walker (2020) UK Physiotherapy 15 Learning disabilities Focus group interviews, phenomenology Thematic analysis – Examinations Examination accommodations Olave-Encina (2022) Australia International relations 1 Visual impairment Semi-structured interviews and written responses Narrative analysis – Multiple forms of feedback – Pfeifer et al. (2020) USA STEM disciplines 25 ADHD and learning disabilities Semi-structured interviews Coding Self-advocacy Examinations Examination accommodations Pfeifer et al. (2021) USA STEM disciplines 25 ADHD and learning disabilities Semi-structured interviews Coding Self-advocacy Examinations Examination accommodations Redpath et al. (2013) Ireland Multiple 13 Mental health issues, bulimia, depression, epilepsy, mobility disabilities, learning disabilities, autism, celebral palsy Semi-structured interviews Unclear Obstacles for participation (Tinklin & Hall, 1999) Examinations Examination accommodations Slaughter, Lindstrom, & Anderson, 2022 USA Multiple 21 ADHD, learning disabilities, psychological disabilities, brain injuries, mobility and sensory disorders, systemic disorders Semi-structured interviews Coding and categorising – Examinations Examination accommodations Stamp et al. (2014) USA Multiple 12 Dyslexia In-depth semi-structured interviews Categorisation – Examinations Examination accommodations Stampoltzis et al. (2015) Greece Multiple 10 Dyslexia Semi-structured interviews Thematic analysis and Grounded Theory – Examinations Examination accommodations Stein (2013) USA Multiple 16 Psychological disabilities Intensive interviews Grounded Theory – Examinations Examination accommodations Tai et al. (2022) Australia Multiple 40 Unclear: students with an access plan Semi-structured interviews Sociomaterial analysis with a codebook Sociomaterial theories Examinations Examination accommodations Timmerman and Mulvihill (2015) USA Special education 2 Learning disabilities, blindness, celebral palsy, Asperger’s Syndrome, ADHD Observations and interviews Content and thematic analysis – Examinations Examination accommodations Yusof et al. (2020) Malaysia Multiple 14 Mobility and visual impairments Semi-structured interviews Thematic analysis Social model of disability Examinations Examination accommodations a =We use the original terminology of the studies. J.H. Nieminen et al. 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