- School of Business, Society and Engineering, Mälardalen University, Västerås, Sweden
The extent to which people with intellectual disabilities (ID) are voting is an under-researched area. In order to fill this gap, we conducted a systematic literature review with a focus on voter turnout and democratic inclusiveness among people with ID. In total, we found N = 9 studies that met our inclusion criteria, all of which were based on samples from Western countries such as Croatia, Ireland, Netherlands, Sweden, Switzerland, UK and US. Our findings suggest that people with ID have substantially lower voter turnout than ordinary voters. Constraining factors for voting and other instances of democratic inclusion include educational limitations and physical obstacles at ballot places, as well as being under full guardianship. On the other hand, living in a household with a voter constitutes a facilitating factor. Because of the limited number of studies, we suggest that more basic quantitative and qualitative research in many countries ought to be conducted.
Introduction
Political participation is a basic citizen’s right in many countries around the world, inclusive of people with an intellectual disability (ID; e.g., Amado et al., 2013; James et al., 2018; UNESCO, 2015; United Nations Commission on Human Rights, 1989; United Nations General Assembly, 2007; World Health Organization, 2007). Although legal barriers disenfranchising individuals with ID are increasingly removed, there are reasons to expect that this group is particularly absent at the polling station. Even if the current state of knowledge is deficient. Patterns of political participation (including electoral turnout) and determinants influencing participation in representative democracies have been systematically studied for more than a half-century. However, electoral participation among individuals with ID and the specific obstacles that this group faces are neither covered by systematic reviews (see for a recent example Ektiren, 2024) nor by handbooks on the topic. A case in point is the Oxford Handbook on Political Participation (2022), containing 52 chapters and covering a large number of topics, in which disability is largely missing and ID is not mentioned at all. It is therefore important to review the limited number of studies that exist.
There are of course reviews of studies of individuals with ID. Over the years, a substantial number of systematic reviews on pupils and students with ID have been carried out. For instance, a recent meta-analysis by Dessemonetet et al. (2024) focused on effects of shared reading for students with ID. They found that in many contexts shared reading is effective. Algazlan et al. (2019) examined post-secondary education experiences among people with ID. Overall, their findings indicate that for all involved stakeholders (e.g., students, parents) the experiences were positive.
Regarding people with intellectual disabilities (ID) more generally, several systematic literature reviews have been conducted (e.g., McKenzie et al., 2016) but to our knowledge there is a lack of studies on focusing on the democratic inclusion of people with ID e.g., (see Capri et al., 2021, for such as review in the South African context). More specifically, no systematic review of patterns among people with ID has been done thus far. While Arvidsson et al. (2008) systematically reviewed participation among young people with mild ID they focused on educational settings and included no studies on aspects such as electoral turnout or political participation more broadly. Similarly, Verdonschot et al. (2009a, 2009b) have examined factors which underlie social inclusion of people with ID but have not studied voter turnout and other aspects of democratic inclusion.
Hence, this article aims to fill this gap by conducting a systematic literature review on the electoral participation of individuals with ID. The included studies are coded and analyzed thematically. For each study included in the review, estimates of electoral turnout are recorded together with suggested determinants for variation in participation within the group. We conclude the review with suggestions for future research which are based on the overall state of knowledge about the specific obstacles that this group faces.
Theoretical background
The conditions of people with ID are seldom acknowledged in the major works of egalitarian political philosophy and democratic theory. If mentioned at all, this group is treated as an exception that is not fully included in the defended cooperation schemes (Simplican, 2015). That may be because liberal philosophers, while focusing on equality, value rationality, and intellectual prowess. The ideal within liberal political ideology is to become an enlightened societal agent with a vast knowledge, capacity to reason and appropriate values. For example, Rawls has referred to IQ tests as an explanation for what constitutes the normal range of intellectual capacity, which is required to be a functional citizen (Simplican, 2015, p. 75).
The democratic-theoretical discussion that exists has, with a few notable exceptions (Mráz, 2023; Nussbaum, 2009), mainly dealt with arguments for and against the de jure disenfranchisement of people with ID (Beckman, 2007; Barclay, 2013; Hultin Rosenberg, 2016; López-Guerra, 2014; Mráz, 2020). This is indeed an important question, not least considering that legal restrictions that still remain in a majority of the democracies of the world. Countries such as Austria, Bolivia, Canada, Croatia, Finland, Ireland, Italy, Kenya, Mexico, Netherlands, Norway, Sweden and United Kingdom (UK) represent a minority of states (although growing) where people with cognitive impairments have no status-based judicial restrictions in terms of voting (Beckman, 2014). However, we believe that it is time to shift the focus and look at the conditions for people with ID to fully participate in democracy on equal terms with people without ID. As such, our position aligns with Taylor (2018) and Redley (2008), who emphasize that the primary question should be how rather than if people with ID should be included in the knowledge and citizen communities in our societies.
Important steps to take in this endeavor include establishing precise estimations of voter turnout among people with ID and systematically mapping of obstacles that prevent people with ID from electoral participation. From a normative perspective, the goal is not necessarily for everyone to participate. Variations in electoral participation do not inherently pose a democratic issue. It only becomes problematic if these variations stem from unjustifiable differences in opportunities to participate (Saunders, 2012). However, significant differences in participation indicate unequal opportunity. Knowledge of obstacles that prevent people with ID from participating indicates what is needed to ensure equal political opportunities.
Democratic inclusion includes more than equal opportunities for electoral participation, it also includes equal access to other forms of political participation. Voting in general elections is usually seen as the least demanding form of political participation and is therefore a good place to start. How demanding electoral participation is depends on how the democratic procedures are designed (for example how accessible the polling stations and the election procedures are) and how election information and political information are communicated. What is required to be able to participate fully in democracy is in this sense institution-dependent. Within disability studies, it has since long been argued that disabilities are not the result of individuals’ impairments that should be fixed but of disabling social structures and practices (see Oliver, 1996). Although there are limits to this “social model of disability,” it offers an important perspective on the issue at hand. Equalizing political opportunity is not just about strengthening political resources and increasing political interest. Equally important, is to adjust what is required to participate politically.
Accessibility reforms are not enough, however. Effective electoral participation will unavoidably require the ability to form an independent political opinion or make an independent political judgment based on one’s interest or one’s idea of the common good, to translate it into an informed political choice among different alternatives, parties or representatives, and to communicate this choice to others (for example by casting a vote). Ensuring equal opportunity for electoral participation among people with ID thus involves making participation as accessible as possible and providing the support needed to handle things that inevitably come with making an informed and independent political choice. Empirical knowledge about patterns of electoral participation within the group and obstacles that prevent people with ID from participating is needed to determine what reforms are needed to ensure equal political opportunities.
Based on general research on determinants for electoral participation (not focusing on people with ID) one could expect that people with ID are particularly absent at the polling station. According to the highly influential Civic voluntarism model, variation in turnout can be accounted for by differences in resources, motivation, and recruiting network (Verba et al., 1995). Just like for other groups, differences in motivation and recruiting network can be expected to matter for turnout among individuals with ID. There is no reason to assume that people with ID are less willing to participate politically than people without. The cost of participation is higher for citizens with limited intellectual resources which might impact their expressed political motivation in the current situation, however. Recruiting network (being asked or invited to participate) correlates strongly with electoral turnout. Living together with someone who votes (“the companion effect”) seems especially important (Bhatti et al., 2012). Being asked to vote can be expected to be more decisive for individuals with ID than for the general electorate since limitation in executive ability is often part of the intellectual disability. Limitation in participatory resources can be expected to be particularly prevalent, accounting for differences in turnout between individuals with ID and the general electorate, as well as differences in turnout within the group. Resources that favor electoral participation are unequally distributed among the members of the political community and individuals with ID are particularly disfavored. Studies suggest that resources such as time, money, and civic skills account for differences in turnout (Schlozman and Brady, 2022). Cognitive and intellectual resources are likely to be particularly important in explaining the low turnout among individuals with ID since limited intellectual and cognitive abilities are part of the disability of individuals with ID, which is usually defined by a deficit in adaptive behavior in combination with an intelligence quotient (IQ) below 70.
Method and data
Systematic literature review is a conventional method within medicine and the social sciences, whose purpose typically is to find general patterns about a certain research topic. By taking advantage of specific search techniques and elaborating specific inclusion criteria, researchers can pinpoint pertinent studies and simultaneously avoid biases (Moher et al., 2015; Torgersen, 2003). In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), it is important to have clear and transparent search and coding processes, among other items.
In July 2024, we conducted systematic search processes in the following databases: ERIC, Google Scholar, PubMed, and PsycINFO. Earlier research emphasizes the need for several databases in relation to systematic reviews. While covering grey literature, Google Scholar is inappropriate to use exclusively (Gusenbauer and Haddaway, 2020). Because democratic inclusiveness, on a broader and international scale, is both an extensive and often incremental goal it is difficult to find non-arbitrary years of demarcation. When is it reasonable to expect democratic inclusiveness with an emphasis also on people with ID? Indeed, it is impossible to answer because of the different development patterns within different countries and regions. However, because of the growth of international organizations such as the OECD (Organization for Economic Co-operation and Development) since the new millennium, it is reasonable to have 2000–2023 as a demarcation for the review.
Search strings
Overall, we used the following search strings:
A Democracy OR democratic inclusiveness AND intellectual disabilities.
B Voting patterns OR voter turnout AND intellectual disabilities.
Because most democratic countries constitute some form of representative democracy it is effectively synonymous with democracy. Hence, we chose the broad term democracy in order to not exclude research with emphasis on, for example direct democracy or deliberative democracy.
Inclusion criteria
In line with Petticrew and Roberts (2008), we applied a multistep selection process to screen the articles identified in the literature search. First, we read all titles and abstracts to identify studies potentially relevant to the research questions. We used the following inclusion criteria to identify relevant articles:
1. Scientific, peer-reviewed journal articles published in English (full-texts available).
2. Meeting scientific quality criteria based on Petticrew and Roberts (2008), such as building on non-biased methodologies and having relevance for the posed research topic.
3. The studies must focus on electoral participation among people with ID.
4. The articles should be empirical in nature, either with a qualitative (e.g., interviews), quantitative (e.g., descriptive statistics, multivariate analysis, surveys) or mixed-methods design (e.g., questionnaires and interviews). Thus, conceptual articles and literature reviews were omitted.
Notably, we put no geographical boundaries on our review. Although we expected much previous research to be conducted within WEIRD (Western, educated, industrialized, rich and democratic, e.g., see Mutukrishna et al., 2020) countries, we also expected at least some non-Western countries and regions to be included in this regard (e.g., Scior et al., 2020) which enables comparisons between countries and regions.
Moreover, we put no sample restrictions in terms of when the research was conducted. For instance, longitudinal research may include long time frames. However, as our search focus was on the years 2000–2023 we expected most studies to focus on recent years and decades.
In the first step, we searched Google Scholar as it is the broadest and most comprehensive research database (e.g., Bardach and Klassen, 2020), using both search strings. After a certain number of pages, it was no longer meaningful to continue the examination of Google Scholar as the relevance of the results began to decrease.
Thereafter, we searched ERIC, PubMed, and PsycINFO with both of the search strings. In the last steps, we also did forward and backward searches through hyperintextual examinations. That means that we examined the reference lists in the included studies for additional eligible studies, as well as used Google Scholar to see if any of the included studies have been cited by later studies that may fit the inclusion criteria.
Thematic content analysis
In line with earlier content analysis of research, a qualitative and thematic content analysis was chosen as the main method of analyzing the included studies (e.g., Boman and Mosesson, 2023; Braun and Clarke, 2006; Fereday and Muir-Cochrane, 2006; Krippendorff, 2018). In practice, it is very similar to discourse analysis such as critical discourse analysis (CDA) as both account for the interplays between textual, contextual and social levels of analysis.
There is a reflexive involvement of researchers within such analyses (Krippendorff, 2018). However, as Ratner (2002) has emphasized, all textual analyses must have an objective basis in order to be meaningful. The goal should be to reflect rather than distort reality as it is perceived within oral or written textual resources. Thus, research typologies derived from textual analysis of any kind should have such an “enlightening” and objective purpose (Ratner, 2002).
In conjunction with the reading processes, we aimed to discern a set of themes and compare these with previous research findings in this particular context (Krippendorff, 2018), as well as to interpret these in line with the theoretical framework. Thematic analysis does have both deductive and inductive features (Braun and Clarke, 2006). This may imply that on the one hand earlier theory and research guide the research questions, inclusion criteria and analytical processes (i.e., deductive method), but on the other hand the actual findings in the included studies decide which themes that are given salience (i.e., inductive method). The identification of themes was dependent on close readings of the studies which met all the inclusion criteria. Attention was paid to elements in the articles such as methods, results, and discussions.
Results
Table 1 summarizes the main steps of the search and coding process, whereas Table 2 focuses on the studies which were included in the literature review. These are marked with an asterisk in the reference list. The quantitative enumeration process resulted in eight main themes, which are discussed below in the main text.
The search processed in Google Scholar resulted in 18,700 for “democracy or democratic inclusiveness AND intellectual disabilities” and 17,600 for “voting patterns OR voter turnout AND intellectual disabilities.”
In ERIC, 5779 scholarly articles were found for “democracy or democratic inclusiveness AND intellectual disabilities” (single search field) but only four records were identified when we used the double search fields. Fifty five scholarly articles (peer reviewed) were found for “voting patterns OR voter turnout AND intellectual disabilities” and 0 with double search fields.
In PsycINFO, 2,268 records were identified using “democracy or democratic inclusiveness AND intellectual disabilities” but only two records were identified after all rigid criteria had been implemented (e.g., use of two search fields with the Boolean operator AND, only peer reviewed journal articles in English from 2000 to 2023). 245 results were found for “voting patterns OR voter turnout AND intellectual disabilities” (single search field) and 527 with three search fields. However, as in ERIC the search results were irrelevant or mostly irrelevant for our research focus.
In PubMed’s advanced search option, seven records were identified for “democracy or democratic inclusiveness AND intellectual disabilities” and three for “voting patterns OR voter turnout AND intellectual disabilities.”
Overall, the lack of additional benefit using specialized research databases echoes Bardach and Klassen (2020) who found it more conducive to use Google Scholar in their review. Google Scholar provided not just many search results but also a high degree of hierarchical relevance as most of the studies were found at the top of the results (i.e., the first pages).
After removing duplicates and studies that did not meet all the inclusion criteria, in total N = 9 records were retained. It is worth noting that most of the studies included in this review are published in specialized journals focusing on intellectual disability and none in general political science journals. This confirms our initial hypothesis that disability in general and intellectual disability, in particular, is missing in political science studies on patterns and determinants of electoral participation. When available, reported voter turnout rates were noted. In addition, we identified eight major themes concerning determinants of electoral participation of individuals with ID in these empirical studies. These are described below.
Voter turnout
Voter turnout rates reported in the studies included in this review vary significantly. Some of the studies included are small-N interview studies (Agran et al., 2016; Friedman, 2018; Kjellberg and Hemmingsson, 2013). Voter turnout rates reported in these studies are hard to generalize. The large-N studies included report turnout rates of between 16.5% (Keeley et al., 2008) and 48.6% (Fontana-Lana et al., 2023). The latter result is based on data from four French-speaking cantons in Switzerland (Fontana-Lana et al., 2023). Because Switzerland has strong elements of direct democracy, the results could be even lower in the federal elections.
Theme 1: legal restrictions
Some people with ID are disenfranchised due to their legal status of being fully supported by guardians (e.g., Friedman and Rizzolo, 2017; Lineberry and Bogenschutz, 2023). As Lineberry and Bogenschutz (2023) accentuate, it would be conducive to reform guardianship status so that more people with ID could vote. Moreover, social workers could take a more active role in reforming such legislation. Moreover, some people have not fully understood that they have the legal right to vote (Fontana-Lana et al., 2023). Some studies underline the importance of the right to vote as both a facilitating and constraining factor (Fontana-Lana et al., 2023). For those people with ID that share the view that they possess basic citizen rights, voting is likelier to occur. Hence, this may function as both a constraining and facilitating factor for political participation.
Theme 2: inaccessible voting procedures
In countries such as the US and UK, people with ID are often given sufficient support in terms of citizen rights, physical and digital practices that are directly related to democratic participation (e.g., voting procedures). That is also the case in Croatia, which has substantially lower GDP per capita and average income but is being part of the European Union and is considered a high-income country. However, information in the balloting places should be better tailored for the needs of disabled people. For example, people with severe reading difficulties (either as a consequence of intellectual or visual impairment) should be given tailored support (Femec et al., 2017).
Essentially, all countries seem to have some limitations and deficiencies regarding both physical and digital information which is crucial for democratic participation of people with ID. Even Switzerland, one of the world’s wealthiest countries in terms of GDP per capita and average income, have palpable deficiencies in this respect. For instance, only 52.7% of the sample reported that they had received voting material. However, factors such as Swiss citizenship play a key role in this regard as foreigners who reside in the country may not be legally allowed to participate in federal elections. While this is a general pattern it is especially significant to consider in countries with a large share of migrants and non-citizens residing there. Part of the sample does also have deputyship (similar to guardianship), but after reforms were implemented in 2013 there are much less judicial restrictions on people with ID, even if they have some form of deputyship (Fontana-Lana et al., 2023).
Furthermore, Agran et al. (2016) underline the educational shortfalls in terms of voting processes among people with ID. While 61% of the sample reported that they had received some teaching on voting procedures in previous education, most stressed that it was limited and they had to rely on additional support from parents, support personnel or friends.
Theme 3: inaccessible political information
Agran et al. (2016) reported difficulties in preparing for political participation due to inaccessible political information.
Theme 4: lack of appropriate support from assisting personnel and organizations
Friedman (2018) underscores that support of relevant organizations and assisting personnel can function as both facilitators and gate keepers in relation to democratic participation of intellectually disabled people. Several studies report that such constraints exist, which leads to fewer people with at least mild to moderate ID having lower voter turnout (Lineberry and Bogenschutz, 2023).
Theme 5: proximity to other voters as a facilitating factor for higher voter turnout
Keeley et al. (2008) underscore that living in supported accommodation and having at least one other voter in the household significantly predicted a higher voter turnout. Surprisingly, no other study investigated this variable. However, somewhat similar factors are included in other studies. Lineberry and Bogenschutz (2023) report that proper support networks and social participation (e.g., in self-advocacy events) predicted higher voter turnout (Lineberry and Bogenschutz, 2023). McCausland et al. (2018) show in their study of people with ID in Ireland that type of residency and contact with family correlates significantly with voter opportunity.
Theme 6: older people with ID are more likely to vote
Two studies (Femec et al., 2017; Kjellberg and Hemmingsson, 2013) report that older people are more likely to vote. On the other hand, other studies (Fontana-Lana et al., 2023; Friedman and Rizzolo, 2017; Keeley et al., 2008) suggest that they do not. Of these studies, Fontana-Lana et al. (2023) and Friedman and Rizzolo (2017) are based on larger and more representative samples. McCausland et al. (2018) reports a slightly higher turnout among those who are younger than 65 than among those who are 65 and older. Nevertheless, this is a research theme which is worthy of further scrutiny. For example, it indicates that younger people with ID may lack the experiential knowledge that their older counterparts typically possess to a larger extent. In this respect, it might be important to tailor both education and support networks in order to increase voter turnout among young people with ID (e.g., Friedman, 2018).
Theme 7: level of disability
Some of the studies only included participants with mild or moderate disability (eg. Kjellberg and Hemmingsson, 2013). Other studies are based on data where the severity of disability could not be discerned (Keeley et al., 2008). McCausland et al. (2018) report that people with mild ID participate far more than people with moderate ID who in turn participate far more than people with severe or profound ID. Lineberry and Bogenschutz (2023) reports similar results.
Theme 8: discrimination and negative social attitudes
Friedman’s (2018) focus group study, which gave voice to 34 people with ID, underlines the significance of discrimination and negative social attitudes towards people with ID. While people with ID stress that it is generally easy to vote, using either voting machines or other options, some also emphasize that negative attitudes exist in these contexts.
Discussion
Summary of the studies
In total, N = 9 studies were included in the review. The relatively low number of included studies is related to the specific inclusion criteria, which limit eligible studies to those that focus on democratic inclusion (e.g., voting patterns or voter turnout) among people with ID, thus excluding aggregated studies with no clear separation between people with ID from people with other related or overlapping disabilities (e.g., people with cognitive impairment; Schur et al., 2017) and people with learning disability (Schur et al., 2002; van Hees et al., 2019) and/or physical disabilities. Moreover, we only included empirical refereed articles in English from 2000 to 2023.
For each study, reported voter turnout rates were noted when available. As expected, these studies show that citizens with ID have lower voter turnout than citizens without ID. Eight main themes related to determinants for electoral participation among people with ID were identified.
The results in relation to earlier research and theory
Earlier research and theory (e.g., Agran and Hughes, 2013; Agran et al., 2015; Schur and Adya, 2013) have shown that people with ID tend to vote if they are at least sufficiently educated. In general, appropriate education is a facilitator for the democratic inclusion of people with ID as well as of people with other disabilities. Other facilitators include having a support network (e.g., another person who votes living in the household) and previous experience of voting, whereas constraining factors include being taken care of by a (legal) guardian and lack of appropriate political and judicial rights. In general, many people with ID report that ballot places are often sufficiently conducive and helpful. However, a substantial share reports that there are some limitations in that regard. Hence, more practical reforms in both the physical and digital realms ought to be done. Level of disability correlates significantly with voter turnout suggesting that democratic procedures are especially inaccessible for people with severe or profound intellectual disability.
According to Beckman (2014) and Scior et al. (2020), many countries face political, judicial and perhaps sociocultural constraints for the inclusion of ID people (and disabled people in general). Hence, the samples in included studies are from WEIRD countries such as Croatia, Ireland, Sweden, Switzerland, UK, and US. The most striking difference is that research in the US focuses on different state legislations (Lineberry and Bogenschutz, 2023). Furthermore, Fontana-Lana et al. (2023) emphasize that people with ID who reside in Geneva have lower voter turnout compared to other French-speaking Swiss cantons. More generally, the differences between regions and countries are not particularly striking as people with ID face similar conditions, although far from identical. Nevertheless, these findings related to differences between different countries and regions might be seen as exploratory and preliminary.
Limitations and directions for future research
Our review has several limitations. For instance, while we systematically searched several databases and screened a vast number of titles and abstracts it is possible that some eligible studies have been excluded. Moreover, the review was limited to a thematical analysis of refereed research; thus books, book chapters, white papers and dissertations were excluded. No quantifiable characteristics such as effect sizes were calculated. Furthermore, qualitative analyses are difficult to replicate (Bryman, 2016; Moher et al., 2015).
Given the limitations of our review in terms of the limited number of included studies, more research on the democratic inclusion of people with ID is required. Such research may preferably rely on large samples and clear differentiation between different age groups and disability profiles. While we encourage qualitative research such as interviews, it is likely that large samples are required in order to identify broader patterns. Moreover, mixed methods research such as surveys in tandem with interviews may be particularly conducive. Future reviews may calculate effect sizes using meta-analytical techniques.
Concluding remarks
In summary, there is a small but growing body of research on electoral turnout among people with ID. Generally, the research is published in specialized journals on disability rather than political science journals. Hence, it would be conducive with more such studies in the political science field. Although the numbers fluctuate across studies and contexts, the percentage of voters among people with ID is substantially lower compared to people without ID. Some of the constraining factors are related to legal factors, level of disability, lack of appropriate social support, discriminatory attitudes towards people with ID, and inaccessible voting procedures. Hence, these issues must be addressed in the future.
Data availability statement
The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.
Author contributions
BB: Conceptualization, Formal analysis, Investigation, Methodology, Writing – original draft. JH: Conceptualization, Funding acquisition, Project administration, Writing – original draft.
Funding
The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. The Swedish Research Council (Vetenskapsrådet) has funded this research. This study is published in support of Mälardalen University and the Swedish Research Council [2021-03315].
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
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Keywords: democratic inclusiveness, people with intellectual disabilities, voter turnout, intellectual disability, cognitive ability
Citation: Boman B and Rosenberg JH (2024) Democratically included? A systematic literature review on voter turnout of people with intellectual disabilities. Front. Polit. Sci. 6:1485383. doi: 10.3389/fpos.2024.1485383
Edited by:
Maria Ferreira, University of Lisbon, PortugalReviewed by:
Stefanie Reher, University of Strathclyde, United KingdomSamuel Pires, University of Lisbon, Portugal
Joakim Ekman, Södertörn University, Sweden
Copyright © 2024 Boman and Rosenberg. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Björn Boman, bjornboman84@mail.com