We included studies if they met the following criteria: (a) the study focused on students and/or graduates with disabilities, (b) participants were students in higher education or graduates with disabilities, their parents/guardians, higher education employees, or employers.

We excluded studies if they (a) did not explicitly address barriers and/or facilitators, e.g., they only reported employment outcomes without addressing factors that may have influenced these outcomes (b) focused on short-term or vocational training rather than general higher education and (c) focused on students with intellectual disabilities. The decision to exclude participants with intellectual disabilities was to avoid the risk of comparing education programs specifically designed for people with intellectual disabilities with mainstream education programs designed without targeting specific groups of students.

The most frequently reported barrier among students and graduates was their concern over disclosing a disability (Stein, 2012; Atkinson and Hutchinson, 2013; Walker et al., 2013; Luckowski, 2014; Cunnah, 2015; Easterbrook et al., 2015; Nolan et al., 2015; Clouder et al., 2016; Nolan and Gleeson, 2017; Vlachou and Papananou, 2018; Ali et al., 2020; Grimes et al., 2020; Saltes, 2020; Vincent, 2020; Odame et al., 2021; Shpigelman et al., 2021; Sullivan, 2021). These concerns stemmed mainly from the fear that disclosure would result in stigma from peers, faculty staff, placement educators, and/or employers. In academia, students felt that they were treated differently by their professors after disclosure (Grimes et al., 2020) and some were concerned that students without disabilities would perceive them as receiving “special treatment” if they were to disclose (Walker et al., 2013). Some participants also feared that disclosing their disability would impact future employment prospects (Cunnah, 2015; Easterbrook et al., 2015; Grimes et al., 2020; Vincent, 2020; Odame et al., 2021). This fear seems to be well justified based on other findings from the review, which suggest that some students and graduates who did disclose their disability experienced negative reactions from prospective employers (Cunnah, 2015; Vincent, 2020; Li et al., 2021; Odame et al., 2021; Sullivan, 2021). For example:

“One the comments [my daughter] got was ‘if we knew you had Asperger’s then we wouldn’t have hired you’ and that’s what was said and she freaked out and started crying…” interview quote from Vincent (2020, p. 18).

“Your appearance (using a wheelchair) will affect our corporate image.” “That’s the kind of blatant discrimination I experienced at job interviews.” interview quote from Li et al. (2021, p. 6).

However, key actors within academic and professional environments including instructors, professors, and tutors expressed the importance of disclosure, warning that they could not offer help if they were not made aware of a student’s disability (Ashcroft and Lutfiyya, 2013; Cunnah, 2015; Nolan et al., 2015; Langørgen et al., 2020; Palan, 2021). Disclosure was considered especially important in clinical professions:

“Where things really begin to break down is usually when the disability is not disclosed and is then disclosed mid-placement. This usually means the student is struggling, there is no official information on disability and there is no information on reasonable accommodations” interview quote from Nolan et al. (2015, p. 495).

In some instances, disclosing a disability acted as a facilitator in receiving adequate support. Students and graduates who had positive experiences of disclosing their disability felt that the process opened doors to accessing support services and enabled them to receive help that they would not have received otherwise (Ashcroft and Lutfiyya, 2013; Cunnah, 2015; Ali et al., 2020). Foundation doctors in Walker et al. (2021) expressed positive experiences of disclosing their disability, stating that it helped colleagues become more accepting through understanding their differences. In the context of employment, Gillies (2012) found that some participants felt that the openness in disclosing their disability at the beginning of their employment set the relationship with their employer off to a good start. However, these positive instances do not represent the majority of experiences reported across the included studies. Difficulties with disclosure prompted students and graduates to question when the right time is to disclose a disability, with many criticizing the lack of an inclusive and supportive disclosure process (Nolan et al., 2015; Nolan and Gleeson, 2017; Vlachou and Papananou, 2018; Grimes et al., 2020; Vincent, 2020).

Many participants with disabilities across most studies had experienced some form of stigma throughout the journey from higher education to work. In the context of higher education, students and graduates reported experiences of social isolation, discrimination, prejudice from classmates, and negative attitudes from tutors, staff, and faculty (Stumbo et al., 2011; Atkinson and Hutchinson, 2013; Strnadová et al., 2015; da Silva Cardoso et al., 2016; Shpigelman et al., 2016, 2021; Vlachou and Papananou, 2018; Grimes et al., 2020; Hamilton et al., 2021; Li et al., 2021; Morgan, 2021; Sullivan, 2021; Walker et al., 2021). Negative attitudes were also directly communicated from university staff during interview studies. For example, when discussing students with disabilities who require support, one lecturer commented “I don’t believe there is the time or the inclination of staff out there to nurture or babysit people” (interview quote from Evans, 2014, p. e43). This quote reflects an overall lack of understanding and awareness toward people with disabilities—something which was reported by many students in relation to the higher education institutions, academic staff, and peers across the included studies (Stumbo et al., 2011; Walker et al., 2013; da Silva Cardoso et al., 2016; Sgroi, 2016; Accardo et al., 2019; Cage and Howes, 2020; Hamilton et al., 2021; Pesonen et al., 2021; Shpigelman et al., 2021). This lack of awareness may be a contributing factor to the ableist expectations reported by participants in more recent studies included in the review (Cage and Howes, 2020; Epstein et al., 2020; Saltes, 2020).

Despite the resounding reports of negative attitudes, a common source of support for some in higher education were the positive attitudes from other students, including those without disabilities. There were numerous instances where students without disabilities provided support by helping make learning material more accessible, e.g., sharing lecture notes (Strnadová et al., 2015; Kunnath and Mathew, 2019). Developing friendships and social networks with other students was also seen as a facilitator for success within higher education (Stack-Cutler et al., 2015; Vlachou and Papananou, 2018; Accardo et al., 2019). Positive attitudes—expressed through emotional, social, informational, financial, material, and physical support—from those outside of the educational environment, such as friends and family, also helped students and graduates in achieving their goals (Stein, 2012; Berry and Domene, 2015; Stack-Cutler et al., 2015; Strnadová et al., 2015; da Silva Cardoso et al., 2016; Li et al., 2021; Pesonen et al., 2021; Sefora and Ngubane, 2021).

Other key actors within educational environments could also provide support, with a small number of students commenting on individual support they had receiving from certain supervisors, tutors, or lecturers (Stack-Cutler et al., 2015; da Silva Cardoso et al., 2016; Vlachou and Papananou, 2018; Vincent, 2020; Hamilton et al., 2021; Pesonen et al., 2021). In some instances, university professors went beyond their role as educators and helped prepare students for the transition to work: “[She] helped me with eye contact a lot and how to interact socially as a professional. So, she taught me how to act in job interviews and some things that maybe you should and shouldn’t say” (interview quote from Pesonen et al., 2021, p. 9). Some students also experienced positive attitudes from placement supervisors, who would provide students with positive feedback or emotional support (Luckowski, 2014; Langørgen and Magnus, 2020). Interestingly, Ashcroft and Lutfiyya (2013) found that the positive attitudes of nurse educators was influenced by higher years of teaching experience and past experience of teaching someone with a disability. Despite these instances of support, however, many students and graduates felt that they had to work extra hard—sometimes beyond their capacity—to prove themselves as good students, future practitioners, or as competent employees (Georgiou et al., 2012; Atkinson and Hutchinson, 2013; Easterbrook et al., 2015; Sgroi, 2016; Antonelli et al., 2018; Langørgen and Magnus, 2020).

Negative attitudes also made the transition to the world of work additionally challenging. Some graduates experienced employer bias during the recruitment process (Sgroi, 2016; Kunnath and Mathew, 2019; Odame et al., 2021). For example, some participants reported that—despite an invitation to interview—employers refused to interview them upon learning of the candidate’s disability (Kunnath and Mathew, 2019; Odame et al., 2021). Participants who had managed to gain employment reported discrimination within the workforce and negative attitudes from professionals (Gillies, 2012; Atkinson and Hutchinson, 2013; Sgroi, 2016; Antonelli et al., 2018). The competitive and productivity-driven nature of the workforce can create an atmosphere of discrimination for people with disabilities (Gillies, 2012). However, there were also a few instances of positive attitudes and support from work supervisors reported among graduates in employment. For example, employed STEM graduates in Stumbo et al. (2011) reported that their supervisors were important facilitators in helping them socialize in the workplace. One graduate with a visual impairment working in the NHS reported that she had developed a helpful relationship with her supervisor, who took a “hands-on” approach to discussing and developing helpful strategies for her to work with her impairment (Atkinson and Hutchinson, 2013).

It is also important to note that attitudes of motivation, determination, and aspiration among the students and graduates themselves acted as facilitators toward achieving success in their academic and professional goals (Luckowski, 2014; Berry and Domene, 2015; Strnadová et al., 2015; Clouder et al., 2016; da Silva Cardoso et al., 2016; Accardo et al., 2019; Sefora and Ngubane, 2021; Sullivan, 2021; Walker et al., 2021). For example, positive thinking acted as an important personal resource for students with disabilities: “I think just having the attitude that I’m going to take this on and I’m going to be good at it and that’s all that’s going to matter really helped” (interview quote from Berry and Domene, 2015, p. 83). The motivation of students was also considered as an important asset to placement supervisors (Ashcroft and Lutfiyya, 2013; Bettencourt et al., 2018; L’Ecuyer, 2019).

Findings from the review suggest that services provided by higher education institutions play a pivotal role in the transition from higher education to work. However, the evidence on the efficiency of these services is varied. There were numerous instances where career services and career-focused activities provided by the higher education institutions helped facilitate the transition to employment for students and graduates (Berry and Domene, 2015; Stack-Cutler et al., 2015; Huber et al., 2016; Nolan and Gleeson, 2017; Hadley, 2018; Vincent, 2020; Pesonen et al., 2021). Participants valued opportunities such as mock interviewing, resume writing, social networking, career fairs, and job search assistance that were offered through these services. A particularly helpful facilitator reported by students was having a mentor helping with the transition from college to employment (Lund et al., 2014; Nolan and Gleeson, 2017; Antonelli et al., 2018; Accardo et al., 2019; Collins et al., 2019). Furthermore, having a mentor with a disability was seen as a valuable asset to students and trainees (Lund et al., 2014; Nolan and Gleeson, 2017). A recent study also highlighted the value of civil society organizations, which were found to help graduates with disabilities access the labor market, advise on issues of discrimination and benefits, and help with broader public policy concerns (William and Cunningham, 2021).

However, there were also instances where students and graduates felt that they had been let down by career services or were not made aware of them during their time at university (Vickerman and Blundell, 2010; Vincent, 2020; Pesonen et al., 2021). For example, one student reported:

“I have had to go there myself to get some actual support… And the only real support they’ve given me is just kind of tips for writing a CV…interviews and employment… but other than that, there’s not really been any supporting in finding a job…” interview quote from Pesonen et al. (2021, p. 8).

Disability support services were helpful in some instances, and students felt that accessing these services early-on in their higher education provided benefits with receiving support (Stumbo et al., 2011; Georgiou et al., 2012; Stein, 2012; Bettencourt et al., 2018; Vlachou and Papananou, 2018; Ali et al., 2020; Vincent, 2020; Pesonen et al., 2021; Shpigelman et al., 2021). Students with autism in one study found it particularly beneficial when career services and disability support services collaborated in providing autism-specific pre-employment provision (Vincent, 2020). However, as with the career services, the disability services were not always perceived by students as helpful and some also reported that they were not made visible to students (Vlachou and Papananou, 2018; Morgan, 2021). Furthermore, numerous participants with disabilities reported an overall lack of support from the University in general, commenting on the lack of any assistance with accommodations, lack of assistance with job searching or internship guidance, and the lack of transition programs in helping with employment opportunities (Easterbrook et al., 2015; Strnadová et al., 2015; da Silva Cardoso et al., 2016; Sgroi, 2016; Cage and Howes, 2020; Odame et al., 2021).

Institutional and organizational barriers also hindered academic staff and placement educators/supervisors. Many staff felt that there needed to be better policies in place to enable them to provide support to students with disabilities (Ashcroft and Lutfiyya, 2013; Walker et al., 2013; Nolan et al., 2015; Bettencourt et al., 2018; Collins et al., 2019; L’Ecuyer, 2019; Epstein et al., 2020; Langørgen et al., 2020). Faculty staff in one study commented on the tenure system prioritizing research productivity over teaching and, thus, the participants believed that improvement in teaching required individual investment beyond the daily structures and demands of academic life: “I would love to be a better teacher. I would love to have time to read pedagogy, but that’s not happening” (interview quote from Bettencourt et al., 2018, p. 19).

In terms of placement, poor communication with the disability services department, or in some cases the higher education institution as a whole, resulted in difficulties for placement educators when it came to evaluating and supporting students with disabilities (Ashcroft and Lutfiyya, 2013; Langørgen et al., 2020). For example, one nursing educator expressed her frustration over the lack of consistent guidelines resulting in reasonable accommodations being developed independently and differently by each educator from course to course:

“What really bothers me is having no strategies or structures in place so we have to go through the same thing every time. It’s a waste of time. There needs to be coordination or smoother application of these processes” interview quote from Ashcroft and Lutfiyya (2013, p. 1320).

Despite many universities and employer organizations worldwide adopting disability policies that promote the right of people with disabilities to receive reasonable accommodations, many students and graduates across the included studies experienced little to no support in receiving accommodations. Students often had to act as their own advocates to receive accommodations (Accardo et al., 2019). However, the students’ efforts were not always successful. For example, there were reported instances of lecturers refusing to provide lecture notes or refusing to let students use assistive technology such as a frequency modulation system (Strnadová et al., 2015; Shpigelman et al., 2021). Denial to such accommodations can hinder access to learning material, and thus be detrimental to the success of students as they try to reach their goals. Additionally, numerous students avoided asking for accommodations due to fears of offending professors, drawing attention to themselves, or receiving negative attitudes from other students without disabilities (Easterbrook et al., 2015; Grimes et al., 2020; Shpigelman et al., 2021), e.g., “Often times the professors aren’t using the microphone that’s in the lecture hall, they are just projecting with their voice… I could say something and get them to use it but it comes to a point where you don’t want to conflict with their teaching style… You can’t be expected to get full access always. You have to go in knowing that you’re not going to get everything you need” interview quote from Easterbrook et al. (2015, p. 1513).

Students who did receive accommodations were sometimes subject to negative experiences as a consequence of receiving support. Some students experienced negative responses from faculty and staff for gaining accommodations (da Silva Cardoso et al., 2016). Students receiving accommodations in clinical placements were considered as less competent professionals (Epstein et al., 2020). There was a particularly negative incident reported by Luckowski (2014), where a student had declared her disability to the university’s disability department, but her clinical instructor was reportedly negative toward her using accommodations during placement and threatened her with failure if she were to continue reporting conflicts with the Americans with Disabilities Act (ADA) accommodations. This resulted in the student failing the course, and ultimately the program.

Findings from the studies suggest numerous reasons as to why university and placement educators are reluctant to provide accommodations to students. For example, placement educators had to determine the balance between supporting students by providing accommodations while still helping them reach professional standards (Walker et al., 2013; Nolan et al., 2015). A main concern among university staff was that providing accommodations to students with disabilities could create a sense of dependence and limit their chances of succeeding in the workplace, which may be less accommodating compared to higher education (Bettencourt et al., 2018; Collins et al., 2019). This concern may be well-justified, with Kim and Williams (2012) finding that reasonable workplace accommodations were sometimes denied by employers, and Kunnath and Mathew (2019) finding that employed graduates did not receive any accommodations in the workplace. Furthermore, participants in one study suggested that the employment sector is not as accommodating as the education sector (Collins et al., 2019). Contrastingly, however, Stumbo et al. (2011) found that workplaces were willing to pay for assistive technology and workplace accommodations for graduates working in STEM.

Despite negative reports from the included studies, it should be noted that there were positive instances of students receiving reasonable accommodations. Students who received accommodations felt that these helped them successfully complete their course of education (Hinman et al., 2015). One study also suggests that grades improved as a result of receiving accommodations (Stein, 2012). However, from the included studies, it was clear that rather than there being support structures in place to ensure requests for reasonable accommodations were fulfilled, the students would often have to rely on the generosity of professors, lecturers, or other students to help them in receiving necessary accommodations.

Facilitators and barriers regarding accessibility spanned across issues such as physical access, transportation, access of essential information, course access, and access to meaningful employment. In terms of physical access, numerous campuses had architectural barriers such as steep wheelchair ramps or old buildings that lacked wheelchair access (Strnadová et al., 2015; Vlachou and Papananou, 2018; Collins et al., 2019; Saltes, 2020; Hamilton et al., 2021; Li et al., 2021; Shpigelman et al., 2021). A university reported in Zárate-Rueda et al. (2021) lacked ramps and lifts all together, which resulted in classmates having to carry students between classrooms. Additionally, some workplaces reportedly had inaccessible office spaces and restrooms (Gillies, 2012; Kim and Williams, 2012; Kunnath and Mathew, 2019).

Accessibility was particularly problematic during the transition from higher education to work. Numerous participants were limited with participating in internships or work experiences due to transportation issues (Joseph and Robinson, 2012; Kim and Williams, 2012; Sgroi, 2016; Antonelli et al., 2018; Odame et al., 2021). There was one instance where a student with a physical disability was denied the opportunity to take an internship located less than a block away because his faculty believed it was inaccessible (Sgroi, 2016). Given that work experience was reported as a key facilitator to accessing employment (Cunnah, 2015; Hadley, 2018), not being able to obtain work experience meant that participants struggled with job competition. Other access-related barriers hindered the transition to employment. For instance, job adverts sometimes lacked clarity (Vincent, 2020). Additionally, organized job fairs, training programs, and information sessions did not always consider the needs of students with disabilities, making them inaccessible (Odame et al., 2021).

Accessing meaningful employment relevant to the participants’ qualifications was reportedly challenging (Kim and Williams, 2012; Antonelli et al., 2018; Vincent, 2020; Hamilton et al., 2021; Lessy et al., 2021; Li et al., 2021; Morgan, 2021; Odame et al., 2021; Palan, 2021). A particularly troubling finding stemmed from studies conducted in Asia and Africa, with students with disabilities often being denied access to particular courses or majors (Kunnath and Mathew, 2019; Li et al., 2021; Morgan, 2021; Odame et al., 2021; Palan, 2021; Sefora and Ngubane, 2021).

However, even when students did have the autonomy to make their own decisions, they would sometimes rule out certain career paths based on their disability and fitting into the work environment:

“…it’s not equal and it’s not going to be equal today or tomorrow and as disabled people and disabled graduates, we need to accept that too and you need to make your choices about what is more important to you” interview quote from Nolan and Gleeson (2017, p. 237).

While findings from the review suggest that students with disabilities across many disciplines experience similar barriers, some studies highlighted additional challenges that come with certain subject areas. The biggest concern of supervisors, nurse preceptors, and clinical educators within professional education was that of patient safety (Ashcroft and Lutfiyya, 2013; Evans, 2014; Hinman et al., 2015; Nolan et al., 2015; Epstein et al., 2020; Philion et al., 2021). Additionally, some clinical instructors were resistant to providing accommodations as they believed accommodations risked students not reaching the required level of competence in order to practice in healthcare (Evans, 2014; Epstein et al., 2020). There was also a sense of ableism from instructors who felt that nursing students had to “fit in” with other students who did not have disabilities:

“I know that many of them [students with disabilities] rely on technology, some carry around an iPad or a laptop. That’s not going to help them in clinical… because no other nurses are doing that, why are you being different? Why do you need that to help you?” Interview quote from Epstein et al. (2020, p. 3).

Negative attitudes in nursing were also reported by Shpigelman et al. (2016), who found that nursing students held negative attitudes toward colleagues with disabilities, as well as toward people with disabilities in general. Despite the findings of negative attitudes, however, Ali et al. (2020) reported some positive placement experiences and found that students with disabilities had no difficulties in communicating with patients or learning practical clinical skills. However, students reported difficulties with writing up clinical notes. This is a concern expressed by placement educators in other studies (Walker et al., 2013; Evans, 2014).

STEM subjects were seen as additionally challenging compared to non-STEM subjects, with studies highlighting the demanding and competitive nature of STEM (da Silva Cardoso et al., 2016; Bettencourt et al., 2018). The large class sizes of STEM subjects meant that even minor accommodations created time restraints for staff (Bettencourt et al., 2018). STEM students with disabilities expressed that students without disabilities were not open to teamwork and therefore did not want to help them (da Silva Cardoso et al., 2016). Stumbo et al. (2011) also found that STEM students were more likely to report career barriers of access, negative attitudes, and increased health problems in comparison to non-STEM students. Additionally, Bellacicco and Pavone (2020) reported that students with disabilities could be penalized in accessing “hard” degree courses, due to their selectivity and expected commitment.

Two studies also found that academia as a potential career path can be challenging for students with disabilities due to its rigid expectations and high social demands (Saltes, 2020; Vincent, 2020). Ali et al. (2020) also found that students with dyslexia were less likely to pursue careers in research due to difficulties with spelling and written assignments.

While all barriers and facilitators reported above are connected with disability in general, some studies included in the review reported barriers and facilitators related to specific types of disabilities. For example, some participants saw strengths in their disabilities. Participants with autism believed that their dedication, attention to detail, ability to commit to a project, and strong working memory all served as skills that could be applied to future employment (Vincent, 2020). Some participants in health professions considered their disability as a unique competency, as it enabled them to relate to service users and respond to patients’ needs (Epstein et al., 2020; Langørgen and Magnus, 2020). However, other participants pursuing healthcare professions were concerned that their disabilities might affect the care of patients:

“…sometimes I even question myself. Is that gonna be a good fit for me with my ADD (attention-deficit disorder) because I am kind of like over—like I have problems focusing on certain things” interview quote from Luckowski (2014, p. 259).

While a number of different disabilities were present in the included studies, mental health disorders and less visible disabilities were considered harder to disclose (Easterbrook et al., 2015). Students believed that mental health issues and chronic illnesses are treated differently and under prioritized in comparison to other disabilities (Luckowski, 2014; Grimes et al., 2020; Hamilton et al., 2021):

“…some thought it [chronic illness] was an excuse not to turn up to lectures… I felt that people seemed to view invisible and visible illnesses and completely differently. Those with clear disabilities were treated with more understanding than those with invisible from my point of view” interview quote from Hamilton et al. (2021, p. 13).

In terms of the influence of disability type and severity on success-related outcomes, Fichten et al. (2016) found that students reporting multiple disabilities are less likely to intend to graduate, and have worse scores related to academic performance and persistence. However, positive findings from Bellacicco and Pavone (2020) suggest that the severity of disability was not associated with employment opportunities.