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VOLUME 8, ISSUE 1 

 2025 
 

RESEARCH ARTICLE 

 

Eshraghi A, Safaeepour Z. Glass ceiling among female prosthetists & orthotists: Perceptions, opportunities and strategies for moving forward. Canadian 

Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 6. Https://doi.org/10.33137/cpoj.v8i1.44720 

 

  

 

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1 

Eshraghi A, Safaeepour Z. Glass ceiling among female prosthetists & orthotists: Perceptions, opportunities and strategies for moving forward. Canadian Prosthetics 
& Orthotics Journal. 2025; Volume 8, Issue 1, No. 6. Https://doi.org/10.33137/cpoj.v8i1.44720 

 

 

RESEARCH ARTICLE 

 

GLASS CEILING AMONG FEMALE PROSTHETISTS & ORTHOTISTS: PERCEPTIONS, 

OPPORTUNITIES AND STRATEGIES FOR MOVING FORWARD 

Eshraghi A1*, Safaeepour Z 2  

1. West Park Healthcare Centre, University Health Network, Toronto, Canada. 
2. Department of Human Performance and Health, University of South Carolina Upstate, Spartanburg, South Carolina, United States. 
 
  
 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

INTRODUCTION   

The glass ceiling metaphor is frequently used to describe 

the obstacles and barriers in front of women seeking 

promotions to the top levels of organizations.1-2 There is 

strong evidence of the under-representation of women in 

leadership positions in countries such as Australia,3 China,4 

France,5 and the United States.6 

 

 

 

 

There is a strong need for ongoing investigations into the 

causes and consequences of glass ceilings, especially in 

corporate organizations. Research on the glass ceiling 

shows that women may encounter obstacles in pursuing 

high-level management positions. Hymowitz and 

Schellhardt introduced the term glass ceiling in their 1986 

Wall Street Journal article.7 Although they were the first to 

use the metaphor, they were not the first to write about the 

challenges women faced as they attempted their climb up 

the corporate ladder to senior-level positions. Hymowitz and 

Schellhardt remarked that even women who successfully 

climbed the corporate ladder would eventually crash into an 

invisible barrier. Although high-level positions appeared to 

 
OPEN  ACCESS 

ABSTRACT 

BACKGROUND: The glass ceiling, a metaphorical barrier hindering women’s career advancement, is prevalent 

across various sectors, including healthcare. Women have proved their competence as successful senior-level 

leaders. Despite this, there is still a striking under-representation of female prosthetists and orthotists in 

leadership positions as managers and business owners. This study investigated the "glass ceiling" phenomenon 

in the prosthetics and orthotics (P&O) field, where women, despite growing representation in the profession, 

are underrepresented in leadership roles.  

OBJECTIVE: This study aimed to examine the beliefs and expectations of female prosthetists and orthotists 

regarding career advancement and leadership opportunities. 

METHODOLOGY: This survey study had two sections; the first section was general demographic questions, 

and any gender could participate but the second section was the Career Pathways Survey (CPS), which 

assessed beliefs about the glass ceiling and only female practitioners could participate. The survey evaluated 

four factors: Denial, Resilience, Acceptance, and Resignation, to understand how women perceive their ability 

to break through the glass ceiling. All individuals with a professional qualification in prosthetics and/or orthotics 

were eligible to participate. The survey was distributed worldwide through the ISPO and other professional 

associations. The survey was opened in April 2021 and remained active for six months.  

FINDINGS: 110 female participants completed the survey. The participants were mainly from North America, 

Europe and Australia. Findings revealed that factors like age, marital status, and salary were significant 

predictors of different belief scores, particularly with respect to career acceptance and denial. Results 

highlighted that women’s beliefs about their career advancement were influenced by their personal life 

situations, such as having children, and the number of years of professional experience. 

CONCLUSION: The study calls for organizational reforms to address gender inequalities by implementing 

policies that support work-life balance, mentoring, and career development. It also emphasizes the importance 

of further research, particularly examining the intersectionality of gender, race, and other diversity factors, to 

provide a comprehensive understanding of barriers to leadership in P&O and other healthcare fields. 

ARTICLE INFO 

Received: February 10, 2025 

Accepted: May 12, 2025 

Published: June 17, 2025 
 

CITATION 

Eshraghi A, Safaeepour Z. 

Glass ceiling among female 

prosthetists & orthotists: 

Perceptions, opportunities 

and strategies for moving 

forward. Canadian Prosthetics 

& Orthotics Journal. 2025; 

Volume 8, Issue 1, No. 6. 

Https://doi.org/10.33137/cpoj.

v8i1.44720 

KEYWORDS 

Glass Ceiling; Prosthetics; 

Orthotics; Gender Inequality; 

Diversity; Prosthetists; Career 

Advancement; Leadership; 
Women; Gender; Orthotists. 

 

* CORRESPONDING AUTHOR: 

Arezoo Eshraghi, PhD, CP(c) 

Affiliation: West Park Healthcare Centre, University Health Network, 
Toronto, Canada.  

E-Mail: Arezoo.eshraghi@uhn.ca 

ORCID ID: https://orcid.org/0000-0002-1525-8093 

 

Journal Homepage: https://jps.library.utoronto.ca/index.php/cpoj/index 

Volume 8, Issue 1, Article No. 6, 2025 

 

 

https://doi.org/10.33137/cpoj.v8i1.44720
https://doi.org/10.33137/cpoj.v8i1.44720
https://doi.org/10.33137/cpoj.v8i1.44720
mailto:Arezoo.eshraghi@uhn.ca
https://orcid.org/0000-0002-6349-2992
https://jps.library.utoronto.ca/index.php/cpoj/index


 

2 

Eshraghi A, Safaeepour Z. Glass ceiling among female prosthetists & orthotists: Perceptions, opportunities and strategies for moving forward. Canadian Prosthetics 
& Orthotics Journal. 2025; Volume 8, Issue 1, No. 6. Https://doi.org/10.33137/cpoj.v8i1.44720 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X GLASS CEILING AMONG FEMALE PROSTHETISTS & ORTHOTISTS 

Eshraghi & Safaeepour, 2025 

be within women's reach, they could not crack the glass 

ceiling. Since these remarks were made, others have 

continued the effort to better understand the antecedents of 

the phenomenon through research, which has led to the 

development of theories attempting to explain the 

phenomenon.7  

Prosthetics and orthotics are established disciplines in 

health science and are often practiced together as they 

have many commonalities from clinical, technical, and 

therapy perspectives. Prosthetic and orthotic devices are 

usually part of the secondary/tertiary care, habilitation, and 

rehabilitation programs. The number of female prosthetists 

and orthotists has risen worldwide. In the United States 

only, according to the American Orthotic & Prosthetic 

Association (AOPA), in 2014, 20% of practitioners who had 

registered with the American Board for Certification in 

Orthotics, Prosthetics and Pedorthics (ABC) were women, 

a 748% increase since 1994; ABC also estimates women 

and men now enter O&P in about a 1:1 ratio. Among 

professional members of the American Society for 

Biomechanics (ASB) who report their gender, 31% are 

women, as are 42% of student members (2016 data).8 

Women have proved their competence as successful 

senior-level leaders. Despite this, there is still a striking 

under-representation of female prosthetists and orthotists in 

leadership positions as managers and business owners.9 It 

is unknown what female graduates expect from their future 

careers, and if those expectations are realistic, especially 

when it comes to managerial positions. Also, it is not known 

what role cultural context plays in success expectations and 

professional promotions among females, and other non-

traditional prosthetists and orthotists. 

Research in other fields, such as medicine, banking, and 

sports management, emphasize gender differences as the 

major reason for gender inequality in leadership.10-13 The 

glass ceiling is supported by conscious and unconscious 

gender stereotypes and biases, a lack of policies that 

support work-life balance, a lack of mentors or role models 

for women interested in high-level career advancement, and 

a paucity of networks that can open doors to women. 

Nothing is known about other diversity barriers in 

prosthetics and orthotics, such as age, place of origin or 

education, or language proficiency. The field is small and 

internationally connected. Anecdotally, there is a sense that 

the location of education is a significant barrier to entering 

the field of prosthetics and orthotics. Therefore, this study is 

the first to develop pilot information on women's beliefs 

about glass ceilings among female prosthetists and 

orthotists. 

METHODOLOGY 

Ethics approval was obtained from the British Columbia 

institute of technology (BCIT) Research Ethics Board (2021-

05). The first part of this survey study measured the 

demographics: age, marital status, number of children, 

years of work experience in P&O, qualification, and country 

of work (Table 1). Both male and females participants could 

fill in this part. 

The second part involved the Career Pathways Survey 

(CPS) adopted from Smith et al.14,15 This part was only 

asked to be answered by female participants. The CPS is a 

multi-factorial instrument which quantitatively assesses four 

sets of beliefs about glass ceilings: Denial, Resilience, 

Acceptance, and Resignation. The CPS provides scores for 

four groups of beliefs about glass ceilings.  

• Denial: Denial is defined as the belief that men and 

women face the same issues and problems in seeking 

leadership. Examples of items in the CPS assessing 

Denial are: “Women have reached the top in all areas of 

business and politics”, and “Women starting careers today 

will face sexist barriers” (reverse scored).  

• Resilience: Resilience is defined as the belief that women 

are able to break glass ceilings. Examples of this factor 

are: “The more women seek senior positions, the easier it 

will be for those who follow”, and “Women are capable of 

making critical leadership decisions”.  

• Acceptance: Acceptance is the belief that women prefer 

other life goals, such as family involvement, over 

developing a career. Therefore, Acceptance is summed 

up as a pro-family/anti-career advancement set of beliefs. 

Examples of items in the CPS assessing acceptance are: 

“Women reject the need to work incredibly long hours”, 

and “Women are less concerned about promotions than 

men are”.15 

• Resignation: Resignation is the belief that women suffer 

many more negative consequences than men when 

pursuing career advancement and thus, there are 

overwhelming reasons for women not attempting to break 

glass ceilings. Two CPS items measuring this factor are: 

“Women are more likely to be hurt than men when they 

take big risks necessary for corporate success”, and 

“Jealousy from coworkers prevents women from seeking 

promotions”.  

The 38 items of the CPS represent beliefs about a wide 

variety of variables that considerable research has shown 

to be linked to women's career advancement.7,16 For 

example, the CPS items refer to issues such as role models, 

lack of promotion opportunities for women, sexist barriers in 

organizations, successful organizations wanting talented 

women leaders, work-family compromises, benefits of 

higher education, networking, jealousy from female 

colleagues after promotions, support from mentors, and 

sexual harassment. Participants rated their level of 

agreement with 38 statements on a scale from 1 (strongly 

disagree) to 7 (strongly agree). Individual factor scores are 

calculated by the mean score of the relevant items. 

https://doi.org/10.33137/cpoj.v8i1.44720


 

3 

Eshraghi A, Safaeepour Z. Glass ceiling among female prosthetists & orthotists: Perceptions, opportunities and strategies for moving forward. Canadian Prosthetics 
& Orthotics Journal. 2025; Volume 8, Issue 1, No. 6. Https://doi.org/10.33137/cpoj.v8i1.44720 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X GLASS CEILING AMONG FEMALE PROSTHETISTS & ORTHOTISTS 

Eshraghi & Safaeepour, 2025 

Data collection   

All individuals (male and female) with a professional 

qualification in prosthetics and/or orthotics that was valid in 

the region in which they worked were eligible to participate 

in the survey. Subjects were recruited by posting on the 

OandP List-Serve and distribution of an invitation to 

participate by the Orthotics Prosthetics Canada (OPC), 

British Association of Prosthetists & Orthotists (BAPO), 

American Orthotic & Prosthetic Association (AOPA), and 

International Society for Prosthetics and Orthotics (ISPO). 

Moreover, persons receiving the invitation were asked to 

forward the invitation to Prosthetists and Orthotists in their 

networks (snowball sampling method). The link in the 

invitation directed interested persons to an explanatory 

letter with information on the study purpose, inclusion 

criteria, confidentiality, risk, and consent, along with a link to 

a SurveyMonkey that enabled the anonymous submission 

of responses to the questionnaire (Appendix A and B).  

Statistical Analysis   

 Statistical analyses were performed using SAS 9.4M7 

(SAS Institute, Cary, North Carolina). One-way analysis of 

variance (ANOVA) was used to test for differences in mean 

scale response variables (Denial, Resilience, Acceptance, 

and Resignation) between levels of categorical 

demographic variables. A separate one-way ANOVA was 

conducted for each of these scale responses. Post hoc tests 

using a Tukey-Kramer adjustment were performed to locate 

differences in mean responses between pairs of levels of 

demographic variables. The standard model assumptions 

regarding the residuals were verified. The residuals were 

approximately normally distributed random variables 

centered about zero with constant variance. In cases where 

outliers were detected, the analysis was re-run removing 

the outlier, but none of the final model conclusions changed, 

so the outliers remained in the model. Sample size was 

determined using GPower, with an expected effect size of 

0.8, alpha level of 0.05, and power of 95%. 

RESULTS 

110 female participants completed the survey. The survey 

was opened in April 2021 and remained active for six 

months. Some participants did not answer all the questions 

and therefore were not included in the data analysis to avoid 

potential issues with model estimation. The participants 

were mainly from North America (n = 56), Europe (n = 18) 

and Australia (n = 21) followed by Asia (n = 9) and Africa  

(n = 6). Table 1 shows the summary statistics for each set of 

beliefs broken down by each level of the demographic 

variable. The responses from Asia and Africa were 

excluded from the analysis due to the number of participants 

needed for model estimation. 

The one-way ANOVA revealed a statistically significant 

difference in mean denial scores between age groups 

(F2,107 = 3.21, p = 0.04). A post-hoc Tukey-Kramer test for 

multiple comparisons found that the mean value of denial 

scores was statistically significantly (p-value = 0.03) higher 

in the 46+ age group (mean = 38.3) than in the 18-35 age 

group (mean = 29.3). 

Table 2 represents results of one-way analysis of variance 

(ANOVA) for differences in mean scale response variables 

(Denial, Resilience, Acceptance, and Resignation) between 

levels of categorical demographic variables. 

 

Table 1: Summary statistics of four sets of beliefs about the glass ceiling based on the Career Pathway Survey. 

Factors 
Denial 

Mean (SD) 
Resilience 
Mean (SD) 

Resignation 
Mean (SD) 

Acceptance 
Mean (SD) 

Age (year) 

18-35  29.3 (11.5)a 40.0 (14.4) 55.5 (6.6) 23.2 (6.9) 

36-45  33.0 (12.93) 36.5 (10.7) 56.3 (7.1) 24.9 (5.5) 

46+  38.3 (14.3)a 35.2 (13.0) 55.6 (12.6) 26.6 (7.02) 

Marital Status 
Married  33.6 (13.4) 36.9 (12.2) 56.5 (8.5) 24.8 (6.5) 

Single  29.5 (11.5) 40.0 (14.6) 54.7 (7.3) 23.7 (6.7) 

Number of 
Children 

None  29.1 (11.3)b 39.3 (14.0) 54.3 (8.9) 22.4 (6.1) 

At least one child  34.6 (13.6)b 36.0 (11.9) 56.8 (7.6) 25.7 (6.1) 

Years of 
Experience 

0-5  29.2 (11.6) 39.9 (15.0) 54.6 (7.4) 22.3 (7.7) 

6-10  29.4 (11.1) 39.9 (13.8) 56.0 (5.01) 25.3 (5.5) 

11-15  35.7 (13.7) 35.2 (11.4) 56.5 (7.7) 23.6 (5.8) 

16-25  31.4 (13.2) 39.7 (11.1) 55.6 (11.5) 26.1 (6.7) 

>26  40.0 (14.0) 31.6 (11.8) 57.1 (9.5) 26.4 (5.7) 

Country of 
Work 

Europe  30.4 (7.4) 41.9 (9.1) 56.2 (6.3) 24.1 (6.4) 

Australia  30.3 (10.1) 34.9 (12.4) 54.5 (7.6) 24.0 (5.4) 

North America  31.7 (13.8) 37.3 (14.1) 55.5 (9.0) 24.0 (6.9) 

Qualification 

1-4 Semesters  34.2 (14.0) 36.6 (13.5) 56.9 (7.9) 25.3 (6.2) 

Bachelor  33.7 (10.6) 40.9 (11.6) 55.5 (9.0) 25.0 (6.3) 

Master  28.1 (14.9) 35.8 (13.3) 55.5 (6.9) 21.3 (6.7) 
 

a Shows a statistically significant difference in mean denial scores between age groups, 18-35 and 46+ at the 0.05 level of significance. 
b Shows a statistically significant difference in mean denial scores between the number of children groups, no children and at least one child 
at the 0.05 level of significance. 
 

https://doi.org/10.33137/cpoj.v8i1.44720
https://opcanada.ca/
https://www.bapo.com/
https://www.aopanet.org/
https://www.ispoint.org/


 

4 

Eshraghi A, Safaeepour Z. Glass ceiling among female prosthetists & orthotists: Perceptions, opportunities and strategies for moving forward. Canadian Prosthetics 
& Orthotics Journal. 2025; Volume 8, Issue 1, No. 6. Https://doi.org/10.33137/cpoj.v8i1.44720 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X GLASS CEILING AMONG FEMALE PROSTHETISTS & ORTHOTISTS 

Eshraghi & Safaeepour, 2025 

Table 2: One-way analysis of variance (ANOVA) for differences in 
mean scale response variables (Denial, Resilience, Acceptance, 
and Resignation). 

Pearson Correlation Coefficients 
Prob > |r| under H0: Rho=0 
Number of Observations 

 Denial Resignation Resilience Acceptance 

Denial 

1.00 -0.41 0.01 0.24 

- <.0001 0.95 0.02 

99.00 99.00 97.00 96.00 

Resignation 

-0.41 1.00 -0.07 0.16 

<.0001 - 0.49 0.11 

99.00 99.00 97.00 96.00 

Resilience 

0.01 -0.07 1.00 0.08 

0.95 0.49 - 0.43 

97.00 97.00 97.00 96.00 

Acceptance 

0.24 0.16 0.08 1.00 

0.02 0.11 0.43 - 

96.00 96.00 96.00 96.00 
 

The one-way ANOVA revealed a statistically significant 

difference in mean denial scores between the number of 

children groups (F1,88 = 4.47, p = 0.04). A post hoc Tukey-

Kramer test found that the mean value of denial scores was 

statistically significantly (p-value = 0.04) higher in 

participants with one child (mean = 34.6) compared to those 

with no children (mean = 29.1). A borderline statistically 

significant difference was seen in mean acceptance scores 

between academic qualification groups (F2,87 = 2.87 p = 

0.06). The mean acceptance scores were higher for 

employees with 1-4 semesters of education (mean = 34.2) 

compared to employees with master’s degrees (mean = 

28.1). 

The type III tests of fixed effects from a multiple regression 

model in Table 3 show that salary is a statistically significant 

predictor of mean denial scores with p-values of 0.02.  

Table 3 shows there is a statistically significant difference (p-

value = 0.02) in mean denial scores between subjects with 

salary >40k (mean = 34.6) and salary <40k (mean = 27.3). 

Resilience was predicted by both salary >40k and having no 

children. Resilience scores were significantly higher for 

people with salary >40k compared to salary <40k (F1, 92 = 

5.6, p = 0.02). The lack of children in an individual’s 

demographic category significantly predicted increased 

resilience scores (F1, 92 = 3.7, p = 0.04).  

Table 3: Results of multiple regression model. 

 

A weak positive correlation was detected between number 

of children and denial (r = 0.27, p < 0.01) and resilience 

scores (r = 0.23, p-value  = 0.02) (Table 4).  

Table 4: Results of Pearson correlation for number of children and 

hours of work in relation to four sets of beliefs about glass ceilings.   

Pearson Correlation Coefficients 
Prob > |r| under H0: Rho=0 
Number of Observations 

 Denial Resignation Resilience Acceptance 

Number 
of 
Children 

0.27 -0.16 0.23 0.15 

0.01 0.11 0.02 0.14 

100.00 100.00 98.00 - 

Hours 
Work in 
Week 

0.10 0.00 0.04 -0.13 

0.32 0.99 0.71 0.17 

109.00 109.00 107.00 106.00 
 

DISCUSSION 

This study investigated the perceptions and beliefs of 

female prosthetists and orthotists regarding the glass ceiling 

and professional advancement. The findings indicate a 

complex interplay of factors that contribute to barriers in 

career progression for women in the field, including gender, 

family status, and educational background. These results 

are consistent with studies in other fields that have found 

that women often encounter significant obstacles in 

advancing to senior leadership positions.2 Similar to other 

professions, the findings of this study is an empirical 

evidence that the glass ceiling phenomenon still exists for 

female prosthetists & orthotists.17-19 One major finding was 

the difference in denial scores among age groups, with older 

participants exhibiting more denial about the existence of 

gender-based barriers than younger participants. This 

suggests that, over time, women may become more aware 

of the glass ceiling or, conversely, become more accepting 

of its limitations as they progress in their careers. 

Furthermore, the study showed that women with one child 

were more likely to deny the existence of gender-based 

barriers compared to those without children. This might be 

due to the demands of balancing career and family life, 

which may lead to a pragmatic acceptance of organizational 

limitations.20 In contrast, women without children were 

found to have higher resilience scores, which may reflect 

fewer family-related barriers to professional advancement. 

This is consistent with the finding that women with fewer 

family commitments are better able to dedicate time and 

energy to career advancement.17 In some professions, it is 

possible to work from home, which provides an opportunity 

to take care of children.21 This is barely possible for orthotist 

& prosthetist clinician and technicians due to responsibilities 

of direct in-person patient care and manufacturing 

requirements that should be done in a prosthetic and 

orthotic workshop.  

Educational background also played a significant role in the 

beliefs about glass ceilings. Participants with lower levels of 

education (1-4 semesters) reported higher acceptance of 

the idea that women prefer family life over career 

advancement. This suggests that education, especially 

higher education, may increase awareness of career 

opportunities and career advancement processes. 

 DF Type III SS 
Mean 

Square 
F Value Pr > F 

Salary 1 567.33 567.33 5.56 0.02 

Education Cat 2 396.63 198.31 1.94 0.16 

Age 2 46.92 23.46 0.23 0.80 

Country of 
Work 

2 222.23 111.12 1.09 0.35 

Years of 
Experience 

4 531.57 132.89 1.30 0.29 

Number of 
Children 

1 166.17 166.17 1.63 0.20 

https://doi.org/10.33137/cpoj.v8i1.44720


 

5 

Eshraghi A, Safaeepour Z. Glass ceiling among female prosthetists & orthotists: Perceptions, opportunities and strategies for moving forward. Canadian Prosthetics 
& Orthotics Journal. 2025; Volume 8, Issue 1, No. 6. Https://doi.org/10.33137/cpoj.v8i1.44720 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X GLASS CEILING AMONG FEMALE PROSTHETISTS & ORTHOTISTS 

Eshraghi & Safaeepour, 2025 

Salary was also identified as a significant predictor of denial, 

with individuals earning more than $40,000 reporting higher 

denial scores. This suggests that higher earnings may lead 

to a greater sense of professional success and thus reduce 

the perceived impact of gender-related barriers to career 

advancement. 

These findings are valuable for understanding the factors 

that contribute to the under-representation of women in 

leadership roles within prosthetics and orthotics, as they 

point to a combination of personal, professional, and 

cultural influences that impact career progression. 

Furthermore, they underscore the importance of developing 

policies and programs that support work-life balance, 

professional development, and mentorship to help break the 

glass ceiling in this field.15,22 

Limitations 

To our knowledge, there is no other similar research work 

done and published on this topic in P&O so we couldn’t 

make comparisons across the literature. Our initial intention 

was to do sampling worldwide but during the time that 

survey was active, we got mainly participants from North 

America, Europe and Australia, while only few from other 

regions so we could not include those participants in the 

data analysis. The literature shows that glass ceiling may 

be experienced more in low- and middle-income countries; 

therefore, the future study will seek sampling methods that 

would increase participation from those areas. 

In this study, we only asked female clinicians to answer the 

glass ceiling survey while it is worthwhile to know how male 

clinicians perceive the glass ceiling. Both males and 

females may experience glass ceilings and therefore we will 

consider including both genders in the study in future study. 

Another limitation was that not all the participants answered 

every section and/or question on the survey, which made it 

difficult to come to conclusions or study the relationship 

between all variables. 

CONCLUSION 

Since the latter half of the 20th century, women have made 

great strides in increasing their representation in the work 

force. However, a considerable gap remains in achievement 

of leadership positions across fields such as healthcare. 

Thus, the bewildering glass ceiling remains intact and, at 

times, seemingly invulnerable. We propose that glass 

ceiling beliefs can lift or diminish desires to be promoted. 

These beliefs may lead to career pathway choices and long-

lasting behaviors within organizations. Women who express 

an ambition to become part of upper management, could 

gain insights by analyzing their levels of Resilience and 

Denial. High Acceptance scores could help identify women 

with little or no ambition to be promoted, yet would benefit 

from professional development whilst maintaining their level 

in the organization. Finally, feedback from CPS testing 

might also facilitate women gaining greater awareness of 

the possible causes for their subjective success in 

organizations. Those women who score high on 

Resignation could benefit from training and development 

courses that help them examine the validity of their negative 

thoughts about women seeking promotions. However, if it is 

found that an organization's structure and actions do indeed 

lead to Resignation, major changes will be needed before 

women in that organization can dismiss their negative 

beliefs. 

ACKNOWLEDGEMENTS 

The authors wish to thank Dr. Silvia Raschke for consultation on 

this study from the design to conduct and knowledge translation. 

We extend our gratitude to Dr. Nancy Paris and the BCIT MAKE+ 

Department for funding the statistical analysis and for the 

administrative support. Special thanks to Mr. Ian Bercovitz, Director 

of Statistical Consulting, Department of Statistics and Actuarial 

Science, Simon Fraser University, for his thorough work on the data 

analysis. 

DECLARATION OF CONFLICTING INTERESTS 

The authors report no conflict of interest. 
 

AUTHORS CONTRIBUTION 

• Arezoo Eshraghi: Conceptualization, Ethics Application, 

Methodology, Data Collection   and   Analysis, Writing/Revising   

the Manuscript, Final Manuscript Approval. 

• Zahra Safaeepour: Conceptualization, Ethics Application, 

Methodology, Data Collection   and   Analysis, Writing/Revising   

the Manuscript, Final Manuscript Approval. 

 

SOURCES OF SUPPORT 

British Columbia Institute of Technology (BCIT) MAKE+. 

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requisite management characteristics. J Appl Psychol. 

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10.1037/0033-295X.109.3.573 

3.Evans M, Edwards M, Burmester B, May D. ‘Not yet 50/50’–

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& Orthotics Journal. 2025; Volume 8, Issue 1, No. 6. Https://doi.org/10.33137/cpoj.v8i1.44720 

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ISSN: 2561-987X GLASS CEILING AMONG FEMALE PROSTHETISTS & ORTHOTISTS 

Eshraghi & Safaeepour, 2025 

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February 10]. Available from: 

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gender-barriers-in-lower-extremity-specialties 

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amputee care. Living with Amplitude [Internet]. 2023 Aug 31 [cited 

2025 February 10]. Available from: 

https://livingwithamplitude.com/article/women-prosthetists-are-

making-an-impact-on-amputee-care/ 

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Sport management students' perceptions of the leadership 

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DOI:10.1123/smej.2017-0039 

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10.1177/0141076818790661 

13.Kim KY, Kearsley EL, Yang HY, Walsh JP, Jain M, Hopkins L, 

et al. Sticky floor, broken ladder, and glass ceiling in academic 

obstetrics and gynecology in the United States and Canada. 

Cureus. 2022;14(2):e22535. DOI: 10.7759/cureus.22535 

14.Smith P, Caputi P, Crittenden N. Measuring optimism in 

organizations: development of a workplace explanatory style 

questionnaire. J Happiness Stud. 2013;14(2):415–32. 

DOI:10.1007/s10902-012-9336-4 

15.Smith P, Crittenden N, Caputi P. Measuring women's beliefs 

about glass ceilings: Development of the Career Pathways Survey. 

Gend Manag. 2012;27(2):68-80. DOI:10.1108/ 

17542411211214130 

16.Morrison AM, White RP, Van Velsor E. Breaking the glass 

ceiling: can women reach the top of America’s largest 

corporations? Updated ed. Reading (Mass): Addison‑Wesley Pub 

Co; 1992. 

17.Eddleston KA, Veiga JF, Powell GN. Explaining sex differences 

in managerial career satisfier preferences: The role of gender self-

schema. J Appl Psychol. 2006;91(2):437-45. DOI: 10.1037/0021-

9010.91.2.437 

18.Min S, Yoon B. The role of glass ceiling perception on work 

engagement and service orientation behavior among female hotel 

employees. J Hum Resour Hosp Tour. 2021; 20(4):497-511. DOI: 

10.1080/15332845.2021.1959799 

 

19.Javadizadeh B, Ross J, Valenzuela MA, Adler TR, Wu B. What’s 

the point in even trying? Women’s perception of glass ceiling drains 

hope. J Soc Psychol. 2024;164(4):488-510. DOI: 

10.1080/00224545.2022.2119121 

20.Naseviciute L, Juceviciene R. Overcoming the barriers to 

women's career in information and communication technology 

business. Equal Divers Incl. 2024;43(1):23-40. DOI: 10.1108/EDI-

09-2022-0265 

21.Taparia M, Lenka U. An integrated conceptual framework of the 

glass ceiling effect. Organ Eff-People P. 2022;9(3):372-400. DOI: 

10.1108/JOEPP-06-2020-0098 

22.Smith P, Caputi P, Crittenden N. How are women's glass ceiling 

beliefs related to career success? Career Dev Int. 2012;17(5):458–

74. doi:10.1108/13620431211269702 

 

 

 

 

 

 

 

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https://lermagazine.com/cover_story/womens-work-overcoming-gender-barriers-in-lower-extremity-specialties
https://lermagazine.com/cover_story/womens-work-overcoming-gender-barriers-in-lower-extremity-specialties
https://livingwithamplitude.com/article/women-prosthetists-are-making-an-impact-on-amputee-care/
https://livingwithamplitude.com/article/women-prosthetists-are-making-an-impact-on-amputee-care/


 

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APPENDIX  

Appendix A 

 

 

Explanatory Letter with Survey (February 2, 2021) 

Baseline Survey: Glass ceilings in prosthetics & orthotics: Perceptions, opportunities and 

strategies for moving forward  

Principle Investigator: Silvia Raschke, PhD, BCIT MAKE+   

Tel:  604-412-7597  E-Mail: Silvia_Raschke@bcit.ca 

 

Co-Investigator:  Zahra Safaeepour, PhD University of South Carolina Upstate.  

Co-Investigator:       Arezoo Eshraghi, PhD, CP (c) West Park Healthcare Centre. 
 

The purpose of this project is to examine perceptions and beliefs that contribute to the glass ceiling effect for persons choosing a career in 

prosthetics and orthotics.  Factors such as gender, age and career aspirations will be explored.  There will be no compensation provided for 

participating in the survey. 

This study will provide baseline survey data to take an objective snapshot of the prosthetics and orthotics profession in 2021.  The researchers 

intend to apply for grant funding to explore this topic more deeply with the goal of developing strategies, recommendations and tools for 

engaging and recruiting persons not traditionally considering prosthetics and orthotics as a career, with a focus on females.  Results will also 

be presented at a conference(s) and will be submitted for publication in a peer-reviewed journal.   

The survey consists of two parts:   

• Part A is for all participants and should take between 10 and 15 minutes to complete. 

Part B is an additional set of questions for all participants identifying as female and will take approximately 15 additional minutes to complete. 

 

 The survey is open to all persons who hold a recognized international qualification in prosthetics and/or orthotics (e.g  Bachelor’s 

Degree, Certification, Licensure, Meister, etc.) and who have reading and writing comprehension in English It is not necessary for 

you to be qualified to practice in your country of residence. 

 

To keep your identity confidential, no personally identifiable information will be collected or stored during this research project (i.e. you will not 

be identifiable in any reports, publications or presentations resulting from this study).  All data and comments will be collapsed into a summary 

document.   Please note that researchers may be required to make the survey data publicly available at the time of publication.   You should 

be aware that once data is made publicly available you will not be able to withdraw any comments.  If, at any time during the survey you wish 

to withdraw from the survey you can do so at any point by simply closing the browser.  

There is minimal anticipated risk to participating in this survey.  If you would like to have a summary of the results of the survey or if you have 

any questions, or concerns, regarding this survey or your participation you can email me directly at: Silvia_Raschke@bcit. If there are any 

further concerns you may contact the Research Ethics Board at research_ethics@bcit.ca.  

 

 

 

 

 

 

 

 

 

 

 

 

https://doi.org/10.33137/cpoj.v8i1.44720
mailto:Silvia_Raschke@bcit.ca


 

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Appendix B 

Survey Questions 

Project: Baseline Survey: Glass ceilings in prosthetics & orthotics: Perceptions, opportunities and strategies 
for moving forward 

 

PART A Survey Questions (for all respondents) 

 

Professional History 

1- Highest Level of General Education (Check one): 
_____Apprenticeship 
_____1 to 2 Semester Certificate  
_____2 to 4 Semester Diploma/Certificate  
_____Bachelor’s Degree 
_____Master’s Degree 
_____PhD 
_____Other: (please specify) ____________________ 
 

2- Country in which you received your highest level of education: ________ 

3- Country(ies) in which you received your Prosthetics and Orthotics education: 

Note: If you have more than one certification and/or degree please note each completed Certificate/Diploma and/or 
Degree and, in brackets next to it, note the country in which it was obtained.   (e.g.   Master’s Degree (UK)) 

 
4- Highest Level of Prosthetics and Orthotics Specific Education: 

Check one: 
_____Apprenticeship 
_____1 to 2 Semester Certificate  
_____2 to 4 Semester Diploma/Certificate  
_____Bachelor’s Degree 
_____Master’s Degree 
_____PhD 
_____Other: (please specify) ____________________ 

5- Country in which you work :  _________________ 
6- Country in which you live/are a resident of: _______________ 
7- If you are seeking work in a country different from where you currently work and/or live, what is the country in which you are seeking work:  
8- Professional Qualification(s) held in Prosthetics and Orthotics (over and above general education degree): 
              (Choose all that apply)  

______Certified Orthotist,  
______Certified Prosthetist,  
______Licensed Orthotist,  
______Licensed Prosthetist,  
______Certified Prosthetist Orthotist, 
______ Meister  .  
______Registered Prosthetic Technician,  
______Registered Orthotic Technician 
______Other (please specify):  

9- Is this qualification required for you to work in the country of your education? _____     Yes_____     No 
10- Is this qualification required for you to work in your country of residence?_____     Yes _____     No 
11- Is this qualification recognized in the country in which you are aspiring to work in? _____     Yes _____     No    _____     Not Applicable 
12 – How many years have you worked in the field of Prosthetics and Orthotics? ________ 
13 - What is your current employment status in the field of Prosthetics and Orthotics? 

____Employed full-time 
____Employed part-time 
____Self-employed 
____Unemployed, seeking opportunities 
____Unemployed, not seeking opportunities 
____Retired 
____Other: _________ 

14 – How many hours per week are you currently working in the field of Prosthetics and Orthotics? _____ 
15 - Would having the ability to have a permanent part-time position be of interest to you at any point in your career?      (yes/no) 

 
16 - Have you ever sought a permanent part-time position at any point in your career?  (yes/no)    
17 -  If yes, were you able to find a permanent part-time position?   (yes/no)  
   
 

1. First Certificate/Diploma/Degree (country obtained) 

2. Second Certificate/Diploma/Degree (country obtained) 

3. Third Certificate/Diploma/Degree (country obtained) 

4. Fourth  Certificate/Diploma/Degree (country obtained) 

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General Exploratory Survey 

18 - This question asks you to consider your personal professional aspirations as a Prosthetics and Orthotics practitioner.   
E.g. My ultimate career goal is to: *   

• be a dual qualified prosthetist orthotist 

• be leading prosthetic and orthotic research 

• be working in a public hospital or clinic 

• own my own prosthetics/orthotics business 

• be managing a hospital department 

• be working for a private practice 

• be working clinically part time and will spend the remainder of my time doing (x) . 

• be carrying out prosthetic and orthotic research 

• Other ___________________ 
 

*Note: the examples given above have been randomized (other than the last item ‘other’) in order to mitigate order bias. 
In each box below, identify up to 3 professional aspirations you hope to achieve in the field of prosthetics and orthotics field (max. 30 words, 
10 per box) 

 
19 - What is the highest professional level you anticipate you will have achieved in your career as a certified prosthetics/orthotics 
practitioner?  (pick one)* 

____   Employee  
____  Researcher  
____  Will have left the profession 
____  Manager 
____  Business owner 
____    Other:  ___________________________(please provide details) 

*Note: the examples given above have been randomized (other than the last item ‘other’) in order to mitigate order bias 
20 - In the region where you live what is the most common business model in P&O? (pick one)* 

______ Private Clinic with multiple employees 
______ Prosthetic and Orthotic Services are provided by a Non Governmental Organization (NGO) 
______ Public Service Hospital/Clinic 
______ Small Family Businesses 
______ Other ___________________________(please describe on line provided) 

*Note: the examples given above have been randomized (other than the last item ‘other’) in order to mitigate order bias 
21 - In the region where you live what is the second most common business model in P&O? (pick one)* 

______ Prosthetic and Orthotic Services are provided by a Non Governmental Organization (NGO) 
______ Small Family Businesses 
______ Private Clinic with multiple employees 
______ Public Service Hospital/Clinic 
______ Other ___________________________(please describe on line provided) 

*Note: the examples given above have been randomized (other than the last item ‘other’) in order to mitigate order bias 
22 - Describe what success in your chosen career of Prosthetics and Orthotics looks like for you. (max. 100 words) 

 

23 - Do you see any barriers to your achieving personal success in prosthetics and orthotics, as you have described above? _  Yes_   No 
 

If yes, please list those barriers in the box below (max 25 words). 

 

24 - Describe what the glass ceiling looks like in prosthetics and orthotics, from your perspective, even if you have not experienced it.  If you 

do not believe a glass ceiling exists, please note that. 

1- 

2- 

3- 

Next we will explore what a Glass Ceiling looks like in the fields of Prosthetics and Orthotics.  
 

A Glass Ceiling is described as:  
 
“Invisible artificial barriers (sometimes generated by management) that can limit the career advancement of employees, particularly 
women and members of minority groups. The expectations and aspirations of all staff within an organization should be met equally. 
While standards of practice in this area are laid down by law in many countries, they are not always observed.” 

From: Oxford Reference: https://www.oxfordreference.com/view/10.1093/oi/authority.20110803095854441 

For the purpose of this General Exploratory Survey component, this question applies to ALL PERSONS who could experience ‘invisible 
artificial barriers that limited <their> career advancement” for any range of reasons that include but are not limited to: gender, age, 
country of origin or education. 

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25 - Have you ever experienced a glass ceiling effect in the course of your career?__     Yes __     No 
26 - If yes, describe your glass ceiling experience in the box below. (max. 150 words) 

 

 

27 - Which identifying factor do you believe was the root of your experience with the glass ceiling described above?* 
Check all that apply: 

_____ race 
_____ age 
_____ disability 
_____ gender  
_____ country of education 
_____ cultural background 
_____ language 
_____ religion 
_____  country of origin  
_____  other   __________________________(describe) 

 
*Note: the examples given above have been randomized (other than the last item ‘other’) in order to mitigate order bias 
28 - If you trained in a country different from the one you now live and subsequently sought employment in Prosthetics and Orthotics, did you 
face any barriers on the path to employment in Prosthetics and Orthotics in the country in which you now live/work in? _     Yes  _     No 
29 - If yes, please list up those barriers in the box below (max 40 words) 

i.E.g. *  difficulty in: finding work, having a credential recognized, adapting to clinical and technical practices in country you are now working in, 
adapting to workplace culture, language difficulties, etc. 

*Note: the examples given above have been randomized (other than the last item ‘other’) in order to mitigate order bias 

 

 

2- Demographic Details 

30 - What is your age?   

_____18-25 
_____26-35 
_____36-45 
_____46-55 
_____56-65 
_____65+ 

31- Country of birth: (pull down menu) 
32- Which of the following best represents your racial and/or heritage?  (non-mandatory question) 

Choose all that apply. 

___Hispanic or Latino 

___East Asian 

___White or Caucasian  

___Middle Eastern  
___Native Hawaiian or Pacific Islander 
___Mixed 

___South Asian  

___Asian 

___First Nations or Indigenous  

___Black or African 

___Other preferred identifier: _____________ 

 
Please print your specific ethnicities in the space below, if you wish. 
(Examples of ethnicities include (for example): German, Korean, Mexican American, Navajo Nation, Samoan, Puerto Rican, Southerner 
(American), Chinese, etc. Note, you may report more than one group.) 

 
Ethnicity(s) _________________________________ 

 
*Note: the above have been randomized (other than the last two items) in order to mitigate order bias. 
**Note: There are numerous potential lists that could be used for this question.  We have used a list that combines what is used by researchers 
in  US Veteran’s Association research applications and Holland Bloorview Hospital (Toronto).  We anticipate most respondents will come from 
US/US Territories and Canada so the categories will be familiar to them.  In addition the simplicity of this list will be understandable to persons 
from outside this geographic area who may also answer (through posting/distribution via the International Society for Prosthetics and Orthotics 
network).  

 

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CANADIAN PROSTHETICS & ORTHOTICS JOURNAL                                              

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33- Marital status: 
___Single (never married) 
___Married, or in a domestic partnership 
___Widowed 
___Divorced 
___Separated 

34- Number of children: ______ 
35- The gender you identify as is:* 

____Female 
____Male  
____Other   (provide gender identity, if you wish, in the space provided): ___________ 

*Note: the examples given above have been randomized (other than the last item ‘other’) in order to mitigate order bias 
Note: Only persons choosing the Female option above will proceed to Part B.   
All others will be send to a page with the submit button.   
The follow reminder will placed above the Submit button:  
Clicking on the Submit button below will submit your data to the survey, after which it can no longer be retrieved or changed.  
If you wish to withdraw from the study, you can still do so at this point by simply closing the browser. 

 
After clicking the submit button they will be taken to a page thanking them for participating them in the survey.  

 

PART B Survey Questions (for respondents identifying as female) 

 
Career Pathways Survey 

Please consider each of the statements below and rank them from 1 (strongly disagree) to 7 (strongly agree) 
 
Women starting careers today will face sexist barriers. 
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7 
 

Women and men have to overcome the same problems at the workplace. 
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7 
 

It will take decades for women to reach equality with men in high level management positions. 
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7 
 

Even women with many skills and qualifications fail to be recognized for promotions. 
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7 
 

Women have reached the top in all areas of business and politics. 
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7 
 

Women face no barriers to promotions in most organizations. 
(strongly disagree)         (Neutral)      (strongly agree) 
1   2  3  4  5  6  7  
 
Women leaders are seldom given full credit for their successes. 
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Women in senior positions face frequent putdowns of being too soft or too hard. 
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Women who have a strong commitment to their careers can go right to the top. 
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Talented women are able to overcome sexist discrimination. 
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Women executives are very uncomfortable when they have to criticize members of their teams. 
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Women leaders suffer more emotional pain than men when there is a crisis within their teams.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
  

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Being in the limelight creates many problems for women.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Women are more likely to be hurt than men when they take big risks necessary for corporate success.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Women believe they have to make too many compromises to gain highly paid positions.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Jealousy from co-workers prevents women from seeking promotions.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Even very successful women can quickly lose their confidence. 
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
 Women know that work does not provide the best source of happiness in life.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
If women achieve promotions, they might be accused of offering sexual favours.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Smart women avoid careers that involve intense competition with colleagues.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
The more women seek senior positions, the easier it will be for those who follow.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Higher education qualifications will help women overcome discrimination.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Women have the strength to overcome discrimination.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
When women are given opportunities to lead, they do effective jobs.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Daughters of successful mothers are inspired to overcome sexist hurdles. 
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
   
Women are capable of making critical leadership decisions.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7 
 
A supportive spouse/partner or close friend makes it easier for a woman to achieve success in her career.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Successful organizations seek and want to retain talented female staff.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
The support of a mentor greatly increases the success of a woman in any organization.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Women's nurturing skills help them to be successful leaders.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
 

https://doi.org/10.33137/cpoj.v8i1.44720


 

13 

Eshraghi A, Safaeepour Z. Glass ceiling among female prosthetists & orthotists: Perceptions, opportunities and strategies for moving forward. Canadian Prosthetics 
& Orthotics Journal. 2025; Volume 8, Issue 1, No. 6. Https://doi.org/10.33137/cpoj.v8i1.44720 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL                                              

ISSN: 2561-987X GLASS CEILING AMONG FEMALE PROSTHETISTS & ORTHOTISTS 

Eshraghi & Safaeepour, 2025 

A
P

P
E

N
D

IX
 

Networking is a smart way for women to increase the chances of career success.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Women are just as ambitious in their careers as men.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
   
Women have the same desire for power as men do.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Motherhood is more important to most women than career development.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Women are less concerned about promotions than men are.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Women prefer a balanced life more than gaining highly paid careers.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Women reject the need to work incredibly long hours.  
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
     
Women commonly reject career advancement as they are keener to maintain a role raising children. 
(strongly disagree)         (Neutral)      (strongly agree) 

1   2  3  4  5  6  7
   

 

For those completing Part B: On completion of Part B the respondent will be taken to a Submit button that looks the same as what 
the respondents who did Part A only looks like: 

 

The follow reminder will placed above the Submit button:  

Clicking on the Submit button below will submit your data to the survey, after which it can no longer be retrieved or changed.  

If you wish to withdraw from the study, you can still do so at this point by simply closing the browser. 

 

After clicking the submit button they will be taken to a page thanking them for participating them in the survey.  

https://doi.org/10.33137/cpoj.v8i1.44720

