21 research outputs found
Multiple barriers to participation for people with psychosocial disability in Dehradun district, North India: a cross-sectional study.
OBJECTIVES: This study used a population-based cross-sectional survey to describe the prevalence of psychosocial disability and unmet need for access to services in North India. SETTING: This study was conducted in Dehradun district, Uttarakhand, in 2014. PARTICIPANTS: A population-based sample of 2441 people over the age of 18 years. PRIMARY OUTCOME MEASURES: The Rapid Assessment of Disability survey tool identified people with disability and used an adapted version of the Kessler scale to identify those with psychosocial disability. It additionally collected information on socioeconomic variables, access to community services and barriers to participation. Prevalence of psychosocial disability and unmet needs and descriptions of barriers to services were calculated, and multivariable logistic regression was used to assess associations between risk factors and psychosocial disability. RESULTS: Prevalence of psychosocial disability was 4.8% and 75% of participants with psychological distress also reported comorbid functional impairments. Adjusted ORs for depression of more than two were found for people who were unschooled, unemployed and of moderate or poor socioeconomic status. The unmet need for access to services was significantly higher in every domain for people with psychosocial disability and was more than 25% in the areas of employment, health service access and community consultation. People with psychosocial disability encountered greater barriers in each domain compared with controls. CONCLUSIONS: People who are poor, uneducated and unemployed are two to four times more likely to have psychosocial disability in Dehradun district. They face unmet needs in accessing community services and perceive negative social attitudes, lack of physical accessibility and lack of information as barriers limiting their participation. Social policy must increase access to education and reduce poverty but additionally ensure action is taken in all community services to increase information, physical accessibility and social inclusion of people with psychosocial and other forms of disability
The relative impact of vision impairment and cardiovascular disease on quality of life: the example of pseudoxanthoma elasticum
<p>Abstract</p> <p>Objective</p> <p>To investigate the impact of pseudoxanthoma elasticum (PXE), a rare hereditary disease of concurrent vision impairment (VI) and cardiovascular complications (CVCs), on vision-related (VRQoL) and health-related quality of life (HRQoL).</p> <p>Methods</p> <p>VRQoL and HRQoL were assessed using the Impact of Vision Impairment (IVI) questionnaire and the Short Form Health Survey (SF-36) in 107 PXE patients. Patients were stratified into four groups: A = no VI or CVC; B = CVCs only; C = VI only; and D = both VI and CVCs.</p> <p>Results</p> <p>Following Rasch analysis, the IVI was found to function as a vision-specific functioning and emotional well-being subscale, and the SF-36 as a health-related physical functioning and mental health subscale. The presence of VI and CVC were significant predictors of vision-specific functioning and emotional well-being (p < 0.001), with a clinically meaningful decrement in vision-specific functioning in patients with VI. No associations were found for the SF-36 Physical Functioning and Mental Health scores between any groups.</p> <p>Conclusions</p> <p>Vision impaired patients with PXE report significantly poorer vision-specific functioning than PXE patients without VI. In contrast, the relative impact of PXE on reported general HRQoL was much less. Our results suggest that vision impairment has the larger impact on QoL in this sample.</p
Access to Services and Barriers faced by People with Disabilities: A Quantitative Survey
Purpose: In low- and middle-income middle-income countries, reliable and disaggregated disability data on prevalence, participation and barriers are often unavailable available. This study aimed to estimate disability prevalence, determine associated socio-demographic factors and compare access in the community between people with and without disability in Dehradun district of Uttarakhand, India, using the Rapid Assessment of Disability survey. Methods: A cross-sectional population-based survey was conducted on a sample of 2431 adults, selected using a two-stage cluster randomised sampling technique. The survey comprised an interviewer-administered household survey and an individual survey measuring disability, wellbeing and participation. For each person with disability, an age-and sex-matched control (without disability) was selected. In addition to prevalence, the differences in participation and barriers faced by people with and without disability were analysed. Results and Conclusions: The prevalence of disability was 6.8% (95% CI 5.8-7.8) with significant associations with age, sex, economic status, education and employment. Psychosocial distress (4.8%) and mobility impairment (2.7%) were the most common disabilities identified. The study showed that people with disabilities had significantly less access to services than those without disability, and the barriers reported most often were lack of information, transport and physical inaccessibility
W-DARE: a three-year program of participatory action research to improve the sexual and reproductive health of women with disabilities in the Philippines
BACKGROUND: In many contexts, women with disability have less access to sexual and reproductive health information, screening, prevention, and care services than women without disability. Women with disability are also known to be more likely to experience physical and sexual violence than women without disability. In the Philippines, health service providers often have little awareness of the sexual and reproductive experiences of women with disability and limited capacity to provide services in response to their needs. Very limited data are available to inform development of disability-inclusive sexual and reproductive health, and violence prevention and response, services in the country. This paper presents the protocol for W-DARE (Women with Disability taking Action on REproductive and sexual health), a three-year program of participatory action research that aims to improve the sexual and reproductive health of women with disability in the Philippines. DESIGN: W-DARE is a disability-inclusive program that will use mixed methods to 1) increase understanding of factors influencing the sexual and reproductive health of women with disability, and 2) develop, implement and evaluate local interventions to increase supply of and demand for services. W-DARE will generate data on the prevalence of disability in two districts; the wellbeing and community participation of people with and without disability, and identify barriers to community; and describe the sexual and reproductive health needs and experiences, and service-related experiences of women with disability. These data will inform the development and evaluation of interventions aiming to improve access to sexual and reproductive health services, and violence prevention and response services, for women with disability. Local women with disabilities, their representative organisations, and SRH service providers will be involved as members of the research team across all stages of the research. DISCUSSION: This three-year study will provide evidence about factors undermining the sexual and reproductive health of women with disability in a lower-middle income country, and provide new insights about what may be effective in increasing access to services in settings of limited resources. Findings will be relevant across Asia and the Pacific. Analysis of the program will also provide evidence about disability-inclusion in participatory action research approaches
Global report on assistive technology
There is a large, unmet need for assistive technology worldwide. The Global report on assistive technology was developed in response to the World Health Assembly resolution (WHA71.8) on improving access to assistive technology adopted in May 2018. The Global report is expected to play an instrumental role in setting the global roadmap for improving access to assistive technology for everyone, everywhere.
The Global report on assistive technology presents a comprehensive dataset and analysis of current assistive technology access, drawing the attention of governments and civil society to the need for, and benefit of, assistive technology, including its return on investment. The Global report sets out ten recommendations for improving access to assistive technology, which in turn support the achievement of the Sustainable Development Goals, inclusive Universal Health Coverage, and alignment with the Convention on the Rights of Persons with Disabilities.
Guided by an Expert Advisory Group, the WHO and UNICEF have jointly developed this report in the context of an integrated approach, based on the best available scientific evidence and international experience, in collaboration with stakeholders from diverse settings, multiple countries, and all regions. It is primarily directed at policy-makers, providers of assistive technology, donors and funding agencies, and industry leaders. It is also aimed at broader stakeholders including users and potential users of assistive technology and their families or caregivers.publishedVersio
Development of a Digital Case Management Tool for Community Based Inclusive Development Program
Disability inclusive development practices require reliable data to identify people with disabilities, their barriers to participation and support needs. Although several tools are available for measuring different components of disability, it is often difficult for program teams in low resource settings, including lay community workers of community based inclusive development (CBID) programs, to collect and analyze data for program monitoring and evaluation. This paper presents the development of a digital CBID Modular Tool with automated data analysis to support routine case management processes and monitoring of a CBID program in Laos PDR. The tool was developed in different phases involving stakeholder consultations, auditing of existing tools, content development for the different modules for disability assessment and support needs, software development and testing. The tool was developed in a participatory process including people with disabilities. The tool measures needs and support requirements of people with disabilities in health, functioning, economic, education and caregiver support domains, and enables intervention planning. The content included is both context specific and universal as derived from the widely used validated tools. This unique digital CBID Modular Tool can support data collection by lay community workers and support reliable data collection to measure disability inclusion in a development program
Development and validation of an evaluation framework for vision-related community-based rehabilitation (CBR) programs
© 2011 Dr. Manjula MarellaCommunity-based rehabilitation (CBR) services were introduced to improve coverage, equity and participation in daily living for people with disabilities (PWD). Since the inception of CBR, there have been several changes in models of service delivery. The initial ones focussed primarily on improving the physical function of PWDs. The recent model, recommended in the World Health Organisation’s (WHO) CBR Guidelines, includes a holistic approach to promote inclusion, economic independence and education of PWDs. There is an immense need of CBR for people with vision impairment because of the poor coverage of services. Paradoxically, even though approximately 90% of people with vision impairment live in resource-poor settings, most of the vision rehabilitation services are institution-based and located in major cities and towns.
However, the effectiveness of CBR programs, particularly those related to people with vision impairment is not well understood, primarily because there are no published evaluations conducted on the vision-related CBR programs. While there is literature on CBR programs other than vision impairment, these are mainly descriptions of services. In order to promote a greater adoption of vision-related CBR programs, there is a need to empirically demonstrate the effectiveness of different models. This thesis addresses this need by developing an evaluation framework for vision-related CBR programs, namely the Centre for Eye Research Australia (CERA)-CBR Framework (CCF).
This research was conducted in three phases. First, a literature review was conducted to obtain indicators needed to evaluate CBR programs, which were grouped into themes, key areas and components of the CCF using grounded theory. Second, the CCF was reviewed by an expert panel for content validity. Finally, it was field-tested in two different vision-related CBR programs in Fiji and Cambodia to investigate the utility of the indicators in the field using two specific criteria: applicability and measurability. An indicator was considered applicable if it was relevant in determining the strengths and limitations of a CBR program and measurable if it provided qualitative or quantifiable information.
The CCF comprises four components namely “service delivery system,” “program management,” “networks” and “outcomes”; 21 key areas; and 230 indicators. “Service delivery system” includes three key areas: ‘availability,’ ‘utilisation’ and ‘quality’ of services; “program management” has five key areas: ‘program planning,’ ‘human resources,’ ‘infrastructure,’ ‘coverage’ and ‘sustainability’; “networks” contained five key areas: ‘linkages,’ ‘referrals,’ ‘advocacy’ and ‘support from families’ and ‘support from communities’; and “outcomes” had eight key areas: ‘intended outcomes,’ ‘functional independence,’ ‘psycho-social wellbeing,’ ‘education,’ ‘economic independence,’ ‘empowerment,’ ‘changes in community’ and ‘satisfaction with services.’
Of the initial 230 indicators, 201 (87%) and 219 (95%) were shown to be applicable to identify the strengths and limitations of CBR programs in Fiji and Cambodia respectively. Of these, 167 (83%) and 178 (81%) were measurable in Fiji and Cambodia respectively. Across both countries 197 (85%) indicators were applicable and of these 156 (79%) were measurable. The CCF was useful to understand the strengths and limitations of the two CBR programs and provide recommendations to improve the services.
This research has made an important contribution towards initiating empirical research to evaluate and compare vision-related CBR programs. It has provided the first structured and practical tool to evaluate such programs. The majority of the proposed indicators were applicable and measurable in Fiji and Cambodia indicating its potential as a useful and practical evaluation tool for use in CBR programs
Combining Child Functioning Data with Learning and Support Needs Data to Create Disability-Identification Algorithms in Fiji’s Education Management Information System
Disability disaggregation of Fiji’s Education Management Information System (FEMIS) is required to determine eligibility for inclusive education grants. Data from the UNICEF/Washington Group Child Functioning Module (CFM) alone is not accurate enough to identify disabilities for this purpose. This study explores whether combining activity and participation data from the CFM with data on environmental factors specific to learning and support needs (LSN) more accurately identifies children with disabilities. A survey on questions related to children’s LSN (personal assistance, adaptations to learning, or assessment and assistive technology) was administered to teachers within a broader diagnostic accuracy study. Descriptive statistics and correlations were used to analyze relationships between functioning and LSN. While CFM data are useful in distinguishing between disability domains, LSN data are useful in strengthening the accuracy of disability severity data and, crucially, in identifying which children have disability amongst those reported as having some difficulty on the CFM. Combining activity and participation data from the CFM with environmental factors data through algorithms may increase the accuracy of domain-specific disability identification. Amongst children reported as having some difficulty on the CFM, those with disabilities are effectively identified through the addition of LSN data
Unmet Needs and Use of Assistive Products in Two Districts of Bangladesh: Findings from a Household Survey
Access to assistive products (AP) is an under-researched public health issue. Using an adaptation of a draft World Health Organization tool—the ‘Assistive Technology Assessment—Needs (ATA-N)’ for measuring unmet needs and use of AP, we aimed to understand characteristics of AP users, self-reported needs and unmet needs for AP, and current access patterns in Bangladesh. The ATA-N was incorporated in a Rapid Assessment of Disability (RAD), a population-based survey to estimate prevalence and correlates of disability. In each of two unions of Kurigram and Narsingdi districts, 60 clusters of 50 people each aged two years and older were selected using a two-staged cluster random sampling process, of whom, 4250 (59% Female; 41% Male) were adults, including 333 using AP. We estimate 7.1% of the studied population used any AP. AP use is positively associated with age and self-reported functional difficulty. The proportion of people using AP is higher for mobility than for sensory and cognitive difficulties. Of all people with any functional difficulty, 71% self-reported an unmet need for AP. Most products were home or self-made, at low cost, but provided benefits. Needs and unmet needs for AP are high, especially for people with greater functional difficulties. Assessing unmet needs for AP revealed important barriers to scale that can inform policy and practice
Barriers to access to ear and hearing care services in low- and middle- income countries: A scoping review
People living in low- and middle- income countries (LMICs) meet significant challenges in accessing ear and hearing care (EHC) services. We conducted a scoping review to identify and summarise such barriers, to recognise gaps in the literature, and to identify potential solutions. Reviewers independently screened titles, abstracts and full-text articles and charted data. We undertook thematic analysis of supply and demand side dimensions of access, and summarised findings mapped against the Levesque framework. Of 3048 articles screened, 62 met inclusion criteria for review. Across the five access dimensions, supply-side constraints were more frequently described, the most common being a shortage of EHC workforce or appropriate facilities, despite high demand. We identified a thin geographical spread of literature on barriers to accessing EHC services in LMICs, reflecting low availability of such services. LMICs face a diverse range of demand and supply side challenges including workforce, equipment and resource shortages, and challenges for the majority of the population to pay for such services. There is a need for many LMICs to develop health policy and programmes in EHC, including integration into primary care, scaling up the EHC workforce through increased training and education, and improving EHC literacy through public health measures