Photovoice: Life Through the Eyes of People with Disability in North India

The authors used photovoice methodology to gain insight into the lives of 18 people with disabilities in rural North India. This project provided participants with an opportunity to express their joys and difficulties and provided important insights to help structure future programs and supports within the community

Opportunistic Research in Rural Areas through Community Health Worker Training: A Cost-effective method of Researching Medication Misuse in Rural India

Background: In India it is estimated that one third of expenditure of households is spent on health related expenses, and medication purchases make up a large proportion of these costs. Objective: To investigate a novel methodology, which was cost effective, to collect large amounts of data to further understand medication purchases and misuse in rural India. Methods: This study explores the research approach that was conducted in 2012-13 by Layleaders enrolled in the Community Lay-Leaders’ Health Certificate Program initiative by Christian Medical College (CMC), Vellore, India. Results: The methodology demonstrated a large data collection capacity, where 100 Layleaders participated and collected over 5000 surveys across 515 villages in North, Central and North East India. Conclusions: Incorporating opportunistic research methods into community health worker training can be a cost effective way to collect meaningful and useful data in rural India. This study demonstrates a successful methodology that may be transferable to other rural areas and others conducting research training as part of community health worker training should consider such opportunistic research

Disabled People's Organisations increase access to services and improve well-being: evidence from a cluster randomized trial in North India.

BACKGROUND: Disabled People's Organisations (DPOs) are the mainstay of disability responses worldwide. Yet there is no quantitative data assessing their effectiveness in low-and middle-income countries (LMICs). The aim of this study was to measure the effectiveness of DPOs as a low-cost intervention to improve well-being and access to services and facilities for people with disabilities. METHODS: We undertook a cluster randomised intervention control trial across 39 distinct rural villages in Uttarakhand State, North India. A total of 527 participants were included from 39 villages: 302 people from 20 villages were assigned to the intervention arm and 225 from 19 villages were assigned to the control group. Over a 2-year period, people with disabilities were facilitated to form DPOs with regular home visits. Participants were also given financial support for public events and exposure visits to other DPOs. Seven domains were used to measure access and participation. RESULTS: DPO formation had improved participation in community consultations (OR 2.57, 95% CI 1.4 to 4.72), social activities (OR 2.46, 95% CI 1.38 to 4.38), DPOs (OR 14.78, 95% CI 1.43 to 152.43), access to toilet facilities (OR 3.89, 95% CI 1.31 to 11.57), rehabilitation (OR 6.83, 95% CI 2.4 to 19.42) and Government social welfare services (OR 4.82, 95% CI 2.35 to 9.91) in intervention when compared to the control. People who were part of a DPO had an improvement in having their opinion heard (OR 1.94, 95% CI 1.16 to 3.24) and being able to make friends (OR 1.63, 95% CI 1 to 2.65) compared to those who were not part of a DPO. All other well-being variables had little evidence despite greater improvement in the DPO intervention group. CONCLUSIONS: This is the first randomised control trial to demonstrate that DPOs in LMICs are effective at improving participation, access and well-being. This study supports the ongoing role of DPOs in activities related to disability inclusion and disability services. This study also suggests that supporting the establishment, facilitation and strengthening of DPOs is a cost-effective intervention and role that non-governmental organisations (NGOs) can play. TRIAL REGISTRATION: ISRCTN36867362, 9th Oct 2019 (retrospectively registered)

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

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

'Believing' in HIV :The effect of faith on the response of Christian Faith Based Organisations to HIV in India

Internationally, faith based groups are increasingly being called upon to play a part in the response to HIV. In India, where there are approximately 2.5 million people living with HIV, there is an increasing interest by groups such as the Centre for Disease Control and the World Health Organisation to partner with Faith Based Organisations (FBOs) to maximise the response to HIV. However, little is understood about these FBOs, and, in particular, how faith might affect their response. Some postulate that faith is no longer relevant; others view faith as merely an impediment. This thesis therefore seeks to understand how, if at all, the Christian faith affects the FBO's response to HIV.EThOS - Electronic Theses Online ServiceGBUnited Kingdo