Abstract
Research has shown that people with disabilities experience poorer access to healthcare. This study aims to explore the perceived barriers to accessing primary healthcare services for adults with disabilities in low- and middle-income countries. By identifying and targeting such barriers, OT practitioners can both contribute and lead the way to improving access to quality healthcare for not only people with disabilities, but also other vulnerable populations globally.
Primary Author and Speaker: Goli Hashemi
Contributing Authors: Mary Wickenden, Hannah Kuper
It is estimated that 400 million people worldwide lack access to healthcare services, including rehabilitation. Access is particularly low among vulnerable populations, including people with disabilities. People with disabilities make up about 15% or 1 billion of the world population. Evidence shows that people with disabilities not only experience poorer access to health, but even when they do access it, may receive poorer quality services, and are more likely to self-report that their health is worse than people without disabilities. While the presence of a health condition may be the original cause of impairment, there are many reasons why people with disabilities may experience worse health than others. The aim of this study is to explore the perceived barriers to accessing primary healthcare services for adults with disabilities in low and middle countries, specifically Guatemala. Recognizing such barriers is important to the practice of occupational therapy both from a traditional perspective of providing direct client care in rehabilitation settings but also in more emergent roles emphasizing health promotion, community health and well-being, given the current trends in healthcare and social services globally.
The study used a qualitative approach, conducting in-depth interviews with adults with disabilities in Guatemala to explore barriers to accessing primary healthcare services and factors considered when making healthcare decisions at the household level. Participants were identified through a local community-based rehabilitation program. A total of 27 adults, consisting of both genders with a variety of disabilities including sensory, physical, neurological, and psychological impairments participated in the interviews.
In depth interviews were conducted using an interview guide developed by the author, based on the of results from an earlier systematic review on qualitative studies on barriers to accessing primary health care for adults with disabilities in low and middle-income countries. Interviews were audio recorded and transcribed and data were managed and analysed using thematic analysis in Nvivo 12.
Findings indicate that the while some barriers are commonly recognized and understood such as physical access, transportation and communication, many are more complex. The complexities are a result of the interaction between underlying impairments, structural barriers, socio-economic status, and the various intersectionalities that may influence an individual with a disability and their decision-making process in both identifying the need for and the decision to seek primary healthcare. The results highlight the need for a more detailed and proactive approaches towards removing barriers and adapting services, including more participatory approaches with people with disabilities for improving access to healthcare services for people with disabilities.
Occupational therapy’s holistic approach to occupation and participation, skills in activity and task analysis, and awareness in disability and impairments places the profession at an advantage in exploring and targeting the various nuances that may result in barriers and challenges in accessing healthcare services for people with disabilities. Occupational therapy practitioners can both contribute and lead the way to improving access to quality healthcare for not only people with disabilities but also other vulnerable populations. This is especially important given AOTA’s Vision 2025 of maximizing health, well-being, and quality of life for all people, populations, and communities through effective solutions that facilitate participation in everyday living.
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