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Keegan G, Rizzo JR, Joseph KA. Disparities in breast cancer among patients with disabilities: care gaps, accessibility, and best practices. J Natl Cancer Inst 2023; 115:1139-1144. [PMID: 37421404 DOI: 10.1093/jnci/djad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/19/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023] Open
Abstract
Pronounced disparities exist in detecting and treating breast cancer in women with disabilities, leading to cancer detection at advanced stages. This paper provides an overview of disparities for women with disabilities related to breast cancer screening and care, primarily focusing on clinically significant mobility disabilities. Current care gaps include screening barriers related to accessibility and inequitable treatment options, with race and ethnicity, socioeconomic status, geographic location, and disability severity factors mediating the disparities for this population. The reasons for these disparities are myriad and stem from both system-level deficiencies and individual-level clinician bias. Although structural changes are warranted, individual healthcare professionals must also be incorporated into the requisite change. Intersectionality is critical to disparities and inequities and should be central to any discussion of strategies for improving care for people with disabilities, many of whom have intersectional identities. Efforts to reduce screening rate disparities for breast cancer in women with mobility-related disabilities should start with improving accessibility through removing structural barriers, establishing comprehensive accessibility standards, and addressing healthcare professional bias. Future interventional studies are needed to implement and assess the value of programs to improve breast cancer screening rates in women with disabilities. Increasing the representation of women with disabilities in clinical trials may provide another avenue for reducing treatment disparities because these trials often provide breakthrough treatment to women with cancer diagnosed at later stages. Ultimately, attention to the specific needs of patients with disabilities should be improved across the United States to promote inclusive and effective cancer screening and treatment.
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Affiliation(s)
- Grace Keegan
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - John-Ross Rizzo
- Department of Physical Medicine and Rehabilitation and Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
- New York University Langone Health Institute of Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA
| | - Kathie-Ann Joseph
- New York University Langone Health Institute of Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA
- Departments of Surgery and Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Jean S, Vishwanath V, Chung HL, Moseley TW. Identifying and Reducing Barriers to Breast Imaging. CURRENT BREAST CANCER REPORTS 2023; 15:114-118. [PMID: 37293273 PMCID: PMC10074341 DOI: 10.1007/s12609-023-00480-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 04/08/2023]
Abstract
Purpose of Review The purpose of this review is to discuss disparities in breast health care access and outcomes related to race, gender, cultural diversity, sexual orientation, socioeconomic status, geographic location, and disability. The authors recognize the complexity of eliminating inequalities in health care but are optimistic that all patients will one day have equal access to care through dialogue, acknowledgment, recognition, and action. Recent Findings After lung cancer, breast cancer is the second leading cause of death among American women. Mammography as a preventative screening tool has resulted in significant reductions in breast cancer mortality. Despite existing breast cancer recommendations, it has been projected that 43,250 women will die from breast cancer in 2022. Summary Disparities in healthcare outcomes exist for many reasons including inequalities based on race, gender, cultural diversity, religion, sexual orientation, and socioeconomic status. Disparities, no matter how large or complex, are not insurmountable.
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Affiliation(s)
- Shanen Jean
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ USA
| | - Varnita Vishwanath
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ USA
| | - Hannah L. Chung
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Box 1350, Houston, TX 77030 USA
| | - Tanya W. Moseley
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Box 1350, Houston, TX 77030 USA
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Lagu T, Haywood C, Reimold K, DeJong C, Sterling RW, Iezzoni LI. 'I Am Not The Doctor For You': Physicians' Attitudes About Caring For People With Disabilities. Health Aff (Millwood) 2022; 41:1387-1395. [PMID: 36190896 PMCID: PMC9984238 DOI: 10.1377/hlthaff.2022.00475] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
People with disabilities face barriers when attempting to gain access to health care settings. Using qualitative analysis of three physician focus groups, we identified physical, communication, knowledge, structural, and attitudinal barriers to care for people with disabilities. Physicians reported feeling overwhelmed by the demands of practicing medicine in general and the requirements of the Americans with Disabilities Act of 1990 specifically; in particular, they felt that they were inadequately reimbursed for accommodations. Some physicians reported that because of these concerns, they attempted to discharge people with disabilities from their practices. Increasing health care access for people with disabilities will require increasing the accessibility of space and the availability of proper equipment, improving the education of clinicians about the care of people with disabilities, and removing structural barriers in the health care delivery system. Our findings also suggest that physicians' bias and general reluctance to care for people with disabilities play a role in perpetuating the health care disparities they experience.
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Affiliation(s)
- Tara Lagu
- Tara Lagu , Northwestern University, Chicago, Illinois
| | | | | | | | | | - Lisa I. Iezzoni
- Harvard University and Massachusetts General Hospital, Boston, Massachusetts
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4
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An Update on the Measurement of Motor Cerebellar Dysfunction in Multiple Sclerosis. THE CEREBELLUM 2022:10.1007/s12311-022-01435-y. [PMID: 35761144 PMCID: PMC9244122 DOI: 10.1007/s12311-022-01435-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 12/03/2022]
Abstract
Multiple sclerosis (MS) is a progressive disease that often affects the cerebellum. It is characterised by demyelination, inflammation, and neurodegeneration within the central nervous system. Damage to the cerebellum in MS is associated with increased disability and decreased quality of life. Symptoms include gait and balance problems, motor speech disorder, upper limb dysfunction, and oculomotor difficulties. Monitoring symptoms is crucial for effective management of MS. A combination of clinical, neuroimaging, and task-based measures is generally used to diagnose and monitor MS. This paper reviews the present and new tools used by clinicians and researchers to assess cerebellar impairment in people with MS (pwMS). It also describes recent advances in digital and home-based monitoring for people with MS.
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Agaronnik N, El-Jawahri A, Iezzoni L. Implications of Physical Access Barriers for Breast Cancer Diagnosis and Treatment in Women with Mobility Disability. JOURNAL OF DISABILITY POLICY STUDIES 2022; 33:46-54. [PMID: 35875606 PMCID: PMC9307057 DOI: 10.1177/10442073211010124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVE More than 30 years since enactment of the Americans with Disabilities Act, people with disability continue to face physical access barriers, notably inaccessible medical diagnostic equipment, in clinical settings. Access barriers affect breast cancer screening and treatment for women with disability. METHODS We used standard diagnosis codes and natural language processing to screen electronic health records (EHRs) in a digital data repository from a large healthcare delivery system for patients with pre-existing mobility disability diagnosed with breast cancer between 2005-2017. We reviewed EHRs of 20 patients, using conventional content analysis to examine breast cancer diagnosis and treatment experiences. RESULTS Clinicians noted challenges positioning patients for routine procedures including manual breast exam, screening mammography, and breast biopsies. Given challenges accommodating disability for adjuvant therapies, mastectomy was favored over breast-conserving options despite early stages of diagnosis. Notations contained little information about proactive problem-solving for arranging accommodations. CONCLUSIONS Notations described physical access barriers for breast cancer detection and treatment, with limited planning for mitigating barriers. Despite 2017 promulgation of federal Standards for Accessible Medical Diagnostic Equipment, implementing these standards requires further rulemaking.
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Affiliation(s)
- Nicole Agaronnik
- Health Policy Research Center-Mongan Institute, Massachusetts General Hospital
| | - Areej El-Jawahri
- Department of Medicine, Harvard Medical School
- Division of Hematology and Oncology, Massachusetts General Hospital
| | - Lisa Iezzoni
- Health Policy Research Center-Mongan Institute, Massachusetts General Hospital
- Department of Medicine, Harvard Medical School
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6
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Song YLA, Park JH. Differences in Body Mass Index Trajectories and Their Classification, Sociodemographic Characteristics, and Health Behaviors between People with and without Disabilities Using Korea Health Panel Survey Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052827. [PMID: 35270519 PMCID: PMC8910118 DOI: 10.3390/ijerph19052827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022]
Abstract
A high body mass index (BMI) is an important factor that negatively affects the health of people with disabilities. In particular, since the high BMI has a cumulative effect on the occurrence of complications such as cardiovascular disease, it is required to investigate the data through longitudinal studies rather than cross-sectional studies. Therefore, we conducted a longitudinal follow-up study to examine the differences in the BMI trajectories of people in South Korea with disabilities, as well as the sociodemographic characteristics and health behaviors that classify individual trajectories into clusters. Participants aged 40 to 79 years who responded to the Korea Health Panel Survey (KHPS) from 2009 to 2018, 283 people with physical disabilities or brain lesion disorders, and 849 people without disabilities, were extracted. We found that the differences in the initial BMI between clusters were larger in 60-79-year-old people with disabilities (men 22.5 kg/m2, 26.9 kg/m2; women 23.8 kg/m2, 28.1 kg/m2) than in those without disabilities (men 22.1 kg/m2, 23.3 kg/m2; women 24.8 kg/m2, 25.6 kg/m2). Also, logistic regression analysis showed that, among the people with disabilities, women (OR = 1.94), those who lived alone (OR = 2.36), and those who were economically inactive (OR = 1.78) were more likely to be classified into the higher BMI category than those who were not. To effectively manage the BMI, it would be better to focus on women with disabilities, people with disabilities living alone, and people who are economically inactive.
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Affiliation(s)
- Yea-Li-A Song
- Medical Research Institute, Sungkyunkwan University School of Medicine, Suwon 16419, Korea;
| | - Jae-Hyun Park
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon 16419, Korea
- Correspondence: ; Tel.: +82-031-299-6301
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Iezzoni LI, Rao SR, Ressalam J, Bolcic-Jankovic D, Agaronnik ND, Lagu T, Pendo E, Campbell EG. US Physicians' Knowledge About The Americans With Disabilities Act And Accommodation Of Patients With Disability. Health Aff (Millwood) 2022; 41:96-104. [PMID: 34982624 PMCID: PMC8740697 DOI: 10.1377/hlthaff.2021.01136] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
More than thirty years since the enactment of the Americans with Disabilities Act (ADA), people with disability continue to experience health care disparities. The ADA mandates that patients with disability receive reasonable accommodations. In our survey of 714 US physicians in outpatient practices, 35.8 percent reported knowing little or nothing about their legal responsibilities under the ADA, 71.2 percent answered incorrectly about who determines reasonable accommodations, 20.5 percent did not correctly identify who pays for these accommodations, and 68.4 felt that they were at risk for ADA lawsuits. Physicians who felt that lack of formal education or training was a moderate or large barrier to caring for patients with disability were more likely to report little or no knowledge of their responsibilities under the law and were more likely to believe that they were at risk for an ADA lawsuit. To achieve equitable care and social justice for patients with disability, considerable improvements are needed to educate physicians and make health care delivery systems more accessible and accommodating.
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Affiliation(s)
- Lisa I Iezzoni
- Lisa I. Iezzoni , Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Sowmya R Rao
- Sowmya R. Rao, Massachusetts General Hospital and Boston University School of Public Health, Boston, Massachusetts
| | - Julie Ressalam
- Julie Ressalam, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Tara Lagu
- Tara Lagu, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth Pendo
- Elizabeth Pendo, Saint Louis University, St. Louis, Missouri
| | - Eric G Campbell
- Eric G. Campbell, University of Colorado Anschutz Medical Campus
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8
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Iezzoni LI, Rao SR, Ressalam J, Bolcic-Jankovic D, Donelan K, Agaronnik N, Lagu T, Campbell EG. Use of Accessible Weight Scales and Examination Tables/Chairs for Patients with Significant Mobility Limitations by Physicians Nationwide. Jt Comm J Qual Patient Saf 2021; 47:615-626. [PMID: 34364797 PMCID: PMC8464497 DOI: 10.1016/j.jcjq.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mobility limitations are the most common disability type among the 61 million Americans with disability. Studies of patients with mobility limitations suggest that inaccessible medical diagnostic equipment poses significant barriers to care. METHODS The study team surveyed randomly selected US physicians nationwide representing seven specialties about their reported use of accessible weight scales and exam tables/chairs when caring for patients with mobility limitations. A descriptive analysis of responses was performed, and multivariable logistic regression was used to examine associations between accessible equipment and participants' characteristics. RESULTS The 714 participants (survey response rate = 61.0%) were primarily male, White, and urban, and had practiced for 20 or more years. Among those reporting routinely recording patients' weights (n = 399), only 22.6% (standard error [SE] = 2.2) reported always or usually using accessible weight scales for patients with significant mobility limitations. To determine weights of patients with mobility limitations, 8.1% always, 24.3% usually, and 40.0% sometimes asked patients. Physicians practicing ≥ 20 years were much less likely than other physicians to use accessible weight scales: odds ratio (OR) = 0.51 (95% confidence interval [CI] = 0.26-0.99). Among participants seeing patients with significant mobility limitations (n = 584), only 40.3% (SE = 2.2) always or usually used accessible exam tables or chairs. Specialists were much more likely than primary care physicians to use accessible exam tables/chairs: OR = 1.96 (95% CI = 1.29-2.99). CONCLUSION More than 30 years after enactment of the Americans with Disabilities Act, most physicians surveyed do not use accessible equipment for routine care of patients with chronic significant mobility limitations.
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Morris MA, Wong AA, Dorsey Holliman B, Liesinger J, Griffin JM. Perspectives of Patients with Diverse Disabilities Regarding Healthcare Accommodations to Promote Healthcare Equity: a Qualitative Study. J Gen Intern Med 2021; 36:2370-2377. [PMID: 33564941 PMCID: PMC8342676 DOI: 10.1007/s11606-020-06582-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with disabilities often require healthcare accommodations in order to access high-quality, equitable healthcare services. While attention has been paid to accommodation needs in specific disability populations, limited research to date has explored healthcare accommodations that cross-cut diverse disability populations. OBJECTIVE To identify a deeper understanding regarding accommodations in healthcare settings that could apply across disability populations and promote equitable healthcare. DESIGN We conducted qualitative focus groups with patients with disabilities and caregivers to understand their experiences and preferences for healthcare accommodations. PARTICIPANTS We recruited patients and caregivers across all major disability categories to participate in focus groups. Participants were recruited through advocacy organizations and healthcare settings in Southeastern Minnesota. APPROACH A total of eight focus groups were conducted with 56 participants. Participants described their healthcare experiences and desires for healthcare accommodations. The multidisciplinary research team recorded, transcribed verbatim, and coded all focus groups. The team thematically coded transcripts using content analysis within and across focus groups to identify major themes. KEY RESULTS Patients identified four challenges and corresponding steps healthcare team could take to promote equitable care: (1) consistent documentation of disabilities and needed accommodations in the medical record; (2) allowance for accommodations to the environment, including adapting physical space, physical structures, and scheduling and rooming processes; (3) provide accommodations for administrative tasks, such as completing paper or electronic forms; and (4) adapt communication during interactions, such as speaking slower or using terms that patients can easily understand. CONCLUSION These identified themes represent specific opportunities for healthcare teams to effectively provide accessible care to patients with disabilities. Many of the accommodations require minimal financial investment, but did require behavioral changes by the healthcare team to ensure equitable healthcare.
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Affiliation(s)
- Megan A Morris
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Aurora, CO, USA.
- Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, USA.
| | - Alicia A Wong
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Brooke Dorsey Holliman
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | | | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
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Agaronnik ND, El-Jawahri A, Iezzoni LI. Perspectives of Patients with Pre-existing Mobility Disability on the Process of Diagnosing Their Cancer. J Gen Intern Med 2021; 36:1250-1257. [PMID: 33205226 PMCID: PMC8131437 DOI: 10.1007/s11606-020-06327-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mobility disability is the most common disability among adult Americans, estimated at 13.7% of the US population. Cancer prevalence is higher among people with mobility disability compared with the general population, yet people with disability experience disparities in cancer screening and treatment. OBJECTIVE We explored experiences of patients with mobility disability with the process of cancer diagnosis. DESIGN Open-ended individual interviews, which reached data saturation. Interviews were transcribed verbatim for conventional content analysis. PARTICIPANTS We interviewed 20 participants with pre-existing mobility disability that required the use of an assistive device or assistance with performance of activities of daily living and who were subsequently diagnosed with cancer (excluding melanoma). KEY RESULTS Concerns coalesced around five broad categories: inaccessibility of medical diagnostic equipment affecting the process of cancer diagnosis, attitudes of clinical staff about accommodating disability, dismissal of cancer signs/symptoms as emotional responses to chronic health conditions, misattributing cancer signs/symptoms to underlying disability, and attitudes about pursuing legal action for substandard care. Participants provided examples of how erroneous assumptions and potentially biased attitudes among clinicians interfered with the process of their cancer diagnosis, sometimes contributing to an insufficient workup and diagnostic delays. CONCLUSIONS Physical and attitudinal barriers affect the process of cancer diagnosis in people with mobility disability. Though people with mobility disability may be clinically complex, clinicians should be aware of the risks of diagnostic overshadowing (i.e., the misattribution of cancer signs/symptoms to underlying disability) and other erroneous assumptions that may affect timeliness of cancer diagnosis and quality of care. Further efforts, including educating clinicians about challenges in caring for persons with disability, should be considered to improve the process of cancer diagnosis for this population. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Nicole D Agaronnik
- Health Policy Research Center-Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - Areej El-Jawahri
- Department of Medicine, Harvard Medical School, Boston, MA, USA.,Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa I Iezzoni
- Health Policy Research Center-Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA.
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Agaronnik ND, Lagu T, DeJong C, Perez-Caraballo A, Reimold K, Ressalam J, Iezzoni LI. Accommodating patients with obesity and mobility difficulties: Observations from physicians. Disabil Health J 2020; 14:100951. [PMID: 32723692 DOI: 10.1016/j.dhjo.2020.100951] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Given the growing population of U.S. adults with obesity and mobility disability, physicians will need to accommodate these patients. OBJECTIVE To explore attitudes and practices of US physicians related to caring for patients with obesity and mobility disability. METHODS Three open-ended, semi-structured, web-based focus group interviews with practicing physicians in selected specialties, which reached data saturation. Interviews were video recorded and transcribed for qualitative, conventional content analysis. Measurements included commonly expressed themes around caring for patients with obesity. RESULTS Physicians recognized obesity as a disability that poses challenges to high quality, safe, and efficient patient care. Observations coalesced around four themes: (1) difficulty routinely tracking weight; (2) reluctance to transfer obese patients to exam tables; (3) barriers to diagnostic testing; and (4) weight stigma. Physicians described difficulties accurately assessing weight, performing complete physical examinations, arranging diagnostic imaging, and providing prenatal care for obese patients. Lack of accessible medical diagnostic equipment impeded care for patients with obesity. Other participants did not contest comments of individual participants' that suggested weight stigma. CONCLUSIONS Our findings suggest that important gaps may remain in providing equitable access to care for patients with obesity, requiring additional training and accessible medical diagnostic equipment to safely accommodate these patients.
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Affiliation(s)
- Nicole D Agaronnik
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, United States
| | - Tara Lagu
- Institute for Healthcare Delivery and Population Science and Department of Medicine, Baystate Health, Springfield, MA, United States; University of Massachusetts Medical School, United States
| | - Christene DeJong
- Institute for Healthcare Delivery and Population Science and Department of Medicine, Baystate Health, Springfield, MA, United States
| | - Aixa Perez-Caraballo
- Institute for Healthcare Delivery and Population Science and Department of Medicine, Baystate Health, Springfield, MA, United States
| | | | - Julie Ressalam
- Center for Bioethics and Humanities, University of Colorado School of Medicine, United States
| | - Lisa I Iezzoni
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, United States; Department of Medicine, Harvard Medical School, United States.
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12
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Bouhmam H, Romanoski NL, Chetlen AL. Reducing Barriers to Breast Imaging in Patients with Mobility Limitations. JOURNAL OF BREAST IMAGING 2020; 2:56-60. [PMID: 38424998 DOI: 10.1093/jbi/wbz079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/29/2019] [Indexed: 03/02/2024]
Abstract
Over 1 billion people worldwide live with a disability. Patients living with disability are often challenged by many barriers to healthcare access, especially preventive and screening services. The Americans with Disabilities Act of 1990 mandated that access to public accommodations related to medical care in the United States be available to all; however, many healthcare facilities fall short of meeting this requirement. Research studies suggest that women with chronic disabilities are less likely to undergo breast cancer screening due to financial, environmental, and physical limitations, as well as psychological barriers. There is scarcity of research on the needs of individuals with mobility impairments and the features of the barriers they face when accessing healthcare services, especially breast imaging services. The objective of this article is to illustrate the existing barriers to breast imaging services that individuals with mobility impairments face and to provide a list of guidelines to be used in clinical practice for breast care practices and medical staff working with patients who have mobility impairments.
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Affiliation(s)
| | - Natasha L Romanoski
- Penn State Health-Hershey Medical Center, Department of Physical Medicine and Rehabilitation, Hershey, PA
| | - Alison L Chetlen
- Penn State Health-Hershey Medical Center, Department of Radiology, Hershey, PA
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13
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Koontz AM, Bass SR, Kulich HR. Accessibility facilitators and barriers affecting independent wheelchair transfers in the community. Disabil Rehabil Assist Technol 2020; 16:741-748. [PMID: 31913066 DOI: 10.1080/17483107.2019.1710771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study is to identify facilitators and barriers to wheelchair transfers in the community and to identify specific places and surfaces in the community where increasing transfer accessibility could enable greater participation. METHODS This study enrolled 112 wheeled mobility device users who completed a survey describing barriers to independent transfers. Descriptive statistics (means, standard deviations, and percentages) were used to report the survey results. RESULTS The majority of subjects (≥50% of the sample) who were impacted by the following features found them to be helpful while transferring: presence of transfer aids, presence of grab bars, large enough transfer surface size, storage space for a wheeled mobility device (WMD), large amounts of space and clearance for legs and feet, soft surfaces, and enough space next to the transfer surface. Ninety percent (90.5%) felt their participation was limited when surfaces higher than their WMD were encountered. Participants also reported feeling limited in their participation due to lack of transfer accessibility at a variety of community destinations, including medical facilities (35.1%), modes of transportation (38.5-52.1%), pools and hot tubs (45.4%), dressing rooms (50.0%), amusement parks (49.1%), and boating areas (52.1%). CONCLUSION Improving accessibility for independent transfers in the community may support greater participation and lead to a better quality of life. Study findings provide insight into changes that would make the built environment more accessible and safer for wheelchair users who independently transfer.Implications for rehabilitationTransferring independently is one of the most physically demanding tasks for wheelchair users, and physical and environmental factors may affect transferability in the community.Identifying environmental facilitators and barriers to transfers may improve accessibility for wheelchair users, allowing for greater community participation, reduced risk of falls and injuries, and improvements to quality of life.
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Affiliation(s)
- Alicia M Koontz
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah R Bass
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hailee R Kulich
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
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Mudrick NR, Swager LC, Breslin ML. Presence of Accessible Equipment and Interior Elements in Primary Care Offices. Health Equity 2019; 3:275-279. [PMID: 31223670 PMCID: PMC6585465 DOI: 10.1089/heq.2019.0006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose: To describe the disability accessibility level of primary care office interiors and the presence of accessible examination equipment. Methods: Data from on-site audits of 3993 primary care offices in California for 2013–2016 are descriptively analyzed. Architectural access is assessed using an instrument based on ADA Accessibility guidelines (ADAAG), along with noting accessibility of examination equipment. Results: Compliance across architectural elements was ∼85%. Accessible examination tables and scales were observed in 19.1% and 10.9% of offices, respectively. Conclusions: Proactive accessibility auditing makes visible the infrequent presence of accessible examination equipment. It offers data for tracking progress to increase medical office disability access.
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Affiliation(s)
- Nancy R Mudrick
- School of Social Work, Syracuse University, Syracuse, New York
| | - LeeAnn C Swager
- School of Social Work, Syracuse University, Syracuse, New York
| | - Mary Lou Breslin
- Disability Rights Education and Defense Fund, Berkeley, California
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15
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Kilic A, Tastan S, Guvenc G, Akyuz A. Breast and cervical cancer screening for women with physical disabilities: A qualitative study of experiences and barriers. J Adv Nurs 2019; 75:1976-1986. [PMID: 31087581 DOI: 10.1111/jan.14048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 02/20/2019] [Accepted: 04/17/2019] [Indexed: 12/24/2022]
Abstract
AIM To determine the experiences of women with physical disabilities regarding the barriers to their participation in breast and cervical cancer screening. DESIGN Qualitative descriptive study. METHOD Sixteen women who use wheelchairs were recruited. Data were collected via semi-structured face-to-face interviews between January - March 2017. Interviews were transcribed and data were analysed thematically. RESULTS Three main themes were uncovered: (a) Personal factors; such as lack of knowledge, fear and embarrassment, feeling anxious about the examination process and dependency on others; (b) Environmental and structural factors; and (c) expectations and suggestions of women with disabilities to enable their participation in screening. CONCLUSION The participation rate of women with physical disabilities in screening is low. The participation of women with disabilities in breast and cervical cancer screening may increase if physical barriers to accessing healthcare services are removed, appropriate and less time-consuming examination conditions are met, and healthcare personnel are informed about the needs of persons with disabilities. IMPACT Knowing the barriers for women with physical disabilities to participate in cancer screening can help health professionals develop new procedures to increase their participation to cancer screening. Women with physical disabilities encountered various barriers such as; lack of knowledge, fear and embarrassment, feeling anxious about the examination process and dependency on others, access to the healthcare services, environmental, physical limitations, and inadequate knowledge of healthcare professional about their disability. This study will guide healthcare professionals in developing strategies to increase the participation of women with physical disabilities in screening.
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Affiliation(s)
- Ayse Kilic
- Florance Nightingale Hospital School of Nursing, Demiroglu Bilim University, Istanbul, Turkey
| | - Sevinc Tastan
- Health Sciences Faculty, Nursing Department, Eastern Meditarrenean University, Fagamusta, Turkey
| | - Gulten Guvenc
- Gulhane Faculty of Nursing, University of Health Sciences, Ankara, Turkey
| | - Aygul Akyuz
- Florance Nightingale Hospital School of Nursing, Demiroglu Bilim University, Istanbul, Turkey
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Horner-Johnson W, Moe EL, Stoner RC, Klein KA, Edelman AB, Eden KB, Andresen EM, Caughey AB, Guise JM. Contraceptive knowledge and use among women with intellectual, physical, or sensory disabilities: A systematic review. Disabil Health J 2019; 12:139-154. [DOI: 10.1016/j.dhjo.2018.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 01/08/2023]
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Agaronnik N, Campbell EG, Ressalam J, Iezzoni LI. Accessibility of Medical Diagnostic Equipment for Patients With Disability: Observations From Physicians. Arch Phys Med Rehabil 2019; 100:2032-2038. [PMID: 30922882 DOI: 10.1016/j.apmr.2019.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 02/11/2019] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To explore attitudes and practices of physicians relating to accessible medical diagnostic equipment in serving patients with mobility disability. DESIGN Open-ended individual telephone interviews, which reached data saturation. Interview recordings were transcribed verbatim for qualitative conventional content analysis. SETTING Massachusetts, the United States, October 2017-January 2018. PARTICIPANTS Practicing physicians from 5 clinical specialties (N=20). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Common themes concerning physical accessibility. RESULTS Mean ± SD time in practice was 27.5±12.5 years; 14 practices had height-adjustable examination tables; and 7 had wheelchair-accessible weight scales. The analysis identified 6 broad themes: height-adjustable examination tables have advantages; height-adjustable examination tables have drawbacks; transferring patients onto examination tables is challenging; rationale for examining patients in their wheelchairs; perceptions of wheelchair-accessible weight scales; and barriers and facilitators to improving physical accessibility. Major barriers identified by participants included costs of equipment, limited space, and inadequate payment for extra time required to care for persons with disability. Even physicians with accessible examination tables sometimes examined patients seated in their wheelchairs. CONCLUSIONS Even if physicians have accessible equipment, they do not always use it in examining patients with disability. Future efforts will need to consider ways to eliminate these access barriers in clinical practice. Given small sample size, results are not generalizable to physicians nationwide and globally.
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Affiliation(s)
- Nicole Agaronnik
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, the United States
| | - Eric G Campbell
- Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, CO, the United States
| | - Julie Ressalam
- Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, CO, the United States
| | - Lisa I Iezzoni
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, the United States; Department of Medicine, Harvard Medical School, Boston, MA, the United States.
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18
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Chiu C, Bishop M, Pionke J, Strauser D, Santens RL. Barriers to the Accessibility and Continuity of Health-Care Services in People with Multiple Sclerosis: A Literature Review. Int J MS Care 2017; 19:313-321. [PMID: 29270089 PMCID: PMC5734715 DOI: 10.7224/1537-2073.2016-016] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Individuals with multiple sclerosis (MS) face a range of barriers to accessing and using health-care services. The aim of this review was to identify specific barriers to accessing and using health-care services based on a continuum of the health-care delivery system. METHODS Literature searches were conducted in the PubMed, PsycINFO, CINAHL, and Web of Science databases. The following terms were searched as subject headings, key words, or abstracts: health care, access, barriers, physical disability, and multiple sclerosis. The literature search produced 361 potentially relevant citations. After screening titles, abstracts, and citations, eight citations were selected for full-text review. RESULTS Health-care barriers were divided into three continuous phases of receiving health care. In the before-visit phase, the most commonly identified barrier was transportation. In the during-visit phase, communication quality was the major concern. In the after-visit phase, discontinued referral was the major barrier encountered. CONCLUSIONS There are multiple interrelated barriers to accessing and using health-care services along the health-care delivery continuum for people with MS and its associated physical disabilities, ranging from complex and long-recognized barriers that will likely require extended advocacy to create policy changes to issues that can and should be addressed through relatively minor changes in health-care delivery practices, improved care coordination, and increased provider awareness, education, and responsiveness to patients' needs.
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Maragh-Bass AC, Griffin JM, Phelan S, Finney Rutten LJ, Morris MA. Healthcare provider perceptions of accessible exam tables in primary care: Implementation and benefits to patients with and without disabilities. Disabil Health J 2017; 11:155-160. [PMID: 28456614 DOI: 10.1016/j.dhjo.2017.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 03/17/2017] [Accepted: 04/03/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recent healthcare mandates require availability of accessible medical exam equipment, which may reduce barriers to care for patients with disabilities (PWD). However, more research is needed to explore healthcare provider views on implementation and routine use of accessible equipment. OBJECTIVE This study qualitatively explored healthcare provider perceptions of: (1) daily use of accessible medical examination tables with PWD; and (2) recommendations for addressing challenges to using this equipment. METHODS Qualitative interviews and focus groups were conducted with physicians, nurse practitioners and registered nurses at a clinic where accessible examination tables were recently implemented in all clinic rooms. Data were coded and thematically analyzed by two researchers trained in qualitative methods. RESULTS A total of 17 providers participated in focus groups or interviews. Participants were mostly female (82%; N = 14), and registered nurses (47%; N = 8), but also included nurse practitioners (29.4%; N = 5), and physicians (23%; N = 4). Common themes were: (1) Ease of use and functionality of tables; and (2) Challenges with use and available training. Overall, providers reported satisfaction with the tables' ability to accommodate patients who are PWD, although they expressed challenges with functionally using the tables with specific populations, such as pediatric patients. CONCLUSIONS Healthcare organizations seeking to implement height-adjustable tables should account for structural requirements of the height-adjustable tables (e.g. accommodating clearance needed when planning room sizes). Practical recommendations and policies for integrating height-adjustable tables into routine clinical care are needed to ensure equitable care for PWD.
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Affiliation(s)
- Allysha C Maragh-Bass
- Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA
| | - Joan M Griffin
- Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Sean Phelan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Megan A Morris
- Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA; Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
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20
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Empowering Adults With Chronic Spinal Cord Injury to Prevent Secondary Conditions. Arch Phys Med Rehabil 2016; 97:1687-1695.e5. [DOI: 10.1016/j.apmr.2016.04.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 03/29/2016] [Accepted: 04/04/2016] [Indexed: 11/21/2022]
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21
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Sherrod BA, Dew DA, Rogers R, Rimmer JH, Eberhardt AW. Design and validation of a low cost, high-capacity weighing device for wheelchair users and bariatrics. Assist Technol 2016; 29:61-67. [PMID: 27450105 DOI: 10.1080/10400435.2016.1201170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Accessible high-capacity weighing scales are scarce in healthcare facilities, in part due to high device cost and weight. This shortage impairs weight monitoring and health maintenance for people with disabilities and/or morbid obesity. We conducted this study to design and validate a lighter, lower cost, high-capacity accessible weighing device. A prototype featuring 360 kg (800 lbs) of weight capacity, a wheelchair-accessible ramp, and wireless data transmission was fabricated. Forty-five participants (20 standing, 20 manual wheelchair users, and five power wheelchair users) were weighed using the prototype and a calibrated scale. Participants were surveyed to assess perception of each weighing device and the weighing procedure. Weight measurements between devices demonstrated a strong linear correlation (R2 = 0.997) with absolute differences of 1.4 ± 2.0% (mean±SD). Participant preference ratings showed no difference between devices. The prototype weighed 11 kg (38%) less than the next lightest high-capacity commercial device found by author survey. The prototype's estimated commercial price range, $500-$600, is approximately half the price of the least expensive commercial device found by author survey. Such low cost weighing devices may improve access to weighing instrumentation, which may in turn help eliminate current health disparities. Future work is needed to determine the feasibility of market transition.
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Affiliation(s)
- Brandon A Sherrod
- a School of Medicine , University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Dustin A Dew
- b Lakeshore Foundation , Birmingham , Alabama , USA
| | | | - James H Rimmer
- c School of Health Professions , University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Alan W Eberhardt
- d Department of Biomedical Engineering , University of Alabama at Birmingham, School of Engineering , Birmingham , Alabama , USA
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Houlihan B, Brody M, Plant A, Skeels SE, Zazula J, Pernigotti D, Green C, Hasiotis S, Jette A. Health Care Self-Advocacy Strategies for Negotiating Health Care Environments: Analysis of Recommendations by Satisfied Consumers with SCI and SCI Practitioners. Top Spinal Cord Inj Rehabil 2016; 22:13-26. [PMID: 29398890 PMCID: PMC5790025 DOI: 10.1310/sci2201-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bethlyn Houlihan
- Boston University School of Public Health, New England Regional Spinal Cord Injury Center, Health & Disability Research Institute, Boston, Massachusetts
| | - Miriam Brody
- Boston University School of Public Health, New England Regional Spinal Cord Injury Center, Health & Disability Research Institute, Boston, Massachusetts
| | - Andrea Plant
- The Life Care Center of America, Plymouth, Massachusetts
| | - Sarah Everhart Skeels
- Boston University School of Public Health, New England Regional Spinal Cord Injury Center, Health & Disability Research Institute, Boston, Massachusetts
| | - Judi Zazula
- Boston University School of Public Health, New England Regional Spinal Cord Injury Center, Health & Disability Research Institute, Boston, Massachusetts
| | | | | | | | - Alan Jette
- Boston University School of Public Health, New England Regional Spinal Cord Injury Center, Health & Disability Research Institute, Boston, Massachusetts
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Ramjan L, Cotton A, Algoso M, Peters K. Barriers to breast and cervical cancer screening for women with physical disability: A review. Women Health 2015; 56:141-56. [PMID: 26325597 DOI: 10.1080/03630242.2015.1086463] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This review critically examined the barriers to breast and cervical cancer screening services for women with physical disability and discussed ways forward to change practice. When compared to the rest of the community, women with disability were less likely to use preventive health screening services for multiple reasons. Moreover, women with disability live longer than in previous years, and as age is linked to an increased risk of developing cancer, it is imperative that the barriers to screening for these women become a focus of discussion. We designed an integrative literature review to investigate this. Multiple databases were systematically searched for literature published between 2001 and 2013. Search terms used were a combination (AND/OR) of key terms. After excluding duplicates and articles not meeting the eligibility criteria, twenty-five articles were systematically and critically reviewed. Sociodemographic factors were associated with less access to preventive health screening for women with disability. The literature reviewed indicated that this was complicated further by three prominent barriers: health insurance, health care workers, and physical barriers. Sociodemographic, health insurance, health workers, and physical barriers impair access for disabled women to breast and cervical cancer screening, which are vital measures in the timely detection of breast and cervical cancers and preventable morbidity and mortality. Measures are needed to address these limiting factors for women with disability so that they can be active participants in health care, rather than being marginalized because of their disability.
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Affiliation(s)
- Lucie Ramjan
- a School of Nursing and Midwifery , University of Western Sydney , Penrith , New South Wales , Australia
| | - Antoinette Cotton
- a School of Nursing and Midwifery , University of Western Sydney , Penrith , New South Wales , Australia
| | - Maricris Algoso
- a School of Nursing and Midwifery , University of Western Sydney , Penrith , New South Wales , Australia
| | - Kath Peters
- a School of Nursing and Midwifery , University of Western Sydney , Penrith , New South Wales , Australia
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Scheffler E, Visagie S, Schneider M. The impact of health service variables on healthcare access in a low resourced urban setting in the Western Cape, South Africa. Afr J Prim Health Care Fam Med 2015; 7:820. [PMID: 26245611 PMCID: PMC4656938 DOI: 10.4102/phcfm.v7i1.820] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 05/19/2015] [Accepted: 05/06/2015] [Indexed: 11/30/2022] Open
Abstract
Background Health care access is complex and multi-faceted and, as a basic right, equitable access and services should be available to all user groups. Objectives The aim of this article is to explore how service delivery impacts on access to healthcare for vulnerable groups in an urban primary health care setting in South Africa. Methods A descriptive qualitative study design was used. Data were collected through semi-structured interviews with purposively sampled participants and analysed through thematic content analysis. Results Service delivery factors are presented against five dimensions of access according to the ACCESS Framework. From a supplier perspective, the organisation of care in the study setting resulted in available, accessible, affordable and adequate services as measured against the District Health System policies and guidelines. However, service providers experienced significant barriers in provision of services, which impacted on the quality of care, resulting in poor client and provider satisfaction and ultimately compromising acceptability of service delivery. Although users found services to be accessible, the organisation of services presented them with challenges in the domains of availability, affordability and adequacy, resulting in unmet needs, low levels of satisfaction and loss of trust. These challenges fuelled perceptions of unacceptable services. Conclusion Well developed systems and organisation of services can create accessible, affordable and available primary healthcare services, but do not automatically translate into adequate and acceptable services. Focussing attention on how services are delivered might restore the balance between supply (services) and demand (user needs) and promote universal and equitable access.
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Affiliation(s)
- Elsje Scheffler
- Centre for Rehabilitation Studies, Stellenbosch University and Psychology Department, Stellenbosch University.
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25
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Morris MA, Yorkston K, Clayman ML. Improving communication in the primary care setting: perspectives of patients with speech disabilities. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2015; 7:397-401. [PMID: 24939644 DOI: 10.1007/s40271-014-0067-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients with speech disabilities can present with challenges when communicating during primary-care clinical encounters. Little is known about the healthcare communication experiences of patients with severe speech disabilities. METHODS Twelve participants took part in open-ended, in-person interviews. All participants had either acquired or developmental, severe speech disabilities but were not limited by cognitive and language disabilities. A multi-disciplinary team conducted a thematic analysis that included reading the transcripts and then developing and applying a list of codes through consensus. RESULTS Participants discussed provider behaviors that affected communication during clinical encounters. They wanted providers to acknowledge their competence by speaking directly to them and using age-appropriate language. Additionally, participants appreciated when providers adapted to their communication style by maintaining eye contact, asking the patient how to best communicate with them, providing time for the patient to communicate, not interrupting the patient, and admitting when they do not understand the patient. CONCLUSION Primary-care providers need to be cognizant of the communication needs of patients with communication disabilities. While the needs might be similar to other patient populations, patients with communication disabilities present with unique challenges. With accommodations, patients with speech disabilities can potentially be more engaged in their healthcare conversations.
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Affiliation(s)
- Megan A Morris
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA,
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Gulley SP, Rasch EK, Chan L. Difference, disparity, and disability: a comparison of health, insurance coverage, and health service use on the basis of race/ethnicity among US adults with disabilities, 2006-2008. Med Care 2014; 52:S9-16. [PMID: 25222647 PMCID: PMC4166572 DOI: 10.1097/mlr.0000000000000129] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the United States, research on health disparities has begun to include people with disabilities as a minority population. However, there is a gap in our knowledge of whether, and to what extent, racial and ethnic disparities may affect the health or health care access of people with disabilities. OBJECTIVES We examined potential disparities in overall health, insurance coverage status, and health service use between non-Hispanic whites, non-Hispanic blacks, and Hispanics, among a nationally representative US sample of adults with and without disabilities (N=63,257), using both bivariate and multivariate methods. We tested 2 definitions of disparity. RESULTS Under the more conservative definition, we confirmed the presence of both racial and ethnic disparities in overall health, total annual health care visits, and the percentage reporting no doctor visit during the year among people with less severe disabilities; Hispanics also evidenced a disparity in rates uninsured relative to non-Hispanic whites in this group. Racial/ethnic disparities were less common among persons with more severe disabilities that affected activities of daily living or instrumental activities. CONCLUSIONS We conclude that the reduction of disparities between the populations of people with and without disabilities will require specific attention to racial and ethnic disparities in health, insurance coverage, and service use.
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Affiliation(s)
- Stephen P. Gulley
- Brandeis University, Waltham, MA
- National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD
| | - Elizabeth K. Rasch
- National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD
| | - Leighton Chan
- National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD
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27
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Fung CH, Igodan U, Alessi C, Martin JL, Dzierzewski JM, Josephson K, Kramer BJ. Human factors/usability barriers to home medical devices among individuals with disabling conditions: in-depth interviews with positive airway pressure device users. Disabil Health J 2014; 8:86-92. [PMID: 25126995 DOI: 10.1016/j.dhjo.2014.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/19/2014] [Accepted: 06/17/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Evidence suggests that medical equipment often fails to accommodate the needs of individuals with disabling conditions. Few studies have focused on the accessibility of home medical devices such as positive airway pressure (PAP), which is a type of home medical equipment prescribed for long-term therapy. OBJECTIVE The purpose of this study was to explore in detail the types of difficulties experienced by patients with physical/sensory impairments who use PAP devices, as an initial step in designing a questionnaire to survey users about this topic. METHODS In this descriptive study, in-depth interviews were conducted with 19 participants (9 patients with physical/sensory impairment and 10 health care providers). Interviews were coded and analyzed for major topics. RESULTS Participants detailed the numerous ways in which current PAP devices fail to meet the needs of individuals with physical/sensory impairments (e.g., tremor, poor depth perception, paresis), by requiring patients to perform manually difficult tasks, such as inserting PAP parts through small apertures, attaching parts using a twisting motion, and lifting arms overhead to apply PAP headgear. These demands contributed to patients' frustration with and reduced usage of the home medical device. CONCLUSIONS Our findings suggest that home medical devices such as PAP may not be currently designed to meet the needs of some users with physical/sensory impairments. Additional studies are needed to measure the prevalence and impact of impairment-related barriers on PAP adherence for this common medical equipment.
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Affiliation(s)
- Constance H Fung
- David Geffen School of Medicine at University of California, Los Angeles, 16111 Plummer Street (11E), North Hills, CA 91343, USA; Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, 16111 Plummer Street (11E), North Hills, CA 91343, USA.
| | - Uyi Igodan
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, 16111 Plummer Street (11E), North Hills, CA 91343, USA
| | - Cathy Alessi
- David Geffen School of Medicine at University of California, Los Angeles, 16111 Plummer Street (11E), North Hills, CA 91343, USA; Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, 16111 Plummer Street (11E), North Hills, CA 91343, USA
| | - Jennifer L Martin
- David Geffen School of Medicine at University of California, Los Angeles, 16111 Plummer Street (11E), North Hills, CA 91343, USA; Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, 16111 Plummer Street (11E), North Hills, CA 91343, USA
| | - Joseph M Dzierzewski
- David Geffen School of Medicine at University of California, Los Angeles, 16111 Plummer Street (11E), North Hills, CA 91343, USA; Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, 16111 Plummer Street (11E), North Hills, CA 91343, USA
| | - Karen Josephson
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, 16111 Plummer Street (11E), North Hills, CA 91343, USA
| | - B Josea Kramer
- David Geffen School of Medicine at University of California, Los Angeles, 16111 Plummer Street (11E), North Hills, CA 91343, USA; Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, 16111 Plummer Street (11E), North Hills, CA 91343, USA
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Pharr JR. Accommodations for patients with disabilities in primary care: a mixed methods study of practice administrators. Glob J Health Sci 2013; 6:23-32. [PMID: 24373261 PMCID: PMC4825235 DOI: 10.5539/gjhs.v6n1p23] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 08/19/2013] [Accepted: 08/01/2013] [Indexed: 11/12/2022] Open
Abstract
Structural barriers that limit access to health care services for people with disabilities have been identified through qualitative studies; however, little is known about how patients with disabilities are accommodated in the clinical setting when a structural barrier is encountered. The purpose of this study was to identify how primary care medical practices in the United States accommodated people with disabilities when a barrier to service is encountered. Primary care practice administrators from the medical management organization were identified through the organization’s website. Sixty-three administrators from across the US participated in this study. Practice administrators reported that patients were examined in their wheelchairs (76%), that parts of the exam where skipped when a barrier was encountered (44%), that patients were asked to bring someone with them (52.4%) or that patients were refused treatment due to an inaccessible clinic (3.2%). These methods of accommodation would not be in compliance with requirements of the Americans with Disabilities Act. There was not a significant difference (p>0.05) in accommodations for patients with disabilities between administrators who could describe the application of the ADA to their clinic and those who could not. Practice administrators need a comprehensive understanding of the array of challenges encountered by patients with disabilities throughout the health care process and of how to best accommodate patients with disabilities in their practice.
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Predicting barriers to primary care for patients with disabilities: a mixed methods study of practice administrators. Disabil Health J 2013; 6:116-23. [PMID: 23507162 DOI: 10.1016/j.dhjo.2012.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 11/05/2012] [Accepted: 11/17/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND People with disabilities continue to be identified as a group who experience disparate health/health care. They are less likely to engage in some health care services. Structural barriers are often identified as one of the reasons for the underutilization of some health care services by people with disabilities. However, to date no study has been conducted to understand why structural barriers persist twenty years after the Americans with Disabilities Act (ADA) became law. OBJECTIVES We examined the relationship between primary care practice administrators' knowledge of the ADA and the number of accessibility barriers that patients with mobility disabilities might encounter. METHODS Primary care practice administrators who were members of a medical management organization were surveyed between December 20, 2011, and January 17, 2012. A mixed methods research design was employed. Data were analyzed using a Guttman scale, linear and multiple linear regression. RESULTS ADA knowledge questions conformed to a valid Guttman scale. There was a significant inverse relationship between practice administrators' knowledge of the ADA and the number of barriers reported in their clinics. Age of the administrators and buildings built before 1993 were also significant predictors of the number of barriers. CONCLUSION This study helps to identify medical practices that are more likely to have access barriers and have the greatest need for ADA compliance interventions. Results from this study highlight practice administrators' need for specific knowledge of the ADA as it applies to their medical practice. Efforts are needed to improve disability training for health professionals.
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Accessible medical equipment for patients with disabilities in primary care clinics: why is it lacking? Disabil Health J 2013; 6:124-32. [PMID: 23507163 DOI: 10.1016/j.dhjo.2012.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 10/24/2012] [Accepted: 11/18/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous research has identified inaccessible medical equipment as a barrier to health care services encountered by people with disabilities. However, no research has been conducted to understand why medical practices lack accessible equipment. OBJECTIVES/HYPOTHESIS The purpose of this study was to examine practice administrators' knowledge of accessible medical equipment and cost of accessible medical equipment to understand why medical practices lack such equipment. Hypotheses were: 1) Practice administrators lacked knowledge about accessible medical equipment and 2) The cost of accessible medical equipment was too great compared to standard equipment for the clinic. METHODS This study was a mixed methods survey of primary care practice administrators. The sixty-three participates were members of a medical management organization. Data were collected between December 20, 2011 and January 17, 2012. Proportions, Guttman scalogram, and Spearman's Rho correlation analyses were utilized. RESULTS For this sample, less than half of the administrators knew that accessible equipment existed and a fourth knew what accessible equipment existed. There was a significant (p < 0.01), positive correlation between knowledge of accessible equipment and pieces of accessible equipment in the clinics. Because less than half of the administrators had ever considered purchasing accessible equipment, it was inconclusive if cost of accessible equipment was too great. CONCLUSION Practice administrators' lack of knowledge of accessible medical equipment emphasizes the need not only for more education about the availability of accessible equipment but also about the importance of accessible equipment for their patients with disabilities and for physicians who provide them care.
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The association between difficulty using positive airway pressure equipment and adherence to therapy: a pilot study. Sleep Breath 2012; 17:853-9. [PMID: 23149875 DOI: 10.1007/s11325-012-0779-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 10/12/2012] [Accepted: 10/22/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Little is known about the ease of use of positive airway pressure (PAP) equipment and whether PAP equipment usability is associated with adherence. This pilot project aims to determine whether perceived difficulty with the mechanics of using PAP equipment is associated with nonadherence. METHODS Within a larger study of insomnia treatments, we screened (via telephone interview) 148 adults for sleep apnea/prior PAP use and asked them to describe the degree of difficulty putting on their PAP mask, adjusting their mask straps, turning dials/pushing PAP machine buttons, disconnecting tubing, and removing the machine's water chamber (five items; five-point Likert-like scale) and to report their PAP use (0 versus ≥1 days in the past week). RESULTS Mean age of participants was 66.7 years (SD 7.0). Thirty respondents (20.3 %) reported at least "some difficulty" with at least one aspect of PAP equipment usability, and 15 respondents (10.1 %) reported at least "quite a lot of difficulty" with one or more aspects of PAP equipment usability. Of the participants, 43.9 % reported not using PAP equipment at all during the past week. Participants (73.3 %) with substantial PAP equipment difficulty (at least quite a lot of difficulty) versus 40.6 % without substantial difficulty reported zero nights of PAP use in the past week (chi-square 5.86, p = .015). CONCLUSIONS Difficulty using PAP equipment is associated with PAP nonadherence. Studies are needed to confirm these findings and to identify determinants of poor usability. If findings are confirmed, strategies could be developed to improve PAP usability, which may improve adherence.
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Pharr JR, Bungum T. Health disparities experienced by people with disabilities in the United States: a Behavioral Risk Factor Surveillance System study. Glob J Health Sci 2012; 4:99-108. [PMID: 23121746 PMCID: PMC4776960 DOI: 10.5539/gjhs.v4n6p99] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 08/30/2012] [Indexed: 11/12/2022] Open
Abstract
The Americans with Disabilities Act became law in 1990; since then research has shown that people with disabilities continue to experience barriers to health care. The purpose of this study was to compare utilization of preventive services, chronic disease rates, and engagement in health risk behaviors of participants with differing severities of disabilities to those without disabilities. This study was a secondary analysis of 2010 data collected in the Behavioral Risk Factor Surveillance System national survey in the United States. Rao Chi square test and logistic regression were employed. Participants with disabilities had significantly higher adjusted odds ratios for all chronic diseases, for physical inactivity, obesity and smoking. They were significantly more likely to participate in some preventive services (flu/pneumonia vaccination, HIV test) and significantly less likely to participate in other preventive services (mammogram, Pap test). Our findings suggest that people with disabilities are less able to fully participate in all preventive services offered.
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Mudrick NR, Breslin ML, Liang M, Yee S. Physical accessibility in primary health care settings: results from California on-site reviews. Disabil Health J 2012; 5:159-67. [PMID: 22726856 DOI: 10.1016/j.dhjo.2012.02.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 02/05/2012] [Accepted: 02/08/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND People with disabilities report physical barriers in doctors' offices that affect the quality of care. Whether most or few doctors' offices are accessible is not known. We address this gap with data on 2389 primary care provider facilities. OBJECTIVES The analysis seeks to describe overall primary care office physical accessibility and identify (1) in which areas offices meet access criteria, (2) which accessibility criteria are most often not met, and (3) whether there are urban/non-urban differences. METHODS Reviewers rated medical offices using a 55-item instrument that assessed parking, exterior access, building entrance, interior public spaces, doctor's office interior, and the presence of accessible exam equipment. Five health plans that serve California Medicaid patients conducted reviews of providers signed with their plans. Data from the plans were merged, coded, and a descriptive analysis conducted. RESULTS An accessible weight scale was present in 3.6% and a height adjustable examination table in 8.4% of the sites. Other high prevalence access barriers were in bathrooms and examination rooms. Parking, exterior access, building access, and interior public spaces generally met the access criteria, except for van accessible parking. CONCLUSIONS These findings provide a base for quantitative expectations about accessibility nationwide, and indicate significant barriers exist. They show it is possible to conduct a large number of accessibility site reviews, providing one model to meet the Affordable Care Act requirement for provider accessibility information. Physical access is important as it may affect the quality of care and willingness of patients to engage in preventive care.
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Affiliation(s)
- Nancy R Mudrick
- School of Social Work, Syracuse University, Syracuse, NY 13244, USA.
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Mitra M, Bogen K, Long-Bellil LM, Heaphy D. Unmet needs for home and community-based services among persons with disabilities in Massachusetts. Disabil Health J 2011; 4:219-28. [DOI: 10.1016/j.dhjo.2011.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 07/30/2011] [Accepted: 08/21/2011] [Indexed: 11/30/2022]
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Story MF, Winters JM, Lemke MR, Barr A, Omiatek E, Janowitz I, Brafman D, Rempel D. Development of a method for evaluating accessibility of medical equipment for patients with disabilities. APPLIED ERGONOMICS 2010; 42:178-183. [PMID: 20723883 DOI: 10.1016/j.apergo.2010.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 01/31/2010] [Accepted: 07/18/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this study was to develop a method for evaluating accessibility of medical equipment for patients with disabilities. METHODS The researchers reviewed videotapes of patient-participants with various physical and sensory disabilities using different types of medical equipment. For each of 11 videotapes, four observers independently identified and documented access and safety barriers, such as physical, sensory, cognitive, and environmental barriers. Inter-observer variability for identifying barrier presence was assessed with kappa statistics for pairs of observers. RESULTS A list of 10 access and safety barriers was developed through an iterative consensus process, which identified design features of medical equipment that presented difficulties for participants with disabilities. The list is useful for identifying and categorizing accessibility problems found in equipment. While reliability of barrier identification was substantial or moderate for some barriers, reconciliation of barrier events identified by multiple video observers is recommended for optimal results.
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Affiliation(s)
- Molly Follette Story
- University of California, Berkeley, Bioengineering, 1301 S 46th Street, Bldg 163, Richmond, CA 94804, United States
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Mudrick NR, Schwartz MA. Health care under the ADA: A vision or a mirage? Disabil Health J 2010; 3:233-9. [DOI: 10.1016/j.dhjo.2010.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Revised: 07/08/2010] [Accepted: 07/13/2010] [Indexed: 10/19/2022]
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Burke K. It's time to go to the doctor's. Disabil Health J 2009; 2:167-8. [PMID: 21122756 DOI: 10.1016/j.dhjo.2009.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Revised: 06/25/2009] [Accepted: 06/25/2009] [Indexed: 11/30/2022]
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