Access barriers to medical facilities for people with physical disabilities: the case of Peru

Disability inclusion assessment in primary healthcare centers in Eastern Saudi Arabia: a way forward

Individuals with disabilities often experience barriers in accessing healthcare facilities, including physical barriers such as inaccessible facilities, transportation difficulties, and a lack of assistive devices. Other barriers may include a lack of communication assistive devices and stigma or negative attitudes from healthcare personnel or society. Published literature emphasizes the value of creating a supportive and safe environment for the inclusion of persons with disabilities in society. Establishing guidelines for disability inclusion becomes imperative to ensure equitable access to healthcare services. This study aimed to identify challenges related to accessibility in infrastructure, services, equipment, processes, and training in primary healthcare settings. The study was conducted in Dammam, AlKhobar, and AlQatif in August 2022, using an analytical, quantitative cross-sectional approach. A total of 56 primary healthcare centers (PHCs) were assessed across multiple domains. Government-built PHCs had an average accessibility rate of 83.2%, while those located in rented buildings scored an average of 67.1%. One domain that scored highly among both building types was the clinic rooms domain, with an average score of 90%. Conversely, the services domain showed significant differences, with an average accessibility rate of 47% for rented buildings and 75% for government-built buildings. Finally, the study looked into recommendations drawn from other health systems and recommended ways to help improve disability needs inclusion in the Eastern Region of Saudi Arabia.

A systematic review of population and patient perspectives and experiences as measured in Latin American and Caribbean surveys

High-quality health systems must provide accessible, people-centred care to both improve health and maintain population trust in health services. Furthermore, accurate measurement of population perspectives is vital to hold health systems accountable and to inform improvement efforts. To describe the current state of such measures in Latin America and the Caribbean (LAC), we conducted a systematic review of facility and population-based assessments that included patient-reported experience and satisfaction measures. Five databases were searched for publications on quantitative surveys assessing healthcare quality in Spanish- or Portuguese-speaking LAC countries, focusing on the domains of processes of care and quality impacts. We included articles published since 2011 with a national sampling frame or inclusion of multiple subnational regions. We tabulated and described these articles, identifying, classifying and summarizing the items used to assess healthcare quality into the domains mentioned earlier. Of the 5584 publications reviewed, 58 articles met our inclusion criteria. Most studies were cross-sectional (95%), assessed all levels of healthcare (57%) and were secondary analyses of existing surveys (86%). The articles yielded 33 unique surveys spanning 12 LAC countries; only eight of them are regularly administered surveys. The most common quality domains assessed were satisfaction (in 33 out of 58 articles, 57%), evidence-based/effective care (34%), waiting times (33%), clear communication (33%) and ease of use (31%). Items and reported ratings varied widely among instruments used, time points and geographical settings. Assessment of patient-reported quality measures through population- and facility-based surveys is present but heterogeneous in LAC countries. Satisfaction was measured frequently, although its use in accountability or informing quality improvement is limited. Measurement of healthcare quality in LAC needs to be more systematic, regular, comprehensive and to be led collaboratively by researchers, governments and policymakers to enable comparison of results across countries and to effectively inform policy implementation.

Teleconsultation for Children With Developmental Disabilities During the Coronavirus Pandemic: Caregivers' Experience

Background The unprecedented situation due to the coronavirus disease 2019 (COVID-19) lockdown necessitated the need for teleconsultations with caregivers of children with disabilities. The objective of this study was to explore the acceptability, satisfaction, perceived relevance, and barriers to teleconsultation from a caregiver's perspective. Methodology This was a descriptive qualitative study (telephonic interviews) involving in-depth interviews (IDIs) with the caregivers of children with developmental disabilities who received teleconsultations. Manual content analysis of transcripts of IDIs was done. Results Eight IDIs were conducted with the caregivers of children with cerebral palsy, autism, and developmental delay. The respondents expressed increased challenges in managing their children during the pandemic and the need for professional consultation. They also expressed difficulty in accessing professional help during the pandemic due to poor healthcare access and fear of getting COVID-19. The following responses were noted: "For almost a year we couldn't take her for the therapy," "We were unable to take him to therapy which resulted in an increase in tightness of his limbs, and he became more irritable." All respondents preferred video teleconsultations during lockdown due to flexible timings, ease of communication, and no travel restrictions; "I can benefit from teleconsultation because she does not have any physical problem." However, caregivers of children with physical ailments preferred face-to-face consultation. Conclusions Teleconsultation was found to effectively support the treatment and rehabilitation of children with disabilities during the COVID-19 lockdown, although direct face-to-face consultation was preferred by caregivers of children with physical ailments. The use of modern mobile/digital technologies creates new opportunities to improve the quality and accessibility of such services.

Water, land, and air: how do residents of Brazilian remote rural territories travel to access health services?

BACKGROUND

Ensuring adequate and safe means of travel is essential for maintaining and improving the health and well-being of residents of rural communities worldwide. This article maps costs, distances, travel times, and means of elective and urgent/emergency health transport in Brazilian remote rural municipalities.

METHODS

Multiple case studies were conducted in 27 remote rural municipalities using a qualitative method. A total of 178 key informants (managers, doctors, and nurses) were interviewed. Secondary data from national information systems were analyzed for the socioeconomic characterization, to identify the costs, distances, and travel times. Through the thematic content analysis of the interviews, the means of transport, and strategies developed by managers, professionals and users for their provision were identified.

RESULTS

The costs of traveling between remote rural municipalities and locations where most of specialized and hospital services are centered can compromise a significant part of the families' income. The insufficiency, restriction of days, times, and routes of health transport affects the selection of beneficiaries based on socioeconomic criteria in places of high vulnerability and less investment in road infrastructure. In remote rural municipalities, travelling to seek health care involves inter-municipal and intra-municipal flows, as their territories have dispersed populations. Several means of transport were identified - air, river, and land - which are often used in a complementary way in the same route. Some patients travel for more than 1000 km, with travel times exceeding 20 h, especially in the Amazon region. While the demands for urgent and emergency transport are partially met by national public policy, the same is not true for the elective transport of patients. The impossibility of providing health transport under the exclusive responsibility of the municipalities is identified.

CONCLUSIONS

For the remote rural municipalities populations, the absence of national public policies for sufficient, continuous, and timely provision of transport for health services worsens the cycle of inequities and compromises the assumption of the universal right to health care.

Accessibility in People with Disabilities in Primary Healthcare Centers: A Dimension of the Quality of Care

The purpose of this research is to evaluate universal accessibility in primary healthcare (PHC) centers in the Atacama region, Chile, through an analytical cross-sectional study with a quality approach, which uses the external audit model with the application of a dichotomous comparison guideline, evaluating levels of compliance with four dimensions of universal accessibility described in the literature: participation, information, accessibility chain and architectural aspects. This was carried out in 18 PHC, and set as Lower Control Limit (LCL) of 70% to compare levels of compliance, and a hierarchical model and k-mean analysis were applied. Results: Very low compliance averages were obtained, 37.7% participation, 4% information, 44.4% access chain, and 63.9% architectural aspects, indicating a critical situation. Moreover, the cluster comparison allowed to observe that a group of healthcare centers complies more than other groups, which requires more attention. Conclusions: The low level of accessibility for people with disabilities may be associated with various factors that require further monitoring and analysis. However, low levels of accessibility require changing the way of relating to this vulnerable group of the population, and considering including them in the design and reasonable adjustments made in PHC centers. The findings from this research open the possibility for future research that increases understanding of how to reduce barriers in a such wide variety of forms of disability.

Mobility impairment and life satisfaction in the Northern Region of Malawi

Background

There exist many psychosocial sequelae associated with mobility impairment, especially in low-resource settings where access to mobility assistive devices is limited.

Objectives

This study aims to (1) define the burden and presenting aetiologies of mobility impairment in the rural Northern Region of Malawi and (2) assess the relationship between physical disability, life satisfaction and access to mobility aids.

Methods

At mobility device donation clinics throughout the Northern Region of Malawi, adults living with mobility impairment were surveyed with a demographic questionnaire and a series of validated surveys to assess their physical activity levels (Global Physical Activity Questionnaire [GPAQ]), degree of mobility impairment (Washington Group Extended Set Questions on Disability) and life satisfaction (patient-reported outcomes measurement information systems satisfaction with participation in social roles and general life satisfaction).

Results

There were 251 participants who qualified for inclusion, of which 193 completed all surveys. Higher physical activity scores were positively correlated with increased life satisfaction: (1) satisfaction with participation in social roles (0.481, p < 0.0001) and (2) general life satisfaction (0.230, p < 0.001). Respondents who had previously used a formal mobility device reported 235.5% higher physical activity levels ([139.0%, 333.0%], p = 0.006), significantly higher satisfaction with participation in social roles ([0.21, 6.67], p = 0.037) and equivocally higher general life satisfaction ([-1.77, 3.84], p = 0.470).

Conclusion

Disability and mental health do not exist in isolation from one another. Given the positive correlations between formal mobility device usage and both physical activity and life satisfaction, interventions that increase access to mobility-assistive devices in undertreated populations are imperative.

Contribution

This study contributes to the understanding of the complex relationship between physical disability, access to mobility aids, and life satisfaction. Results from this study suggest the potential benefit that increasing access to mobility aids may have in improving the quality of life of mobility impaired persons in resource-limited settings, such as the Northern Region of Malawi.

Relationship between achieving Sustainable Development Goals and promoting optimal care and prevention of birth defects globally

Birth defects affect eight million newborns annually worldwide. About 8% of global under-5 mortality is attributable to birth defects. The United Nations (UN) Sustainable Development Goals (SDGs) have set 17 global goals for human growth and development to be achieved by 2030 using multi-sectorial approaches. The third goal (SDG-3) focuses on ensuring healthy lives and promoting well-being; achieving SDG-3 improves birth defects care and prevention. However, we aimed to show how achieving other SDGs also influence optimal care and prevention of birth defects. SDGs focused on poverty reduction, access to nutritious food, universal health coverage, equitable education, gender equality, environment, inclusivity through infrastructure innovation, and strengthening social justice is crucial to addressing social determinants of health for individuals and families affected by birth defects. Understanding birth defects in the context of several relevant SDGs will allow practitioners, researchers, and policymakers to leverage the momentum generated by SDGs and make a case for commitment and allocation of funding and resources for advancing birth defects surveillance, care, and prevention. SDGs are built on principles of equity and social justice and we urge policy-makers to approach birth defects using various SDGs as a catalyst. The synergy between several SDGs helps to optimize birth defect outcomes and prevention. Our effort to present a more comprehensive look at various SDGs and their relationship with birth defects is parallel to several other health advocacy groups conducting a similar mapping exercise, thus bringing to the forefront millions of lives that are impacted by birth defects worldwide.

Healthcare Barriers Among Working-Age Persons with Disabilities in Trinidad

Even though easily accessible and cost-effective healthcare is a fundamental human right, many persons with disabilities experience healthcare barriers and poor health outcomes. We explore the healthcare barriers among working-age persons with disabilities in Trinidad using a qualitative descriptive approach. Semi-structured interviews with 26 participants reveal barriers at the personal, healthcare facility, and societal levels. The findings indicate the need for a nation-wide integrated digitalized system and increased intersectoral collaborations to support adequate healthcare among persons with disabilities in Trinidad. Increased consultation with persons with disabilities and transformation of the disability discourses within the healthcare system and at the national level are also recommended as part of the humanisation of their care.