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Stillman MD, Mallow M, Ankam N, Ojeda J, Stephens M, Heckert K, Gustafson K. The Dearth of Disability Medical Education and a Partial Solution. TEACHING AND LEARNING IN MEDICINE 2024; 36:83-88. [PMID: 36082770 DOI: 10.1080/10401334.2022.2119239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
Issue: While over one-quarter of adult Americans have a disability, there is a paucity of disability-specific curricula in American medical schools and residency programs. Potential consequences of this educational dearth include persistent inaccessibility of health care facilities and delivery of inequitable health care to individuals with disabilities. Evidence: Several working groups have proposed disability-specific competencies for health professions education and means by which to integrate them into existing curricula. A limited number of medical schools and residency programs have formally introduced disability-specific materials into their curricula. To our knowledge, however, there are no generalist (internal medicine or family medicine) residency programs that offer specialized training in the clinical care of people with disabilities. Implications: Offering generalist physicians the opportunity to acquire the clinical and cognitive skills required to provide thorough and equitable health care to people with disabilities is critically important. There are too few physiatrists to see to their care needs. In this manuscript, we present a novel concentration in an Internal Medicine residency program in the care of individuals with a variety of disabilities. Our hope is that this work will initiate discussions among educational leaders about how to address the lack of graduate medical education-level training in disability care. We also hope it will afford program directors the opportunity to implement similar concentrations and tracks and will eventually produce a generation of generalists who are well-equipped to help care for people with disabilities.
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Affiliation(s)
- Michael D Stillman
- Department of Internal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael Mallow
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nethra Ankam
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jason Ojeda
- Department of Internal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mary Stephens
- Department of Family & Community Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kimberly Heckert
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kirstin Gustafson
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Buning GE, James TG, Richards B, McKee MM. Self-Reported Accommodation Needs for Patients with Disabilities in Primary Care. Jt Comm J Qual Patient Saf 2024; 50:59-65. [PMID: 38052659 DOI: 10.1016/j.jcjq.2023.10.012] [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: 06/05/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND People with disabilities experience barriers to engaging with health care due to inaccessible social and physical environments at primary care clinics. Despite legal mandates, identification and provision of necessary accommodations for this population at primary care clinics are poor. The objective of this cross-sectional study was to assess patient-reported disability status and accommodation needs among patients at a primary care clinic. METHODS An electronic health record-based Disability and Accommodations Questionnaire assessing disability status, types, and accommodation needs was developed by subject matter experts at Michigan Medicine and the University of Michigan Council for Disability Concerns. The questionnaire underwent multiple rounds of reviews and revisions before its use in clinical settings. A paper-based questionnaire was administered to all patients presenting for a wellness-based visit at an academic health system primary care clinic in southeast Michigan. Data were collected between March 2022 and August 2022. RESULTS Approximately 13% of the 541 patients self-reported a disability, with 54.2% indicating at least one needed accommodation. The most commonly reported disabilities were mental health and hearing-related disabilities, by 4.8% and 4.6% of patients, respectively. The most frequently requested accommodations were communication- or language-based (for example, presence of an American Sign Language interpreter, assistive listening devices), cognitive-based (for example, inclusion of a support person with care decisions), and mobility-based (for example, assistance with transfers). CONCLUSION The Disability and Accommodations Questionnaire helped identify the presence of a disability, its types, and any requested accommodations requested at a primary care health center.
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Sharma R, Kumar A, Suri V, Kaur S, Singh AJ. An integrated qualitative and quantitative study on sexual and reproductive health problems faced by women with disabilities in Chandigarh, India. Int J Gynaecol Obstet 2023; 163:818-824. [PMID: 37345270 DOI: 10.1002/ijgo.14931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 03/14/2023] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVES To estimate the prevalence of sexual and reproductive health (SRH) problems among women with disabilities (WWD) in Chandigarh, India, and to ascertain the difficulties experienced by WWD in accessing hospital services. METHODS This cross-sectional study was conducted during 2014 to 2017 in Chandigarh, India. The study participants were women 15 years and older with at least 40% disability. A pretested questionnaire and in-depth interview were used to determine sociodemographic profile, medical history, sexual and reproductive morbidity, treatment-seeking behavior, and the type, extent, and course of the disability. Verbatim responses of the participants were noted. Data were manually coded and collated into possible themes. RESULTS Postpolio residual paralysis (80; 30.7%) was the main reported disability, followed by severe sight impairment (52; 19.9%). A majority (170; 65%) of participants were unmarried. Of them, 66 (39%) were not willing to get married. The prevalence of SRH problems was high (151; 57.9%) among WWD, and only 82 (54%) took treatment. Dysmenorrhea (47; 31.1%), irregular periods (36; 23.8%), and vaginal discharge (17; 11.3%) were the main problems reported. The WWD in this study were likely to hide their SRH problems from others out of shame or fear. CONCLUSION Among WWD, the prevalence of SRH problems is high and obtaining relief is difficult.
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Affiliation(s)
- Ruchi Sharma
- Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | - Vanita Suri
- Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | | | - Amar Jeet Singh
- Community Medicine and School of Public Health, PGIMER, Chandigarh, India
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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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Holt L, Carney MH, Duncanson L, Hazen C, Kumar A, McKeon BA, Woodard L. Perceived Barriers to Gynecologic Care by Women Who Use Wheelchairs. Cureus 2021; 13:e15647. [PMID: 34306857 PMCID: PMC8279694 DOI: 10.7759/cureus.15647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/29/2022] Open
Abstract
Objective The aim of this study was to evaluate the current barriers associated with gynecologic care as perceived by women who use wheelchairs. Methods This qualitative study evaluated the barriers to gynecologic healthcare as described by female wheelchair users. We recruited English-speaking female participants aged 18 years and older who primarily used a wheelchair for mobility through flyer and email distribution. Interviews were conducted by three investigators using a semi-structured interview guide and recorded for transcription. Two investigators reviewed all transcriptions for accuracy which were then coded to identify emergent themes. Results The thematic saturation was achieved with 16 interviews. The most common barrier cited was transferring to the exam table (n=16). Women reported that their providers lacked knowledge and experience with women who use wheelchairs (n= 11). Conclusion There are many barriers to gynecologic care for women who use wheelchairs. Interventions are needed to improve accessibility to care for women who use wheelchairs.
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Affiliation(s)
- Lauren Holt
- Family and Community Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Madeline H Carney
- Family Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Lauren Duncanson
- Family and Community Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Christopher Hazen
- School of Health Sciences, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Ambuj Kumar
- Biostatistics and Epidemiology, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Bri Anne McKeon
- Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Laurie Woodard
- Family Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
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Nicolaidis C, Zhen KY, Lee J, Raymaker DM, Kapp SK, Croen LA, Urbanowicz A, Maslak J, Scharer M. Psychometric testing of a set of patient-reported instruments to assess healthcare interventions for autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:786-799. [PMID: 33103457 PMCID: PMC8068734 DOI: 10.1177/1362361320967178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Interventions to improve healthcare for autistic adults are greatly needed. To evaluate such interventions, researchers often use surveys to collect data from autistic adults (or sometimes, their supporters), but few survey measures have been tested for use with autistic adults. Our objective was to create and test a set of patient- or proxy-reported survey measures for use in studies that evaluate healthcare interventions. We used a community-based participatory research (CBPR) approach, in partnership with autistic adults, healthcare providers, and supporters. We worked together to create or adapt survey measures. Three survey measures focus on things that interventions may try to change directly: (1) how prepared patients are for visits; (2) how confident they feel in managing their health and healthcare; and (3) how well the healthcare system is making the accommodations patients feel they need. The other measures focus on the outcomes that interventions may hope to achieve: (4) improved patient-provider communication; (5) reduced barriers to care; and (6) reduced unmet healthcare needs. We then tested these measures in a survey of 244 autistic adults recruited from 12 primary care clinics in Oregon and California, USA (with 194 participating directly and 50 participating via a proxy reporter). Community partners made sure items were easy to understand and captured what was important about the underlying idea. We found the survey measures worked well in this sample. These measures may help researchers evaluate new healthcare interventions. Future research needs to assess whether interventions improve healthcare outcomes in autistic adults.
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Affiliation(s)
- Christina Nicolaidis
- Portland State University (PSU), USA
- Oregon Health & Science University (OHSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
| | - Kelly Y Zhen
- Portland State University (PSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
| | | | - Dora M Raymaker
- Portland State University (PSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
| | - Steven K Kapp
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
- University of Portsmouth, UK
| | | | - Anna Urbanowicz
- Portland State University (PSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
- RMIT University, Australia
| | - Joelle Maslak
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
| | - Mirah Scharer
- Portland State University (PSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
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Stillman MD, Ankam N, Mallow M, Capron M, Williams S. A survey of internal and family medicine residents: Assessment of disability-specific education and knowledge. Disabil Health J 2020; 14:101011. [PMID: 33041247 DOI: 10.1016/j.dhjo.2020.101011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/24/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The literature suggests that primary care physicians are inadequately educated in the care of people with disabilities. No study to date has evaluated whether internal medicine (IM) and family medicine (FM) residents have received disability-specific education or their level of comfort in caring for people with physical disabilities. OBJECTIVES To assess IM and FM residents' receipt of disability-specific education during medical school and residency; to evaluate their self-reported comfort in managing secondary conditions associated with physical disabilities and in coordinating therapies and services for individuals with disabilities; to gauge their interest in receiving disability-specific education. METHODS An on-line survey distributed to residents at a convenience sample of ten academic IM and FM residency programs in the northeastern United States. Participants (n = 176) were asked about their socio-demographic and training-specific characteristics and their self-assessed ability to manage secondary conditions associated with physical disabilities and coordinate care and services for individuals with disabilities. Chi Square tests were used to compare participant characteristics and outcomes. RESULTS Few participants had received disability-specific education during medical school or residency (34.6% and 11.2%, respectively), and nearly all (96.0%) expressed interest in receiving more. Small minorities reported feeling comfortable managing common secondary conditions or in coordinating therapies and services for individuals with disabilities. CONCLUSION Although one-fifth of adult Americans have a disability, few of our participating IM and FM residents had received disability-specific education or felt comfortable managing the care of people living with disabilities. Our results indicate a need to develop and disseminate disability-specific curricula.
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Affiliation(s)
- Michael D Stillman
- Department of Internal Medicine, Sidney Kimmel Medical College, 1100 Walnut Street, Suite 601, Philadelphia, PA, 19107, USA; Department of Rehabilitation Medicine, Sidney Kimmel Medical College, 25 South 9th Street, Philadelphia, PA, 19107, USA.
| | - Nethra Ankam
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, 25 South 9th Street, Philadelphia, PA, 19107, USA.
| | - Michael Mallow
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, 25 South 9th Street, Philadelphia, PA, 19107, USA.
| | - Maclain Capron
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, 25 South 9th Street, Philadelphia, PA, 19107, USA.
| | - Steve Williams
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, 25 South 9th Street, Philadelphia, PA, 19107, USA.
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Agaronnik ND, Pendo E, Campbell EG, Ressalam J, Iezzoni LI. Knowledge Of Practicing Physicians About Their Legal Obligations When Caring For Patients With Disability. Health Aff (Millwood) 2020; 38:545-553. [PMID: 30933590 DOI: 10.1377/hlthaff.2018.05060] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Disability civil rights laws require equitable treatment of the approximately sixty-one million Americans with disability. However, federal reports and numerous research studies indicate that this diverse and growing population often experiences health care disparities. To examine one possible contributing factor, we interviewed practicing physicians to explore their knowledge of their obligations to accommodate patients with disability under federal civil rights law. Interviewees reported having had little formal training about, and demonstrated superficial or incorrect understanding of, their obligations in three potentially problematic areas: deciding which accommodations their practices should implement, refusing patients with disability, and holding patients accountable for costs of accommodations. The fact that practicing physicians might not fully understand their legal responsibilities when caring for people with disability may contribute to persisting inequity in their care, and it suggests that further education in the Americans with Disabilities Act and other disability civil rights laws may be warranted.
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Affiliation(s)
- Nicole D Agaronnik
- Nicole D. Agaronnik is a research assistant in the Mongan Institute Health Policy Center, Massachusetts General Hospital, in Boston
| | - Elizabeth Pendo
- Elizabeth Pendo is a professor in the Center for Health Law Studies, Saint Louis University School of Law, in Missouri
| | - Eric G Campbell
- Eric G. Campbell is a professor and director of research in the Center for Bioethics and Humanities, Anschutz Medical Campus, University of Colorado, in Denver
| | - Julie Ressalam
- Julie Ressalam is a research assistant in the Center for Bioethics and Humanities, Anschutz Medical Campus, University of Colorado
| | - Lisa I Iezzoni
- Lisa I. Iezzoni ( ) is a professor of medicine in the Department of Medicine, Harvard Medical School, and based at the Mongan Institute Health Policy Center, Massachusetts General Hospital
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Accessibility and accommodations for patients with mobility disabilities in a large healthcare system: How are we doing? Disabil Health J 2019; 12:679-684. [DOI: 10.1016/j.dhjo.2019.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/01/2019] [Accepted: 03/21/2019] [Indexed: 11/19/2022]
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10
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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: 17] [Impact Index Per Article: 3.4] [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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Sabatello M. Cultivating inclusivity in precision medicine research: disability, diversity, and cultural competence. J Community Genet 2018; 10:363-373. [PMID: 30539340 DOI: 10.1007/s12687-018-0402-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 12/03/2018] [Indexed: 12/31/2022] Open
Abstract
Cultural competence is increasingly viewed as key for the inclusion of diverse populations in precision medicine research (PMR) in the USA. Precision medicine researchers and personnel are thus increasingly expected to undergo cultural competency trainings and to engage with relevant racial/ethnic communities to ensure that all research components are culturally and linguistically sensitive to these communities. However, the need for PMR enterprises to ensure competence with and understanding of disability rights, history, and needs (hereinafter disability culture competency) have not received attention. This article discusses the importance of disability inclusivity in PMR and the construct-and challenges-of disability as a cultural community. Reviewing and extrapolating from studies in healthcare settings, the article considers three interrelated issues that are likely to impact disability inclusivity in PMR: disability accessibility and accommodation; disability stigma and unconsious bias; and disability language and communication. Next, disability competency trainings that were developed in healthcare settings are surveyed and their applicability for PMR is discussed. The arguments advanced are that disability culture competency among precision medicine researchers, personnel, and oversight committees is essential to upholding the welfare and rights of human subjects with disabilities in PMR; that engagement with disability communities is imperative for this endeavor; and that such knowledge of disability culture is crucial for cultivating inclusivity of people with different (dis)abilities in PMR.
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Affiliation(s)
- Maya Sabatello
- Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Columbia University, New York, NY, USA. .,NY State Psychiatric Institute, 1051 Riverside Drive, Unit 122, New York, NY, 10032, USA.
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12
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Vergunst R, Swartz L, Hem KG, Eide AH, Mannan H, MacLachlan M, Mji G, Braathen SH, Schneider M. Access to health care for persons with disabilities in rural South Africa. BMC Health Serv Res 2017; 17:741. [PMID: 29149852 PMCID: PMC5693516 DOI: 10.1186/s12913-017-2674-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 11/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Global research suggests that persons with disabilities face barriers when accessing health care services. Yet, information regarding the nature of these barriers, especially in low-income and middle-income countries is sparse. Rural contexts in these countries may present greater barriers than urban contexts, but little is known about access issues in such contexts. There is a paucity of research in South Africa looking at "triple vulnerability" - poverty, disability and rurality. This study explored issues of access to health care for persons with disabilities in an impoverished rural area in South Africa. METHODS The study includes a quantitative survey with interviews with 773 participants in 527 households. Comparisons in terms of access to health care between persons with disabilities and persons with no disabilities were explored. The approach to data analysis included quantitative data analysis using descriptive and inferential statistics. Frequency and cross tabulation, comparing and contrasting the frequency of different phenomena between persons with disabilities and persons with no disabilities, were used. Chi-square tests and Analysis of Variance tests were then incorporated into the analysis. RESULTS Persons with disabilities have a higher rate of unmet health needs as compared to non-disabled. In rural Madwaleni in South Africa, persons with disabilities faced significantly more barriers to accessing health care compared to persons without disabilities. Barriers increased with disability severity and was reduced with increasing level of education, living in a household without disabled members and with age. CONCLUSIONS This study has shown that access to health care in a rural area in South Africa for persons with disabilities is more of an issue than for persons without disabilities in that they face more barriers. Implications are that we need to look beyond the medical issues of disability and address social and inclusion issues as well.
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Affiliation(s)
- R. Vergunst
- Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, PO Box X1, Stellenbosch, Matieland 7602 South Africa
| | - L. Swartz
- Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, PO Box X1, Stellenbosch, Matieland 7602 South Africa
| | - K.-G. Hem
- SINTEF Technology and Society, Department of Health Research, PB 124 Blindern, 0314 Oslo, Norway
| | - A. H. Eide
- SINTEF Technology and Society, Department of Health Research, PB 124 Blindern, 0314 Oslo, Norway
- Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa
| | - H. Mannan
- School of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - M. MacLachlan
- Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa
- ALL Institute and Department of Psychology, Maynooth University, Maynooth, Ireland
- Olomouc University Social Health Institute, Palacký University Olomouc, Olomouc, Czech Republic
| | - G. Mji
- Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa
| | - S. H. Braathen
- Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, PO Box X1, Stellenbosch, Matieland 7602 South Africa
- SINTEF Technology and Society, Department of Health Research, PB 124 Blindern, 0314 Oslo, Norway
| | - M. Schneider
- Alan J Flisher Centre for Public Mental Health Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
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Vergunst R, Swartz L, Mji G, MacLachlan M, Mannan H. 'You must carry your wheelchair'--barriers to accessing healthcare in a South African rural area. Glob Health Action 2015; 8:29003. [PMID: 26434691 PMCID: PMC4592846 DOI: 10.3402/gha.v8.29003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/22/2015] [Accepted: 09/07/2015] [Indexed: 11/18/2022] Open
Abstract
Background There is international evidence that people with disabilities face barriers when accessing primary healthcare services and that there is inadequate information about effective interventions that work to improve the lives of people with disabilities, especially in low-income and middle-income countries. Poor rural residents generally experience barriers to accessing primary healthcare, and these problems are further exacerbated for people with disabilities. Objective In this study, we explore the challenges faced by people with disabilities in accessing healthcare in Madwaleni, a poor rural Xhosa community in South Africa. Design Purposive sampling was done with 26 participants, using semi-structured interviews and content analysis to identify major themes. Results This study showed a number of barriers to healthcare for people with disabilities. These included practical barriers, including geographical and staffing issues, and attitudinal barriers. Conclusions It is suggested that although there are practical barriers that need to be addressed, attitudinal barriers could potentially be addressed more easily and cost effectively.
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Affiliation(s)
- Richard Vergunst
- Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Leslie Swartz
- Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa;
| | - Gubela Mji
- Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa
| | - Malcolm MacLachlan
- Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa.,Centre for Global Health, School of Psychology, Trinity College, Dublin, Ireland
| | - Hasheem Mannan
- School of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland
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14
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McColl MA, Aiken A, Schaub M. Do people with disabilities have difficulty finding a family physician? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:4638-51. [PMID: 25927477 PMCID: PMC4454931 DOI: 10.3390/ijerph120504638] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/13/2015] [Accepted: 04/20/2015] [Indexed: 11/16/2022]
Abstract
Primary care has been ideally characterized as the medical home for all citizens, and yet recent data shows that approximately 6% do not have a family physician, and only 17.5% of family practices are open to new patients. Given acknowledged shortages of family physicians, this research asks the question: Do people with disabilities have particular difficulty finding a family physician? Health Care Connect (HCC) is a government-funded agency in Ontario Canada, designed to "help Ontarians who are without a family health care provider to find one". Using data from HCC, supplemented by interviews with HCC staff, the study explores the average wait time for patients with disabilities to be linked with a primary care physician, and the challenges faced by agency staff in doing so. The study found that disabled registrants with the program are only slightly disadvantaged in terms of wait times to find a family physician, and success rates are ultimately comparable; however, agency staff report that there are a number of significant challenges associated with placing disabled patients.
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Affiliation(s)
- Mary Ann McColl
- School of Rehabilitation Therapy, Queen's University, Kingston, ON K7L-3N6, Canada.
- Centre for Health Services & Policy Research, Queen's University, Kingston, ON K7L-3N6, Canada.
| | - Alice Aiken
- School of Rehabilitation Therapy, Queen's University, Kingston, ON K7L-3N6, Canada.
| | - Michael Schaub
- Centre for Health Services & Policy Research, Queen's University, Kingston, ON K7L-3N6, Canada.
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