The Zimbabwe Patients’ Charter of Rights: Effects on Health Care Access by People with Disabilities Living with HIV and AIDS

Abstract Introduction People with disabilities experience significant health inequalities. In Malawi, where most individuals live in low-income rural settings, many of these inequalities are exacerbated by restricted access to health care services. This qualitative study explores the barriers to health care access experienced by individuals with a mobility or sensory impairment, or both, living in rural villages in Dowa district, central Malawi. In addition, the impact of a chronic lung condition, alongside an impairment, on health care accessibility is explored. Method Using data from survey responses obtained through the Research for Equity And Community Health (REACH) Trust’s randomised control trial in Malawi, 12 adult participants, with scores of either 3 or 4 in the Washington Group Questions, were recruited. People with cognitive impairments were excluded. Each of the selected participants underwent an individual in-depth interview and full recordings of these were then transcribed and translated. Findings and discussion Through thematic analysis of the transcripts, three main barriers to timely and adequate health care were identified: 1) Cost of transport, drugs and services, 2) Insufficient health care resources, and 3) Dependence on others. Other barriers identified were distance to a facility, which was most hindering for the participants with a chronic lung condition, and unfavourable health seeking behaviour, whilst ‘time’ was found to be a common underlying factor. Attitudinal factors were not found to influence health care accessibility for this cohort. Conclusions This study finds that health care access for people with disabilities in rural Malawi is hindered by closely interconnected financial, practical and social barriers. There is a clear requirement for policy makers to consider the challenges identified here, and in similar studies, and to address them through improved social security systems and health system infrastructure, including outreach services, in a drive for equitable health care access and provision.

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Access to health care for people with disabilities in rural Malawi: what are the barriers?

10.21203/rs.2.13970/v3 ◽

2020 ◽

Author(s):

Josephine Harrison ◽

Rachael Thomson ◽

Hastings T. Banda ◽

Grace B. Mbera ◽

Stefanie Gregorius ◽

...

Keyword(s):

Health Care ◽

Health Care Access ◽

Access To Health Care ◽

People With Disabilities ◽

Randomised Control Trial ◽

Sensory Impairment ◽

Care Access ◽

Health Care Accessibility ◽

Access To Health ◽

The Impact

Abstract Background People with disabilities experience significant health inequalities. In Malawi, where most individuals live in low-income rural settings, many of these inequalities are exacerbated by restricted access to health care services. This qualitative study explores the barriers to health care access experienced by individuals with a mobility or sensory impairment, or both, living in rural villages in Dowa district, central Malawi. In addition, the impact of a chronic lung condition, alongside a mobility or sensory impairment, on health care accessibility is explored. Methods Using data from survey responses obtained through the Research for Equity And Community Health (REACH) Trust’s randomised control trial in Malawi, 12 adult participants, with scores of either 3 or 4 in the Washington Group Short Set (WGSS) questions, were recruited. The WGSS questions concern a person’s ability in core functional domains (including seeing, hearing and moving), and a score of 3 indicates ‘a lot of difficulty’ whilst 4 means ‘cannot do at all’. People with cognitive impairments were not included in this study. All who were selected for the study participated in an individual in-depth interview and full recordings of these were then transcribed and translated. Results Through thematic analysis of the transcripts, three main barriers to timely and adequate health care were identified: 1) Cost of transport, drugs and services, 2) Insufficient health care resources, and 3) Dependence on others. Attitudinal factors were explored and, whilst unfavourable health seeking behaviour was found to act as an access barrier for some participants, community and health care workers’ attitudes towards disability were not reported to influence health care accessibility in this study. Conclusions This study finds that health care access for people with disabilities in rural Malawi is hindered by closely interconnected financial, practical and social barriers. There is a clear requirement for policy makers to consider the challenges identified here, and in similar studies, and to address them through improved social security systems and health system infrastructure, including outreach services, in a drive for equitable health care access and provision.

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Telehealth Use By Persons with Disabilities During the COVID-19 Pandemic

International Journal of Telerehabilitation ◽

10.5195/ijt.2021.6402 ◽

2021 ◽

Vol 13 (2) ◽

Author(s):

Carli Friedman ◽

Laura VanPuymbrouck

Keyword(s):

Health Care ◽

Health Care Access ◽

Secondary Analysis ◽

People With Disabilities ◽

Census Bureau ◽

United States Census ◽

United States Census Bureau ◽

Persons With Disabilities ◽

Care Access ◽

Second Year

Telehealth use rapidly expanded during the COVID-19 pandemic. Understanding if, and how, people from disabilities used telehealth during the pandemic is vital to assuring this evolving and increasingly common form of health care is equitably developed and delivered to avoid reproducing the health disparities people with disabilities already face. Our aim was to explore the use of telehealth among people with disabilities during the pandemic. We conducted a weighted secondary analysis of United States Census Bureau data (April-July 2021) from 38,512 (unweighted) people with disabilities. Our findings revealed 39.8% of people with disabilities used telehealth during the second year of the pandemic, ranging from 34.5% of people with hearing disabilities to 43.3% of people with mobility disabilities. There were also differences in telehealth use based on sociodemographics. Telehealth promises to open doors to more equitable health care access for many people with disabilities, but only if access barriers are removed.

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Community Engagement in Health Care: An Approach to Improve Health Care Access for People with Disabilities

Disability Studies Quarterly ◽

10.18061/dsq.v37i3.5254 ◽

2017 ◽

Vol 37 (3) ◽

Author(s):

Dianne Sabat ◽

Michael Richardson ◽

Kathe F. Matrone ◽

Darrin Umbarger ◽

Angela Weaver

Keyword(s):

Health Care ◽

Community Engagement ◽

Health Care Access ◽

People With Disabilities ◽

Local Communities ◽

Provider Attitudes ◽

Care Access ◽

Physical Accessibility ◽

Significant Health ◽

Improve Health

People with disabilities (PWD) experience significant health disparities, at least partly due to difficulties accessing health care. These difficulties are multi-focal, including difficulties with transportation, effective communication, physical accessibility, and provider attitudes. Community engagement offers one method for working with local communities around health care access for PWD. By engaging PWD and the local infrastructure (e.g., providers, government, transportation, advocates), unique solutions are generated and awareness in the community is increased. We describe the use of our approach "Community Engagement in Health Care" with one such Oregon community.

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Effects of the Medicaid expansion under the Affordable Care Act on health insurance coverage, health care access, and use for people with disabilities

Disability and Health Journal ◽

10.1016/j.dhjo.2021.101180 ◽

2021 ◽

pp. 101180

Author(s):

Xiaobei Dong ◽

Tim Gindling ◽

Nancy A. Miller

Keyword(s):

Health Care ◽

Health Insurance ◽

Affordable Care Act ◽

Health Care Access ◽

Insurance Coverage ◽

People With Disabilities ◽

Health Insurance Coverage ◽

Medicaid Expansion ◽

Care Access ◽

The Affordable Care Act

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Validation of the integration of HIV and AIDS related nursing competencies into the undergraduate nursing curriculum in South Africa

Curationis ◽

10.4102/curationis.v38i2.1521 ◽

2015 ◽

Vol 38 (2) ◽

Author(s):

Regis R. Marie Modeste ◽

Oluyinka Adejumo

Keyword(s):

South Africa ◽

Health Care ◽

Health Care Access ◽

Personal Development ◽

Process Model ◽

Hiv And Aids ◽

Nursing Curriculum ◽

Undergraduate Nursing ◽

Care Access ◽

Nursing Competencies

Background: Being in its fourth decade, HIV remains an epidemic that requires combined efforts for the global fight. The strategies planned and implemented in the fight against HIV include reversing and halting the spread of HIV, increasing health care access, and strengthening the health care system. South Africa has made the fight one of its top priorities, and has developed plans to increase the role of nurses in the management of HIV, demonstrating its willingness, commitment and progress in the fight against HIV.Objective: This article presents the validation process conducted to confirm the integration and mapping of the HIV and AIDS related nursing competencies into the four-year Bachelor of Nursing programme at a university in South Africa.Methods: This study adopted a constructivist paradigm, using a qualitative approach, applyingthe design step of the process model of curriculum development, to validate the inte gration of the mapped HIV and AIDS related nursing competencies into the undergraduate nursing curriculum.Results: For each competency, outcomes were developed for each year. Participants confirmed completeness of outcomes and appropriateness of the mapping of the HIV and AIDS related outcomes into the nursing curriculum, as well as the feasibility and practicability of the integration.Conclusion: Required resources for integration of HIV and AIDS related nursing competencies, such as human resources and nurse educators’ continued personal development were identified, as well as barriers to integration, and measures to eliminate them were discussed. The importance of integration of HIV and AIDS nursing competencies into the curriculum was reiterated.

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Access to health care for people with disabilities in rural Malawi: what are the barriers?

10.21203/rs.2.13970/v2 ◽

2020 ◽

Author(s):

Josephine Harrison ◽

Rachael Thomson ◽

Hastings T. Banda ◽

Grace B. Mbera ◽

Stefanie Gregorius ◽

...

Keyword(s):

Health Care ◽

Health Care Access ◽

Access To Health Care ◽

People With Disabilities ◽

Randomised Control Trial ◽

Sensory Impairment ◽

Care Access ◽

Health Care Accessibility ◽

Access To Health ◽

The Impact

Abstract Background People with disabilities experience significant health inequalities. In Malawi, where most individuals live in low-income rural settings, many of these inequalities are exacerbated by restricted access to health care services. This qualitative study explores the barriers to health care access experienced by individuals with a mobility or sensory impairment, or both, living in rural villages in Dowa district, central Malawi. In addition, the impact of a chronic lung condition, alongside a mobility or sensory impairment, on health care accessibility is explored. Methods Using data from survey responses obtained through the Research for Equity And Community Health (REACH) Trust’s randomised control trial in Malawi, 12 adult participants, with scores of either 3 or 4 in the Washington Group Short Set (WGSS) questions, were recruited. The WGSS questions concern a person’s ability in core functional domains (including seeing, hearing and moving), and a score of 3 indicates ‘a lot of difficulty’ whilst 4 means ‘cannot do at all’. People with cognitive impairments were not included in this study. All who were selected for the study participated in an individual in-depth interview and full recordings of these were then transcribed and translated. Results Through thematic analysis of the transcripts, three main barriers to timely and adequate health care were identified: 1) Cost of transport, drugs and services, 2) Insufficient health care resources, and 3) Dependence on others. Attitudinal factors were explored and, whilst unfavourable health seeking behaviour was found to act as an access barrier for some participants, community and health care workers’ attitudes towards disability were not reported to influence health care accessibility in this study. Conclusions This study finds that health care access for people with disabilities in rural Malawi is hindered by closely interconnected financial, practical and social barriers. There is a clear requirement for policy makers to consider the challenges identified here, and in similar studies, and to address them through improved social security systems and health system infrastructure, including outreach services, in a drive for equitable health care access and provision.

Download Full-text

Access to health care for people with disabilities in rural Malawi: what are the barriers?

10.21203/rs.2.13970/v4 ◽

2020 ◽

Author(s):

Josephine Harrison ◽

Rachael Thomson ◽

Hastings T. Banda ◽

Grace B. Mbera ◽

Stefanie Gregorius ◽

...

Keyword(s):

Health Care ◽

Health Care Access ◽

Access To Health Care ◽

People With Disabilities ◽

Randomised Control Trial ◽

Sensory Impairment ◽

Care Access ◽

Health Care Accessibility ◽

Access To Health ◽

The Impact

Abstract Background People with disabilities experience significant health inequalities. In Malawi, where most individuals live in low-income rural settings, many of these inequalities are exacerbated by restricted access to health care services. This qualitative study explores the barriers to health care access experienced by individuals with a mobility or sensory impairment, or both, living in rural villages in Dowa district, central Malawi. In addition, the impact of a chronic lung condition, alongside a mobility or sensory impairment, on health care accessibility is explored. Methods Using data from survey responses obtained through the Research for Equity And Community Health (REACH) Trust’s randomised control trial in Malawi, 12 adult participants, with scores of either 3 or 4 in the Washington Group Short Set (WGSS) questions, were recruited. The WGSS questions concern a person’s ability in core functional domains (including seeing, hearing and moving), and a score of 3 indicates ‘a lot of difficulty’ whilst 4 means ‘cannot do at all’. People with cognitive impairments were not included in this study. All who were selected for the study participated in an individual in-depth interview and full recordings of these were then transcribed and translated. Results Through thematic analysis of the transcripts, three main barriers to timely and adequate health care were identified: 1) Cost of transport, drugs and services, 2) Insufficient health care resources, and 3) Dependence on others. Attitudinal factors were explored and, whilst unfavourable health seeking behaviour was found to act as an access barrier for some participants, community and health care workers’ attitudes towards disability were not reported to influence health care accessibility in this study. Conclusions This study finds that health care access for people with disabilities in rural Malawi is hindered by closely interconnected financial, practical and social barriers. There is a clear requirement for policy makers to consider the challenges identified here, and in similar studies, and to address them through improved social security systems and health system infrastructure, including outreach services, in a drive for equitable health care access and provision. Key words Health care access, barriers, disability, impairment, Malawi, rural, in-depth interviews

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