Estimating need and coverage for five priority assistive products: a systematic review of global population-based research

Abstract

IntroductionTo improve access to assistive products (APs) globally, data must be available to inform evidence-based decision-making, policy development and evaluation, and market-shaping interventions.MethodsThis systematic review was undertaken to identify studies presenting population-based estimates of need and coverage for five APs (hearing aids, limb prostheses, wheelchairs, glasses and personal digital assistants) grouped by four functional domains (hearing, mobility, vision and cognition).ResultsData including 656 AP access indicators were extracted from 207 studies, most of which (n=199, 96%) were cross-sectional, either collecting primary (n=167) or using secondary (n=32) data. There was considerable heterogeneity in assessment approaches used and how AP indicators were reported; over half (n=110) used a combination of clinical and self-reported assessment data. Of 35 studies reporting AP use out of all people with functional difficulty in the corresponding functional domains, the proportions ranged from 4.5% to 47.0% for hearing aids, from 0.9% to 17.6% for mobility devices, and from 0.1% to 86.6% for near and distance glasses. Studies reporting AP need indicators demonstrated >60% unmet need for each of the five APs in most settings.ConclusionVariation in definitions of indicators of AP access have likely led to overestimates/underestimates of need and coverage, particularly, where the relationship between functioning difficulty and the need for an AP is complex. This review demonstrates high unmet need for APs globally, due in part to disparate data across this sector, and emphasises the need to standardise AP data collection and reporting strategies to provide a comparable evidence base to improve access to APs.

Exploring the Use of Washington Group Questions to Identify People with Clinical Impairments Who Need Services including Assistive Products: Results from Five Population-Based Surveys

“…Fifth, when using the WG questions in service/AP need surveys, consideration could be given to ask about the presence of functional difficulties without the use of assistance or APs. For example, Danemayer et al’s systematic review recommended AP indicators of total need and met need, as well as unmet and undermet need for service/AP need, are collected in population-based surveys [ 50 ]. To collect these data, a first-stage screening would also need to capture people who are using services/APs who could then undergo impairment assessment.…”

Disability and the achievement of Universal Health Coverage in the Maldives

“…seeing, hearing, walking, remembering) and most have four response options on level of difficulty experienced in performing each activity (none, some, a lot, cannot do). People were defined as having a disability if they reported "a lot of difficulty" or "cannot do at all" for at least one question or experienced "daily" symptoms of anxiety or depression at an intensity described as "a lot" (adults 18+; "daily" symptoms for children [5][6][7][8][9][10][11][12][13][14][15][16][17]. People were also defined as having a disability if they received the Disability Allowance or reported a health condition that made them eligible for the Disability Allowance (e.g.…”

“…Poor availability, quality and affordability of services can lead to unmet needs for many people with disabilities, resulting in worsening health and functioning [ 2 ]. These gaps may be particularly pronounced for people with disabilities living in rural areas, or with certain types of impairments [ 4 , 6 , 7 ]. They may also incur higher healthcare costs, as they may need to seek care more often and incur additional costs in doing so (e.g.…”

Assistive technology access in longitudinal datasets: a global review

“…Systematic [ 21 ] and scoping reviews [ 18 , 22 ] have identified that most research publications on AT access are single-wave cross-sectional studies, which lack follow-up and inhibit the exploration of trends in this sector. Only ten studies were identified in a large systematic review that had any longitudinal/follow-up consideration, comprising <5% of all 207 included studies [ 21 ].…”

“…Systematic [ 21 ] and scoping reviews [ 18 , 22 ] have identified that most research publications on AT access are single-wave cross-sectional studies, which lack follow-up and inhibit the exploration of trends in this sector. Only ten studies were identified in a large systematic review that had any longitudinal/follow-up consideration, comprising <5% of all 207 included studies [ 21 ]. However, a wealth of standardised longitudinal data do exist in the forms of repeated cross-sectional administrative surveys and population cohort studies, where questions on AT are incorporated.…”