Factors affecting access to primary health care services for persons with disabilities in rural areas: a “best-fit” framework synthesis

Abstract

BackgroundAccess to primary health care (PHC) is a fundamental human right and central in the performance of health care systems, however persons with disabilities (PWDs) generally experience greater barriers in accessing PHC than the general population. These problems are further exacerbated for those with disabilities in rural areas. Understanding PHC access for PWDs is particularly important as such knowledge can inform policies, clinical practice and future research in rural settings.MethodsWe conducted a synthesis of published literature to explore the factors affecting access to PHC for PWDs in rural areas globally. Using an adapted keyword search string we searched five databases (CINAHL, EMBASE, Global Health, Medline and Web of Science), key journals and the reference lists of included articles. We imported the articles into NVivo and conducted deductive (framework) analysis by charting the data into a rural PHC access framework. We subsequently conducted inductive (thematic) analysis.ResultsWe identified 36 studies that met our inclusion criteria. A majority (n = 26) of the studies were conducted in low-and middle-income countries. We found that PWDs were unable to access PHC due to obstacles including the interplay of four major factors; availability, acceptability, geography and affordability. In particular, limited availability of health care facilities and services and perceived low quality of care meant that those in need of health care services frequently had to travel for care. The barrier of geographic distance was worsened by transportation problems. We also observed that where health services were available most people could not afford the cost.ConclusionOur synthesis noted that modifying the access framework to incorporate relationships among the barriers might help better conceptualize PHC access challenges and opportunities in rural settings. We also made recommendations for policy development, practice consideration and future research that could lead to more equitable access to health care. Importantly, there is the need for health policies that aim address rural health problems to consider all the dimensions and their interactions. In terms of practice, the review also highlights the need to provide in-service training to health care providers on how to enhance their communication skills with PWDs. Future research should focus on exploring access in geographical contexts with different health care systems, the perspectives of health care providers and how PWDs respond to access problems in rural settings.Electronic supplementary materialThe online version of this article (10.1186/s41256-018-0091-x) contains supplementary material, which is available to authorized users.

Closing the gaps in defining and conceptualising acceptability of healthcare: A synthesis review and thematic content analysis

“…Our findings agree with other publications describing acceptability as a dimension of access to healthcare [15][16][17]. This is particularly important and could help in resolving some misunderstandings surrounding the definition of acceptability.…”

“…(5) Timeliness; (6) Acceptability; and (7) Awareness [14]. Dassah et al [16] applied this framework to explore the factors affecting access to primary healthcare for persons with disability. They also looked at how this framework can inform policies, clinical practices and future research projects [16].…”

Measuring spatial accessibility and disparity to county hospitals in western China: based on the web map navigation data

“…Mortality of other time-critical diseases, like stroke, may have the same risk. Another study showed that geography obstacles were one of the four major factors that persons with disabilities were unable to access primary health care [33]. Moreover, we found an obvious regional disparity in spatial accessibility to county hospital exist across the Shaanxi Province.…”

Disability and its prevalence and cause in northwestern Ethiopia: evidence from Dabat district of Amhara National Regional State: A community based cross-sectional study

“…The relationship between health outcomes and disability is complicated and the provision of longterm care in everyday life for people living in resource limited settings is a major public health problem especially in developing countries where the prevention and the health service is very scarce [16]. Moreover, negative attitude towards and stereotyping of PwDs limit educational and employment opportunity that creates dependency and exclusion of PwDs [27], and this was noted in the current study.…”

“…In Ethiopia, about 46% of PwDs are women [14] and they, for instance, carry the double burden of stereotypes, discrimination and economic challenges associated with being women and person with disability. Age is also a factor whereby children with disabilities (CwDs) are less likely to attend schooling or access healthcare services leaving them vulnerable to poverty and poor health that substantially reduce their quality of life [15,16]. As a group, without underplaying variations within, PwDs are still among the most disadvantaged segment of the society.…”