Perceived Barriers for Accessing Health Services among Individuals with Disability in Four African Countries
Perceived Barriers for Accessing Health Services among Individuals with Disability in Four African Countries
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DOI：
10.1371/journal.pone.0125915
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发表时间：
2015-05-20
期刊：
影响因子：
3.7
通讯作者：
Dyrstad, Karin
中科院分区：
文献类型：
--
作者：
Eide, Arne H.;Mannan, Hasheem;Dyrstad, Karin
研究人员和其他人日益认识到，边缘化和弱势群体在获得保健方面面临问题。特别是低收入国家的准入问题可能危及联合国通过千年发展目标确定的目标。因此，确定残疾人在获得卫生服务方面的障碍是研究的优先事项。目前的研究旨在确定具体障碍的程度，并估计残疾对获得医疗保健的障碍的影响。在苏丹、纳米比亚、马拉维和南非进行了一项基于人口的住户调查，共调查了9 307人。抽样战略是在每个国家选定的地理区域内进行两阶段的整群抽样。使用华盛顿第六组筛选问题确定有残疾成员的家庭的列表程序之后，在有和没有残疾成员的家庭中管理家庭问卷，并对有和没有残疾的个人进行问卷调查。研究表明，缺乏交通、服务、药品或设备不足以及费用是获得服务的四大障碍。这项研究还表明，在感知的障碍方面存在很大差异，主要反映了参与国之间的社会经济差异。城市化程度、社会经济地位和活动限制的严重程度是障碍的重要预测因素，但没有性别差异。有人认为，教育只有在减少贫困的情况下才能减少获得保健服务的障碍。残疾人在获得保健服务方面面临更多和特别的障碍。要消除这些障碍，就需要采取一种强调公平而非平等的健康方法。
There is an increasing awareness among researchers and others that marginalized and vulnerable groups face problems in accessing health care. Access problems in particular in low-income countries may jeopardize the targets set by the United Nations through the Millennium Development Goals. Thus, identifying barriers for individuals with disability in accessing health services is a research priority. The current study aimed at identifying the magnitude of specific barriers, and to estimate the impact of disability on barriers for accessing health care in general. A population based household survey was carried out in Sudan, Namibia, Malawi, and South Africa, including a total of 9307 individuals. The sampling strategy was a two-stage cluster sampling within selected geographical areas in each country. A listing procedure to identify households with disabled members using the Washington Group six screening question was followed by administering household questionnaires in households with and without disabled members, and questionnaires for individuals with and without disability. The study shows that lack of transport, availability of services, inadequate drugs or equipment, and costs, are the four major barriers for access. The study also showed substantial variation in perceived barriers, reflecting largely socio-economic differences between the participating countries. Urbanity, socio-economic status, and severity of activity limitations are important predictors for barriers, while there is no gender difference. It is suggested that education reduces barriers to health services only to the extent that it reduces poverty. Persons with disability face additional and particular barriers to health services. Addressing these barriers requires an approach to health that stresses equity over equality.