KEY ISSUES
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2022 Jun 27; 56:64. doi: 10.11606/s1518-8787.2022056003893
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Barriers to the Access of People with Disabilities to Health Services: A Scoping Review
Karina Aparecida Padilha Clemente I, Simone Vieira da Silva I, Gislene Inoue Vieira I, Maritsa Carla de Bortoli II, Tereza Setsuko Toma II, Vinícius Delgado Ramos III, Christina May Moran de Brito IV
PMCID: PMC9239543 PMID: 35792776
ABSTRACT
OBJECTIVE
To analyze the scientific evidence regarding barriers to the access of people with disabilities to health services.
METHODS
A scoping review was carried out from the main question: “What are the main barriers that people with disabilities face in accessing health services?” The articles were surveyed in July 2019 in six scientific literature databases. Of the 1,155 documents identified in the searches, after selection by title and abstract, 170 publications were read in full and, thus, 96 articles were included and categorized according to the theoretical framework.
RESULTS
The main barriers indicated by the users of the service were: communication failure between professionals and patient/caregiver; financial limitations; attitudinal/behavioral issues; scarce service provision; organizational and transport barriers. The main barriers presented by service providers were: lack of training to professionals; failure of the health system; physical barriers; lack of resources/technology; and language barriers.
CONCLUSIONS
It was evident that people with disabilities face several barriers when trying to access the health services they need and that users and health professionals have distinct and complementary views on difficulties.
Keywords: Disabled Persons, Barriers to Access of Health Services, Communication Barriers, Physician-Patient Relations, Health Services for Persons with Disabilities, Review
INTRODUCTION
The Lei Brasileira de Inclusão da Pessoa com Deficiência (LBI – Brazilian Law for the Inclusion of Persons with Disabilities) incorporates into the Brazilian legal system the current concept of disability that considers it the result of the interaction between people with physical, mental, intelectual, and sensory impairments and disabling environmental barriers1.
According to the World Health Organization (WHO) there are approximately one billion people with disabilities, making up 15% of the world’s population2. In Brazil, the 2010 Demographic Census estimated that 23.9% of people had some type of self-reported disability and that 6.7% of them considered them “severe” disabilities3. With the aging of the population and the increasing prevalence of chronic non-communicable and disabling diseases, and of harmful behaviors that can affect health, these numbers are likely to increase2.
These people may have specific health needs due to their disabilities and associated health conditions. Evidence indicates that people with disabilities have greater health needs than people without disabilities and that these needs are generally not met. In addition to the common health needs, such as immunization, they have worse levels of access to health services and worse health outcomes, especially in low, medium/low, and medium/high income countries, such as Brazil2. This situation is indeed evident in our country, where studies indicate that people with disabilities show higher levels of morbidity, behaviors that have a negative impact on health, and greater use of health services and hospitalizations4.
People with disabilities, therefore, need adequate general health care that covers all aspects, including prevention and health promotion, based on primary, secondary, and tertiary care, and may also require rehabilitation care and specialized treatment – related or not to their underlying disability – to “optimize functionality and reduce disability”2.
There is strong evidence around the world that people with disabilities have difficulties in accessing health services and the scarce data available about research conducted in Brazil also show this. For example, the Brazilian National Health Survey showed a low level of access to rehabilitation services among this population (5–30% in all types of disability), with some geographical variation5. Although Brazilian policies and laws strongly support the inclusion of this group in the health system, the Zika epidemic in 2015 revealed gaps in the Unified Health System (SUS) in terms of health care for people with disabilities. Caregivers of children with congenital Zika virus syndrome have great difficulties in accessing relevant services, centered on people, both locally and nationally6.
Although fundamental for the performance of health systems worldwide, access to health care by people with and without disabilities remains a complex concept7. Potential challenges faced in accessing health care include discrimination, physical inaccessibility, information inaccessibility and unavailability. Around the world, evidence on how to promote the inclusion of people with disabilities in the health system is lacking2.
Based on the problem exposed, we carried out a scoping review, whose objective was to analyze global and local scientific evidence on barriers for the access of people with disabilities to health services.
METHODS
According to the Joanna Briggs Institute Reviewer’s Manual8, a scoping review consists of the following phases: 1) identify the research question; 2) identify relevant studies; 3) select the available studies; 4) map the data; 5) collect, summarize, and report the results; and 6) perform the consultation exercise, which is optional and was not applied in this study. This type of knowledge synthesis has an original structure and must be conducted with rigor, transparency, and reliability. It has been used by researchers interested in mapping the scientific literature and detecting knowledge gaps8. This manuscript was anchored by a specific version of PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews, PRISMA, 2020), a 22-item checklist designed to guide the development of a scoping review report9.
The proposed guide question for this review was: “What are the main barriers that people with disabilities face in accessing health services?”
This study, to explore the findings from a comprehensive and dynamic perspective, adopts the proposal of Levesque et al.7, who structure the concept of access to health care at multiple levels and identify the determinants that can affect it from factors related to health systems, institutions, and professionals, and individuals, communities, and the population.
A systematic search for evidence published in Portuguese, English, or Spanish, was conducted addressing the themes: people with disabilities, accessibility to health services, health services for people with disabilities, availability of health services, disparities and inequities in health, health care accessibility, health services accessibility. The descriptors were accompanied by the Boolean operators “or” and “and” in the searches.
The articles were surveyed in July 2019 in six scientific literature databases: PubMed, Health Systems Evidence, Scopus, EMBASE, Health Evidence, and Lilacs as described in the Box.
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