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Accessing health services

In this video, Dorothy Boggs (LSHTM) explores different types of access barriers for people with disabilities in more detail.
DOROTHY BOGGS: The case studies in the previous steps highlighted some of the difficulties that people with disabilities might face when they’re accessing health services, such as sexual and reproductive health services or mental health services, and also suggested ways to overcome these difficulties. In this step, we will explore different types of access barriers encountered by people with disabilities in health care in more detail. The United Nations Convention on the Rights of Persons with Disabilities, or UNCRPD, defines discrimination on the basis of disability as “any distinction, exclusion, or restriction on the basis of disability” that limits or prevents “the recognition, enjoyment, or exercise on an equal basis with others of all human rights and fundamental freedoms.”
This includes the right to access health care. Despite the fact that the UNCRPD has been ratified in over 170 countries, people with disabilities continue to experience many different forms of discrimination, whether directly intended or indirectly unintended. All people, whether disabled or not, may face difficulties in accessing health care. However, people with disabilities face additional barriers as highlighted in the World Report on Disability, and this is discriminatory. Barriers to access can be defined as conditions or obstacles that prevent individuals with disabilities from using or accessing knowledge and resources as effectively as people without disabilities. Barriers to accessibility of health care are varied. There can be many different types, and often, more than one type of barrier occurs at a time.
We will now explore five different types of access barriers in more detail . Attitudinal barriers to accessibility are the most common barrier that people with disabilities encounter. This access barrier includes behaviours, perceptions, and assumptions that discriminate against people with disabilities, and often emerges from a lack of understanding, which can lead people to ignore, judge, or have misconceptions or stereotypes about a person with a disability.
Examples of attitudinal barriers in health care include: a health care worker assumes someone with a speech impairment cannot understand so doesn’t offer a health appointment, and a doctor refuses to treat a person with schizophrenia because he doesn’t like his behaviour. Physical barriers to accessibility are typically the most commonly known. Physical barriers are structural obstacles in either natural or man-made environments, that prevent or block people with disabilities access. This type of access barrier in health care may be related to the architectural design of health facilities, or to medical equipment, or transportation.
Examples of physical barriers in health care include: a health clinic does not have a ramp so it cannot be accessed by a wheelchair user, and poor signage and lighting make it unsafe for a person with a low vision impairment to navigate in the health clinic. Informational barriers to accessibility often occur when people with intellectual disabilities and people with sensory disabilities, such as hearing or seeing impairments needs have not been considered. This access barrier relates to both the giving and receiving of information. Examples of informational barriers in health care
include: a doctor does not offer a woman with disabilities advice on contraception because it is assumed she is not sexually active, and a pamphlet is provided to a person with a visual impairment, without a braille version. Communication barriers to accessibility are often experienced by people who have impairments that affect hearing, speaking, reading, writing, and/or understanding. Examples of communication barriers in health care
include: a sign language interpreter is not available at a health appointment for a deaf individual, and a nurse uses complex language with a patient who is an older person with dementia. Financial barriers to accessibility involves how much it might cost to access a service. Financial barriers can be experienced by all people but maybe more pronounced for people with disabilities, as they are more likely to be poor and because they incur additional costs in seeking health care.
Examples of financial barriers in health care include: a man with a disability cannot afford the accessible transport to reach the hospital for his appointment, and the medicine for a child with a disability is too expensive for her parents to afford. There can also be additional types of barriers that we will not cover in detail now, but that you should be aware of. This includes organisational or systemic structural barriers, such as barriers that relate to policy, procedures, or practises and programmes, and social barriers, which are dependent upon the individual social context.
To help us bring together all this information about barriers to accessibility, let’s take a look at this diagram of a health clinic. Can you identify some of the barriers that a person with a disability might experience when accessing this health service? Take a few moments to identify any barriers to accessibility that people with disabilities might encounter, making sure you think about a range of environmental factors and a range of disabilities, such as physical or sensory impairments, intellectual disabilities, and/or mental health conditions. Let’s start by looking at this diagram thinking about the journey that a person with a disability might experience at the clinic.
Both outside and inside the health clinic, there is poor signage that is confusing with poor colour contrast, and it is blocked by obstacles, the tree. These are examples of physical access barriers. The health care staff are not welcoming to the caregiver and child with a disability at the front desk, exhibiting attitudinal access barriers. Outside, the environment has obstacles and the ground is uneven, and there are only two entrances to the health clinic with stairs only. All exhibiting physical access barriers. Further, a person with a disability will need to travel from his or her home to the health clinic, which might be challenging depending on the person’s age, level of mobility and cognition, and the distance from home to the clinic.
Once inside the health clinic, the reception desk is high and the doorways are narrow, and the cost of treatment is high. These are all examples of physical and financial barriers.
Finally, in the examination room, alternative forms of communication are not offered, such as the sign language interpreter for a clinic consultation with a person with a hearing impairment. This is an example of a communication barrier.
Negative experiences in the health system, including insensitive or disrespectful situations, can lead to further difficulties, such as mistrust of health care providers, not seeking care, and relying upon self-diagnosis and treatment. Barriers to access must be removed so that people with disabilities can attend health consultations with full participation, as all countries strive towards health care systems that are more inclusive and accessible to people with disabilities. More research is needed to find ways to overcome access barriers to ensure accessibility in health care for people with disabilities. You will now take a quiz reviewing the information we have covered, and then, in the next activity, you will be presented with additional case studies about long term health conditions and disability.
It will be important to apply what you have learned, noting the different types of access barriers and possible solutions that are mentioned.

Through the case studies in the previous steps, we focused on how people with disabilities might have difficulties accessing different health services, such as sexual reproductive health services or mental health services. In this step, you will explore different types of access barriers for people with disabilities in more detail with Dorothy Boggs, a researcher and staff doctoral student at LSHTM and occupational therapist.

In this video, Dorothy defines discrimination as defined in Article 2 of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) and describes the cross cutting nature of barriers across individuals and groups and settings. She presents an overview of different types of barriers to accessibility that people with disabilities might encounter when accessing different health services. Specifically, she discusses attitudinal, physical, communication, informational and financial barriers and provides examples of each type.

The presentation concludes by looking at a health clinic setting diagram, discussing the various barriers to accessibility that are identified.

What access barriers have you encountered? Share your thoughts in the comments area below. Please remember not to reveal any confidential information when posting your comments.

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Global Health and Disability

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