Access to primary healthcare services for adults with disabilities in Latin America and the Caribbean: a review and meta-synthesis of qualitative studies

This review and meta-synthesis of qualitative studies aims to provide an overview of qualitative evidence on primary healthcare access of people with disability in Latin America and the Caribbean, as well as to identify barriers that exist in this region.
Six databases were searched for studies from 2000 to 2022. 34 qualitative studies were identified.
Barriers exist on both demand and supply sides. The thematic synthesis process generated three broad overarching analytical themes, which authors have related to Levesque et al.’s aspects of “ability to perceive,” “availability, accommodation and ability to reach” and “appropriateness and ability to engage.” Access to information and health literacy are compromised due to a lack of tailored health education materials. Barriers in the urban environment, including inadequate transportation, and insufficient healthcare facility accessibility create challenges for people with disabilities to reach healthcare facilities independently. Attitudinal barriers contribute to suboptimal care experiences.
People with disabilities face several barriers in accessing healthcare. Lack of healthcare provider training, inappropriate urban infrastructure, lack of accessible transport and inaccessibility in healthcare centers are barriers that need to be addressed. With these actions, people with disabilities will be closer to having their rights met.

The identification of barriers on both the supply and demand sides highlights implications for individuals with disabilities seeking access to primary healthcare services, primarily in Brazil, with similar concerns noted in Colombia and Trinidad and Tobago.
Service providers should enhance access to people with disabilities by providing accessible information and reasonable accommodation for people with disabilities.
More training of healthcare professionals is required to support the provision of care for people with disabilities.
There is a need to improve healthcare centre accessibility, as well as local infrastructure and transportation to prevent people with disabilities from having their rights violated.
Linkages should be strengthened between sectors like transportation, urban development, and health to enhance overall accessibility and prevent violations of the rights of individuals with disabilities.

The identification of barriers on both the supply and demand sides highlights implications for individuals with disabilities seeking access to primary healthcare services, primarily in Brazil, with similar concerns noted in Colombia and Trinidad and Tobago.
Service providers should enhance access to people with disabilities by providing accessible information and reasonable accommodation for people with disabilities.
More training of healthcare professionals is required to support the provision of care for people with disabilities.
There is a need to improve healthcare centre accessibility, as well as local infrastructure and transportation to prevent people with disabilities from having their rights violated.
Linkages should be strengthened between sectors like transportation, urban development, and health to enhance overall accessibility and prevent violations of the rights of individuals with disabilities.

本项针对质性研究的系统综述与元综合研究，旨在梳理拉丁美洲及加勒比地区残障人士初级卫生保健可及性相关质性证据，并明确该区域存在的各类障碍。
本研究检索了2000年至2022年间的6个数据库，最终纳入34项质性研究。
障碍同时存在于需求方与供给方。通过主题综合流程，研究归纳出三大核心分析维度，研究者将其对应至Levesque等人提出的“感知能力”“可及性、适配性与抵达能力”以及“适宜性与参与能力”三大维度。
由于缺乏定制化健康教育材料，残障人士的信息获取渠道与健康素养均受到不利影响。
城市环境中的障碍——包括交通设施不完善、卫生保健机构可及性不足——使得残障人士难以独立抵达医疗服务机构。
态度类障碍则会导致残障人士获得的照护体验欠佳。
残障人士在获取医疗服务时面临多重障碍，包括医护人员培训不足、城市基础设施适配性不佳、无障碍交通缺失以及医疗中心无无障碍设施等，这些均为亟待解决的问题。若能针对性解决上述问题，残障人士的权利将更有望得到保障。
对供需双方障碍的识别，为主要位于巴西的残障人士获取初级卫生保健服务的相关实践提供了启示，哥伦比亚与特立尼达和多巴哥也存在类似问题。
服务提供者应通过提供无障碍信息与合理便利，提升残障人士的医疗服务可及性。
需加强对医护专业人员的培训，以更好地为残障人士提供照护服务。
亟需改善医疗中心的无障碍设施、当地基础设施与交通状况，以避免残障人士的权利受到侵害。
应加强交通、城市发展与卫生等领域的联动，提升整体无障碍水平，防止残障人士的权利遭到侵犯。
对供需双方障碍的识别，为主要位于巴西的残障人士获取初级卫生保健服务的相关实践提供了启示，哥伦比亚与特立尼达和多巴哥也存在类似问题。
服务提供者应通过提供无障碍信息与合理便利，提升残障人士的医疗服务可及性。
需加强对医护专业人员的培训，以更好地为残障人士提供照护服务。
亟需改善医疗中心的无障碍设施、当地基础设施与交通状况，以避免残障人士的权利受到侵害。
应加强交通、城市发展与卫生等领域的联动，提升整体无障碍水平，防止残障人士的权利遭到侵犯。