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（qualitative studies）的综述与元综合（meta-synthesis）研究，旨在系统梳理拉丁美洲及加勒比地区残疾人获取基层医疗服务（primary healthcare）的质性证据，并明确该区域存在的相关障碍。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。研究发现，障碍同时存在于需求端与供给端。通过主题综合分析流程，本研究提炼出三大核心分析维度，研究者将其对应至莱维斯克等（Levesque et al.）提出的「感知能力（ability to perceive）」「可及性、适配性与抵达能力（availability, accommodation and ability to reach）」以及「适宜性与参与能力（appropriateness and ability to engage）」三大维度。由于缺乏定制化的健康宣教材料，残疾人获取健康信息的渠道与健康素养均受到制约。城市环境层面的障碍——包括交通配套不足、医疗设施无障碍性欠缺——使得残疾人难以独立抵达医疗服务机构。态度层面的障碍则导致残疾人的医疗服务体验欠佳。残疾人在就医过程中面临多重障碍：医疗服务提供者培训不足、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障碍性不足等问题，均为亟待解决的障碍。针对性解决此类问题，将有助于残疾人的合法权益更好地得到保障。供需两端障碍的识别，为寻求基层医疗服务的残疾人群体提供了针对性启示，这一情况在巴西尤为突出，哥伦比亚与特立尼达和多巴哥也存在类似关切。服务提供者应通过提供无障碍信息与合理适配（reasonable accommodation），提升残疾人的就医可及性。需加强医护人员培训，以支撑为残疾人提供优质医疗服务。应改善医疗中心无障碍性、本地基础设施与交通条件，避免残疾人的合法权益遭受侵害。需加强交通、城市开发、医疗等部门间的联动，提升整体无障碍水平，防范残疾人权利被侵害。供需两端障碍的识别，为寻求基层医疗服务的残疾人群体提供了针对性启示，这一情况在巴西尤为突出，哥伦比亚与特立尼达和多巴哥也存在类似关切。服务提供者应通过提供无障碍信息与合理适配（reasonable accommodation），提升残疾人的就医可及性。需加强医护人员培训，以支撑为残疾人提供优质医疗服务。应改善医疗中心无障碍性、本地基础设施与交通条件，避免残疾人的合法权益遭受侵害。需加强交通、城市开发、医疗等部门间的联动，提升整体无障碍水平，防范残疾人权利被侵害。