Barriers to accessing primary healthcare services for people with disabilities in low and middle-income countries, a Meta-synthesis of qualitative studies

<b>Background: </b>Access to healthcare contributes to the attainment of health and is a fundamental human right. People with disabilities are believed to experience widespread poor access to healthcare services, due to inaccessible environments and discriminatory belief systems and attitudes. Qualitative data on these barriers has not previously been systematically reviewed. A meta-synthesis was undertaken of qualitative studies exploring the barriers to primary healthcare services experienced by people with disabilities in low- and middle-income countries. Six electronic databases were searched for relevant studies from 2000 to 2019. Forty-one eligible studies were identified. Findings suggest that the people with disabilities’ choice to seek healthcare services or not, as well as the quality of intervention provided by primary healthcare providers, are influenced by three types of barriers: cultural beliefs or attitudinal barriers, informational barriers, and practical or logistical barriers. In order to achieve full health coverage at acceptable quality for people with disabilities, it is necessary not only to consider the different barriers, but also their combined effect on people with disabilities and their households. It is only then that more nuanced and effective interventions to improve access to primary healthcare, systematically addressing barriers, can be designed and implemented.IMPLICATIONS FOR REHABILITATIONPeople with disabilities in both high income and low- and middle-income country settings are more likely to experience poorer general health than people without disabilities.Barriers to accessing primary healthcare services for people with disabilities result from a complex and dynamic interacting system between attitudinal and belief system barriers, informational barriers, and practical and logistical barriers.Given primary healthcare is often the initial point of contact for referral to specialty care and rehabilitation services, it is crucial for people with disabilities to access primary healthcare services in order to get appropriate referrals for such services, specifically rehabilitation as appropriate.To achieve full health coverage at acceptable quality for people with disabilities, starting with primary healthcare, it is necessary for healthcare stakeholders, including rehabilitation professionals, to consider the combined and cumulative effects of the various barriers to healthcare on people with disabilities and their families and develop an understanding of how healthcare decisions are made by people with disabilities at the personal and the household level. People with disabilities in both high income and low- and middle-income country settings are more likely to experience poorer general health than people without disabilities. Barriers to accessing primary healthcare services for people with disabilities result from a complex and dynamic interacting system between attitudinal and belief system barriers, informational barriers, and practical and logistical barriers. Given primary healthcare is often the initial point of contact for referral to specialty care and rehabilitation services, it is crucial for people with disabilities to access primary healthcare services in order to get appropriate referrals for such services, specifically rehabilitation as appropriate. To achieve full health coverage at acceptable quality for people with disabilities, starting with primary healthcare, it is necessary for healthcare stakeholders, including rehabilitation professionals, to consider the combined and cumulative effects of the various barriers to healthcare on people with disabilities and their families and develop an understanding of how healthcare decisions are made by people with disabilities at the personal and the household level.

<b>背景：</b>
获得医疗保健服务是实现健康的必要条件，亦是一项基本人权。学界普遍认为，由于环境不可达、歧视性信念体系与态度等因素，残障群体（people with disabilities）在获取医疗保健服务时普遍面临诸多障碍。此前，针对这类障碍的定性研究尚未得到系统性综述。本研究针对中低收入国家（low- and middle-income countries）残障群体所遭遇的初级医疗保健（primary healthcare）服务障碍相关定性研究开展了元综合（meta-synthesis）分析。研究检索了2000年至2019年间的6个电子数据库，最终纳入41项符合标准的研究。结果显示，残障群体是否选择寻求医疗保健服务，以及初级医疗保健服务提供者所提供干预措施的质量，均受三类障碍的影响：文化信念或态度障碍、信息障碍，以及实际操作或后勤障碍。若要为残障群体提供可接受质量的全民健康覆盖，不仅需要考量各类障碍本身，还需关注其对残障群体及其家庭的综合影响。唯有如此，才能设计并实施更具精细化且有效的干预措施，系统性地破除各类障碍，以改善残障群体的初级医疗保健服务可及性。
<b>康复领域启示：</b>
残障群体无论身处高收入国家还是中低收入国家，其整体健康状况普遍差于非残障群体。残障群体获取初级医疗保健服务的障碍，源于态度与信念体系障碍、信息障碍、实际操作及后勤障碍之间复杂且动态的交互系统。鉴于初级医疗保健通常是转诊至专科护理与康复服务的初始接触点，残障群体获得初级医疗保健服务对于获取此类服务（尤其是必要的康复服务）的恰当转诊至关重要。若要从初级医疗保健入手，为残障群体提供可接受质量的全民健康覆盖，包括康复专业人员在内的医疗保健利益相关方，需考量各类医疗保健障碍对残障群体及其家庭的综合与累积影响，并理解残障群体在个人与家庭层面如何做出医疗保健相关决策。
残障群体无论身处高收入国家还是中低收入国家，其整体健康状况普遍差于非残障群体。残障群体获取初级医疗保健服务的障碍，源于态度与信念体系障碍、信息障碍、实际操作及后勤障碍之间复杂且动态的交互系统。鉴于初级医疗保健通常是转诊至专科护理与康复服务的初始接触点，残障群体获得初级医疗保健服务对于获取此类服务（尤其是必要的康复服务）的恰当转诊至关重要。若要从初级医疗保健入手，为残障群体提供可接受质量的全民健康覆盖，包括康复专业人员在内的医疗保健利益相关方，需考量各类医疗保健障碍对残障群体及其家庭的综合与累积影响，并理解残障群体在个人与家庭层面如何做出医疗保健相关决策。