Health Information Seeking by Women with Physical Disabilities: A Qualitative Analysis

Pilot study for a preconception educational intervention for people with mobility disabilities

OBJECTIVES

To assess the feasibility and acceptability of our newly designed, tailored preconception educational intervention for people with mobility disabilities.

METHODS

A prospective pre-post pilot study to measure the feasibility and acceptability of an educational intervention for people with mobility disabilities who could become pregnant in the next five years. Before and after general health and preconception knowledge were compared using paired t-tests.

RESULTS

26 participants completed the study from November 2023 - July 2024. The most common diagnoses related to mobility disability were spinal cord injury (n = 9), spina bifida (n = 4), and cerebral palsy (n = 4). The intervention increased general health knowledge by 0.9 points (p = 0.13) and preconception health knowledge by 2.7 points (p = 0.025). A significant increase (1.8 points (95 % CI 0.9-2.6 points), p < 0.001) in preconception health knowledge compared to general health knowledge suggests the intervention successfully improved the targeted knowledge area.

CONCLUSIONS

This pilot study demonstrated the feasibility and acceptability of a preconception educational intervention tailored to individuals with mobility disabilities. This intervention holds the potential to improve health literacy, increase preconception health knowledge, and ultimately improve pregnancy outcomes among people with mobility disabilities.

Choosing non-pharmacological treatments for neuropathic pain in spinal cord injury: a qualitative study

PURPOSE

The aims of this study were to explore (1) the considerations of people with spinal cord injury (SCI) in choosing to use non-pharmacological treatments (N-PTs) for neuropathic pain (NP), (2) which factors influence their decision and who is involved in this choice.

MATERIALS AND METHODS

Eleven individuals with SCI and NP were interviewed. Interviews were transcribed verbatim, transcripts were analysed through thematic coding, following an inductive content analysis approach.

RESULTS

A journey towards finding and choosing N-PTs emerged. Key phases in this journey were: motives, strategy and practical considerations. Pain and its impact on their life led participants to consider N-PTs. Motives were participants' negative attitudes towards regular medication, willingness to try everything and disappointment and frustration with the guidance from their health care provider (HCP). The search strategies often involved third parties and the internet. This led them to choose a specific N-PT. The journey was influenced by one's attitude, previous personal experience, experience of HCPs, financial considerations, availability and convenience of the treatment.

CONCLUSIONS

The journey individuals with SCI and NP go through to find N-PTs to manage pain is difficult and often lonely. Findings highlight the importance of HCPs accompanying people with SCI in finding N-PTs.

Demographic, socioeconomic, and social barriers to use of mobility assistive products: a multistate analysis of the English Longitudinal Study of Ageing

BACKGROUND

Cross-sectional evidence suggests that access to essential mobility assistive products (MAPs) might be dependent on non-clinical factors. However, MAP use is better understood as a dynamic process wherein individuals pass through different states of MAP need and use. We aimed to test associations of demographic, socioeconomic, and social factors with transitions between MAP need and use states.

METHODS

For this multistate modelling study, data were drawn from 13 years (May, 2006, to July, 2019) of the English Longitudinal Study of Ageing, a prospective cohort study. We included respondents aged 50-89 years who participated in at least two waves of data collection. We used multistate models to examine associations of demographic, socioeconomic, and social factors, including age, sex, education, employment, wealth, marital status, and help with activities of daily living (ADL), with transitions between three main states: no need for MAPs, unmet need for MAPs, and use of MAPs.

FINDINGS

We used data collected from 12 080 respondents (6586 women and 5494 men). During follow-up, 5102 (42·2%) of participants had unmet MAP need and 3330 (27·6%) used MAPs. Women were more likely than men to transition from no need to unmet need (hazard ratio [HR] 1·49, 95% CI 1·38-1·60) and less likely to transition from unmet need to use (0·79, 0·72-0·86). We found an increase in risk of transitioning from no need to unmet need for each 1-year increase in age (1·06, 1·06-1·07), for those with low education level (1·34, 1·23-1·45), those with help with ADL (1·32, 1·16-1·49), and who were not employed (1·22, 1·07-1·40) or disabled (3·83, 2·98-4·93). Similarly, we found an increase in risk of transitioning unmet need to use for each 1-year increase in age (1·06, 1·05-1·06), for those with low education level (1·20, 1·10-1·31), and those with help with ADL (1·25, 1·13-1·38). Increasing wealth was associated with a reduced risk of transitioning from no need to unmet need (0·78, 0·74-0·81) and from unmet need to use (0·94, 0·89-0·99). Single people were more likely to transition from unmet need to use than partnered people (HR 1·21, 95% CI 1·10-1·33).

INTERPRETATION

Women might be disproportionately likely to have unmet MAP needs, whereas other demographic, socioeconomic, and social factors are associated with high MAP need overall. Our findings directly support efforts towards expanding access to assistive products and identifying groups that could particularly benefit. As the first study of its kind to our knowledge, replication with other longitudinal datasets is needed.

FUNDING

UK Aid.

Perceptions from people with physical disabilities about accessibility and social conditions: interventions for rehabilitation nursing

OBJECTIVES

to analyze the experiences of people with acquired physical disabilities regarding accessibility and social conditions; to identify nurse-led rehabilitation interventions for accessibility and social conditions; to determine nursing-sensitive indicators to improve accessibility and social conditions.

METHODS

a descriptive-exploratory qualitative study employed semi-structured interviews with people with acquired physical disabilities through purposive snowball sampling to address all objectives. Data analysis followed Bardin's content analysis principles. Furthermore, objectives 2 and 3 were achieved through a reflective theoretical approach.

RESULTS

the 27 participants reported accessibility challenges, impacting activities of living and social conditions. This influences rehabilitation nursing, leading to three intervention fields: Assess the ability to perform activities of living and influencing factors; Develop and implement training to perform activities of living; Promote mobility, accessibility, and social participation.

FINAL CONSIDERATIONS

based on participants experiences, we identified nurse-led rehabilitation interventions to promote accessibility and social conditions.

Meta-synthesis of the motherhood-related needs of women with multiple sclerosis

BACKGROUND

The treatment of multiple sclerosis, an autoimmune disease that predominantly affects women of reproductive age, has undergone considerable advancements. Nevertheless, their unique needs, particularly those related to motherhood, continue to be disregarded. This study aims to ascertain the needs of women diagnosed with MS about motherhood.

METHODS

Using the Noblit and Hare methods, meta-synthesis research was conducted on 10 qualitative studies. The relevant studies were obtained by conducting a comprehensive search using keywords in the PubMed, Scopus, Web of Science (ISI), and ProQuest databases without any time limitations until June 2023. The CASP checklist was used to assess the quality of the articles, while the technique of Brown and Clark (2006) was utilized for data synthesis.

RESULTS

Four key themes emerged from this meta-synthesis, highlighting the significance of a support system, psychoeducational counseling, knowledge promotion, and continuous, comprehensive, and unique care.

CONCLUSION

Identifying the needs of women diagnosed with MS and addressing these needs concerning motherhood can enhance the quality of services rendered and enhance women's contentment with their choice to embark on motherhood. Furthermore, recognizing these needs during subsequent stages can be utilized in formulating tailored programs catering to this specific cohort of women.

Gender differences in patient experience among persons with spinal cord injury: A comparison across 22 countries

BACKGROUND

Due to the majority of males within the population of persons with spinal cord injuries (SCI), a male-oriented perception of persons with SCI might affect care provision in the way of prioritizing male needs.

OBJECTIVE

The objective of this cross-sectional study is to describe the patient experience of persons with SCI by gender.

METHODS

This study was based on the International Spinal Cord Injury Survey with 12,588 participants from 22 countries. An interval-based patient experience score was attained by partial credit model. Regression analysis was used in exploring the association between patient experience and gender.

RESULTS

Participants reported very good and good patient experience. Respectful treatment was reported by 78 % of participants; clear explanations by 75 %; involvement in decision-making by 71 %; satisfaction with services by 62 %. The average patient experience score was equal among males and females (average: 64, range: 0-100), with the highest score in participants from the USA (78) and the lowest - in Morocco (44). Patient experience score was not associated with gender. Females had lower odds of reporting better decision-making involvement, yet higher odds of better satisfaction. Older participants, with higher household income and better self-rated health, had lower odds of being satisfied.

CONCLUSION

The majority of persons with SCI rated their experience as good or very good. Females were more likely to report higher satisfaction with services and lower involvement in decision-making. For other patient experience categories and the overall patient experience score, no association with gender was found.

Does stronger primary care improve access to health services for persons with spinal cord injury? Evidence from eleven European countries

OBJECTIVE

To determine the association between the strength of primary care and perceived access to follow-up care services among persons with chronic spinal cord injury (SCI).

DESIGN

Data analysis of the International Spinal Cord Injury (InSCI) cross-sectional, community-based questionnaire survey conducted in 2017-2019. The association between the strength of primary care (Kringos et al., 2003) and access to health services was established using univariable and multivariable logistic regression analysis, adjusted for socio-demographic and health status characteristics.

SETTING

Community in eleven European countries: France, Germany, Greece, Italy, Lithuania, the Netherlands, Norway, Poland, Romania, Spain and Switzerland.

PARTICIPANTS

6658 adults with chronic SCI.

INTERVENTION

None.

OUTCOME MEASURES

Share of persons with SCI that reported unmet healthcare needs as a measure of access.

RESULTS

Twelve percent of the participants reported unmet healthcare needs: the highest in Poland (25%) and lowest in Switzerland and Spain (7%). The most prevalent access restriction was service unavailability (7%). Stronger primary care was associated with lower odds of reporting unmet healthcare needs, service unavailability, unaffordability and unacceptability. Females, persons of younger age and lower health status, had higher odds of reporting unmet needs.

CONCLUSIONS

In all investigated countries, persons with chronic SCI face access barriers, especially with service availability. Stronger primary care for the general population was also associated with better health service access for persons with SCI, which argues for further primary care strengthening.

The study of ableism in population health: a critical review

Over the past three decades, health equity has become a guiding framework for documenting, explaining, and informing the promotion of population health. With these developments, scholars have widened public health's aperture, bringing systems of oppression sharply into focus. Additionally, some researchers in disability and health have advocated for utilizing socially grounded frameworks to investigate the health of disabled people. Yet, naming ableism, much less operationalizing it for the empirical study of health, remains scant. This paper critically reviews the study of ableism as a social determinant of disabled people's health within population health research. First, we provide an orientation to the present state of this literature by looking to the past. We briefly trace a history of traditional approaches to studying disability and health and alternatives that have emerged from critiques of the individualized lens that has dominated this work. Next, we delineate the operation of ableism across social levels. We characterize how ableism has been studied in population health in terms of levels of analysis (intrapersonal, interpersonal, institutional, and structural) and measures of interest. To conclude, we discuss hinderances to and promising avenues toward population health research that advances health equity for disabled people.

Health information seeking in the digital age: a national survey of women with disabilities

PURPOSE

Access to high quality and accessible online health information (OHI) is critical for reducing disparities, overcoming barriers, and improving the health of women with disabilities. This study aimed to understand women with physical disabilities' use of the Internet to access OHI, most often searched health topics, perceived usefulness of OHI, and self-reported eHealth literacy and challenges in OHI seeking.

METHODS

We conducted a national online survey with 508 women with physical disabilities who used the Internet.

RESULTS

Respondents utilized a wide variety of OHI resources. They searched a broad array of health and disability-related topics, with bowel/bladder and finding a physician the most highly searched topics. They generally had confidence in their eHealth literacy skills and ability to understand statistics in OHI. Nevertheless, although our sample consisted of a majority of highly educated internet-users, a sizeable percentage found OHI seeking difficult and frustrating, did not find the information very helpful, and had concerns about the quality of information.

CONCLUSIONS

This study serves as a call to action to disability and rehabilitation scientists, health care providers, and other health professionals to enhance the availability and accessibility of OHI critical to empowering women with physical disabilities to make well-informed health decisions. Implications for rehabilitationAccess to high quality online health information (OHI) is critical for reducing disparities, overcoming barriers, and improving the health of women with disabilities.Many of the women with disabilities in our study found OHI seeking difficult and frustrating, did not find the information very helpful, and had concerns about the quality of the information.Disability and rehabilitation scientists, health care providers, and public health and health policy professionals need to do more to enhance the availability and accessibility of OHI and resources critical to empowering women with physical disabilities to make well-informed health decisions.Physical medicine and rehabilitation scientists are encouraged to develop and improve assistive technologies needed for accessing OHI, which in turn can promote the independent functioning of people with disabilities.

Depressive symptoms during the perinatal period by disability status: Findings from the United States Pregnancy Risk Assessment Monitoring System

AIMS

The aim of the current study was to compare the prevalence of depressive symptoms during the perinatal period among respondents with a disability as compared to those without a disability.

DESIGN

We conducted a secondary analysis of nationally representative data from the Pregnancy Risk Assessment Monitoring System data from 24 participating United States between 2018 and 2020.

METHODS

A cross-sectional sample of 37,989 respondents provided data on disability, including difficulty in vision, hearing, ambulation, cognition, communication and self-care. The outcome of interest was perinatal depressive symptoms, defined as experiencing depressive symptoms during the antenatal period or postpartum period. Regression models were used to calculate odds of depressive symptoms during these two time periods by disability status while controlling for relevant sociodemographic characteristics and depressive symptoms prior to pregnancy.

RESULTS

Respondents with disabilities experienced a higher prevalence of depressive symptoms in both the antenatal period and postpartum period as compared to those without disabilities. In fully adjusted models, respondents with disabilities had 2.4 times the odds of experiencing depressive symptoms during pregnancy and 2.1 times the odds of experiencing postpartum depressive symptoms as compared to respondents without disabilities.

CONCLUSION

Respondents with disabilities experience a higher prevalence of depressive symptoms throughout the perinatal period thereby increasing the risk for adverse maternal, neonatal and infant health outcomes.

IMPACT

Perinatal depression is a significant public health issue globally, and our findings suggest that persons with disability are at an increased risk for depressive symptoms both during pregnancy and in the postpartum period. Our findings represent a call to action to improve clinical and supportive services for women with disabilities during the perinatal period to improve their mental health and the consequent health of their offspring.

PATIENT OR PUBLIC CONTRIBUTION

We thank our Community Advisory Board members who have been instrumental in the conception of this study.

Cancer Disparities Experienced by People with Disabilities

People with disabilities, who represent a rapidly growing and seriously disadvantaged segment of the U.S. population, face unremitting barriers to equal and accessible healthcare and a high prevalence of chronic health conditions. A slowly growing body of research suggests multiple cancer-related disparities between people with and without disabilities. This commentary identifies multiple aspects of the cancer experience and highlights ways cancer is impacted by disability. This includes vulnerabilities to risk factors, barriers to accessing healthcare, and disparities in screening, diagnosis, and treatment. The authors offer six essential pathways for reducing cancer disparities faced by people with disabilities. It is clear that reducing cancer health disparities experienced by people with disabilities will require the commitment and cooperation of a wide range of stakeholders.