Abstract
Limited evidence exists about how to design interventions to improve access to health care for people with disabilities in low and middle-income countries (LMICs). This paper documents the development of two behaviour change interventions. Case study one outlines the design of an intervention to improve uptake of referral for ear and hearing services for children in Malawi. Case study two describes the design of an intervention to improve menstrual hygiene management for people with intellectual impairments in Nepal. Both followed existing approaches—Medical Research Council Guidance for developing and evaluating complex interventions and Behaviour Centred Design. The purpose is to demonstrate how these frameworks can be applied, to document the interventions developed, and encourage further initiatives to advance health services targeting people with disabilities. Important components of the intervention design process were: (1) systematic reviews and formative research ensure that interventions designed are relevant to current discourse, practice and context; (2) people with disabilities and their family/carers must be at the heart of the process; (3) applying the theory of change approach and testing it helps understand links between inputs and required behaviour change, as well as ensuring that the interventions are relevant to local contexts; (4) involving creative experts may lead to the development of more engaging and appealing interventions. Further evidence is needed on the effectiveness of these types of interventions for people with disabilities to ensure that no one is left behind.
Highlights
One billion people are estimated to have a disability worldwide, and more than 80% live in low and middle income countries (LMICs) [1]
This paper describes the development of two behaviour change interventions designed to improve access to health or health-related services in Malawi and Nepal drawing on the Medical Research Council’s framework for designing complex interventions and the Behaviour
The case studies described in this paper draw on two key approaches in their development: The Medical Research Council (MRC) framework for designing complex interventions and Behaviour
Summary
One billion people are estimated to have a disability worldwide, and more than 80% live in low and middle income countries (LMICs) [1]. There is evidence from a wide range of LMICs suggesting that people with disabilities face substantial barriers to accessing care, which are often complex and interacting, arising across all dimensions of access – from the individual-level to health system and policy levels [10,11,12,13,14]. Addressing these multi-dimensional barriers, needs a multifaceted or ‘complex’ intervention approach [15]. The purpose is to demonstrate how these frameworks can be applied, to document the interventions developed and to encourage further initiatives to advance health services targeting people with disabilities
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