Disability In Singapore Research Articles

Impact of income and financial subsidies on oral health care utilization among persons with disabilities in Singapore.

Globally, studies have shown that the dental disease burden among persons with intellectual and/or developmental disabilities (IDD) is high and can be attributed to lower utilization levels of dental services. The aim of the study was to assess the influence of income and financial subsidies on the utilization of dental care services among persons with IDD in Singapore. Between August 2020 and August 2021, a cross-sectional study was conducted via centres offering Early Intervention Programme for Infants and Children, special education schools and adult associations in Singapore serving persons with IDD. A sample of 591 caregivers of children and adults with IDD completed the survey. Data on sociodemographic information, oral health behaviours and dental utilization were collected. Financial subsidy status was assessed by the uptake of a government-funded, opt-in Community Health Assist Scheme (CHAS) for low-income families that provided a fixed subsidy amount for dental services in the primary care setting. Statistical analysis was carried out using univariable, multiple logistic regression and modified Poisson regression. Propensity score matching was carried out in R version 4.0.2 to assess the impact of financial subsidies on oral health care utilization among persons with IDD. Compared to those with lower gross monthly household incomes, the adjusted prevalence ratios of having at least one dental visit in the past year, having at least one preventive dental visit in the past year, and visiting the dentist at least once a year for persons with IDD with gross monthly household incomes of above SGD$4000 were 1.28 (95% CI 1.08-1.52), 1.48 (95% CI 1.14-1.92) and 1.36 (95% CI 1.09-1.70), respectively. Among those who were eligible for CHAS Blue subsidies (247 participants), 160 (62.0%) took up the CHAS Blue scheme and 96 (35.4%) visited the dentist at least yearly. There was no statistically significant difference in the utilization of dental services among individuals enrolled in the CHAS Blue subsidy scheme among those eligible for CHAS Blue subsidies. Higher household income was associated with a higher prevalence of dental visits in the past year, preventive dental visits in the past year, and at least yearly dental visits. CHAS Blue subsidies alone had limited impact on dental utilization among persons with IDD who were eligible for subsidies.

What influences stroke survivors with physical disabilities to be physically active? A qualitative study informed by the Theoretical Domains Framework.

Although the benefits of regular physical activity (PA) after stroke are well established, many stroke survivors do not achieve recommended PA levels. To date, studies exploring determinants to PA have not used a behaviour change theory and focused on stroke survivors with physical disabilities. As a precursor to an intervention development study, we aimed to use the Theoretical Domains Framework (TDF) to identify factors influencing PA in stroke survivors with physical disabilities in Singapore. Between November 2021 and January 2022, we conducted interviews with 19 community-dwelling stroke survivors with a weak arm and/or leg. An interview guide based on the TDF was developed. We analysed the data deductively by coding interview transcripts into the theoretical domains of the TDF, and then inductively by generating themes and belief statements. To identify relevant TDF domains, we prioritised the domains based on the frequencies of the belief statements, presence of conflicting belief statements and evidence of strong belief statements. Eight of the 14 TDF domains were relevant, and included environmental context and resources, knowledge, social influences, emotion, reinforcement, behavioural regulation, skills and beliefs about capabilities. The lack of access, suitable equipment and skilled help often limited PA participation at public fitness spaces such as parks, gyms and swimming pools (environmental context and resources). While a few stroke survivors expressed that they had the skills to engage in regular PA, most expressed not knowing how much and how hard to work, which exercises to do, which equipment to use and how to adapt exercises and equipment (knowledge and skills). This often left them feeling afraid to try new activities or venture out to new places for fear of the unknown or adverse events (e.g., falls) (emotion). For some, doing the activities in a group encourage them to get out and engage in PA (social influences). In stroke survivors with physical disabilities, environmental context and resources had a significant influence on PA participation, and this often had a spill over effect into other domains. Our results inform a complex behaviour change intervention to improve PA after stroke, and has implications for intervention design for people with physical disabilities.

Impact on persons with disabilities and their families when they are contributors to society through volunteerism and employment.

Despite various government initiatives, people with disabilities all over the world face some degree of hindrance when they try to contribute to society. This project sought to give voice to and understand the perceptions and experiences of persons with disabilities in Singapore when contributing to society through volunteerism and employment and to explore solutions to help access and retain employment and volunteering. This small qualitative study recruited three convenience samples of people with disabilities aged 18-49 years old who met criteria for daily activity over the previous 12 months. Participant recruitment was limited due to the Covid pandemic lockdown. Ten individuals had maintained open employment, six had worked as a volunteer and four were neither working nor volunteering. All 20 participants were briefed online on the use of the photovoice technique. Interviews were then conducted online, beginning with a 5-min demographic survey. Approximately hour long semi-structured interviews followed. Eleven participants used photovoice but nine who were working or volunteering did not as they were unable to take photos in their workplace. Several individuals were supported during the interview by a caregiver or staff member for example a job coach. Themes were identified within the four central areas of enquiry: (i) self-perceptions of being a beneficiary or contributor to society; (ii) the benefits to working and volunteering; (iii) enablers and barriers to working and volunteering and (iv) solutions to access and retain employment and volunteering. Several barriers to use of photovoice were encountered. The importance of inclusive and conducive environments was recognised along with the roles of all stakeholders across the ecosystem. Employment and volunteering can significantly impact quality of life for persons with disabilities and their families and benefit the society. Collaboration among all stakeholders is required to better address solutions and improve desired employment and volunteer outcomes.

Singapore dentists' attitudes toward dental care provision for older adults with disabilities.

This study aimed to assess dentists' attitudes toward providing dental care for older adults with disabilities in Singapore and the factors influencing their willingness to provide care. Dentists face a rapidly ageing patient demographic. Practitioner unwillingness to circumvent the attending challenges of care provision prevents older adults from accessing the dental care necessary for better oral and systemic health. Previous studies have reported on dentists' attitudes toward caring for older adults with disabilities; however, these are mostly limited to dependent older adults and exclude frail, community-dwelling older persons. A cross-sectional study was conducted in 2020 using a self-administered questionnaire. Quantitative data analysis was presented in the form of descriptive statistics, followed by bivariate analyses. There were 193 respondents, a response rate of under 9%. Dentists were less willing, confident and involved in the care of older adults with disabilities as the individual's severity of impairments increased. Less than half of respondents were willing to treat individuals with severe disabilities in cooperation (23.3%), swallowing (30.6%), mobility (33.7%) and communication (45.1%). Dentists with training in geriatric dentistry were more willing to provide care. However, younger dentists, general dental practitioners, private practitioners and public sector dentists had specific restraining and driving forces, which further modulated their willingness to provide care. The current areas of training needs among Singapore dentists are in severe impairments of swallowing, communication, cooperation and mobility. Further geriatric dentistry training may effectively increase dentists' willingness to provide care; however, additional specific targeted interventions are also needed.

SUPPORTING AND ENABLING IMPROVEMENTS IN THE AREA OF CARE FOR ADULTS WITH DISABILITIES IN SINGAPORE

The purpose of this pilot study is to improve and facilitate enhancement in terms of care for adults with disabilities in Singapore. In many developed countries in the world, many if not all adults with special needs, live out in the community and are fully integrated with society. However, the majority of adults with disabilities in Singapore are residing in institutions because their families are not able to take care of them. There have been some attempts at mainstreaming adults with disabilities into the Singaporean community, however the number is very small. Although there has been much progress in the disability sector in Singapore, much work needs to be done in the adult disability sector. There are few research studies conducted on the adult disability sector in Singapore and the rest of the world (Happe & Firth, 2020; Lee & Burke, 2018). In Singapore and the rest of the world, there needs to be more of a person’s centred model when working and supporting adults with disabilities. Thus, the premise of this study is how do we improve the quality of life of adults with disabilities in Singapore? How do we improve and facilitate enhancement in terms of care for adults with disabilities in Singapore? KEY WORDS: adults, disabilities, quality of life

SG Enable and the Services Available for Persons with Intellectual disability in Singapore

There are an estimated more than 100,000 Persons with Disabilities (PwDs) in Singapore, and these disabilities can include physical, sensory, intellectual disability, and developmental disabilities. The presence of a disability does not only affect the individual themselves but also impacts their caregivers and families significantly. Moreover, the care needs of a PwD often persist throughout their life, and change over the different life stages, leading to various challenges for the PwDs and their families. The Ministry of Social and Family Development (MSF) led the development of the Enabling Masterplans (EMP), which are 5-year road maps that serve to guide the development and support of disability-related services in Singapore. In 2013, MSF also established SG Enable as the focal agency that is the first stop for all disability matters in Singapore. SG Enable currently works closely with social service agencies (SSA) and community partners to provide effective and holistic support to PwDs and their caregivers. This article will outline briefly the different types of disabilities, the needs over the life course, and the role of SG Enable in addressing these needs.

Specialist Mental Health Services for People with Intellectual Disabilities in Singapore - What Do Stakeholders Think of Them and How Do They Relate to Service Accomplishments?

ABSTRACT Introduction This research investigated the views of different stakeholders regarding the specialist mental health service for people with intellectual disabilities (ID) in Singapore. Method Interviews were conducted with mental health professionals, family carers and service users with ID. Framework analysis was adopted to identify common dominant themes among the different participant groups. Results Analysis revealed four themes 1) Giving choice and autonomy; 2) Training to become competent; 3) Respect and 4) Part of the community Conclusions People with ID living in Singapore have limited opportunities to express their choices and autonomy especially when it comes to treatment planning. Family carers have a significant influence on the level of community presence of their relatives with ID. Participants identified employment for people with ID as a way to improve public perceptions. There was no mention of people with ID developing social relationships. Recommendations are discussed in the context of current service provision.

Development and validation of caregiver stress and support scale for caregivers of individuals with disabilities in Singapore

Purpose Few available measures include culturally salient stressors and support systems for caregivers of offspring with disabilities in Asia. The purpose of this study was to develop and validate a self-report measure that included relevant stressors and sources of support for caregivers of offspring with disabilities. Materials and methods Open-ended interviews with eight caregivers in Singapore, along with existing measures were used to develop items. The original 34 items were administered to caregivers of offspring with disabilities in Singapore (n = 234, 85% mothers). Based on an examination of factor loadings, internal consistency, and feedback from professionals, the scale was revised and administered to 370 caregivers (78% mothers), along with other measures of stress, support, depression, and well-being. Results Exploratory factor analysis of the original 34-item scale yielded two factors, Sources of Stress and Sources of Support. After scale revision, confirmatory factor analysis showed that a two-factor structure demonstrated a fair fit. The subscales showed adequate internal consistency and test-retest reliability, and significant associations in expected directions with other measures of stress and support, as well as with depressive symptoms and well-being. Conclusions The measure has adequate reliability and validity, with implications for use by local service providers. Implications for rehabilitation Caregivers face unique challenges, such as stressors associated with caregiving, with varying support systems available to reduce the stress. A psychometrically-sound measure can be used to assess sources of stress and support, monitor services, and address service gaps for caregivers. The Sources of Caregiver Stress and Support Scale is a contextually-sensitive self-report measure for caregivers of people with disabilities in Singapore.

The Prevalence and Correlates of Disability in Singapore: Results from a Nationwide Cross-Sectional Survey.

Objective: The study aims to estimate the prevalence of disability and the association of disability with socio-demographic correlates and health outcomes among the Singapore population. Methods: Face-to-face interviews were conducted with a representative sample of Singapore’s population. Using the Washington Group’s questionnaire, disability was defined using both the ‘standard’ (a lot of difficulty or higher in one or more domains) and the ‘wider’ threshold (of ‘some’ or greater difficulty). Data on socio-demographic correlates, self-reported lifestyle, physical activity, chronic conditions, and health-related quality of life were also collected. Results: The prevalence of any disability using the standard threshold was 3.1% (95% CI: 2.4–4.1). When separated by disability type, mobility (1.8%) was the most prevalent, followed by vision (0.8%), cognition (0.5%), hearing (0.3%), and self-care (0.2). In the adjusted regression analysis, lower education and unemployed and economically inactive status (versus employed) were significantly associated with disability. Conclusions: Although this prevalence is lower than other countries, it is a significant finding in terms of actual numbers and impact at both the individual and the societal levels. Our findings also highlight the need to strengthen health services and preventive interventions targeting older adults and those who are physically inactive to reduce the burden of disability in these groups.

Understanding the mental health experiences of adult men with intellectual disabilities in Singapore

PurposeThis study aims to explore the experiences of people with intellectual disabilities in Singapore receiving inpatient mental health treatment. To date, there has not been any research that examines the views and experiences of this population in Singapore. The research examines how the participants view their mental health problems and their experiences of the services they received.Design/methodology/approachA qualitative design was chosen to address the research question. Six adult men with intellectual disabilities were recruited from the tertiary hospital and interviewed. The transcripts of these interviews were analysed using interpretative phenomenological analysis.FindingsFour super-ordinate themes were identified; awareness of mental health problems; yearn for a life outside the ward; interacting with other people and finding purpose.Originality/valueThe participants reported that they struggled with being segregated from their families and communities following an inpatient admission. They were able to report on the emotional difficulties that they experienced and hoped to find employment after their discharge from the hospital. They talked about reconstructing their self-identity and forming friendships to cope with their hospital stay. This research is one of its kind carried out in a non-western society and the findings are discussed in the light of how mental health professionals can best support people with intellectual disabilities during their inpatient treatment.

Improving the predictive capability of Framingham Risk Score for the risk of myocardial infarction based on coronary artery calcium score in healthy Singaporeans.

Cardiovascular disease was the top cause of deaths and disability in Singapore in 2018, contributing extensively to the local healthcare burden. Primary prevention identifies at-risk individuals for the swift implementation of preventive measures. This has been traditionally done using the Singapore-adapted Framingham Risk Score (SG FRS). However, its most recent recalibration was more than a decade ago. Recent changes in patient demographics and risk factors have undermined the accuracy of SG FRS, and the rising popularity of wearable health metrics has led to new data types with the potential to improve risk prediction. In healthy Singaporeans enrolled in SingHEART study (absence of any clinical outcomes), we investigated improvements in SG FRS to predict myocardial infarction risk based on high/low classification of the Agatston score (surrogate outcome). Logistic regression, receiver operating characteristic and net reclassification index (NRI) analyses were conducted. We demonstrated a significant improvement in the area under curve (AUC) of SG FRS (AUC = 0.641) after recalibration and incorporation of additional variables (fasting blood glucose and wearable-derived activity levels) (AUC = 0.774) ( P < 0.001). SG FRS++ significantly increases accuracy in risk prediction (NRI = 0.219, P = 0.00254). Existing Singapore cardiovascular disease risk prediction guidelines should be updated to improve risk prediction accuracy. Recalibrating existing risk functions and utilising wearable metrics that provide a large pool of objective health data can improve existing risk prediction tools. Lastly, activity levels and prediabetic state are important factors for coronary heart disease risk stratification, especially in low-risk individuals.

Services for people with intellectual disabilities and mental health problems in Singapore: perspectives from mainstream mental health professionals

Background: Generic mental health staff often have contact with people with intellectual disabilities when they access mainstream mental health services. To date, there has not been any research conducted in non-western countries to explore their views. This paper investigates the views and experiences of mainstream mental health professionals regarding the mental health services for people with intellectual disabilities in Singapore. Methods: Eight staff members from generic mental health services were interviewed. Thematic analysis was used to identify main themes. Findings: The main themes are related to their work experiences, perceptions of people with intellectual disabilities, ideal staff characteristics and service recommendations. Conclusions: Participants identified a lack of experience and knowledge when working with this population. They highlighted the challenges they face promoting choice and autonomy for people with intellectual disabilities. The discussion includes recommendations for improving staff knowledge through training opportunities, consideration of non-pharmacological approaches and early collaboration with caregivers during the treatment process.

What do specialist mental health professionals think of the mental health services for people with intellectual disabilities in Singapore?

Background:This research aimed to investigate the views and experiences of specialist mental health professionals working with adults with intellectual disabilities and mental health problems in Singapore in order to gain insight into the functioning of the local specialist intellectual disability mental health service and how it may be improved.Methods:Eight staff members from specialist service were interviewed. The transcriptions of the interviews were analysed using thematic analysis.Results:Analysis revealed four themes (1) Identifying their roles; (2) Ensuring continuity of care; (3) Disempowerment of service users and (4) Improving clinical practice.Conclusions:Participants identified the challenges they faced working with this population. They highlighted the importance of building therapeutic relationships during the treatment process and discussed the stigma that people with intellectual disabilities face in the community. Recommendations and implications are discussed in relation to service provision, improving staff knowledge and recruiting more staff to work in this field.

Prevalence and correlates of bipolar spectrum disorders in Singapore: Results from the 2016 Singapore Mental Health Study (SMHS 2016)

BackgroundPrevalence estimates of Bipolar Spectrum Disorders (BSD) remain scant in Southeast Asia. This study aims to investigate the prevalence of BSD, its correlates with sociodemographic factors, and the associations between the BSD subgroups and clinical severity, impairment, and disability in Singapore. MethodsThis study utilizes data gathered from the second Singapore Mental Health Study (SMHS)- a nationwide cross-sectional survey conducted between 2016 and 2018 (response rate: 69.5%). Respondents were randomly selected and administered, in a single visit, interviewer-led surveys of the World Health Organization Composite International Diagnostic Interview version 3.0 (CIDI 3.0) in their preferred language (i.e. Chinese, Malay, Tamil, or English). A total of 6126 residents completed the study. ResultsThe lifetime weighted prevalence of BSD, Bipolar I, II, and subthreshold bipolar disorder was 3.1%, 1.5%, 0.03%, and 1.6% respectively. A higher prevalence of Bipolar Disorders (BPD) was significantly associated with younger age, being divorced or separated, and being unemployed. Lifetime comorbidity of BSD with at least one other psychiatric or physical condition was 45% and 51% respectively. BSD was most comorbid with Obsessive Compulsive Disorder (psychiatric condition) and Chronic pain (physical condition). LimitationsThis study relies on self-report data which may be subject to unintended response biases leading to the under or over-reporting of results. DiscussionIn addition to the high prevalence of BPD, there is also a concerning shift and increase in the proportion of those who experience severe symptoms of mania/hypomania and depression. Subthreshold bipolar disorder is found to be clinically significant and cross-culturally valid in a multi-cultural setting.

Implementing Active Support in disability day services: A 6-month prospective study on engagement and behaviours of concern among adults with intellectual disability.

Adults with intellectual disability are often disengaged in disability services. While Active Support has found efficacy in residential settings, less is known in day services. This study examines the impact of Active Support in day services for adults with intellectual disability in Singapore, particularly on engagement and behaviours of concern. An experimental design was used, with a group of 32 participants receiving an Active Support programme over 6months, compared to a control group of 16 participants with treatment as usual. Time sampling of behaviours was conducted every 4weeks. The Active Support group saw increases in activity engagement and social engagement with staff, and decreases in disengagement and stereotypical behaviours, compared to the control group over time. Results support the implementation of Active Support across other day services for adults with intellectual disability. Active Support principles should be considered in planning policies and service outcome measures.

Salient employability skills for youth with intellectual and developmental disabilities in Singapore: the perspectives of job developers

Objective: In order to increase employment opportunities for individuals with intellectual and developmental disabilities (IDDs), professionals are tasked with designing and implementing job training services to youth preparing to enter the job market. Having a better understanding of desirable employability skills aids in allowing professionals to develop programs that will target the needs of those who make decisions relating to human resources.Methods: This study features a qualitative research design to identify employability skills that individuals with IDDs in Singapore should possess to be successful in the workplace. Job developers were interviewed to identify and explore desirable employability skills.Results: Results from interviews suggest that soft skills, such as attitude, dependability, stamina, flexibility, and communication are valued over skills that are more job-specific technical skills.Conclusion: These findings highlight the importance including instruction in these skill areas when training youth with IDDs to find and maintain employment.

Outpatient management of transient ischaemic attack.

Stroke is a significant cause of death and disability in Singapore; in 2014, it was the fourth most common cause of death. Transient ischaemic attack (TIA) is defined as a transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia without evidence of acute infarction. The diagnosis of TIA/acute stroke needs to be considered in all patients who present with sudden focal neurological dysfunction. Prompt referral for assessment, neuroimaging and intervention provides the best chance for neurological recovery and/or minimising further neurological damage. Primary care physicians have a crucial role in TIA/stroke prevention and management. This includes referring patients with suspected acute TIA/stroke to hospitals with stroke treatment facilities immediately; managing the modifiable risk factors of cerebral ischaemia; continuing prescription of antiplatelet agents and/or anticoagulation where indicated; and teaching patients to recognise and respond to suspected cerebral ischaemia using the FAST (face, arm, speech, time) acronym.

Disability in Singapore’s Elderly Population

Disability increases an individual's dependence and negatively impacts their physical, mental, and social functioning. The current study aims to establish the prevalence and risk factors of disability in Singapore's population. Data was extracted from the Well-being of the Singapore Elderly (WiSE) study. This cross-sectional study recruited participants aged 60 years and above (n = 2421) who were representative of Singapore's multiethnic population. We used the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 to assess the severity of disability in our sample while establishing its associations and correlations with cognitive levels, sociodemographic variables, and chronic illness. Cognitive deficits, old age, female gender, Malay and Indian ethnicity, lack of education, retired or homemaker status, presence of chronic illness (specifically stroke, heart problems, depression, and dementia) were found to be significantly associated with disability in Singapore's elderly population. As hypothesised, participants with deficits in cognition were more likely to indicate higher WHODAS scores. The findings highlighted specific factors associated with disability in this multiethnic population. The identification of these factors would lead the way to the development of appropriate interventions.

Numeracy Abilities of Children in Grades 4 to 6 with Mild Intellectual Disability in Singapore

Mathematics is an important aspect of daily life. Basic numeracy skills are needed to accomplish everyday tasks. However, research regarding the relationship between cognitive ability, mental age, and basic numeracy skills for children with intellectual disability (ID) is scarce. This research study investigated the correlation between intellectual ability and the development of number sense and arithmetic abilities in individuals with ID. Thirty-two students from a special school for individuals with ID in Singapore participated in this research study. Based on the results, basic numeracy is more closely correlated to the mental ages of the students than their intelligence quotient. This finding will be discussed and suggestions for future research will be provided.

Inclusion in Singapore: a social model analysis of disability policy

A rhetoric of inclusion and increased social spending within a global context of austerity cuts has dominated disability policies in Singapore today. However, there is a lack of academic works that take a critical disability studies view towards the analysis of disability in Singapore. This work aims to address this gap by adopting a critical social model-led analysis of disability policies in Singapore. The article examines the rhetoric of inclusion, how disability is defined and its implementation through various policies in Singapore. It will examine the underpinnings of disability in Singapore today and its impact on the lives of disabled people.