Assistive Technology Provision Research Articles

Factors influencing healthcare access for persons with disabilities in Kakamega County, Kenya during COVID-19: A qualitative study

INTRODUCTION Access to healthcare for persons with disabilities is an indicator of the overall effectiveness of the healthcare system in terms of equity, accessibility and the right to health. This study explores factors affecting access to healthcare among persons with disabilities in Kakamega County in the context of COVID-19. MATERIALS AND METHODS Materials used in this study are part of a larger study that looked at access to healthcare and its effect on the quality of life of persons with disabilities in Kakamega County. In this paper, we present data generated from the qualitative component of the study that comprised 7 focus group discussions, 15 in-depth interviews, and 8 key informants who provided contextual information on health services for persons with disabilities. Data was coded and analysed thematically. RESULTS The study established key barriers to healthcare access for persons with disabilities during the COVID-19 pandemic period ranging from availability, affordability, discrimination, accommodation, assistive devices, and appropriateness of healthcare. In addition, the results show that these obstacles are not limited to the pandemic, but represent everyday challenges that persons with disability experience; but were exacerbated during the pandemic. CONCLUSION AND RECOMMENDATIONS This study highlights the need for disability-friendly infrastructure in healthcare facilities, subsidized medical costs, and the provision of assistive technologies to improve healthcare access for persons with disabilities. We also recommend increasing community and provider awareness of disability rights, enforcing existing laws and policies, and ensuring equal employment opportunities to support full social participation for individuals with disabilities.

The impact of a crisis on the provision of assistive technology in Sweden: the case of COVID-19.

The entitlement to access assistive technology (AT) is fundamental for all individuals. However, challenges encountered during societal crises can significantly impact opportunities for participation and engagement among AT users. Understanding the implications of crises and disasters on AT provision along with their repercussions for end users is crucial. This research endeavors to investigate the experiences of managers overseeing AT provision during crises, using the first wave of the COVID-19 pandemic as a case study. An open-ended questionnaire was distributed to health care managers (n = 18) within AT organizations in Sweden. The responses were analyzed using qualitative content analysis, and four categories derived: Embracing change and navigating new realities, Optimizing strategies due to decreased and limiting prescriptions, Unlocking access and addressing challenges in AT provision, The impact on the staff and their well-being vs effectiveness in the AT organization. The findings indicate that AT organizations have demonstrated remarkable resilience and adaptability in the face of reduced consultations and growing care burden. Despite these challenges, managers have gained valuable insights into developing AT provision more efficiently and sustainably, particularly in digitization. The lessons learned will be critical in ensuring AT provision remains responsive to the needs of patients and society in the future.

Discovering the barriers to scaling a co-design approach for the provision of custom assistive technology within healthcare services

Introduction: Using computer-aided design and 3D printing within a co-design process to produce assistive technology (AT) has a positive impact in delivering customised solutions to end-users’ needs. However, to date its adoption within healthcare services has been limited. This work aims to gather clinicians’ insights to identify and analyse barriers inherent in the AT design, manufacturing, and provision processes and inform a detailed understanding of the current AT eco-system. It forms part of a long-term ambition to efficiently scale up a service for the co-design of custom AT across specialties and healthcare services. Methods: Five interactive workshops were run with 21 healthcare professionals currently involved in AT provision. Participants were recruited from two health boards in the UK. Thematic analysis was used to identify common barriers to scaling up a custom AT approach. Additionally, an eco-system map was created to determine the key stakeholders and their interactions. Results: Nineteen descriptive themes, grouped into four analytical themes, were identified related to the design of AT, access to AT, healthcare staffing and healthcare system pressures. The eco-system map identified sixteen individual stakeholders and ten different groups of significant corporate stakeholders. Discussion: The identified barriers relate to both the provision of off-the-shelf and the co-design of customised AT. Further promoting the scaling up of a co-design custom AT process requires: improving communication between stakeholders, enabling information about AT to be easily accessible, ensuring feedback is gathered and used, and creating tools that enable non-expert designers to modify custom AT designs safely and effectively.

Assistive technology and daily living challenges among students with disabilities at University of Gondar, Ethiopia: a qualitative study

Background Disability influences activities of daily living, leading to unsafe conditions, poor quality of life, and dependence on others and assistive technologies. Despite limited access and unmet needs, assistive technology enables users to participate in education and be independent members of their community. Students with disabilities in higher education face many challenges in their day-to-day activities and evidence is limited in the study area. Therefore, this study aimed to explore assistive technology experience and daily living challenges among students with disabilities in higher education. Method A descriptive qualitative study design was employed at the University of Gondar, Gondar, Ethiopia, between December 20, 2022, and January 20, 2023. A purposive sampling method was employed to recruit 14 students with disabilities. An in-depth interview was employed using semi-structured questionnaires. Open Code version 4 software for coding and reflexive thematic analysis approach was employed for the analysis. Result A total of 14 students with disabilities were included in an in-depth interview. Four main themes emerged, which included activities of daily living, attitudes toward people with disabilities, barriers to accessibility, and access to assistive technology. Conclusion Barriers to activities of daily living among students with disabilities were poor accessibility of infrastructural facilities, lack of teaching/learning materials in an accessible format, and negative attitudes. The present study’s finding is needed to support students in higher education for their academic achievement and to design appropriate rehabilitation strategies and policies on the accessibility of physical infrastructures, inclusive education, and the provision of assistive technology

Exploring rehabilitation providers’ perspectives of assistive technology access after the implementation of a paediatric AT provision program in rural South India

A paediatric Assistive Technology (AT) Provision Program was implemented by a non-governmental rehabilitation facility in rural South India to support rehabilitation providers in providing needed AT access for children with disabilities. Capacity-building measures for providers and other supports based on the AT needs, barriers, and facilitators to AT access were implemented that aligned with the AT global report for low-middle income countries (LMIC). This study explores how the initiatives from the AT Provision Program have influenced the perspectives of rehabilitation providers on AT access. Using a qualitative design eight paediatric rehabilitation providers were purposively sampled for virtual semi-structured interviews. Findings were analysed using thematic analysis. Six overarching themes were identified: (1) Stigma associated with AT use, (2) Organisational response to changing needs, (3) Financial factors related to family socioeconomic status and the organisation providing AT services, (4) Inequity of AT service access in rural areas, (5) Provider AT awareness and confidence and, (6) Quality assurance. Rehabilitation providers’ experiences informed future AT capacity-building strategies within a low-resource context. Our findings provide valuable insights for the development of comprehensive AT Provision Program initiatives to provide AT access for children with disabilities in LMIC settings.

The Mediating Role of Self-Determination in the Relationship Between Assistive Technology and Employment Outcomes for People with Disabilities in Saudi Arabia

The current research study conducts an investigation of the dynamic relationship between three key variables: assistive technology (AT) provision, self-determination (SD), and employment outcomes (EOs) as they pertain to persons with disabilities (PwDs) in Saudi Arabia (KSA). The main objective of the study is to investigate the function of AT in improving EOs for PwDs and contextualize the mediating effect of SD on the observed relationship. The study features a quantitative study design which utilizes survey data obtained from a sample size of 120 PwDs. The study participants are employed in either private or public sector organizations situated in Riyadh and Al-Jouf regions of KSA. The conducted survey provides measurements, using a Likert scale, for AT provision, various aspects of SD (decision-making autonomy, self-belief, self-advocacy, goal setting, and persistence and resilience), and EOs (job placement, satisfaction, retention, income level, and career advancement). For data analysis, the study utilizes the partial least square-structural equation modeling. The study findings demonstrate significant direct and indirect effects of AT provision on EOs for PwDs—with SD playing a key mediating role. Specifically, positive effects of AT can be observed in job placement, satisfaction, income level, retention, and career advancements—SD is observed as a key facilitator of AT adoption and effectiveness (EFF) within workplace settings. The findings emphasize the key role of AT investment (accessibility and EFF) in the enhancement of the SD skills of PwDs, and the resulting effect of more inclusive workplace environments for PwDs in KSA.

Assistive technology: Occupational therapy assessment and services for people with dementia

Introduction: Research suggests that services are not effectively providing suitable assistive technology for people with dementia. There is a need to understand the challenges facing practitioners to identify where service changes should be focussed to improve this situation. Method: This study used an online survey to explore the experiences of 41 occupational therapists working with people with dementia, and/or assistive technology. Eight participants subsequently agreed to participate in online discussion groups. Group discussions were transcribed and checked. Data responses from group discussions and open questions in the survey were analysed thematically using the person-centred framework to identify domains supporting or obstructing effective assistive technology service delivery. Results: Forty-one occupational therapist participants described challenges to providing person-centred assistive technology services. These included restricted access to assistive technology interventions, limited knowledge regarding developments in the field, variable funding, unsupportive systems, limited relevant training and difficulties working across health and social care sectors. Conclusion: There is a need to revise the systems surrounding the provision of assistive technology for people with dementia. Occupational therapists need access to training relative to this field, and systems need to be adapted to support the provision of person-centred care by widening access to assistive technology.

Lessons learned from health system rehabilitation preparedness and response for disasters in LMICs: a scoping review.

Disasters such as earthquakes, conflict, or landslides result in traumatic injuries creating surges in rehabilitation and assistive technology needs, exacerbating pre-existing unmet needs. Disasters frequently occur in countries where existing rehabilitation services are underdeveloped, hindering response to rehabilitation demand surge events. The primary aim of this scoping review is therefore to synthesize the evidence on rehabilitation and assistive technology preparedness and response of health systems in LMICs to the demand associated with disasters and conflict situations. A secondary aim was to summarize related recommendations identified in the gathered literature. A scoping review was conducted using the Arksey and O'Malley framework to guide the methodological development. The results are reported in accordance with PRISMA-ScR. Four bibliographic databases were used: CINHAL, Cochrane, Pubmed, Scopus and. Key international organisations were also contacted. The search period was from 2010-2022. Eligible publications were categorized for analysis under the six World Health Organization health systems buildings blocks. The findings of this scoping review suggest that rehabilitation is poorly integrated into health systems disaster preparedness and response in LMICs. Of the 27 studies included in the scoping review, 14 focused on service delivery, 6 on health workforce, 4 on health information systems and 3 on the leadership and governance building block. No study focused on financing nor assistive technology. This review found the most frequently referenced recommendations for actions that should be taken to develop rehabilitation services in disasters to be: the provision early and multi-professional rehabilitation, including the provision of assistive technology and psychological support, integrated community services; disaster response specific training for rehabilitation professionals; advocacy efforts to create awareness of the importance of rehabilitation in disasters; and the integration of rehabilitation into disaster preparedness and responseplans. Findings of this scoping review suggest that rehabilitation is poorly integrated into health systems disaster preparedness and response in LMIC's, largely due to low awareness of rehabilitation, undeveloped rehabilitation health systems and a lack of rehabilitation professionals, and disaster specific training for them. The paucity of availableevidence hinders advocacy efforts for rehabilitation in disaster settings and limits the sharing of experiences and lessons learnt to improve rehabilitation preparedness and response. Advocacy efforts need to be expanded.

Worldwide Survey on Digital Assistive Technology (DAT) Provision.

Occupational therapists have long been involved in assistive technology (AT) provision worldwide. AT is recognized by the World Health Organization (WHO) to enhance functioning, independence, and autonomy and ultimately promote well-being for people living with disabilities. With the digitalisation of societies, the everyday lives and occupations of individuals are changing, becoming more reliant on digital solutions. The development of digital assistive technology (DAT) also offers opportunities for people with disabilities to access, interact, and pilot the digital world. However, we do not know how occupational therapists are involved in DAT provision worldwide. A survey was conducted in the global occupational therapist's community in June 2022 to describe DAT provision and the factors influencing it. Occupational therapy practitioners were included (n = 660) in the analysis. In DAT provision, occupational therapists mostly provide advice to people, assess their needs, provide instruction or training, prescribe DAT, and fit DAT to people and their environment. The clients served through DAT provision are most frequently people with neurological impairments, chronic illnesses, sensory impairments, and older people. The reasons for providing DAT focus on education, work, school, and leisure. It is expected that DAT provision will enhance independence, self-esteem, occupational participation, and social relationships. Issues faced by occupational therapists when providing DAT are costs of product and funding schemes, sufficient knowledge, and access to knowledge sources. Survey respondents are mostly from Western countries with access to the Internet and the digital world, including having digital literacy, highlighting the digital divide that exists between world regions and countries, but also within countries worldwide. There is a need to continue research to better understand the issues related to digitalisation and the digital participation of people living with disabilities.

Accessible Consumer Electronics Are Essential to Closing the Gap in Assistive Technology Provision.

According to the Global Report on Assistive Technology (2023) [1] more than 2.5 billion people require one or more assistive products - a number that is expected to grow to over 3.5 billion by 2050 due to the aging of our societies. Over the past decade, the design of products that empower people with a disability has shifted from specialized and dedicated products designed only for those with a disability to features and functions integrated into cost-effective consumer technologies for the benefit of all. The opportunity to expand the availability of such technologies is at risk of being ignored due to models of AT delivery that are founded in medical devices, and which have failed to reflect trends in our understanding of technology and the choices and preferences expressed by persons with a disability. This research suggests that such expansion offers significant benefits to people with a disability and better both economic and social return on investment for authorities.

Digital Enabling Assistive Technology Through the Provision Lens - A Global Perspective in a Nordic Context.

The Nordic healthcare system is well-established, taxation-based, and locally administered, featuring person-centered care as a social welfare pillar. Public provision of assistive technology and welfare technology within healthcare systems means every citizen has equal access to services. But how well are policies and procedures keeping pace with demographic changes and technology developments?. This study critically analyses qualitative data from 24 stakeholders involved in municipal-level procurement and allocation of assistive and welfare technology in Sweden with a specific focus on emerging digital technology. An extant analysis framework was used: the World Health Organization-GATE 5P framework for strengthening access to AT. Recommendations are made for agile procurement and an outcome-based decision frame. The voice of the AT user may be a valuable addition to inform policy.

Repair strategies for assistive technology in low resource settings

Purpose To investigate the practices of repair that exist for users of mobility assistive products in low resource settings, as well as the psychosocial impact that the repair, or non-repair, of these devices has on users’ lives. Materials and Methods This article collates data on repair practices and the responses from participants on the topic of repair from studies conducted by the authors across four different low resource settings in Kenya, Uganda, Sierra Leone, and Indonesia. This data was then analyzed to identify the common themes found across geographies. Results Three major models of repair practice emerged from the data: “Individual or Informal Repair in the Community”; “Local Initiatives”; and “Specialist AT Workshop Repair”. Additionally, the wider impact on the participants’ lives of “Problems & Concerns with Repair”; “Experiences of Breakages & Frequencies of Repair” and the “Impact of Broken Devices” are explored. Conclusions The results of this analysis demonstrate the paramount importance of community-based repair of devices, and how despite this importance, repair is often overlooked in the planning and design of assistive products and services. There is a need to further incorporate and support these informal contributions as part of the formal provision systems of assistive device.

How do mobility device users integrate their devices into occupational performance? A narrative literature review

Introduction: Knowledge about how mobility devices are integrated into occupational performance is important to improve participation in daily life among users and assistive technology provision. This study aimed to identify and synthesise literature on how mobility device users integrate their devices into occupational performance. Methods: A narrative review was conducted with a systematic search in PubMed, CINAHL, PsycINFO and SocINDEX for scientific, original, peer-reviewed journal publications in the English or Scandinavian languages. Following search terms were used: mobility devices, occupational performance and synonyms. Publications were screened and read, and data were extracted by two authors independently. Results: A total of 4088 hits led to the identification of six publications. Two categories were identified: (1) how mobility devices are integrated into occupational performance and (2) for what types of occupations beyond mobility are mobility devices used for; seven types were revealed. Conclusion: Mobility devices are integrated into occupations in unique ways to the individual users, shaping how occupations are performed and are used for different types of occupations beyond mobility. Since mobility device use is situational, it is suggested to investigate assistive technology use, applying a transactional perspective to improve assistive technology provision to increase fulfilment of users’ needs and preferences.

Establishing the normative and comparative needs of assistive technology provision in Queensland from the agency and funding scheme perspective.

Assistive technology services and devices support the participation and inclusion of people living with disability. In Australia, the regulatory bodies, agencies and schemes that manage assistive technology provision are governed by national and / or state-based Acts and Legislation. This study examined the assistive technology sector from the perspective of the regulatory bodies, agencies and schemes. Regulatory bodies, agencies and schemes that manage funding for assistive technology in Australia were identified by the research team. A website audit reviewed publicly available documents and information. Semi-structured interviews with representatives from the agencies and schemes were audio-recorded and transcribed verbatim. The audit (n =17) found that the range and level of information publicly available was variable. The availability of assistive technology for driving and transport, design and building for access and safety, and mobility was most often promoted. The qualitative findings (n = 11) indicated variability and challenges within four themes: operationalising the legislation; internal assistive technology processes; reasonable and necessary; and risks in the assistive technology pathway. Regulatory bodies, agencies and schemes are critical to the effectiveness of the sector. The findings identified opportunities for the organisations to review how internal processes are communicated publicly, and for the sector to address the perceived risks related to health professional availability, knowledge and skills, and limited accessibility to trial assistive technology. Subsequent studies explored the perspectives of the assistive technology advisors and suppliers and the recipients of assistive technology services and devices.

A perspective on occupational therapy and assistive technology: Research, contributions, challenges and global initiatives

ABSTRACT Many occupational therapists are skilled assistive technology practitioners and provide a variety of services to assistive technology users and their families through their use of intervention models that integrate the client, occupation and environment. Occupational therapy education, translation of current research into practice and clinical competency ensure that assistive technology users can enjoy accessing their community and environment independently, safely, adequately, and freely. This white paper illustrates the role of occupational therapists in the provision of assistive technology devices to promote better understanding of facilitators and challenges affecting the provision of assistive technology globally. It also reviews literature and discusses positions of professional organizations. Finally, we summarize global efforts, recommendations and strategies to build collaborative partnerships, develop innovative service models, use best available evidence, advocate for supportive public policy, promote occupational therapy services and professional development relating to assistive technology provision, and increase access to affordable, quality assistive technologies worldwide.

Assistive technology services for adults with disabilities in state-federal vocational rehabilitation programs

Purpose Prior research indicates that the provision of assistive technology (AT) services positively predicts successful employment outcomes in vocational rehabilitation (VR) programs. While AT services can be promising, they are underutilized overall, and there are apparent disparities in AT service utilization. The purpose of this study was to identify sociodemographic factors which may act as barriers to receiving AT services in VR programs. Recognizing potential disparities is the first step in improving equity in access to beneficial services. Materials and methods This study is a retrospective analysis of national data collected by the Rehabilitation Service Administration’s Case Service Report from fiscal years 2017–2019. The sample included 788,173 cases that reported having a disability, were aged ≥18 years old, was deemed eligible for VR services, and had a complete set of data. Results Less than 9% of VR clients received AT services. We ran a multiple logistic regression analysis to examine the independent effects of various sociodemographic variables on the likelihood of receiving AT services through VR programs. The following client characteristics were associated with a lower likelihood of receiving AT services: men, unemployed, minority, low income, significant disability, non-enrolled in post-secondary education, mental or cognitive disability, less education, and younger age (all p < .001). Conclusion The findings emphasize the need for more research to identify underlying mechanisms and potential solutions to these apparent disparities in access to AT services for adults with disabilities. Future research and implications are provided. IMPLICATIONS FOR REHABILITATION Increasing assistive technology (AT) training in counsellor education and offering more AT training for in-service rehabilitation counsellors to increase their competence to serve individuals with diverse disabilities, particularly those with cognitive and mental disabilities. Counsellors should be encouraged to use a team approach to ensure the most effective AT solutions are provided, and improve access to age-appropriate AT for younger individuals. Counsellors should identify alternative funding sources and refine eligibility criteria for low-income individuals, and develop effective means for educating less-informed individuals about the benefits of AT, and recognise the limited access of minority groups to receive services within vocational rehabilitation programs.

Assistive technology in palliative medicine: equipment needs

ObjectivesMost people prefer to die at home. Timely and appropriate provision of assistive technology can support people to remain at home in the palliative phase. A state-wide palliative care equipment...

Empowering Individuals with Disabilities through Entrepreneurship in Nigeria: An Integrative Review

This paper examined the available literature on persons with disabilities (PWDs) in Nigeria with respect to empowering them through entrepreneurship. Using the integrative review research method, this paper highlighted some of the barriers faced by PWDs in becoming successful entrepreneurs as well as offered possible solutions/strategies to overcome these barriers. Three databases were searched with search terms carefully coined to generate relevant results. Based on the available literature, the idea of empowerment for the disabled in Nigeria varies across religious and cultural diversity. Empowerment could mean a mandatory religious practice of giving alms (Zakat) to the most deserving individuals. It could be used as a political tool by people in government offices. Empowerment obliges privileged people to remember the less privileged and disabled in the society. Some of the common barriers faced by PWDs in venturing into entrepreneurship were found to include a lack of entrepreneurial education, discrimination, difficulty in raising start-up capital, and poor enactment/implementation of legislation among others. However, potential solutions to these challenges were found to include the enactment and enforcement of legislation favourable for PWDs to thrive in entrepreneurship, educational investment, provision of accommodating environment, adequate financing, and provision of assistive technology among others. Nigeria still has a long way to go in assisting PWDs to achieve their full potential. Empowerment of PWDs should come in the form of entrepreneurial education with which they can learn to become self-reliant and financially independent.

Development of Adaptive Sitting Cum Standing Positional Device - User's Centric Approach

Background As per India Census 2011 Cerebral palsy affects 3.8 of Indians or roughly 15-20 of physically challenged children. An estimated 31000 live births are affected in India. The most prevalent motor impairment in children is cerebral palsy. The adaptive devices need to accommodate different factors in terms of individual health condition body structure body function capacity gender age ethnicity and preference. In addition physical changes that occur in children as they grow and develop need to be accommodated. UNICEF stated that the frequency of changes to be made in an assistive product depends on how fast the child develops and grows which will vary over time as well as between children. This adds to the economic burden especially in families below the poverty line.Aim To build a device for dual usage seating cum standing for children with delayed milestones with versatile features to accommodate as they grow.Methods Anthropometric measurements of children with delayed milestones aged between 3-12 years were collected and assimilated in building the innovative twin device and its features. User satisfaction feedback was collected about the innovative twin device using Quebec User Evaluation of Satisfaction with Assistive Technology QUEST using a prospective qualitative study design. Simple random sampling methods were used to recruit 255 parents of children with delayed milestones from 2016 to 2019 across India and Bangladesh. They were prospectively observed and the perceived effectiveness usability and service delivery system of twin device was collected from parents mostly through telephonic and in-person interviews after three months. Results Around 121 usersparents gave their QUEST feedback. The mean satisfaction on the twin device was recorded as 4.16 Quite satisfied and the service delivery was rated 4.81 Very satisfied. Overall QUEST score was recorded as 4.48 Quite satisfied. The three most satisfying features of the device reported were safe and secure 61.16 easy to use 57.02 and comfortable 56.2.Conclusion Twin device and delivery services quality was measured through user satisfaction in terms of strength durability capacity safety and comfort. Provision of assistive technology includes the design production user satisfaction and quality of life.

تحديات التعلم عبر االنترنت للطلبة ذوي اإلعاقة: حلول النفاذ الرقمي والتصميم الشامل للتعلم

This study aimed to investigate the challenges faced by students with disabilities in online education and to review scientific solutions, digital access solutions and assistive technology for these challenges in higher education institutions. This study analyzed and compared more than seventy references from recent studies that reviewed the challenges and technological solutions available to students with disabilities in some higher education institutions in the United States of America, Australia and the United Kingdom; The aim is to benefit from these experiences in developing support for students with disabilities in online education at Qatar University. It was found throughout the literatures review that the challenges that students with disabilities face in the online learning process are mostly related to the poor technical skills of students and faculty members, insufficient provision of assistive technology; lack of digital accessibility for course materials, and inadequate access to teaching and assessment methods for groups of students with disabilities. To address these challenges, this research reviewed the universal design for learning as a scientific framework that built on the latest studies in neuroscience, computer science, assistive technology, communications and digital accessibility. The aim of this literatures review is to help educators in designing an inclusive, effective and accessible virtual learning environment for all students, including students with disabilities.