Special Issue "Assistive Technology and Support Services for People with Disabilities in Low Resource Settings"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: 31 October 2021.

Special Issue Editors

Dr. Daniel Mont
E-Mail Website
Guest Editor
Center for Inclusive Policy, 1450 Church Street, NW Unit 602 Washington, DC 20005, USA
Interests: disability; inclusion; social protection; education; rehabilitation
Mr. Alexandre Cote
E-Mail Website
Guest Editor
Center for Inclusive Policy, 1450 Church Street, NW Unit 602 Washington, DC 20005, USA
Interests: disability; inclusion; social protection; employment; human rights

Special Issue Information

Dear Colleagues,

About 15 percent of the world’s population has a disability, and a growing body of research shows they are worse off than their nondisabled peers according to a wide range of social and economic indicators, such as education, employment, poverty, violence, HIV infection, and access to health care and social services. This is directly attributable to many barriers in the environment, for example, inaccessible infrastructure and information and discriminatory attitudes. The availability of quality supports, such as personal assistance and assistive technology, is necessary for many people with disabilities in order to fully participate in the economic and social lives of their communities and close these outcome gaps. However, little research has been done demonstrating the extent of this need or how to address it. Examples and guidance on the design and delivery of these supports in low- and middle-income countries are greatly needed. We invite papers addressing the access and impact of support services and assisitive technology for people with disabilities in low- and middle-income countries, and examples and guidance on how they can be effectively provided in low-resource settings, especially those combining a high academic standard coupled with policy recommendations.

Dr. Daniel Mont
Mr. Alexandre Cote
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • disability
  • assistive technology
  • assistive devices
  • support services
  • inclusion

Published Papers (10 papers)

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Research

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Article
Estimating Need for Glasses and Hearing Aids in The Gambia: Results from a National Survey and Comparison of Clinical Impairment and Self-Report Assessment Approaches
Int. J. Environ. Res. Public Health 2021, 18(12), 6302; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18126302 - 10 Jun 2021
Viewed by 589
Abstract
Few estimates are available of the need for assistive devices (ADs) in African settings. This study aimed to estimate population-level need for glasses and hearing aids in The Gambia based on (1) clinical impairment assessment, and (2) self-reported AD awareness, and explore the [...] Read more.
Few estimates are available of the need for assistive devices (ADs) in African settings. This study aimed to estimate population-level need for glasses and hearing aids in The Gambia based on (1) clinical impairment assessment, and (2) self-reported AD awareness, and explore the relationship between the two methods. The Gambia 2019 National Eye Health Survey is a nationally representative population-based sample of 9188 adults aged 35+ years. Participants underwent standardised clinical vision assessments including the need for glasses (distance and near). Approximately 25% of the sample underwent clinical assessment of hearing and hearing aid need. Data were also collected on self-reported awareness, need and access barriers to vision and hearing ADs. Overall, 5.6% of the study population needed distance glasses (95% CI 5.0–6.3), 45.9% (95% CI 44.2–47.5) needed near glasses and 25.5% (95% CI 22.2–29.2) needed hearing aids. Coverage for each AD was very low (<4%). The agreement between self-report and clinical impairment assessment for AD need was poor. In conclusion, there is high prevalence and very low coverage for distance glasses, near glasses and hearing aids in The Gambia. Self-report measures alone will not provide an accurate estimate of AD need. Full article
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Article
“Give Us the Chance to Be Part of You, We Want Our Voices to Be Heard”: Assistive Technology as a Mediator of Participation in (Formal and Informal) Citizenship Activities for Persons with Disabilities Who Are Slum Dwellers in Freetown, Sierra Leone
Int. J. Environ. Res. Public Health 2021, 18(11), 5547; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18115547 - 22 May 2021
Viewed by 953
Abstract
The importance of assistive technology (AT) is gaining recognition, with the World Health Organisation (WHO) set to publish a Global Report in 2022. Yet little is understood about access for the poorest, or the potential of AT to enable this group to participate [...] Read more.
The importance of assistive technology (AT) is gaining recognition, with the World Health Organisation (WHO) set to publish a Global Report in 2022. Yet little is understood about access for the poorest, or the potential of AT to enable this group to participate in the activities of citizenship; both formal and informal. The aim of this qualitative study was to explore AT as mediator of participation in citizenship for persons with disabilities who live in two informal settlements in Freetown, Sierra Leone (SL). The paper presents evidence from 16 participant and 5 stakeholder interviews; 5 focus groups and 4 events; combining this with the findings of a house-to-house AT survey; and two national studies—a country capacity assessment and an informal markets deep-dive. Despite citizenship activities being valued, a lack of AT was consistently reported and hindered participation. Stigma was also found to be a major barrier. AT access for the poorest must be addressed if citizenship participation for persons with disabilities is a genuine global intention and disability justice is to become a reality. Full article
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Article
Development and Pilot Testing of Smartphone-Based Hearing Test Application
Int. J. Environ. Res. Public Health 2021, 18(11), 5529; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18115529 - 21 May 2021
Viewed by 551
Abstract
Background: Identifying and treating hearing loss can help improve communication skills, which often leads to improved quality of life. Many people do not seek medical treatment and, therefore, go undiagnosed for an extended period before realizing they have hearing loss. This study presents [...] Read more.
Background: Identifying and treating hearing loss can help improve communication skills, which often leads to improved quality of life. Many people do not seek medical treatment and, therefore, go undiagnosed for an extended period before realizing they have hearing loss. This study presents a self-administered, low-cost, smartphone-based hearing test application (HearTest) to quantify the pure-tone hearing thresholds of a user. The HearTest application can be used with commercially available smartphone devices and an earphone with the mentioned specification. Methods: Air-conduction-based pure-tone audiometry for the smartphone application was designed and implemented to detect hearing thresholds using a traditional “10 dB down and 5 dB up” approach. Employed smartphone-earphone combination was calibrated with respect to a GSI-61 audiometer and insert earphone ER-3A to maintain clinical standards with the help of subjective testing on 20 normal-hearing (NH) participants. Results: Further subjective testing on 14 participants with NH and retesting on five participants showed that HearTest achieves high-accuracy audiogram within clinically acceptable limits (≤10 dB HL mean difference) when compared with the reference clinical audiometer. Hardware challenges and limitations in air-conduction-based hearing tests through smartphones and ways to improve their accuracy and reliability are discussed. Conclusion: The proposed smartphone application provides a simple, affordable, and reliable means for people to learn more about their hearing health without needing access to a formal clinical facility. Full article
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Article
Supported Decision Making in South America: Analysis of Three Countries’ Experiences
Int. J. Environ. Res. Public Health 2021, 18(10), 5204; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105204 - 13 May 2021
Viewed by 758
Abstract
Background. Following the adoption of the UN Convention on the Rights of Persons with Disabilities, there has been increased interest in supported decision making (SDM) as a strategy to realize the right to legal capacity of persons with intellectual and psychosocial disabilities. [...] Read more.
Background. Following the adoption of the UN Convention on the Rights of Persons with Disabilities, there has been increased interest in supported decision making (SDM) as a strategy to realize the right to legal capacity of persons with intellectual and psychosocial disabilities. Support for decision making has been delivered formally through SDM services as well as informally through interpersonal networks. Various SDM programs have made efforts to systematize informal support, showcasing a variety of SDM delivery models that could benefit SDM implementation in low- and middle-income countries. Methods. This article examines and discusses three SDM projects in South America (Colombia, Peru, and Argentina) that have been directly implemented by civil society organizations, including organizations of persons with disabilities and their families. Analyzed program components include person-centered planning, the nature of support relationships, the presence of supporter training, community involvement, and the utilization of quality assurance measures such as monitoring and program evaluation. Conclusions. The results and learning from these initiatives constitute a valuable source of information for legislators and policymakers for the future development of supported decision-making programs, which are an essential form of support and a mechanism for fulfilling the right to legal capacity in low resource settings. Full article
Article
Examining the Availability and Accessibility of Rehabilitation Services in a Rural District of South Africa: A Mixed-Methods Study
Int. J. Environ. Res. Public Health 2021, 18(9), 4692; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18094692 - 28 Apr 2021
Viewed by 733
Abstract
Introduction: Rehabilitation services aim to optimise individuals’ functioning and reduce disability. However, people with disabilities, who represent a key population of users of rehabilitation services, continue to have unmet needs for rehabilitation services that include the provision of assistive devices. This paper examines [...] Read more.
Introduction: Rehabilitation services aim to optimise individuals’ functioning and reduce disability. However, people with disabilities, who represent a key population of users of rehabilitation services, continue to have unmet needs for rehabilitation services that include the provision of assistive devices. This paper examines the availability and accessibility of rehabilitation services in a rural district of South Africa in order to explore why unmet needs for rehabilitation services persist. Methods: All nine district hospitals in a rural district of South Africa were included in the study. Rehabilitation services capacity was assessed by examining the available assistive devices, consumables and human resources at the level of the health facility. Data collection was conducted using the Global Co-operative Assistive Technology [GATE] Assistive Products List, AT2030’s ATScale priority list and the South African National Catalogue of Commodities for Primary Health Care Facilities. Descriptive statistics were then used for the analysis. For the qualitative component, semi-structured interviews were conducted with adults with physical disabilities at household level to explore barriers to accessing assistive device inclusive rehabilitation services and the consequences thereof in the same rural district. An interview guide based on the WHO health system building blocks was used. Thematic content analysis guided the analysis of the interview transcripts. Findings: The findings of the research demonstrate that rehabilitation service capacity in the district was constrained as a result of low availability of assistive devices [2–22%] and consumables [2–47%], as well as, possibly, a shortage of rehabilitation providers [n = 30] with an unequal distribution across health facilities [n = 9]. In addition, people with physical disabilities reported poor referral pathways, financial constraints, transport and road consideration and equipment unavailability as barriers to accessing rehabilitation services. Moreover, these barriers to access predisposed individuals to finance-, health- and person-related harm. Conclusion: Rehabilitation service availability is constrained by a lack of service capacity in rural South Africa. In addition, the rehabilitation services in district hospitals are not adequately accessible because of existing barriers to enable key populations to achieve optimised functioning. Full article
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Article
“When They See a Wheelchair, They’ve Not Even Seen Me”—Factors Shaping the Experience of Disability Stigma and Discrimination in Kenya
Int. J. Environ. Res. Public Health 2021, 18(8), 4272; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084272 - 17 Apr 2021
Viewed by 943
Abstract
Disability stigma in many low- and middle-income countries represents one of the most pervasive barriers preventing people with disabilities from accessing equal rights and opportunities, including the uptake of available assistive technology (AT). Previous studies have rarely examined how disability stigma may be [...] Read more.
Disability stigma in many low- and middle-income countries represents one of the most pervasive barriers preventing people with disabilities from accessing equal rights and opportunities, including the uptake of available assistive technology (AT). Previous studies have rarely examined how disability stigma may be shaped through factors endemic to social interactions, including how the use of assistive technology itself may precipitate or alleviate disability stigma. Through two strands of work, we address this gap. Via a series of focus groups with Kenyans without disabilities (Study 1) and secondary data analysis of consultations with Kenyans with disabilities and their allies (Study 2), we identify shared and divergent understandings of what shapes disability stigma and discrimination. Specifically, Kenyans with and without disabilities were cognizant of how religious/spiritual interpretations of disability, conceptions of impairments as “different” from the norm, and social stereotypes about (dis)ability shaped the experience of stigma and discrimination. Moreover, both groups highlighted assistive technology as an influential factor that served to identify or “mark” someone as having a disability. However, whereas participants without disabilities saw assistive technology purely as an enabler to overcome stigma, participants with disabilities also noted that, in some cases, use of assistive technologies would attract stigma from others. Full article
Article
Provision of Assistive Technology for Students with Disabilities in South African Higher Education
Int. J. Environ. Res. Public Health 2021, 18(8), 3892; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18083892 - 08 Apr 2021
Viewed by 699
Abstract
This paper used the Critical Disability Theory (CDT) to analyse the provision of assistive technology (AT) and assistive devices at an institution of higher education in South African. In this empirical study, data were collected through interviews with students with disabilities and Disability [...] Read more.
This paper used the Critical Disability Theory (CDT) to analyse the provision of assistive technology (AT) and assistive devices at an institution of higher education in South African. In this empirical study, data were collected through interviews with students with disabilities and Disability Rights Centre staff members. The paper sought to explore the effectiveness of the provision of AT and assistive devices, in terms of enabling students with disabilities’ learning. The provision was deemed inadequate, and a specific AT and assistive device was inaccessible to one category of disability, consequently limiting learning. The paper concludes that the provision of assistive devices at the institution enabled students with disabilities’ learning, however, there was a need for improvement by way of the Universal Design for Learning (UDL). The UDL will help all diverse students, including students with disabilities in all their categories of disability, to be assisted to learn through the provision of AT and assistive devices. It is hoped that the paper will contribute to contemporary debates on the provision of AT and assistive devices for people with disabilities in low-resource settings, from a South African context specifically, and in higher education broadly. Full article
Article
Perspectives of Multidisciplinary Professional Teams during Assessment Processes for ATD Selection in the Japanese Public Provision System
Int. J. Environ. Res. Public Health 2021, 18(5), 2697; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18052697 - 08 Mar 2021
Viewed by 766
Abstract
Selection of assistive technology devices (ATDs), which are imperative for persons with disabilities to improve their quality of life, requires collaboration of users and multidisciplinary professionals. However, it is still unknown how to design and implement an adequate collaborative work flow and a [...] Read more.
Selection of assistive technology devices (ATDs), which are imperative for persons with disabilities to improve their quality of life, requires collaboration of users and multidisciplinary professionals. However, it is still unknown how to design and implement an adequate collaborative work flow and a professional team. Under Japanese governmental ATD provision system, based on the application by clients, ATDs are mainly selected through collaborative processes with the clients and health professionals in public organizations, rehabilitation counseling centers (RCCs). By employing qualitative study methods in this study, we investigated the ATD selection process in which health professionals in RCCs collaboratively assess clients with physical disabilities so as to support them in selecting the adequate ATDs. To identify the perspectives required for ATD selection completely, the assessment processes were recorded and analyzed with a pseudo setting in two RCCs. Content analysis of the conversations between the client and professionals revealed the characteristics of the information exchanged in the assessment processes. A total of 760 assessment items were identified, thus indicating a broad array of interest. Despite the richness of information collected for the assessment, half of the assessment items did not have corresponding items in the documents that were employed during the prescription process. Thematic analysis of the interviews that followed revealed the common values and collaborative processes in ATD selection, which were shared and elaborated among the staff in daily social interactions. To facilitate implementation of ATD provision in various areas with few resources, it may be effective to convert this tacit-to-tacit knowledge sharing into a more explicit sharing by promoting analyses of good practices. Full article
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Article
More Than Just Assistive Devices: How a South African Social Enterprise Supports an Environment of Inclusion
Int. J. Environ. Res. Public Health 2021, 18(5), 2655; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18052655 - 06 Mar 2021
Viewed by 768
Abstract
Appropriate assistive technology has the potential to considerably enhance quality of life, access to health and education, and social and economic participation for people with disabilities. Most disabled people in the world live in low- and middle-income countries where access to assistive devices [...] Read more.
Appropriate assistive technology has the potential to considerably enhance quality of life, access to health and education, and social and economic participation for people with disabilities. Most disabled people in the world live in low- and middle-income countries where access to assistive devices and other support is severely lacking. There is little evidence that describes contextually relevant approaches to meeting these needs, particularly in African countries. We provide a detailed description of a South African organisation which has manufactured mobility and seating devices for children with disabilities since 1992. The Shonaquip Social Enterprise (SSE) also trains and builds capacity among a wide range of stakeholders (caregivers, health workers, educators, government, and communities) to acknowledge and advocate for the wellbeing of disabled children and adults, and works closely with government to strengthen existing service provisions. Using examples from the SSE, we highlight a number of useful principles to consider when trying to provide for the needs of people with disabilities, particularly in low-resource settings. While access to assistive devices is important, devices have limited capacity to improve participation if the broader environment is overly restrictive and stigmatising. Improved access to devices ought to be situated within a range of broader efforts to increase the inclusion and participation of people with disabilities. Full article

Other

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Brief Report
A Narrative Review of the Government Wheelchair Provision System in India
Int. J. Environ. Res. Public Health 2021, 18(10), 5109; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105109 - 12 May 2021
Viewed by 800
Abstract
Background and aim: India has had a wheelchair-delivery system in place for several years but its impact on users is inadequate. Therefore, this research reviews the system to examine how the right to personal mobility can be served better. Method: this paper undertakes [...] Read more.
Background and aim: India has had a wheelchair-delivery system in place for several years but its impact on users is inadequate. Therefore, this research reviews the system to examine how the right to personal mobility can be served better. Method: this paper undertakes a narrative review of the existing government-aided wheelchair provision system from the perspectives of legislation and implementing agencies, both governmental and non-governmental, through document review and key informant interviews. Results: the results indicate that all steps of the government-funded wheelchair provision system are executed by the same system. Manufacture and supply take place nationally, but wheelchair services are largely absent. Moreover, the right to access mobility devices is not upheld for all users. Conclusion: the established government-aided wheelchair provision system is inadequate in terms of coverage, design, production, supply, and wheelchair services. Therefore, there is a need to reconsider the system by increasing its coverage and creating partnerships between the government, non-governmental agencies, and private agencies to improve access. Full article

Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: How social protection systems can improve access to support services and assistive devices
Authors: Alex Cote; Daniel Mont
Affiliation: Center for Inclusive Policy

Title: Analysing predictors of use and need for glasses and vision services from population-based surveys in two low-and-middle income countries: India and Guatemala
Authors: Dorothy Boggs
Affiliation: London School of Hygiene and Tropical Medicine

Title: Analysis of the implementation of the right to personal mobility (Article 20 of the UN CRPD) in India
Authors: Shivani Gupta; Agnes Meershoek
Affiliation: Center for Inclusive Policy Universityof Maastricht

Title: Access to services from persons with disabilities in Afghanistan: Is Community Based Rehabilitation making a difference?
Authors: Jean-Francois Trani
Affiliation: University of Washington- Saint Louis
Abstract: The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) ratified in 2006 states that the achievement of equal rights, empowerment and social inclusion of people with disabilities requires comprehensive rehabilitation services involving educational, social, economic and medical interventions all dimensions of the World Health Organization Community based rehabilitation (CBR) matrix. CBR programs aim at achieving those goals. In the present study, we investigated whether a large scale CBR program implementing the WHO CBR matrix in the context of Afghanistan is having a positive impact on various rehabilitation outcomes. We enrolled in the study 1861 newly recruited CBR participants with disabilities from 169 villages between July 2012 and December 2013 and 1132 controls screened with disabilities randomly selected with a two-stage process within 6000 households from 100 villages in the same provinces as the CBR but outside its catchment area. Using propensity score matching and difference in difference analysis, we estimated the impact of the CBR rehabilitation intervention on mobility, activities of daily living , and employment. There were statistically significant differences between participants and controls on our outcomes of interest between baseline and endline. Our study indicates that a CBR program may provide positive rehabilitation outcomes for persons with disabilities even in a conflict context such as Afghanistan. It contributes to address the longstanding question whether CBR can actually improve rehabilitation of persons with disabilities.

Title: The access to assistive technology in humanitarian settings
Authors: Maria Kett
Affiliation: University College London

Title: Stigma toward assistive technology use among persons with disabilities in Kenya
Authors: Mark Carew
Affiliation: Leonard Cheshire
Abstract: Disability stigma is highly prevalent in many low-and-middle income countries and it represents one of the most complex barriers preventing people with disabilities from accessing equal rights and opportunities (Rohwerder, 2018), including making use of available assistive technology. The majority of empirical work has focused on the impact of stigma on people with disabilities or testing stigma-reduction strategies among non-disabled people. Rarely, have studies examined how disability stigma may be constructed through misconceptions endemic to interactions between both disabled and non-disabled people and the consequent impact of disability stigma on assistive technology use. Through two strands of work, we bridge this gap. First, via a series of focus groups, workshops and interviews with young Kenyans without disabilities, we show that non-disabled youth’s perception of disability are shaped by everyday interactions with people with disabilities, personal experiences and contextual factors (e.g., community attitude towards disability or religious beliefs). Second, via planned qualitative and quantitative work with Kenyans with disabilities, we examine the extent that disability stigma operates as a barrier to assistive technology use. Findings will be discussed in terms of recommendations that could contribute to reduce disability stigma and engender increased assistive technology uptake.

Title: Supported Decision-Making in Latin America: analysis of three countries' experiences
Authors: Alberto Vasquez, Pamela Smith & Brenda Valdivia
Affiliation: SODIS - Sociedad y Discapacidad
Abstract: Since the adoption of the UN Convention on the rights of persons with disabilities, there has been an increased interest in supported decision-making as a strategy to realize the right to legal capacity of persons with intellectual and psychosocial disabilities. The present article examines and discusses three supported decision-making projects in three Latin American countries (Argentina, Colombia and Peru), which have been directly implemented by civil society organizations, including organizations of persons with disabilities and their families. The results and learnings of these initiatives constitute a valuable source of information for legislators and policymakers for the future development of supported decision-making programs in low and middle-income resource settings

Title: Assistive Technology and Inclusive Citizenship for Disabled People in Sierra Leone
Authors: Vicki Austin
Affiliation: University College London

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