Needs Assessment Research: Access to Healthcare

A focus group study of accessibility and related psychosocial issues in diabetes education for people with visual impairment.

Williams AS.
Diabetes Education Associates, 3495 Edison Road, Cleveland Heights, OH 44121, USA. Diabetes Educ 2002 Nov-Dec;28(6):999-1008

Purpose: This study was conducted to identify accessibility and related psychosocial issues in diabetes care and education for visually impaired adults who have diabetes.

Methods: Two focus groups of adults with visual impairment and diabetes were conducted; data were recorded and analyzed.

Results: The 3 main issues identified were lack of access to up-to-date diabetes information in an accessible format, lack of understanding by healthcare providers of the needs and competencies of people with both visual impairment and diabetes, and lack of access to nonvisual diabetes self-management equipment.

Conclusions: This study provides qualitative support for the view that visually impaired people in the United States may, as a group, be systematically excluded from receiving high quality diabetes care and education. Equal access to diabetes care and education for visually impaired people requires increased accessibility of diabetes care and education programs, and increased professional and public awareness that the diabetes programs are accessible. Some specific recommendations are to make all patient education materials available in low-vision/nonvisual formats and to teach all diabetes education professionals how to work effectively with visually impaired people.

Access unrestricted.

McCray J, Carter S.
School of Health and Social Care, University of Portsmouth. Nurs Times 1999 Jun 9-15;95(23):47-9

Perceived dental needs of children enrolled in Iowa’s Medicaid Supplemental Security Income (SSI) health plan.

Slayton RL, Damiano PC, Willard JC. Department of Pediatric Dentistry, University of Iowa, College of Dentistry, S212 DSB, Iowa City, IA 52242, USA. ASDC J Dent Child 2001 May-Jun;68(3):206-10, 152

The purpose of this study was to determine parental perception of the oral health needs of children with disabilities and whether or not they had difficulty obtaining dental care. A survey of parents of children enrolled in the Medicaid Supplemental Security Income (SSI) health plan in Iowa showed that 68 percent of children had dental needs during the previous year. Of these children, parents reported that 9.4 percent had a ‘big problem’ getting that care, 8.1 percent had a ‘small problem’ getting care and 82.5 percent stated that getting dental care was ‘not a problem.’ There were significantly more dental needs reported in children in the older age groups (> or = 5 years) and those with more years of experience in the program (p < 0.01). Further study is necessary to determine the types of barriers faced by those in the SSI program seeking dental care.

Perspectives of dentists, families, and case managers on dental care for individuals with developmental disabilities in Kansas.

Reichard A, Turnbull HR, Turnbull AP.
University of Kansas, Lawrence, KS 66045-29930, USA. Ment Retard 2001 Aug;39(4):268-85

The status of dental care for individuals with developmental disabilities in Kansas was examined. Dentists, family members, and case managers reported general, but partial, satisfaction with the availability, accessibility, appropriateness, and affordability of such care. Reasons for the results and recommendations for

The needs of patients with arthritis: the patient’s perspective.

Neville C, Fortin PR, Fitzcharles MA, Baron M, Abrahamowitz M, Du Berger R, Esdaile JM.
Clinical Epidemiology Unit, Arthritis Society of Canada Research Scholar, Quebec. Arthritis Care Res 1999 Apr;12(2):85-95

Objective: To identify concerns and learning interests of patients with arthritis.
p. Methods: A questionnaire was developed, pilot tested, and then used to evaluate 197 patients with arthritis, including osteoarthritis (OA) (n = 41), rheumatoid arthritis (RA) (n = 57), back disease (n = 55), systemic lupus erythematosus (n = 27), and systemic sclerosis (SSc) (n = 17). Twenty concerns and 12 learning interests were rated. Questionnaires were also administered to assess physical disability (Health Assessment Questionnaire), psychological disability (Arthritis Impact Measurement Scales 2), and pain (visual analog scale). Participants addressed accessibility of health services, satisfaction with their physician, psychosocial needs, use of self-help groups, and behavioral strategies used to assist coping. Patients with RA, OA, and back disease, at both a community and a hospital center, were tested to assess whether concerns and learning interests differed based on site of treatment. Analytic methods included analysis of variance, factor analysis, and multiple linear regression.
p. Results: There were no differences in concerns or learning interests based on treatment site. Between diagnostic groups, patients with SSc were more interested in learning about self-help groups. The most frequently reported concern was worsening of the illness. The majority of respondents were interested in learning more about topics that were illness specific. The physician was chosen as the preferred source of information, and the preferred format was in writing. On factor analysis, the 20 concerns were reduced to 5 factors: psychological, coping, medication, social, and financial. Three factors were identified for learning interests: the illness, traditional health management topics, and nontraditional health management topics. Stepwise multiple linear regression revealed predictors for the 5 concern and 3 learning interest factors. The concerns were best predicted by self-reported disease severity, physical disability, and psychological distress, while learning interests were best predicted by self-reported disease severity, pain, and self-help group membership.
p. Conclusion: Concerns and learning interests of persons with arthritis did not differ based on the center of treatment or the diagnosis, but can be predicted by the level of pain and simple measures of disability. Better understanding of the relationship between health status and patient-perceived needs will result in improved patient-centered care.