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Seeking information about assistive technology: Exploring current practices, challenges, and the need for smarter systems

DANEMAYER, Jamie
HOLLOWAY, Cathy
CHO, Youngjun
BERTHOUZE, Nadia
SINGH, Aneesha
BHOT, William
DIXON, Ollie
GROBELNIK, Marko
SHAWE-TAYLOR, John
September 2023

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Assistive technology (AT) information networks are insular among stakeholder groups, causing unequal access to information. Participants often cited fragmented international marketplaces as a barrier and valued info-sharing across industries. Current searches produce biased results in marketplaces influenced by commercial interests and high-income contexts. Smart features could facilitate searching, update centralised data sources, and disseminate information more inclusively.

 

International Journal of Human - Computer Studies, Volume 177, September 2023, 103078

https://doi.org/10.1016/j.ijhcs.2023.103078

The global birth prevalence of clubfoot: a systematic review and meta-analysis

SMYTHE, Tracey
ROTENBURG, Sarah
LAVY, Chris
August 2023

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Estimates of the birth prevalence of clubfoot in low and middle income settings range from 0.5 to 2 per 1000 births. However, there is currently no estimate of global birth prevalence of clubfoot.

A systematic review of studies was carried out reporting the birth prevalence of clubfoot across all countries and regions worldwide in the last 10 years. Africa Wide Information, EMBASE, CINAHL, Global Health, LILACS and Medline databases were searched for relevant studies from January 1st 2012 to February 9th 2023. Pooled prevalence estimates were calculated using the inverse variance method, and a random effects model was applied to account for heterogeneity between studies.

 

eClinicalMedicine,  Vol 63 September, 2023

DOI:https://doi.org/10.1016/j.eclinm.2023.102178

Using a community-based participatory research (CBPR) approach to explore economic empowerment for youth with disabilities in rural Uganda

GREENWOOD, Margo
BECHANGE, Stevens
EMONG, Paul
KYOSABA, Winnie
NSSAJA, David
THE PEERS RESEARCHER TEAM
August 2023

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This paper presents findings from a community-based participatory study exploring the lived experiences and key livelihood changes post-intervention of a vocational skills training for young people with disabilities in rural Uganda. Twenty-four youth with disabilities (13 female, 11 male) who had previously taken the vocational training were trained to become peer researchers and conducted 72 in-depth interviews with a more recent cohort of youth with disabilities. 

 

Social Sciences & Humanities Open, Volume 8, Issue 1, 2023, 100647

https://doi.org/10.1016/j.ssaho.2023.100647

Repair strategies for assistive technology in low resource settings

OLDFREY, Ben
HOLLOWAY, Cathy
WALKER, Julian
McCORMACK, STEVEN
DEERE, Bernadette
KENNEY, Laurence
SSEKITOLEKO, Robert
ACKERS, Helen
MIODOWNIK, Mark
July 2023

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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

 

DISABILITY AND REHABILITATION: ASSISTIVE TECHNOLOGY

https://doi.org/10.1080/17483107.2023.2236142 

Assistive technology in Korea: Findings from the 2017 National Disability Survey

DANEMAYER, Jamie
LIN, Myung-Joon
July 2023

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Explicitly monitoring the need, use and satisfaction of assistive product (AP) provision is essential to support population health and healthy longevity in ageing/aged countries, like Korea. We present findings from the 2017 Korea National Disability Survey (NDS) on AP access and compare them to international averages, introducing Korea’s data into the wider coherence of global AP research.

 

Disability and Rehabilitation: Assistive Technology

https://doi.org/10.1080/17483107.2023.2225565 

 

Who is disabled? On whether the functional definition of disability targets the same individuals as the subjective definition

Judith Baart
Willem Elbers
Alice Schippers
May 2023

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With the increased attention to disability as a vulnerability criterion in the Sustainable Development Goals, international organizations and NGOs within the international development sector have started to pay explicit attention to persons with disabilities, including the collection of data on persons with disabilities. The Washington Group Short Set of Questions, which focuses on functional limitations, has been gaining popularity as an assessment tool for disability. This set of questions reflects a categorization of disability that does not necessarily correspond with subjective disability assessments, such as the yes/no question (“do you have a disability?”) which many development actors have used in their assessment tools when they collect disability data This study compares the subjective and the functional limitations assessment tools for disability to answer the question: do they identify the same individuals as persons with disabilities? Based on a survey carried out amongst persons with disabilities in Cambodia, we included both the Washington Group Short Set and a subjective question asking respondents to self-identify their disability type. We find that, although all respondents self-identified as disabled, not all respondents would be considered disabled according to the Washington Group Short Set of questions. In addition, there is little overlap between specific disability types according to a subjective classification method and the domains of functioning measured through the Washington Group methodology. Our findings affirm that categorization as abled or disabled depends on the tool used. This is important, as the assessment approach chosen by those collecting disability data can shape the design choices of policies and programs, and determine who benefits.

Assistive technology: The current perspective in India

SENJAM, Suraj S
MANNAM, Hasheem
May 2023

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Despite many challenges, India needs to formulate evidence-based AT policy, planning within the purview of the healthcare delivery system in collaboration with various government and nongovernment sectors, including industries. This article explores the need, access, and potential challenges associated with AT services in India. Finally, we discussed various initiatives on AT in the country and possible recommendations to improve AT services across.

 

Indian J Ophthalmol. 2023 May; 71(5): 1804–1809.

doi: 10.4103/IJO.IJO_2652_22

Assistive technology access in longitudinal datasets: a global review

DANEMAYER, Jamie
MITRA, Sophie
HOLLOWAY, Cathy
HUSSEIN, Shereen
March 2023

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Functional limitations become more prevalent as populations age, emphasising an increasingly urgent need for assistive technology (AT). Critical to meeting this need trajectory is understanding AT access in older ages. Yet few publications examine this from a longitudinal perspective.

This review aims to identify and collate what data exist globally, seeking all population-based cohorts and repeated cross-sectional surveys through the Maelstrom Research Catalogue (searched May 10, 2022) and the Disability Data Report (published 2022), respectively. Datasets incorporating functional limitations modules and question(s) dedicated to AT, with a wave of data collection since 2009, were included.

 

International Journal of Population Data Science; 2023

Vol. 8 No. 1 (2023): IJPDS Standard Issue
 https://doi.org/10.23889/ijpds.v8i1.1901

Experiences of lower limb prosthesis users in Kenya: a qualitative study to understand motivation to use and satisfaction with prosthetic outcomes

MATTICK, Kate
OLDFREY, Ben
DONOVAN-HALL, Maggie
MAGOMERE, Grace
GAKUNGA, Joseph
HOLLOWAY, Catherine
December 2022

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An estimated 1.5 million people undergo limb amputation each year [1]. Low- and middle-income countries (LMICs) are projected to have a rapid increase in people living with an amputation in the coming years due to prevalence of non-communicable disease, trauma and conflict. This paper explores the personal and system factors that motivate and enhance outcomes for patients accessing a prosthetic service and using a lower-limb prosthesis within a low resource setting.

This study employed a qualitative approach to explore the motivations and satisfaction of individuals with lower limb loss engaging with a prosthetic service in Mombasa, Kenya. In-depth interviews were conducted over Microsoft Teams with 10 lower limb prosthesis users and thematic analysis was applied.

 

Disability and Rehabilitation Volume 45, 2023 - Issue 26

https://doi.org/10.1080/09638288.2022.2152875

Evaluating the use of a thermoplastic socket in Kenya: A pilot study

BARBARESCHI, Giulia
TEERLINK, Wesley
NJUGUNA, Josepg Gakunga
MUSUNGU, Purity
KIRINO, Mary Dama
HOLLOWAY, Catherine
October 2022

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Many people with amputations who live in low-resourced settings struggle to access the workshops where qualified prosthetists provide appropriate care. Novel technologies such as the thermoplastic Confidence Socket are emerging, which could help facilitate easier access to prosthetic services. The objective of this study was to evaluate the satisfaction and the performance of transtibial prosthesis featuring the Confidence Socket. This is a longitudinal repeated-measures design study.

 

Prosthet Orthot Int. 2022 Oct; 46(5): 532–537.

Published online 2022 Mar 25. doi: 10.1097/PXR.0000000000000130

Mainstreaming disability inclusive employment in international development

Mary Wickenden
Philip Mader
Stephen Thompson
Jackie Shaw
July 2022

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People with disabilities are under-represented in the global workforce, and this problem is often particularly acute inthe‘global south’. This is an editorial to a special issue that seeks to provide new perspectives on why this is the case. We deliberately wanted to place this collection in the Journal of International Development as a core development publication, rather than in a disability specific one, because we think it is important to ‘mainstream’ disability within development so that the international community can develop an increased understanding and awareness of disability dilemmas. The challenges faced by disabled people need to be tackled as part of all development thinking and programming.

Capability-sensitive principles for assistive technology to support young graduates with disabilities in Bangladesh and Kenya into employment

MORRIS, Lisa-Dione
ALGHAIB, Ola Abu
NORTHRIDGE, James
July 2022

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Owing to increased inclusion of young people with disabilities into the private sector in Bangladesh and Kenya, there is an urgent need to find alternative ways to support young graduates with a disability in the workplace with assistive technology solutions. The aim of the paper is to identify barriers for private workplace sectors to use assistive technology to support young graduates seeking, maintaining and retaining employment. This qualitative study adopted the research onion design of Saunders et al. Data were collected usinginterviews and focus group discussions and analysed using thematic analysis. The findings reveal that barriers are linked to seven key person-centred capability themes: the dream, external factors, internal factors, assistive technology vision,strategic design priorities and gaps and assistive actions.

 

Journal of International Development, Volume 34, No. 5

Barriers to inclusive employment for self-advocates and families

BIALIK, Kimber
MHIRI, Manel
June 2022

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This article is about the barriers to inclusive employment that people with intellectual disabilities and families face in Kenya, Uganda, Nigeria, and Bangladesh.

Through the Inclusion Works Project, we worked with our members in Kenya, Uganda, Nigeria, and Bangladesh to talk with self-advocates and family members about employment.

We had 3 consultation meetings with self-advocates and 3 consultation meetings with families – we talked to 54 self-advocates and 45 family members about access to inclusive employment in their countries.

Some of the barriers that they told us about were discrimination from employers, lack of access to education, unfair pay, issues with safety and security at work, and being pressured to choose self-employment.

This article explains some of the issues accessing inclusive employment that people with intellectual disabilities and their families told us they face in low- and middle-income countries.

The article also gives recommendations for how organisations doing work on inclusive employment can work towards addressing some of these barriers and being more inclusive.

 

 Journal of International Development, Volume 34, Issue 5

Disability inclusive employment in urban Malawi: A multi-perspective interview study

REMNANT, Jennifer
WANGGREN, Lena
HUQUE, Sarah
SANG, Katherine
KACHALI, Limbani
RICHARDS, James
June 2022

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The paper presents interview data from Malawian government representatives, trade unionists, employers and people with disabilities from the country's largest cities Lilongwe and Blantyre. Findings relate to the gap between the discourse of employers and government officials and that of workers with disabilities. Firstly, we find a policy-based assumption of a formalised workforce that is not representative of the predominantly informal disabled workforce. Secondly, the disruptive, intermittent and oftenreactive nature of non-governmental organisation (NGO ) interventions can limit long-term inclusivity agendas and undermine the work of disabled activists in Malawi. Lastly, we present findings on the stigmatised nature of disability in these urban centres. We find that stigma is economic: Urban workers with disabilities are discriminated against locally by employers, landlords and banks on assumptions they will not produce or earn enough to meet productivity demands, rent or repayment costs.

 

Journal of International Development, Volume 34, Issue 5

https://doi.org/10.1002/jid.3678

Qualitative Study Exploring access to learning opportunities for children with disabilities during school closures of COVID-19 in Bangladesh

Mrittika Barua, Sayema Akter, Shamsul Kabir, Faria Binte Arif, Abdul Mannan, Protyasha Ghosh, Jannatul Hridhi, Sumata Chakma, Kamrul Hasan
April 2022

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Background: The COVID-19 pandemic caused significant challenges to education globally, as schools were closed, and alternative means had to be sought to enable students to continue with their studies. In the resource-constrained setting of Bangladesh, the pandemic impacted on the education of 37 million children (UNICEF 2021), of whom children with disabilities have been amongst the most severely affected. Already disadvantaged compared to children without disabilities in terms of access to education, the pandemic and the challenges of accessing remote learning have deepened inequalities between children with disabilities and their able-bodied peers. This study was undertaken as part of DID Task Order 13 Bangladesh, the goal of which is for girls and boys with disabilities to have equal access to quality education and support. Interventions are based in the two districts of Narsingdi and Siranjganj and the subdistricts of Narsingdi Sadar, Tarash and Sirajganj Sadar. The aim of this research was to explore the experiences of children with disabilities, their parents and teachers in respect of access to learning opportunities during school closures and beyond. Its findings inform the interventions of the project, specifically the support required for individual learners with disabilities and their families as well as for the schools where they are enrolled. Method: This qualitative study was carried out in the three sub-districts of Bangladesh mentioned above and based in schools denoted for project intervention. Children with disabilities were purposively selected from school records to represent a range of ages, grades, type of disability and different sexes. Screening was conducted using the UNICEF Child Functioning Module (CFM). Data was collected between October 2021 and February 2022 and included in-depth interviews with 22 children with disabilities, 23 caregivers and six teachers, as well as through household and school observations. Findings: Based on the CFM, 91% of the children interviewed have difficulties in more
than one functional domain, with the most common being difficulties in controlling behaviour, learning and communication. The study found the CFM to be more sensitive to identification of functional difficulties than the teachers’ assessments. Through the interviews, a range of challenges were raised regarding continuation of learning during the pandemic. Almost all the children mentioned that they missed their schools, and particularly their friends. Caregivers expressed concern about their children being out of touch with their studies, acknowledging that schools provide an environment that helps students learn. When movements were restricted, and children could not go to
coaching classes or be with their friends, some children displayed regressive behaviour such as increased agitation because of the social isolation. One of the most common supports that facilitated learning during school closures was the appointment of private tutors. In addition, family members helped their children study at home. Where teachers were able to visit children and provide structure and support for home learning (in the form of assignments), this significantly contributed to children’s motivation to continue with their education. While the caregivers tried to support their children as far as possible, several factors impacted negatively on learning viz. lack of motivation of children to continue with their studies, inadequate support from teachers and financial constraints undermining the ability of families to cover the costs of education. Especially challenging was the lack of access to technological support and limited time and skills of parents to support their children with disabilities, in addition to their household responsibilities and other children to look after. Although caregivers talked about the lack of support from teachers, the teachers, on the other hand, mentioned that they were not fully equipped with knowledge and skills to appropriately support learners with disabilities. In some instances, children with disabilities were kept behind a grade for not passing their class assessments or were allowed to progress to the next grade without achieving the required competencies. Observations of homes revealed that almost all of the children with disabilities interviewed were living in low-income households, with overcrowding, outside washrooms, minimal furniture and no conducive study areas. Some houses had mud flooring and tin rooves, posing multiple safety and physical barriers for children with disabilities. School visits enabled identification of inaccessible infrastructure, including access roads, entrances and washrooms. Although all of the schools visited had ramps, none of these were fully usable and none had rails. As schools reopen, interviewees identified various strategies that would contribute to encouraging learners with disabilities to return to school and participate effectively in learning. These include specific focus on learners with disabilities by teachers in order to
provide targeted support; ending discrimination against those who do not perform well academically; and differentiation of the curriculum and assessments for learners with intellectual disabilities. These interventions, together with ensuring accessible school infrastructure, will contribute to creating a more enabling environment for learners with disabilities.
Recommendations: The COVID-19 pandemic has further deepened vulnerability of low income families and exclusion of children with disabilities from education. In order to address the potential widening gap that could be created by a surge of dropouts following school closures, various interventions need to be prioritized. These include building on the strategies of resilience already developed by families to support learning of their children; and enhancing parents’ confidence in providing support themselves. In addition,linkages between home and school need to be strengthened and appropriate learning resources made available to children at home, taking cognizance of the inaccessibility of
technology and remote programmes for children with disabilities (both in terms of devices and connectivity). It is essential that teachers’ role in supporting learning at home for children with disabilities be strengthened; and that teachers are equipped with skills to cater for disability and diversity among learners. This needs to be accompanied by removal of barriers in the built environments of schools and their surrounds.

Using radio drama to tackle disability discrimination in Nigeria

BBC Media Action
Inclusive Futures
February 2022

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As part of the Inclusive Futures programme, BBC Media Action produced a radio drama, Story Story, and accompanying social media content, to tackle stigma and discrimination around disability in Nigeria. This content was broadcast from November 2020 to November 2021 through local radio partners in six states – Enugu, Federal Capital Territory (FCT), Kano, Kaduna, Kogi and Lagos.

This briefing draws on a literature review and key insights from BBC Media Action’s mixed-methods evaluation of the drama conducted in June and July 2021.

Unemployment in women with psychosocial disabilities during the COVID-19 pandemic: Lessons from Tana River County, Kenya

IBUENYI, Ikenna D.
GITONGA, Isaiah
TELE, Albert
SUYRINA, Elena
February 2022

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In low-income settings, the informal economy is a practical alternative to work and employment for persons with disabilities. However, the COVID-19 pandemic negatively affected the informal economy. This study aimed to explore the experiences of women with psychosocial disabilities in Kenya during the pandemic. We found that the pandemic worsened their experiences of work and employment, and they did not receive any social welfare or support from the government. Our findings suggest that pandemic management must adopt inclusive and context-sensitive approaches that support persons with psychosocial disabilities. Social welfare and protection for persons with disabilities are relevant for socio-economic empowerment and inclusion.

 

Journal of International Development, volume 34, issue 5

https://doi.org/10.1002/jid.3638

Accessible Sanitation in the Workplace – Important Considerations for Disability-Inclusive Employment in Nigeria and Bangladesh

Stephen Thompson
Rasak Adekoya
Utpal Mallick
Omojo Adaji
Abdur Rakib
Mark Carew
January 2022

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This paper explores the relationship between accessible sanitation and disability-inclusive employment in Bangladesh and Nigeria. Both countries have sanitation and hygiene challenges as well as disability-inclusive employment challenges, but the existing evidence on the intersection of these issues that is focused on Nigeria and Bangladesh is extremely limited. Building on the literature where this complex issue is addressed, this paper presents the findings of a qualitative pilot study undertaken in Nigeria and Bangladesh. It focuses on the need for toilets at work that are easy for people with disabilities to use in poor countries. These are sometimes called accessible toilets. Accessible sanitation is not regarded as a challenge that must be addressed by people with disabilities themselves, but as a challenge that must be addressed by many people working together – including governments, employers, and the community.

Estimating need and coverage for five priority assistive products: a systematic review of global population-based research

DANEMAYER, Jamie
BOGGS, Dorothy
DELGADO RAMOS, Vinicius
SMITH, Emma M
KULAR, Ariana
BHOT, William
RAMOS-BARAJAS, Felipe
POLACK, Sarah
HOLLOWAY, Catherine
January 2022

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Assistive technology (AT) includes assistive products (APs) and related services that can improve health and well-being, enable increased independence and foster participation for people with functional difficulties, including older adults and people with impairments or chronic health conditions. This paper uses the umbrella term ‘functional difficulty’ (FD) to refer to all of these groups. This systematic review was undertaken to identify studies presenting population-based estimates of need and coverage for five APs (hearing aids, limb prostheses, wheelchairs, glasses and personal digital assistants) grouped by four functional domains (hearing, mobility, vision and cognition).

 

BMJ Glob Health. 2022; 7(1): e007662

doi: 10.1136/bmjgh-2021-007662

Translating disability-inclusive WASH policies into practice: lessons from Cambodia and Bangladesh: Study details and reports

LONDON SCHOOL OF HYGIENE AND TROPICAL MEDICINE (LSHTM)
WILBUR, Jane
2022

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This is a collaborative study between the LSHTM and WaterAid, funded by the Australian Government’s Water for Women Fund. It aims to improve disability-inclusive WASH policymaking in low and middle-income countries through policy and practice guidance for governments wishing to mainstream disability-inclusive WASH at scale. Using Cambodia and Bangladesh as case studies, we answered these research questions:

  • How do Cambodia and Bangladesh’s national WASH policy and guidance incorporate disability?
  • To what extent do sub-national government officials and service providers implement these commitments to disability inclusion?
  • How does this implementation impact the WASH experiences of people with disabilities and their caregivers?

Resources available

This poster gives an overview of the study.

We conducted a policy analysis of Cambodia and Bangladesh’s WASH policies and guidance documents to explore the inclusion of disability. We published a journal article and an accessible briefing note that summarised the article.

We carried out qualitative research in Cambodia and Bangladesh that explored the implementation of commitments to disability inclusion in national policies at the sub-national level. This journal article captures our research in Cambodia, which is summarised in this briefing note. We worked with Epic Arts (an inclusive arts organisation based in Cambodia that uses art to empower and bring people with disabilities together) to develop a performance and two short films about the findings related to 'independence' and 'caregivers'. 

We wrote a research report capturing findings from Bangladesh, which is supplemented by this poster.      

We produced the Disability-Inclusive WASH Checklist for government officials and service providers to support the meaningful inclusion of people with disabilities and caregivers in national policies, guidance documents, and interventions. The Disability-Inclusive WASH Checklist is based on our study findings and co-developed recommendations. Three films introduce the checklist, give an overview of it and show how to complete it. Each film has transcripts (film 1, film 2, film 3).    

Finally, we wrote a Learning Brief, Foundations of success: driving change through successful research collaborations. This brief documents the process the Principal Investigator followed to support and mentor the research team in Cambodia remotely. The Brief captures the strengths and limitations of approaches and learning gained. It includes recommendations for organisations that remotely support non-academics to conduct ethical research in low-and middle-income countries.

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