Barriers to health care among people with disabilities who are members of underserved racial/ethnic groups: a scoping review of the literature.

BACKGROUND: Understanding barriers to health care access experienced by people with disabilities who are members of underserved racial/ethnic groups is key to developing interventions to improve access. OBJECTIVE: To conduct a scoping review of the literature to examine the published literature on barriers to health care access for people with disabilities who are members of underserved racial/ethnic groups. DATA SOURCES: Articles cited in MEDLINE, PsycINFO, and CINAHL between the year 2000 and June 19, 2013. In addition, table of contents of 4 journals and the reference lists of the included article were reviewed for potentially relevant titles. STUDY SELECTION AND EXTRACTION: Studies examining barriers to health care access among adults aged 18-64 with disabilities who are members of an underserved racial/ethnic group were included. Two reviewers screened abstracts, screened each full-text article and extracted data, and discrepancies were resolved by consensus. RESULTS: Ten studies were identified that met all inclusion criteria. The most frequently described barriers were uninsurance, language, low education level, and no usual source of care. Barriers to health care access related to race or ethnicity (6 studies) and disability (1 study) were observed less often than those related to socioeconomic status or health care systems factors (9 studies). CONCLUSIONS: Our findings reflect a critical gap in the literature. Greater attention is needed to subgroup differences including race, ethnicity, and culture within the population of people with disabilities.

Adaptation and psychometric properties of the self-efficacy/social support for activity for persons with intellectual disability scale (SE/SS-AID) in a Spanish sample.

BACKGROUND: In this study we aimed to develop a Spanish version of the Self-Efficacy/Social Support Scales for Activity for persons with Intellectual Disability (SE/SS-AID). METHOD: A cross-sectional study was carried out in a sample of 117 individuals with intellectual disability (ID). The SE/SS-AID scales were translated into Spanish and their psychometric properties analysed. RESULTS: Confirmatory factor analysis showed acceptable fit (CFI = .94 for the SE-AID and .95 for the SS-AID), but RMSEA values outside of the optimal fit range (.28 and .15, respectively). Cronbach's α was calculated for the SE-AID, SS-AID-family, SS-AID-staff, and SS-AID-peers scales, with results from .80 to .82. CONCLUSIONS: The scales show acceptable validity and reliability evidence. Use of this instrument will allow researchers to gain more knowledge about how personal and social factors influence participation in physical activity in Spanish-speaking people with ID.

Internet networks as a source of social support for women with mobility disabilities during pregnancy.

BACKGROUND: Social support during pregnancy is important for the health of mother and baby, yet little is known about social support available to women with disabilities during pregnancy. Internet social networks are one emerging source of social support, and social networks may help connect mothers with similar disabilities. OBJECTIVE: To examine the perceptions of women with mobility impairments about social support received during pregnancy from three sources: women with similar disabilities and previous pregnancy known in-person, women with similar disabilities and previous pregnancy met via online social networks, and healthcare providers. METHODS: For this cross-sectional study, an online survey of women with mobility impairments examining emotional and informational social support during pregnancy was distributed through email lists, social media and snowball recruitment. Wilcoxon signed-rank tests were conducted to examine differences in social support received by source. RESULTS: Responses from 63 eligible women were received. The majority of participants (n = 32, 51%) were connected both in-person and online to women with similar disabilities who had been pregnant, but 15 women (24%) were not connected to any women with similar disabilities who had been pregnant. Scores for informational social support from women met online were significantly higher than from women known in-person (p < .01) and from healthcare providers (p < .01). Scores for emotional social support from women met online were significantly higher than from women known in-person (p < .05). CONCLUSIONS: Interventions promoting online connections may help leverage an underutilized source of social support for women with mobility impairments seeking social support during pregnancy.

Clinical preventive service use disparities among subgroups of people with disabilities: A scoping review.

BACKGROUND: Recommended use of clinical preventive services (CPS) reduces morbidity and mortality from preventable conditions. Disparities in CPS utilization between individuals with and without disabilities have been shown, but a greater understanding of the disability subpopulations with lowest utilization is needed to better inform research, policy, and practice. OBJECTIVE: The objective was to conduct a scoping review of the literature to identify relevant studies on disparities in receipt of CPS among subgroups of individuals with disabilities. METHODS: In July 2010, electronic and manual literature searches were conducted for years 2000-2009. Review for inclusion/exclusion and data analysis occurred in 2010 and 2011. In 2012, the review was updated to cover abstracts published in 2010 and 2011. Identified abstracts, and then full-text articles of included abstracts, were reviewed according to inclusion/exclusion criteria by multiple reviewers. For articles meeting all criteria, two reviewers performed independent data extraction. A gap analysis was performed to identify areas of concentration and gaps in the literature. RESULTS: Twenty-seven articles met inclusion criteria for this review. Studies varied substantially in sample composition and research methods. CPS examined most often were cervical cancer screening (14 studies) and mammography (13 studies). Potential disparity factors studied most often were disability factors (i.e., disabling condition in 12 studies, disability severity in 10 studies). Stratification of CPS by disparity factors revealed substantial gaps in the literature. CONCLUSIONS: The literature gaps point to a need for high quality research on access disparities among subgroups of individuals with disabilities.

Pap, mammography, and clinical breast examination screening among women with disabilities: a systematic review.

BACKGROUND: Research has found some disparities between U.S. women with and without disabilities in receiving clinical preventive services. Substantial differences may also exist within the population of women with disabilities. The current study examined published research on Pap smears, mammography, and clinical breast examinations across disability severity levels among women with disabilities. METHODS: Informed by an expert panel, we followed guidelines for systematic literature reviews and searched MEDLINE, PsycINFO, and Cinahl databases. We also reviewed in-depth four disability- or preventive service-relevant journals. Two reviewers independently extracted data from all selected articles. FINDINGS: Five of 74 reviewed publications of met all our inclusion criteria and all five reported data on Pap smears, mammography, and clinical breast examination. Articles classified disability severity groups by functional and/or activity levels. Associations between disability severity and Pap smear use were inconsistent across the publications. Mammography screening fell as disability level increased according to three of the five studies. Results demonstrated modestly lower screening, but also were inconsistent for clinical breast examinations across studies. CONCLUSION: Evidence is inconsistent concerning disparities in these important cancer screening services with increasing disability levels. Published studies used differing methods and definitions, adding to concerns about the evidence for screening disparities rising along with increasing disability. More focused research is required to determine whether significant disparities exist in cancer screening among women with differing disability levels. This information is essential for national and local public health and health care organizations to target interventions to improve care for women with disabilities.