Financial inclusion for people with disability: a scoping review.

BACKGROUND: Financial exclusion is a human rights issue affecting health equity. Evidence demonstrates that financial exclusion is exacerbated for people with disability and those in low- to middle-income countries (LMIC). Barriers to financial access include limited demand for services, banking inadequacies in catering to people with disability, and insufficiently accessible information technologies (ICT) and infrastructure. OBJECTIVES: This scoping review sought to identify barriers to and facilitators of financial inclusion for people with disability in LMIC. As a secondary objective, the study explored the potential of financial education and ICT utilisation as viable strategies for enhancing financial inclusion. METHODS: This review utilised the Arksey and O'Malley framework and PRISMA Checklist for systematic literature examination and data extraction. The WHO's Environmental Factors guided the analysis to propose potential interventions and to generate recommendations. RESULTS: The review analysed 26 publications from various global regions and fields including finance, business, technology, health and disability policy. It identified consistent financial inclusion barriers for people with disability, resulting in a set of global recommendations across attitudes, environment, technology, services, and policy. CONCLUSIONS: Recommendations include using ICT, digital innovation and multi-stakeholder collaboration to address the financial barriers experienced by people with disability. These efforts, rooted in social justice, aim to include people with disability in LMIC as valued financial sector participants, promoting health and equity.

Main findings: There are global access barriers and enablers to financial inclusion for people living with disability. Recommendations to improve access include countering stigma and attitudinal barriers, engaging in user centred design of financial services,providing financial education and ensuring accessibility of assistive technology and ICT, along with the physical environment of the bank.Added knowledge: This study reviews the literature and offers a global overview of financial inclusion for people with disabilities, along with recommendations for universally applicable actions to enhance access.Global health impact for policy and action: Identifying barriers to financial inclusion and suggesting strategies to overcome them provides valuable guidance for policymakers and advocates working to improve access to financial services for people with disability.

Symptoms of depression and risk of emergency department visits among people aged 70 years and over.

BACKGROUND: Older people experiencing depression and anxiety have higher rates of health service utilisation than others, but little is known about whether these influence their seeking of emergency care. The aim was to examine the associations between symptoms of depression and the use of emergency health care, in an Australian context, among a population of people aged 70 years and over initially free of cardiovascular disease, dementia or major physical disability. METHODS: We undertook secondary analyses of data from a large cohort of community-dwelling Australians aged [Formula: see text]70 years. Multivariable logistic regression was used to compare the association of symptoms of depression (measured using the Center for Epidemiological Studies Depression Scale 10 question version, CESD at baseline) with subsequent episodes of emergency care, adjusting for physical and social factors of clinical interest. Marginal adjusted odds ratios were calculated from the logistic regression. RESULTS: Data were available for 10,837 Australian participants aged at least 70 years. In a follow-up assessment three years after the baseline assessment, 17.6% of people self-reported an episode of emergency care (attended an ED of called an emergency ambulance) in the last 12 months. Use of emergency healthcare was similar for men and women (17.8% vs. 17.4% p = 0.61). A score above the cut-off on the CESD at baseline was associated with greater use of emergency health care (OR = 1.35, 95% CI 1.11,1.64). When modelled separately, there was a greater association between a score above the cut-off on the CESD and emergency healthcare for women compared with men. CONCLUSIONS: This study is unique in demonstrating how depressive symptoms among healthy older persons are associated with subsequent increased use of emergency healthcare. Improved understanding and monitoring of mental health in primary care is essential to undertake effective healthcare planning including prevention of needing emergency care.

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.

Digital Capabilities of Older People and Uptake of Online Healthy Ageing Interventions: An Australian Study.

The promise of digital health interventions is tempered by the realities of digital capabilities and infrastructure, especially for older persons. This paper critically examines learnings from a rapid evidence review of digital information tools along with a study evaluating the uptake of a digitally-based healthy ageing intervention by 53 older Australians. Findings suggest that digital literacy is an important precursor to engagement with digital information tools, and that digital information tools must be designed with digital literacy in mind. To achieve digital health equity and realise the potential outcomes that digital tools offer, it may well be necessary to support consumers with the basics of mastering digital platforms.

Housing and Support for People with Disability: Perspectives of Motor Accident, Disability and Injury Insurers across Australia and New Zealand.

Housing is a critical enabler of a dignified life, civic participation and the achievement of human rights. Providing appropriate housing for people who experience neurotrauma as a result of road or workplace injury, with both the assistive technology and human support required, continues however to be a policy and practice challenge. Australian and New Zealand motor accident, disability and injury insurers have high and enduring liability in this area, and their under-researched perspectives are needed to strengthen the evidence base for policy and practice development. This qualitative study utilised focus group methodology with representatives from government injury and disability insurers across Australia and New Zealand (n = 8). The study aimed to identify (a) issues and trends; (b) factors for decision making; and (c) service impacts relating to housing and support for people with disability and high daily support needs. Thematic analysis generated results across four key areas: influences on the decision to fund housing and/or support; identifying 'good' housing solutions; evaluating cost-benefit of housing and support investments; and developing future investment in housing and support. Findings such as those regarding decision-making, and investment, attest to the value of capturing the perspectives of this key group of stakeholders to assist to envision better housing and support for people with disability.

Avoiding the Banality of Evil in Times of COVID-19: Thinking Differently with a Biopsychosocial Perspective for Future Health and Social Policies Development.

The COVID-19 pandemic provides the opportunity to re-think health policies and health systems approaches by the adoption of a biopsychosocial perspective, thus acting on environmental factors so as to increase facilitators and diminish barriers. Specifically, vulnerable people should not face discrimination because of their vulnerability in the allocation of care or life-sustaining treatments. Adoption of biopsychosocial model helps to identify key elements where to act to diminish effects of the pandemics. The pandemic showed us that barriers in health care organization affect mostly those that are vulnerable and can suffer discrimination not because of severity of diseases but just because of their vulnerability, be this age or disability and this can be avoided by biopsychosocial planning in health and social policies. It is possible to avoid the banality of evil, intended as lack of thinking on what we do when we do, by using the emergence of the emergency of COVID-19 as a Trojan horse to achieve some of the sustainable development goals such as universal health coverage and equity in access, thus acting on environmental factors is the key for global health improvement.

Assistive technology as a pillar of universal health coverage: qualitative analysis of stakeholder responses to the world health assembly resolution on assistive technology.

Purpose: The importance of assistive technology (AT) as a pillar of universal health coverage was recognized at the 71st World Health Assembly (WHA) through the passing of Resolution 71.8 on improving access to AT (May 2018). A systematic analysis was conducted on the responses made to the Resolution by Member States and non-state actors, in order to provide a snapshot of global intent.Methods: Qualitative content analysis was conducted on over 40 written "Statements" made by Member States and non-state actors in response to Resolution 71.8.Results: The Resolution provides tangible guidance to the World Health Organisation (WHO) and its member states in order for them to meet commitments within the Convention on the Rights of Persons with Disabilities (CRPD). Statements made in response to the Resolution offer a unique plethora of multi-stakeholder views from differing global perspectives. Analysis identified a range of themes within two overarching themes: intersection of health, human rights and sustainable development; and international collaboration and support within an international agenda framework.Conclusion: The content analysis synthesises complex global data and identifies directions to positively influence national and regional AT policy and delivery. The complexity of factors demonstrates the importance of an AT systems-thinking approach; that is, the development and application of organised knowledge, skills, procedures and policies related to assistive products. AT systems thinking will be essential for AT to be effectively deployed as a pillar of universal health coverage.IMPLICATIONS FOR REHABILITATIONAssistive technology is a key facilitator of health and well-being, playing a critical role in global efforts to improve population health outcomes and strengthening health systemsAccess to assistive technology is a public health priority and is an essential health product to be covered under Universal Health CoverageEffective action on access to assistive technology must encompass the reality of diverse contexts yet common purposes expressed by global actorsThis analysis demonstrates the intersection of the health, human rights and sustainable development agendas, and the importance of international collaboration and support in achieving effective access.

Enabling appropriate personnel skill-mix for progressive realization of equitable access to assistive technology.

BACKGROUND AND METHODS: This paper reviews the current capacity of personnel in enabling access to assistive technology (AT) as well as the systems and processes within which they work, and was reviewed, discussed, and refined during and following the Global Research, Innovation, and Education in Assistive Technology (GREAT) Summit. FINDINGS: Key concepts addressed include a person-centred team approach; sustainability indicators to monitor, measure, and respond to needs for service design and delivery; education, research, and training for competent practice, using the six rehab-workforce challenges framework; and credentialing frameworks. We propose development of a competence framework and associated education and training programs, and development and implementation of a certification framework for AT personnel. CONCLUSIONS: There is a resolve to address the challenges faced by People globally to access assistive technology. Context specific needs assessment is required to understand the AT Personnel landscape, to shape and strengthen credentialing frameworks through competencies and certification, acknowledging both general and specific skill mix requirements. Implications for Rehabilitation Personnel in assistive technology (AT) provision should be trained using a person-centred team approach, which emphasizes appropriate skill-mix to address multiple needs within the community. Sustainability indicators should be used which allow personnel to monitor, measure and respond to needs for service design and delivery. A competence framework with associated education and training program, coupled with the development and implementation of a certification framework for AT personnel needs, will promote quality in AT personnel training globally.

Assistive Technology in Australia: Integrating theory and evidence into action.

BACKGROUND: Occupational therapists use a range of strategies to influence the relationship between person, environment and occupation and facilitate people's participation and inclusion in society. Technology is a fundamental environmental factor capable of enabling inclusion, and occupational therapy models articulate a role for assistive technology (AT) devices and services, but there is a gap between theory, research and practice. The context of AT provision in Australia presents systemic barriers that prevent optimal application of AT devices and services for societal health promotion and in individualised solutions. METHODS: The Integrating Theory, Evidence and Action method (ITEA) was used to answer the question 'How can occupational therapy support AT provision to enable older people and people with disability?' A wide range of sources were systematically analysed to explore the complexities of AT provision in Australia. RESULTS: The International Classification of Functioning, Disability and Health (ICF) and IMPACT2 model are used as frameworks to reconstruct evidence into statements that summarise the theory, process and outcomes of AT provision. Analysis of the influence of the global disability rights and local policies and AT provision systems is used to highlight important aspects for occupational therapists to consider in research and practice. Pragmatic recommendations are provided to enable practitioners to translate theory and evidence into action. CONCLUSION: AT provision can be improved by focusing on evidence for and congruence between theory, process and outcomes, rather than isolated interventions. Occupational therapists should consider the influence of contextual factors on practice, and work with consumers to improve access and equity in AT provision systems.

Challenges of user-centred assistive technology provision in Australia: shopping without a prescription.

PURPOSE: People with disability have a right to assistive technology devices and services, to support their inclusion and participation in society. User-centred approaches aim to address consumer dissatisfaction and sub-optimal outcomes from assistive technology (AT) provision, but make assumptions of consumer literacy and empowerment. Policy discourses about consumer choice prompt careful reflection, and this paper aims to provide a critical perspective on user involvement in assistive technology provision. METHODS: User-centred approaches are considered, using literature to critically reflect on what user involvement means in AT provision. Challenges at the level of interactions between practitioners and consumers, and also the level of markets and policies are discussed, using examples from Australia. RESULTS: There is no unanimous conceptual framework for user-centred practice. Power imbalances and differing perspectives between practitioners and consumers make it difficult for consumers to feel empowered. Online access to information and international suppliers has not surmounted information asymmetries for consumers or lifted the regulation of publicly funded AT devices. CONCLUSIONS: Ensuring access and equity in the public provision of AT is challenging in an expanding market with diverse stakeholders. Consumers require personalised information and support to facilitate their involvement and choice in AT provision. Implications for Rehabilitation Variations in approaches informing AT provision practices have a profound impact on equity of access and outcomes for consumers. An internationalised and online market for AT devices is increasing the need for effective information provision strategies and services. Power imbalances between practitioners and consumers present barriers to the realisation of user-centred practice.

"An Environment Built to Include Rather than Exclude Me": Creating Inclusive Environments for Human Well-Being.

Contemporary discourses which challenge the notion of health as the "absence of disease" are prompting changes in health policy and practice. People with disability have been influential in progressing our understanding of the impact of contextual factors in individual and population health, highlighting the impact of environmental factors on functioning and inclusion. The World Health Organization's (WHO) more holistic definition of health as "wellbeing" is now applied in frameworks and legislation, and has long been understood in occupational therapy theory. In practice, however, occupational therapists and other professionals often address only local and individual environmental factors to promote wellbeing, within systems and societies that limit equity in population health and restrict inclusion in communities. This paper presents an in-depth analysis of the supports and accommodations identified by a cohort of individuals (n-100) living with disability. A range of environmental facilitators and barriers were identified in peoples' experience of "inclusive community environs" and found to influence inclusion and wellbeing. The roles and responsibilities of individuals, professionals, and society to enact change in environments are discussed in light of these findings. Recommendations include a focus on the subjective experience of environments, and application of theory from human rights and inclusive economics to address the multiple dimensions and levels of environments in working towards inclusion and wellbeing.

Problems, policies and politics: making the case for better assistive technology provision in Australia.

PURPOSE: Substantial evidence supports assistive technology and environmental adaptations as key enablers to participation. In order to realise the potential of these interventions, they need to be both recognised in policy, and resourced in practice. This paper uses political theory to understand the complexities of assistive technology (AT) policy reform in Australia. AT research will not be influential in improving AT policy without consideration of political drivers. METHOD: Theories of policy formation are considered, with Kingdon's (2003) theory of multiple streams identified as a useful lens through which to understand government actions. This theory is applied to the case of current AT policy reformulation in Australia. RESULTS: The convergence model of problem identification, policy formulation and political will is found to be an applicable construct with which to evaluate contemporary policy changes. This paper illustrates the cogency of this theory for the field of AT, in the case of Australia's recent disability and aged care reforms. CONCLUSIONS: Political theory provides a way of conceptualising the difficulties of consumers and AT practitioners experience in getting therapeutically valid solutions into public policy, and then getting policies prioritised and funded. It is suggested that AT practitioners must comprehend and consider political factors in working towards effective policies to support their practice. IMPLICATIONS FOR REHABILITATION: AT practitioners generally lack political awareness or an understanding of the drivers of policy. The effectiveness of AT practitioners at a systemic level will remain limited without consideration of policy drivers. AT practitioners must comprehend and consider political factors in working towards effective policies to support their practice.

Informing the Australian government on AT policies: ARATA's experiences.

UNLABELLED: This article describes the development and dissemination of an evidence-based Policy Statement and Background Papers by the Australian Rehabilitation and Assistive Technology Association (ARATA). An experienced project team was engaged to conduct literature reviews and member consultations, develop resources and implement a targeted advocacy strategy that included a policy launch and meetings with government officials. The Policy Statement and Background Papers have enabled ARATA to represent the views of Assistive Technology (AT) Practitioners in consultations around the National Disability Insurance Scheme and other AT-related inquiries. In ARATA's experience, developing a policy statement and disseminating it through a targeted advocacy strategy is an effective way for a not-for-profit professional organisation to influence government policy. IMPLICATIONS FOR REHABILITATION: AT practitioners must consider political factors in working towards effective policies to support their practice. To be effective at a systemic level, AT practitioners must develop political awareness and an understanding of the drivers of policy. This case study provides a blueprint for AT practitioners and organisations in tackling policy change.

Using the ICF in economic analyses of Assistive Technology systems: methodological implications of a user standpoint.

PURPOSE: This paper identifies key methodological issues for economic analyses of costs and effectiveness of Assistive Technology (AT) systems based on the International Classification of Functioning, Disability and Health (ICF). Following the biopsychosocial model of the ICF, the paper explores the consequences for cost-effectiveness analyses of AT systems when a user centred approach is taken. In so doing, the paper questions the fiction of neutrality in economic analyses and discusses the distinction between weak and strong objectivity. METHOD: Costs are measured as all resources used when providing a particular level of environmental facilitators and reducing environmental barriers for an AT user, while effectiveness is measured in terms of the resulting increase in activities and participation of the AT user. The ICF's fourth qualifier for activities and participation, which denotes performance without assistance is used to identify the additional performance achieved due to the particular environmental factors in the current situation (first qualifier). A fifth qualifier for activities and participation is introduced to denote performance with optimal assistance, and the fourth qualifier is then again used to identify the increase in activities and participation due to the environmental factors in the situation with optimal assistance. RESULTS: The effectiveness that an AT user achieves in his or her current situation can be compared with the effectiveness he or she could achieve when provided with what is considered an optimal AT system based on current technologies and user priorities. This comparison throws into sharp relief the role of AT systems as well as of universal design (UD) in reducing environmental barriers for AT users in a way that is cost-effective for society as a whole. CONCLUSION: Cost-effectiveness analysis based on the ICF can provide powerful economic evidence for how best to allocate existing funding for AT systems. We can identify three particular scenarios in which clear recommendations can be made. In addition, cost-effectiveness analysis provides a means to identify how society can comply with its obligation towards all its members in the most cost-effective way, using a combination of AT and UD.