Experimental Evaluation of EMKEY: An Assistive Technology for People with Upper Limb Disabilities.

Assistive technology can help people with disabilities to use computers more effectively and can enable them to access the same information and resources as people without disabilities. To obtain more insight into the factors that can bring about the design of an Emulator of Mouse and Keyboard (EMKEY) to higher levels of user satisfaction, an experimental study was conducted in order to analyse its effectiveness and efficiency. The experimental study involved 27 participants (Mage = 20.81, SD = 1.14) who performed three experimental games under different conditions (using the mouse and using EMKEY with head movements and voice commands). According to the results, the use of EMKEY allowed for the successful performance of tasks such as matching stimuli (F(2,78) = 2.39, p = 0.10, η2 = 0.06). However, the execution times of a task were found to be higher when using the emulator to drag an object on the screen (t(52,1) = -18.45, p ≤ 0.001, d = 9.60). These results indicate the effectiveness of technological development for people with upper limb disabilities; however, there is room for improvement in terms of efficiency. The findings are discussed in relation to previous research and are based on future studies aimed at improving the operation of the EMKEY emulator.

Relevance of assistive technology and the sustainable development goals to stakeholder organizations in Malawi.

Assistive technologies are critical to supporting the participation and engagement of persons with disabilities and others who experience functional difficulties in daily life. Assistive products have been demonstrated to be related to the achievement of the Sustainable Development Goals (SDGs); however, no previous research has explored the relationship between assistive technology (AT) and the SDGs from the perspective of stakeholder organisations working in the field of AT provision. In this study, we evaluated the relevance of AT and the SDGs to achieving the organisational missions of key stakeholders in AT ecosystem in Malawi. Key stakeholders (n = 36) in the AT field in Malawi were asked to rate the relevance of AT to achieving their organisational missions, and the relevance of AT to each of the 17 SDGs on a 5-point Likert scale. Stakeholders who participated were engaged in consultative meetings with the government and an action research team as part of a larger policy development project, and represented ministries and government agencies, organisations of persons with disabilities, and local and international non-governmental organisations. AT was rated as being relevant to all of the SDGs, albeit to varying degrees, and not surprisingly to achieving AT stakeholders' organisational missions. The cross-cutting nature of the relevance of AT underscores the importance of cross-ministerial cooperation and shared leadership in provision AT.

Equity in AgeTech for Ageing Well in Technology-Driven Places: The Role of Social Determinants in Designing AI-based Assistive Technologies.

AgeTech involves the use of emerging technologies to support the health, well-being and independent living of older adults. In this paper we focus on how AgeTech based on artificial intelligence (AI) may better support older adults to remain in their own living environment for longer, provide social connectedness, support wellbeing and mental health, and enable social participation. In order to assess and better understand the positive as well as negative outcomes of AI-based AgeTech, a critical analysis of ethical design, digital equity, and policy pathways is required. A crucial question is how AI-based AgeTech may drive practical, equitable, and inclusive multilevel solutions to support healthy, active ageing.In our paper, we aim to show that a focus on equity is key for AI-based AgeTech if it is to realize its full potential. We propose that equity should not just be an extra benefit or minimum requirement, but the explicit aim of designing AI-based health tech. This means that social determinants that affect the use of or access to these technologies have to be addressed. We will explore how complexity management as a crucial element of AI-based AgeTech may potentially create and exacerbate social inequities by marginalising or ignoring social determinants. We identify bias, standardization, and access as main ethical issues in this context and subsequently, make recommendations as to how inequities that stem form AI-based AgeTech can be addressed.

Adapting the World Health Organization rapid Assistive Technology Assessment (rATA) to the Italian context: implementation of a TRAPD-based approach.

BACKGROUND: Measuring access to assistive technology (AT) has become a global priority. Recently, the World Health Organization (WHO) has developed the rapid assistive technology assessment (rATA), a population-based household survey that measures the use, need, unmet need, and barriers to accessing AT. OBJECTIVE: The aim of this paper is to report on the translation and adaptation process undertaken to implement the rATA survey in the Italian context. METHOD: The Translate, Review, Adjudicate, Pretest, and Document (TRAPD) approach was used to translate and adapt the rATA from English to Italian. Eleven independent reviewers and 23 AT users were involved to validate the Italian translation of the rATA and pilot the survey, respectively. RESULTS: The feedback provided by the first users of the rATA indicate that the data collected are reliable and well reflect the state of AT provision in Italy. CONCLUSION: This study confirmed the applicability of the rATA survey to the Italian context. The Italian version of the rATA can be used to support the government, the health system as well as the civil society to monitor the current state of AT access (and abandonment) in the country.

Access to Services from Persons with Disabilities in Afghanistan: Is Community Based Rehabilitation Making a Difference?

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 is improving access to multiple services (namely physical therapy, assistive technology, education, employment, advocacy, and community awareness) and providing satisfactions (by measuring the reduction in unmet needs) of Afghans with disabilities. 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 (PSM) and difference in difference analysis, we estimated the differences in accessing services. There were statistically significant differences between participants and controls on the access of available services between the baseline and endline. Using PSM we also found that needs were more often met among CBR participants compared to the controls. Our study indicates that a CBR program may be an effective way to provide services for persons with disabilities even in a conflict context such as Afghanistan. It contributes to addressing the longstanding question whether CBR can actually improve the rehabilitation of persons with disabilities.

Assistive devices among people living at home with advanced cancer: Use, non-use and who have unmet needs for assistive devices?

OBJECTIVE: To investigate which assistive devices people with advanced cancer have and whether they are in use. In addition, to explore the characteristics of people with advanced cancer who have unmet needs for assistive devices. METHODS: This descriptive cross-sectional study used data from a randomised controlled trial evaluating efficacy of an occupational therapy-based intervention. Participants were 237 people with advanced cancer. Data were collected by means of instruments about demography, functioning and assistive devices. RESULTS: The most frequent assistive devices possessed by the participants were as follows: (1) small aids for dressing (47%), (2) Pillow for positioning (40%) and (3) electrically operated adjustable bed (39%). The prevalence of assistive devices was 92% (95% confidence interval [CI]: 88%-95%) with 14.2% non-use, largest for trolley tables (50%). In all, 27.4% of the participants were found to have unmet needs for assistive devices. These participants had similar characteristics to the other participants except from lower activity of daily living (ADL) ability (p values = <0.001). CONCLUSION: The assistive devices possessed by the participants were primarily for positioning and resting, and most were in use. More than a fourth of the participants had unmet needs for assistive devices and were characterised by lower ADL ability.

Assessment and counseling to get the best efficiency and effectiveness of the assistive technology (MATCH): Study protocol.

AIMS: To determine the psychosocial impact of assistive technology(AT) based on robotics and artificial intelligence in the life of people with disabilities. BACKGROUND: The best match between any person with disabilities and its AT only can be gotten through a complete assessment and monitoring of his/her needs, abilities, priorities, difficulties and limitations. Without this analysis, it's possible that the device won't meet the individual's expectations. Therefore, it is important that any project focused on the development of innovating AT for people with disabilities includes the perspective of outcome measures as an important phase of the research. In this sense, the integration of the assessment, implementation process and outcome measures is crucial to guarantee the transferability for the project findings and to get the perspective from the final user. METHODS: Pilot study, with prospective, longitudinal and analytical cohort. The study lasts from July 2020 until April 2023. The sample is formed by people with disabilities, ages from 2-21, that will participate from the first stage of the process (initial assessment of their abilities and needs) to the final application of outcome measures instruments (with a complete implication during the test of technology). DISCUSSION: Only with the active participation of the person is possible to carry out a user-centered approach. This fact will allow us to define and generate technological solutions that really adjust to the expectations, needs and priorities of the people with disabilities, avoiding the AT from being abandoned, with the consequent health and social spending. TRIAL REGISTRATION: Clinical Trials ID: NCT04723784; https://clinicaltrials.gov/.

Aging Adults' Motivation to Use Embodied Conversational Agents in Instrumental Activities of Daily Living: Results of Latent Profile Analysis.

The rapidly increasing share of ageing adults in the population drives the need and interest in assistive technology, as it has the potential to support ageing individuals in living independently and safely. However, technological development rarely reflects how needs, preferences, and interests develop in different ways while ageing. It often follows the strategy of "what is possible" rather than "what is needed" and "what preferred". As part of personalized assistive technology, embodied conversational agents (ECAs) can offer mechanisms to adapt the technological advances with the stakeholders' expectations. The present study explored the motivation among ageing adults regarding technology use in multiple domains of activities of daily living. Participants responded to the questionnaire on the perceived importance of instrumental activities of daily living and acceptance of the idea of using ECAs to support them. Latent profile analysis revealed four profiles regarding the motivation to use ECAs (i.e., a low motivation profile, two selective motivation profiles with an emphasis on physical and psychological well-being, and a high motivation profile). Profiles were compared in terms of their acceptance of ECA usage in various life domains. The results increase the knowledge needed in the development of assistive technology adapted to the expectations of ageing adults.

Assessment of wheeled mobility devices provided to a commercially insured population in 2017.

In the United States, wheeled mobility devices (WMD) are classified as durable medical equipment (DME). Consistent with the definition of DME, wheeled mobility devices are typically covered by health insurance when deemed medically necessary. Despite the number of persons using wheelchairs, little knowledge is available about the types of wheelchairs provided, user's specific diagnoses and the costs associated with WMD provision. The objective of this analysis was to define the number and types of wheelchairs and associated seating and mobility (S&M) accessories provided in the calendar year 2017. The analysis focused on user demographics, categories of WMDs and associated S&M equipment as well as cost accounting according to the type of insurance and contributions by beneficiaries. Analysis of over 81,000 wheelchair acquisitions found that manual wheelchairs accounted for nearly 90% with standard manual wheelchairs accounting for 86% of all wheelchairs provided. Wheelchair recipients tended to be older with the majority being female. Based upon ICD-10 diagnostic categories over 50% of captured ICD-10 codes came from three classifications, musculoskeletal (M), circulatory (I) and a general category of not otherwise classified disorders (R). Costs associated with seating and mobility equipment were fairly large, exceeding $79 million over a single calendar year.

Policymaker and stakeholder perspectives on access to assistive technologies in Canada: challenges and proposed solutions for enhancing equitable access.

PURPOSE: Unmet needs for assistive technologies (ATs) exist and the need for ATs is growing owing to demographic changes worldwide. Little comprehensive research has examined equity of access to ATs in Canada. Our study elucidates perspectives of policymakers and stakeholders on challenges and solutions for enhancing equitable access to ATs to advance policy discussions. METHODS: We conducted a qualitative interview study with a purposive sample of policymakers and stakeholders. Stakeholders were from non-profit organisations; private insurance companies; ageing or technology industries; and advocacy, consumer, and support groups. We used thematic analysis to develop themes that summarised and facilitated data interpretation. RESULTS: We conducted 24 interviews involving 32 participants. We present three themes: (1) User experiences, detailing challenges experienced by AT system users; (2) System characteristics: Challenges and solutions, outlining governance, financial, and delivery arrangements that create challenges for accessing AT, as well as participants' proposed solutions; and (3) Shifts in models and principles, for approaches that may foster equitable access to ATs. We consolidate results into a set of valued qualities of a system that can enhance equitable AT access, and relate results to relevant national and international activities. CONCLUSIONS: This is the most comprehensive study of Canadian policymaker and stakeholder views on AT access to date. Identified challenges and solutions point to opportunities for policy action and to support work to create a national vision for AT access that strengthens the potential for ATs to enable daily activity participation, independence, and societal inclusion of seniors and people with disabilities.IMPLICATIONS FOR REHABILITATIONAT use supports daily activity participation, independence, and societal inclusion of seniors and people with disabilities.There is an urgent need to ensure that those who need ATs have access to them, considering the benefits of their use, current unmet needs for ATs, and the anticipated demand for ATs because of the ageing population and increased prevalence of chronic disease and disability.A comprehensive understanding of policymakers' and stakeholders' perspectives on challenges and potential solutions for enhancing equitable access to ATs is critical to support development of evidence- and values-informed policies.Understanding challenges and solutions identified by diverse policymakers and stakeholders can lead to national and local opportunities for policy action and support work to create a national vision for enhancing equitable access to AT.

Basic principles for the development of an AI-based tool for assistive technology decision making.

INTRODUCTION: The impact of assistive technology use on the lives of people with disabilities has long been demonstrated in the literature. Despite the need for assistive technologies, and a wealth of innovative, afford-able, and accessible products, a low rate of assistive technology uptake is globally maintained. One of the reasons for this gap is related to data and knowledge formation and management. Low access to information and a lack of assessment services is evident. Fragmentation of data, inconsistency in assessment methodology and heterogeneity in the competence of assistive technology professionals, has led to a growing interest in the opportunities that data sciences, including AI, hold for the future of the assistive technology sector, as a supportive and constructive mechanism in any decision-making process. OBJECTIVES: In this short paper, we seek to describe some of the principles that such an AI-based recommendation system should be built upon, using the Atvisor platform as a case study. Atvisor.ai is an AI-based digital platform that supports assistive technology assessments and the decision-making process. RECOMMENDATIONS: Our recommendations represent the aggregated insights from two pilots held in Israel, testing the platform in multiple environments and with different stakeholders. These recommendations include ensuring the continuum of care and providing a full user journey, incorporating shared decision making and self-assessment features, providing data personalisation and a holistic approach, building a market network infrastructure and designing the tool within a wider service delivery model design. Assessment and decision-making processes, crucial to optimal uptake, cab be leveraged by technology to become more accessible and personalised.IMPLICATIONS FOR REHABILITATIONProvides principles for the development of an AI-based recommendation system for assistive technology decision making.Promotes the use of artificial intelligence to support users and professionals in the assistive technology decision making process.Personalization of data regarding assistive technology, according to functional, holistic and client centered profiles of users, ensures optimal match and better use of assistive technology.Self-assessment and professional assessment components are important for enabling multiple access points to the assistive technology decision making process, based on the preferences and needs of users.

Home modifications and repurposing: perspectives on the accessibility, affordability, and attractiveness.

PURPOSE: Society has progressed in universal design guidelines and assistive devices for individuals with disabilities yet challenges due to affordability and attractiveness concerns remain to incorporate them into existing residences. Repurposing (i.e., replacing or adapting problematic fixtures or spaces, with others not originally intended for that purpose) may be the action to address the concerns of consumers. The purpose of this study was to elicit information on problems and solutions regarding home modifications and identify ways that consumers and professionals implement repurposing, that residents deemed accessible, affordable, and attractive. METHODS: This convergent parallel design study consisted of focus groups who rated images of repurposed spaces. The focus groups included consumers with functional mobility and visual limitations (n = 8); and professionals who devised or recommended home modifications (n = 8). Participants reviewed three images of home modification solutions and completed a Likert-scale rating based on accessibility and attractiveness. RESULTS: Focus group data indicated that high contrast, heights of fixtures, doors, and flooring - all pose threats to accessibility in the home. Consumers placed more value on attractiveness than professionals. Participants were aware and receptive to repurposing as a home modification technique but focused their discussion on adaptations. CONCLUSION: Overall, adoption and implementation of home modifications promote accessibility, but professionals need to consider individualized needs and preferences, before suggesting modifications.IMPLICATIONS FOR REHABILITATIONRepurposing existing spaces, features, and fixtures can serve as a method of home modification.Consumer home modification recommendations are perceived to be more effective when collaboratively and individually developed with professionals.Data gathered through focus groups can be valuable for informing practice and research in home modifications.

Examining social determinants in use of assistive technology for race/ethnic groups of older adults.

OBJECTIVE: Assistive technologies (AT) can compensate for activity limitations and loss of physical functioning. Little is known regarding how minority older adults differ in AT use as they age. This study examined race and ethnic differences in AT use among a nationally representative sample of older adults in the United States. DESIGN: Weighted logistic regression analyses were conducted using the 2012 Behavioural Risk Factor Surveillance System (BRFSS), collected annually by the Centres for Disease Control and Prevention (CDC). The study sample included 282,825 non-Hispanic White, African American, Asian and non-White Hispanic older adults. Activity limitation, health care access, overall health status and sociodemographic characteristics were included as variables in the analysis. Interaction analyses were conducted to examine the moderating effect of race/ethnicity on social determinants with AT use. RESULTS: Results indicated that 13.5% of older adults reported the use of an AT. African American older adults had the highest percentage of AT use (21.0%), and Asian older adults had the lowest (5.1%). Those who were 85 years and older, reported an activity limitation, were unmarried and in poor health were most likely to use an AT. Having health insurance was significantly associated with higher AT use for non-Hispanic Whites (OR = 1.66, p < 0.001) and non-White Hispanics (OR = 1.98, p < 0.01), but not African Americans and Asians. CONCLUSION: Health professionals can promote access and address barriers in AT use, particularly in regard to accessibility and acceptability among minority older adults.Implications for rehabilitationAfrican-Americans older adults were most likely to use ATs, and Asian older adults the leastOlder adults who were 85 years and older, reported an activity limitation, were unmarried and in poor health were most likely to use an ATDifferent social determinants to AT use were found among race/ethnic groups, highlighting the need to promote access and address barriers to health care utilization.

A situation assessment of assistive technology in Ukraine

This publication summarizes the situation of the assistive technology system in Ukraine, as at September 2020, and the findings of a household survey on assistive technology conducted in April–June 2021. It outlines key achievements, needs and opportunities for intervention in the field of assistive technology. The situational analysis was conducted under the leadership of the Ministry of Social Policy, with technical support from the WHO Regional Office for Europe and the WHO Country Office in Ukraine. It was undertaken in collaboration with different Government ministries and State agencies, development partners, United Nations agencies, professional associations, disabled people’s organizations and rehabilitation users. It adopted an evidence-based approach, responsive to the unique social, cultural, economic and political circumstances in the country. The content of this document is a snapshot in time – not an in-depth analysis of the entire assistive technology sector. The analysis focuses on assistive technology policy and governance, service provision, financing, information management and human resources, with the aim of improving access to high-quality assistive technology in Ukraine.

Measuring Self-Reported Access to Assistive Technology Using the WHO Rapid Assistive Technology Assessment (rATA) Questionnaire: Protocol for a Multi-Country Study.

In 2018, the World Health Assembly adopted a resolution on improving access to assistive technology (AT), and mandated the WHO to prepare a global report on assistive technology based on the best available evidence and international experience. As limited data on access to AT at country and global levels were available, there was a need to conduct representative population surveys in order to inform the development of the global report, national AT programs, and global initiatives. The objective of this protocol is to describe a multi-country study of access to assistive technology in six self-reported areas: use, source, payer, satisfaction, unmet need, and barriers. In collaboration with WHO Regional and Country offices, Member States, and other stakeholders, the Assistive Technology Access team in WHO coordinates the study. Data are collected through household surveys using the rapid Assistive Technology Assessment (rATA) questionnaire. Findings from the surveys will be published in the global report.

Social protection and access to assistive technology in low- and middle-income countries.

To overcome widespread barriers and lack of support, persons with disabilities face significant disability-related costs, including assistive technology (AT), that drive them to or maintain them in poverty and undermine their socio-economic participation. In many countries, social protection systems are a gateway to accessing assistive devices either through health insurance, integration in Universal Health Coverage (UHC) packages, subsidies, cash transfers or direct provision. However, the broader issues of access to AT (lack of awareness, information, availability, human resources, etc.) are compounded by barriers to social protection. In low- and middle-income countries globally, less than 20% of persons with significant disabilities, who are likely to need AT, receive disability benefits. This paper reflects on the relation of AT and disability-related costs, the evolution of the role of social protection in line with the CRPD, and the different social protection mechanisms used at the national level to provide access to AT. It further highlights some of the key issues to be tackled by social protection systems to enhance access to AT, with a focus on low- and middle-income countries.

Scoping review of economic evaluations of assistive technology globally.

The paper presents a scoping review of existing economic evaluations of assistive technology (AT). The study methodology utilized a PRISMA flow approach with final included studies that met an adapted PICOS framework. Types of economic evaluations employed, study type and rigor and domains of AT impact were considered and analyzed. The economic evaluations in this study included 13 CBA, 9 CMA, 18 CEAs and 10 CUA. The majority of studies (32 studies in total) mentioned or recorded that AT investment, access and/or usage had impacts on the domain of both informal and formal health care. Specifically, care costs, time, and resources were affected. Our study has found that current AT economic evaluations are limited. This study advocates for a wider use of robust alternative evaluation and appraisal methodologies that can highlight AT value and which would subsequently provide further evidence that may make governments more willing to invest in and shape AT markets.

Differences in assistive technology installed for people with dementia living at home who have wandering and safety risks.

BACKGROUND: Assistive Technology for people with dementia living at home is not meeting their care needs. Reasons for this may be due to limited understanding of variation in multiple characteristics of people with dementia including their safety and wandering risks, and how these affect their assistive technology requirements. This study therefore aimed to explore the possibility of grouping people with dementia according to data describing multiple person characteristics. Then to investigate the relationships between these groupings and installed Assistive Technology interventions. METHODS: Partitioning Around Medoids cluster analysis was used to determine participant groupings based upon secondary data which described the person characteristics of 451 people with dementia with Assistive Technology needs. Relationships between installed Assistive Technology and participant groupings were then examined. RESULTS: Two robust clustering solutions were identified within the person characteristics data. Relationships between the clustering solutions and installed Assistive Technology data indicate the utility of this method for exploring the impact of multiple characteristics on Assistive technology installations. Living situation and caregiver support influence installation of assistive technology more strongly than level of risk or cognitive impairment. People with dementia living alone received different AT from those living with others. CONCLUSIONS: Results suggest that caregiver support and the living situation of the person with dementia influence the type and frequency of installed Assistive Technology. Reasons for this include the needs of the caregiver themselves, the caregiver view of the participants' needs, caregiver response to alerts, and the caregiver contribution to the assistive technology assessment and selection process. Selection processes should be refined to account for the needs and views of both caregivers and people with dementia. This will require additional assessor training, and the development of validated assessments for people with dementia who have additional impairments. Policies should support the development of services which provide a wider range of AT to facilitate interventions which are focused on the needs of the person with dementia.

التكنولوجيات المساعدة في إقليم شرق المتوسط: نتائج تقييم سريع

للتكنولوجيات المُساعِدة دور مهم في الحفاظ عى الأداء الوظيفي للأشخاص وعافيتهم وتحسينهما، مما يُمكِّنهم من التمتع بحياة صحية ومُنتِجة ومستقلة  وكريمة. ولكن عى الرغم من أن إقليم منظمة الصحة العالمية لرق المتوسط يضم قرابة 100 مليون شخص مَِّنْ يحتاجون إلى منتج واحد أو أكثر من المنتجات المُساعِدة، فإن شخصاً واحداً فقط من بن كل عرة أشخاص منهم هو الذي يستطيع الحصول عى ما يحتاج إليه من هذه المنتجات، والطلب آخذ في الازدياد. ويعرض هذا التقرير نتائج تقييم سريع للوضع في بلدان الإقليم، مع التركيز عى خمسة مجالات رئيسية، ألا وهي: السياسات والتمويل، والمعلومات والبحوث، والمنتجات، والعاملون، وتقديم الخدمات. ويقدم التقرير معلومات أساسية عن مستوى توفُّر المنتجات المُساعِدة، إلى جانب توصيات مستندة إلى النتائج لمساعدة البلدان عى تحسن إتاحة التكنولوجيات المُساعِدة.

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.

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.