Barriers to the access of people with disabilities to health services: a scoping review

Clemente, Karina Aparecida Padilha; Silva, Simone Vieira da; Vieira, Gislene Inoue; Bortoli, Maritsa Carla de; Toma, Tereza Setsuko; Ramos, Vinícius Delgado; Brito, Christina May Moran de

doi:10.11606/s1518-8787.2022056003893

Karina Aparecida Padilha Clemente

Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Legal, Ética Médica, Medicina Social e do Trabalho. São Paulo, SP, Brasil.

http://orcid.org/0000-0002-0985-9626

Simone Vieira da Silva

Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Legal, Ética Médica, Medicina Social e do Trabalho. São Paulo, SP, Brasil.

http://orcid.org/0000-0002-7430-5208

Gislene Inoue Vieira

Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Legal, Ética Médica, Medicina Social e do Trabalho. São Paulo, SP, Brasil.

http://orcid.org/0000-0002-6536-9218

Maritsa Carla de Bortoli

Secretaria de Estado da Saúde de São Paulo. Instituto de Saúde. Departamento de Ciência e Tecnologia. São Paulo, SP, Brasil.

http://orcid.org/0000-0001-8236-7233

Tereza Setsuko Toma

Secretaria de Estado da Saúde de São Paulo. Instituto de Saúde. Departamento de Ciência e Tecnologia. São Paulo, SP, Brasil.

http://orcid.org/0000-0001-9531-9951

Vinícius Delgado Ramos

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Instituto de Medicina Física e Reabilitação. São Paulo, SP, Brasil.

http://orcid.org/0000-0002-4566-6637

Christina May Moran de Brito

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Instituto do Câncer do Estado de São Paulo. São Paulo, SP, Brasil.

http://orcid.org/0000-0003-3775-6533

Correspondence: Karina Aparecida Padilha Clemente Av. Dr. Arnaldo, 455 - Cerqueira César 01246-903 São Paulo, SP, Brasil E-mail: karinaapclemente@yahoo.com.br

Authors’ Contribution: Study conception and planning: KAPC, SVS, GIV, MCB, TST, VDR, CMMB. Data collection, analysis, and interpretation: KAPC, SVS, GIV, MCB, TST, VDR, CMMB. Manuscript development and review: KAPC, SVS, GIV, MCB, TST, VDR, CMMB. Final draft approval: KAPC, SVS, GIV, MCB, TST, VDR, CMMB. Public responsibility for the content of the article: KAPC, SVS, GIV, MCB, TST, VDR, CMMB.

Conflict of Interest: The authors declare no conflict of interest.

Figures (1)
Tables (5)

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Figure
Studies’ selection flowchart, adapted from PRISMA⁹9. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71
https://doi.org/10.1136/bmj.n71... .

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Box
Detailing of the bibliographic survey carried out in scientific literature databases.

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Table 1
Barriers to access of people with disabilities in health services, according to the level of care (users).

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Table 2
Barriers to the access of people with disabilities in health services, according to the level of care (service provision).

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Table 3
Barrier categories according to components of the theoretical framework from Levesque et al.⁷7. Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12:18. https://doi.org/10.1186/1475-9276-12-18
https://doi.org/10.1186/1475-9276-12-18... (2013) and LBI¹1. Brasil. Lei Nº 13.146 de 6 de julho de 2015. Institui a Lei Brasileira de Inclusão da Pessoa com Deficiência (Estatuto da Pessoa com Deficiência). Brasília, DF; 2015 [cited 2021 Jan 20]. Available from: http://www.planalto.gov.br/ccivil_03/_ato2015-2018/2015/lei/l13146.htm
http://www.planalto.gov.br/ccivil_03/_at... – users and caregivers.

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Table 4
Barrier categories according to components of the theoretical framework from Levesque et al.⁷7. Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12:18. https://doi.org/10.1186/1475-9276-12-18
https://doi.org/10.1186/1475-9276-12-18... (2013) and LBI¹1. Brasil. Lei Nº 13.146 de 6 de julho de 2015. Institui a Lei Brasileira de Inclusão da Pessoa com Deficiência (Estatuto da Pessoa com Deficiência). Brasília, DF; 2015 [cited 2021 Jan 20]. Available from: http://www.planalto.gov.br/ccivil_03/_ato2015-2018/2015/lei/l13146.htm
http://www.planalto.gov.br/ccivil_03/_at... – health professionals and services.

Base	Date	Strategy
PubMed	07/06/2019	(((Disabled Person OR Person, Disabled OR Persons, Disabled OR Persons with Disabilities OR Disabilities, Persons with OR Disability, Persons with OR Persons with Disability OR Handicapped OR People with Disabilities OR Disabilities, People with OR People with Disability OR Physically Handicapped OR Handicapped, Physically OR Physically Disabled OR Disabled, Physically OR Physically Challenged)) AND (“Health Services Accessibility”[Mesh] OR Availability of Health Services OR Health Services Availability OR Accessibility, Health Services OR Access to Health Care OR Accessibility of Health Services OR Health Services Geographic Accessibility OR Program Accessibility OR Accessibility, Program)) AND (SYSTEMATIC REVIEW OR SYSTEMATIC REVIEWS)
PubMed	07/06/2019	(((Disabled Person OR Person, Disabled OR Persons, Disabled OR Persons with Disabilities OR Disabilities, Persons with OR Disability, Persons with OR Persons with Disability OR Handicapped OR People with Disabilities OR Disabilities, People with OR People with Disability OR Physically Handicapped OR Handicapped, Physically OR Physically Disabled OR Disabled, Physically OR Physically Challenged)) AND ((“Health Services for Persons with Disabilities”[Mesh] OR Health Services for the Disabled OR Health Services for People with Disabilities OR Health Services for Disabled Persons) AND Review[ptyp])) AND (SYSTEMATIC REVIEW OR SYSTEMATIC REVIEWS)
PubMed	07/06/2019	(((Disabled Person OR Person, Disabled OR Persons, Disabled OR Persons with Disabilities OR Disabilities, Persons with OR Disability, Persons with OR Persons with Disability OR Handicapped OR People with Disabilities OR Disabilities, People with OR People with Disability OR Physically Handicapped OR Handicapped, Physically OR Physically Disabled OR Disabled, Physically OR Physically Challenged)) AND ((“Healthcare Disparities”[Mesh] OR Disparity, Healthcare OR Health Care Inequalities OR Health Care Inequality OR Inequalities, Health Care OR Inequality, Health Care OR Healthcare Disparity OR Healthcare Inequalities OR Healthcare Inequality OR Inequalities, Healthcare OR Inequality, Healthcare OR Disparities, Healthcare OR Health Care Disparities OR Disparities, Health Care OR Disparity, Health Care OR Health Care Disparity) AND Review[ptyp])) AND (SYSTEMATIC REVIEW OR SYSTEMATIC REVIEWS)
Health Systems Evidence	07/06/2019	disability OR disabilities
Health Evidence	07/06/2019	[(disabled persons) OR disability OR disabilities]
Scopus	07/06/2019	TITLE-ABS-KEY(“disabled persons”ANDaccessibility)AND(LIMIT-TO(DOCTYPE,”re”))
EMBASE	07/06/2019	(‘disabled person’/exp OR ‘disabled person’ OR ‘disability’/exp OR disability) AND (‘accessibility’/exp OR accessibility) AND (‘health care facilities and services’/exp OR ‘health care facilities and services’) AND [review]/lim AND [embase]/lim
Lilacs via VHL regional portal	07/06/2019	(“pessoas com deficiência” OR “disabled persons” OR “personas con discapacidad” OR deficiência OR deficiências OR “deficiência física” OR “deficiências fisicas” OR “deficiente físico” OR incapacidade OR “incapacidade funcional” OR “limitação física” OR “pessoa com desvantagem” OR “pessoas com desvantagens” OR “pessoa com incapacidade” OR “pessoas com incapacidade” OR “pessoas com deficiências” OR “pessoas com incapacidades” OR “pessoa com incapacidade física” OR “pessoa com deficiência fisica” OR “pessoas com deficiência física” OR “pessoas com incapacidade física” OR “pessoas com deficiências físicas” OR “pessoa com limitação física” OR “pessoas com limitação física” OR “pessoas com limitações físicas” OR “pessoa com necessidade especial” OR “pessoas com necessidade especial” OR “pessoas com necessidades especiais”) AND (“acesso aos serviços de saúde” OR “health services accessibility” OR “accesibilidad a los servicios de salud” OR “disparidades em assistência à saúde” OR “healthcare disparities” OR “disparidades en atención de salud” OR “serviços de saúde para pessoas com deficiência” OR “health services for persons with disabilities” OR “servicios de salud para personas con discapacidad”) AND (instance:”regional”) AND ( db:(“LILACS” OR “BDENF” OR “BBO” OR “IBECS”))

Level of care	Barriers found in the literature
Basic	Limited access to psychological support and little or no community-based psychiatric support¹⁸18. Balogh R, McMorris CA, Lunsky Y, Ouellette‐Kuntz H, Bourne L, Colantonio A, et al. Organising healthcare services for persons with an intellectual disability. Cochrane Database Syst Rev. 2016;(4):CD007492. https://doi.org/10.1002/14651858.CD007492.pub2 https://doi.org/10.1002/14651858.CD00749... ; difficulty in finding physicians willing to care for severely disabled and complex patients¹⁹19. Brown M, Macarthur J, Higgins A, Chouliara Z. Transitions from child to adult health care for young people with intellectual disabilities: a systematic review. J Adv Nurs. 2019;75(11):2418-34. https://doi.org/10.1111/jan.13985 https://doi.org/10.1111/jan.13985... ; difficulty in finding the needed health services¹⁸18. Balogh R, McMorris CA, Lunsky Y, Ouellette‐Kuntz H, Bourne L, Colantonio A, et al. Organising healthcare services for persons with an intellectual disability. Cochrane Database Syst Rev. 2016;(4):CD007492. https://doi.org/10.1002/14651858.CD007492.pub2 https://doi.org/10.1002/14651858.CD00749... ^,¹⁹19. Brown M, Macarthur J, Higgins A, Chouliara Z. Transitions from child to adult health care for young people with intellectual disabilities: a systematic review. J Adv Nurs. 2019;75(11):2418-34. https://doi.org/10.1111/jan.13985 https://doi.org/10.1111/jan.13985... ; lack of request for and performance of preventive tests and care²⁰20. Marrocco A, Krouse HJ. Obstacles to preventive care for individuals with disability: implications for nurse practitioners. J Am Assoc Nurse Pract. 2017;29(5):282-93. https://doi.org/10.1002/2327-6924.12449 https://doi.org/10.1002/2327-6924.12449... ; lack of access to information on reproductive sexual health, family planning and prenatal and postnatal services²¹21. Mheta D, Mashamba-Thompson TP. Barriers and facilitators of access to maternal services for women with disabilities: scoping review protocol. Syst Rev. 2017;6:99. https://doi.org/10.1186/s13643-017-0494-7 https://doi.org/10.1186/s13643-017-0494-... ; lack of professional support²²22. Andresen EM, Peterson-Besse JJ, Krahn GL, Walsh ES, Horner-Johnson W, Iezzoni LI. Pap, mammography, and clinical breast examination screening among women with disabilities: a systematic review. Womens Health Issues. 2013;23(4):205-14. https://doi.org/10.1016/j.whi.2013.04.002 https://doi.org/10.1016/j.whi.2013.04.00... ; lack of communication of the professional with the patient or caregiver^22–25; lack of information to caregivers about the patient’s health conditions and insufficient access to child care services²⁵25. Ziviani J, Feeney R, Rodger S, Watter P. Systematic review of early intervention programmes for children from birth to nine years who have a physical disability. Aust Occup Ther J. 2010;57(4):210-23. https://doi.org/10.1111/j.1440-1630.2010.00850.x https://doi.org/10.1111/j.1440-1630.2010... ; lack of health insurance and inability to pay for any service expenses¹⁸18. Balogh R, McMorris CA, Lunsky Y, Ouellette‐Kuntz H, Bourne L, Colantonio A, et al. Organising healthcare services for persons with an intellectual disability. Cochrane Database Syst Rev. 2016;(4):CD007492. https://doi.org/10.1002/14651858.CD007492.pub2 https://doi.org/10.1002/14651858.CD00749... ^,²⁰20. Marrocco A, Krouse HJ. Obstacles to preventive care for individuals with disability: implications for nurse practitioners. J Am Assoc Nurse Pract. 2017;29(5):282-93. https://doi.org/10.1002/2327-6924.12449 https://doi.org/10.1002/2327-6924.12449... ^,²⁵25. Ziviani J, Feeney R, Rodger S, Watter P. Systematic review of early intervention programmes for children from birth to nine years who have a physical disability. Aust Occup Ther J. 2010;57(4):210-23. https://doi.org/10.1111/j.1440-1630.2010.00850.x https://doi.org/10.1111/j.1440-1630.2010... ; and fear and anxiety regarding the treatment of children with disabilities²⁰20. Marrocco A, Krouse HJ. Obstacles to preventive care for individuals with disability: implications for nurse practitioners. J Am Assoc Nurse Pract. 2017;29(5):282-93. https://doi.org/10.1002/2327-6924.12449 https://doi.org/10.1002/2327-6924.12449... .
Specialized	Lack of access to health services²⁶26. Oral A, Rapidi CA, Votava J, Roussos N, Michail X, Kujawa J, et al. Evidence based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for ageing people with disabilities. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med. 2017;53(5):802-11. https://doi.org/10.23736/S1973-9087.17.04864-X https://doi.org/10.23736/S1973-9087.17.0... ; lack of communication and access to information^27–29; lack of involvement in making decisions about their health²⁸28. Rose A, Rosewilliam S, Soundy A. Shared decision making within goal setting in rehabilitation settings: a systematic review. Patient Educ Couns. 2017;100(1):65-75. https://doi.org/10.1016/j.pec.2016.07.030 https://doi.org/10.1016/j.pec.2016.07.03... ; and problem of location of health units and transport difficulties to reach the services, as well as the cost of transportation²⁹29. Lam N, Leat S J. Reprint of: Barriers to accessing low-vision care: the patient’s perspective. Can J Ophthalmol. 2015;50 Suppl 1:S34-9. https://doi.org/10.1016/j.jcjo.2015.04.007 https://doi.org/10.1016/j.jcjo.2015.04.0... .
High complexity	Organizational, social, and physical barriers to access health services³⁰30. Dunn K, Hughes-McComack L, Cooper SA. Hospital admissions for physical health conditions for people with intellectual disabilities: systematic review. J Appl Res Intellect Disabil. 2018;31 Suppl 1:1-10. https://doi.org/10.1111/jar.12360 https://doi.org/10.1111/jar.12360... ; lack of information about their health and treatment³¹31. Zhou H, Roberts P, Dhaliwal S, Della P. Transitioning adolescent and young adults with chronic disease and/or disabilities from paediatric to adult care services: an integrative review. J Clin Nurs. 2016;25(21-22):3113-30. https://doi.org/10.1111/jocn.13326 https://doi.org/10.1111/jocn.13326... ; and feeling of abandonment by caregivers regarding the treatment of users³¹31. Zhou H, Roberts P, Dhaliwal S, Della P. Transitioning adolescent and young adults with chronic disease and/or disabilities from paediatric to adult care services: an integrative review. J Clin Nurs. 2016;25(21-22):3113-30. https://doi.org/10.1111/jocn.13326 https://doi.org/10.1111/jocn.13326... .
Unspecified level of attention	Difficulties with transportation³²32. Mlenzana NB, Frantz JM, Rhoda AJ, Eide AH. Barriers to and facilitators of rehabilitation services for people with physical disabilities: a systematic review. Afr J Disabil. 2013;2(1): 22. https://doi.org/10.4102/ajod.v2i1.22 https://doi.org/10.4102/ajod.v2i1.22... ^,³³33. Hamilton C, Lovarini M, McCluskey A, Folly de Campos T, Hassett L. Experiences of therapists using feedback-based technology to improve physical function in rehabilitation settings: a qualitative systematic review. Disabil Rehabil. 2019;41(15):1739-50. https://doi.org/10.1080/09638288.2018.1446187 https://doi.org/10.1080/09638288.2018.14... ; financial difficulties^{14,16,34–36}; discrimination from health service providers^{14,16,34–36}; lack of patient support in the rehabilitation process³²32. Mlenzana NB, Frantz JM, Rhoda AJ, Eide AH. Barriers to and facilitators of rehabilitation services for people with physical disabilities: a systematic review. Afr J Disabil. 2013;2(1): 22. https://doi.org/10.4102/ajod.v2i1.22 https://doi.org/10.4102/ajod.v2i1.22... ; lack of communication by professionals³⁷37. Homeyard C, Montgomery E, Chinn D, Patelarou E. Current evidence on antenatal care provision for women with intellectual disabilities: a systematic review. Midwifery. 2016;32:45-57. https://doi.org/10.1016/j.midw.2015.10.002 https://doi.org/10.1016/j.midw.2015.10.0... ^,³⁸38. Robertson J, Hatton C, Emerson E, Baines S. The impact of health checks for people with intellectual disabilities: an updated systematic review of evidence. Res Dev Disabil. 2014;35(10):2450-62. https://doi.org/10.1016/j.ridd.2014.06.007 https://doi.org/10.1016/j.ridd.2014.06.0... ; lack of community awareness regarding disability³²32. Mlenzana NB, Frantz JM, Rhoda AJ, Eide AH. Barriers to and facilitators of rehabilitation services for people with physical disabilities: a systematic review. Afr J Disabil. 2013;2(1): 22. https://doi.org/10.4102/ajod.v2i1.22 https://doi.org/10.4102/ajod.v2i1.22... ; lack of caregivers for adults with physical disabilities³⁹39. Lawang W, Horey D, Blackford J, Sunsern R, Riewpaiboon W. Support interventions for caregivers of physically disabled adults: a systematic review. Nurs Health Sci. 2013;15(4):534-45. https://doi.org/10.1111/nhs.12063 https://doi.org/10.1111/nhs.12063... ; lack of “accessible” information on treatment and health services³⁴34. Bright T, Wallace S, Kuper H. A systematic review of access to rehabilitation for people with disabilities in low-and middle-income countries. Int J Environ Res Public Health. 2018;15(10):2165. https://doi.org/10.3390/ijerph15102165 https://doi.org/10.3390/ijerph15102165... ^,³⁵35. Robertson J, Raghavan R, Emerson E, Baines S, Hatton C. What do we know about the health and healthcare of people with intellectual disabilities from minority ethnic groups in the United Kingdom? A systematic review. J Appl Res Intellect Disabil. 2019;32(6):1310-34. https://doi.org/10.1111/jar.12630 https://doi.org/10.1111/jar.12630... ^,³⁷37. Homeyard C, Montgomery E, Chinn D, Patelarou E. Current evidence on antenatal care provision for women with intellectual disabilities: a systematic review. Midwifery. 2016;32:45-57. https://doi.org/10.1016/j.midw.2015.10.002 https://doi.org/10.1016/j.midw.2015.10.0... ^,³⁸38. Robertson J, Hatton C, Emerson E, Baines S. The impact of health checks for people with intellectual disabilities: an updated systematic review of evidence. Res Dev Disabil. 2014;35(10):2450-62. https://doi.org/10.1016/j.ridd.2014.06.007 https://doi.org/10.1016/j.ridd.2014.06.0... ; and a long waiting period for hospital visits after referral³⁸38. Robertson J, Hatton C, Emerson E, Baines S. The impact of health checks for people with intellectual disabilities: an updated systematic review of evidence. Res Dev Disabil. 2014;35(10):2450-62. https://doi.org/10.1016/j.ridd.2014.06.007 https://doi.org/10.1016/j.ridd.2014.06.0... .

Level of care	Barriers found in the literature
Basic	Lack of reliable and accessible transportation for users to arrive at consultations²⁰20. Marrocco A, Krouse HJ. Obstacles to preventive care for individuals with disability: implications for nurse practitioners. J Am Assoc Nurse Pract. 2017;29(5):282-93. https://doi.org/10.1002/2327-6924.12449 https://doi.org/10.1002/2327-6924.12449... ^,²²22. Andresen EM, Peterson-Besse JJ, Krahn GL, Walsh ES, Horner-Johnson W, Iezzoni LI. Pap, mammography, and clinical breast examination screening among women with disabilities: a systematic review. Womens Health Issues. 2013;23(4):205-14. https://doi.org/10.1016/j.whi.2013.04.002 https://doi.org/10.1016/j.whi.2013.04.00... ^,²⁵25. Ziviani J, Feeney R, Rodger S, Watter P. Systematic review of early intervention programmes for children from birth to nine years who have a physical disability. Aust Occup Ther J. 2010;57(4):210-23. https://doi.org/10.1111/j.1440-1630.2010.00850.x https://doi.org/10.1111/j.1440-1630.2010... ; lack of training and inadequate skills on the part of professionals, environmental issues such as distant health units, insufficient time for consultations, negative attitude and lack of coordinated care by professionals¹⁸18. Balogh R, McMorris CA, Lunsky Y, Ouellette‐Kuntz H, Bourne L, Colantonio A, et al. Organising healthcare services for persons with an intellectual disability. Cochrane Database Syst Rev. 2016;(4):CD007492. https://doi.org/10.1002/14651858.CD007492.pub2 https://doi.org/10.1002/14651858.CD00749... ^,²⁰20. Marrocco A, Krouse HJ. Obstacles to preventive care for individuals with disability: implications for nurse practitioners. J Am Assoc Nurse Pract. 2017;29(5):282-93. https://doi.org/10.1002/2327-6924.12449 https://doi.org/10.1002/2327-6924.12449... ; and failures of health systems in responding adequately to the identified treatable morbidity⁴⁰40. Robertson J, Roberts H, Emerson E, Turner S, Greig R. The impact of health checks for people with intellectual disabilities: a systematic review of evidence. J Intellect Disabil Res. 2011;55(11):1009-19. https://doi.org/10.1111/j.1365-2788.2011.01436.x https://doi.org/10.1111/j.1365-2788.2011... .
Specialized	Poor access to buildings, difficulty in transporting wheelchairs and poor parking facilities for disabled people, community and social environments generally unsuitable for wheelchair access⁴¹41. Bray N, Noyes J, Edwards RT, Harris N. Wheelchair interventions, services and provision for disabled children: a mixed-method systematic review and conceptual framework. BMC Health Serv Res. 2014;14:309. https://doi.org/10.1186/1472-6963-14-309 https://doi.org/10.1186/1472-6963-14-309... ; difficulty for timely access to appropriate services²⁷27. Cohen E, Jovcevska V, Kuo DZ, Mahant S. Hospital-based comprehensive care programs for children with special health care needs: a systematic review. Arch Pediatr Adolesc Med. 2011;165(6):554-61. https://doi.org/10.1001/archpediatrics.2011.74 https://doi.org/10.1001/archpediatrics.2... ; lack of care for secondary health care²⁶26. Oral A, Rapidi CA, Votava J, Roussos N, Michail X, Kujawa J, et al. Evidence based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for ageing people with disabilities. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med. 2017;53(5):802-11. https://doi.org/10.23736/S1973-9087.17.04864-X https://doi.org/10.23736/S1973-9087.17.0... ; lack of training and skills necessary for professionals and fragmentation of the health system²⁸28. Rose A, Rosewilliam S, Soundy A. Shared decision making within goal setting in rehabilitation settings: a systematic review. Patient Educ Couns. 2017;100(1):65-75. https://doi.org/10.1016/j.pec.2016.07.030 https://doi.org/10.1016/j.pec.2016.07.03... ^,⁴²42. Liebel DV, Friedman B, Watson NM, Powers BA. Review of nurse home visiting interventions for community-dwelling older persons with existing disability. Med Care Res Rev. 2009;66(2):119-46. https://doi.org/10.1177/1077558708328815 https://doi.org/10.1177/1077558708328815... ; and long waiting time for care and inadequate procedures for treatments and maintenance of assistive products⁴¹41. Bray N, Noyes J, Edwards RT, Harris N. Wheelchair interventions, services and provision for disabled children: a mixed-method systematic review and conceptual framework. BMC Health Serv Res. 2014;14:309. https://doi.org/10.1186/1472-6963-14-309 https://doi.org/10.1186/1472-6963-14-309... .
High complexity	Lack of self-care oriented to health policies and promotion, accessibility difficulties, limited availability of trained professionals, lack of social support, discrimination, financial restrictions, lack of information and educational interventions directed to users⁴³43. Lindsay S, Kingsnorth S, Mcdougall C, Keating H. A systematic review of self-management interventions for children and youth with physical disabilities. Disabil Rehabil. 2014;36(4):276-88. https://doi.org/10.3109/09638288.2013.785605 https://doi.org/10.3109/09638288.2013.78... ; lack of communication by professionals³¹31. Zhou H, Roberts P, Dhaliwal S, Della P. Transitioning adolescent and young adults with chronic disease and/or disabilities from paediatric to adult care services: an integrative review. J Clin Nurs. 2016;25(21-22):3113-30. https://doi.org/10.1111/jocn.13326 https://doi.org/10.1111/jocn.13326... ^,⁴⁴44. O’Halloran R, Grohn B, Worrall L. Environmental factors that influence communication for patients with a communication disability in acute hospital stroke units: a qualitative metasynthesis. Arch Phys Med Rehabil. 2012;93 (1 Suppl):S77-85. https://doi.org/10.1016/j.apmr.2011.06.039 https://doi.org/10.1016/j.apmr.2011.06.0... ; and lack of funding for the purchase of devices necessary for treatment⁴⁴44. O’Halloran R, Grohn B, Worrall L. Environmental factors that influence communication for patients with a communication disability in acute hospital stroke units: a qualitative metasynthesis. Arch Phys Med Rehabil. 2012;93 (1 Suppl):S77-85. https://doi.org/10.1016/j.apmr.2011.06.039 https://doi.org/10.1016/j.apmr.2011.06.0... .
Unspecified level of attention	Barrier to the use of technology by therapists, lack of training and/or resources to support the use of technology in the practice³³33. Hamilton C, Lovarini M, McCluskey A, Folly de Campos T, Hassett L. Experiences of therapists using feedback-based technology to improve physical function in rehabilitation settings: a qualitative systematic review. Disabil Rehabil. 2019;41(15):1739-50. https://doi.org/10.1080/09638288.2018.1446187 https://doi.org/10.1080/09638288.2018.14... ; communication barriers between professionals and patients and among the health team itself¹⁶16. Breckenridge JP, Devaney J, Kroll T, Lazenbatt A, Taylor J, Bradbury-Jones C. Access and utilisation of maternity care for disabled women who experience domestic abuse: a systematic review. BMC Pregnancy Childbirth. 2014;14:234. https://doi.org/10.1186/1471-2393-14-234 https://doi.org/10.1186/1471-2393-14-234... ^,³²32. Mlenzana NB, Frantz JM, Rhoda AJ, Eide AH. Barriers to and facilitators of rehabilitation services for people with physical disabilities: a systematic review. Afr J Disabil. 2013;2(1): 22. https://doi.org/10.4102/ajod.v2i1.22 https://doi.org/10.4102/ajod.v2i1.22... ^,³⁴34. Bright T, Wallace S, Kuper H. A systematic review of access to rehabilitation for people with disabilities in low-and middle-income countries. Int J Environ Res Public Health. 2018;15(10):2165. https://doi.org/10.3390/ijerph15102165 https://doi.org/10.3390/ijerph15102165... ; language and cultural comprehension barriers³⁵35. Robertson J, Raghavan R, Emerson E, Baines S, Hatton C. What do we know about the health and healthcare of people with intellectual disabilities from minority ethnic groups in the United Kingdom? A systematic review. J Appl Res Intellect Disabil. 2019;32(6):1310-34. https://doi.org/10.1111/jar.12630 https://doi.org/10.1111/jar.12630... ; physical barriers to care¹⁶16. Breckenridge JP, Devaney J, Kroll T, Lazenbatt A, Taylor J, Bradbury-Jones C. Access and utilisation of maternity care for disabled women who experience domestic abuse: a systematic review. BMC Pregnancy Childbirth. 2014;14:234. https://doi.org/10.1186/1471-2393-14-234 https://doi.org/10.1186/1471-2393-14-234... ; barriers to rehabilitation financing⁴⁵45. Pereira S, Graham JR, Shahabaz A, Salter K, Foley N, Meyer M, et al. Rehabilitation of individuals with severe stroke: synthesis of best evidence and challenges in implementation. Top Stroke Rehabil. 2012;19(2):122-31. https://doi.org/10.1310/tsr1902-122 https://doi.org/10.1310/tsr1902-122... and technologies³³33. Hamilton C, Lovarini M, McCluskey A, Folly de Campos T, Hassett L. Experiences of therapists using feedback-based technology to improve physical function in rehabilitation settings: a qualitative systematic review. Disabil Rehabil. 2019;41(15):1739-50. https://doi.org/10.1080/09638288.2018.1446187 https://doi.org/10.1080/09638288.2018.14... ; barriers to performing health exams³⁸38. Robertson J, Hatton C, Emerson E, Baines S. The impact of health checks for people with intellectual disabilities: an updated systematic review of evidence. Res Dev Disabil. 2014;35(10):2450-62. https://doi.org/10.1016/j.ridd.2014.06.007 https://doi.org/10.1016/j.ridd.2014.06.0... ; discrimination from the health service provider³⁴34. Bright T, Wallace S, Kuper H. A systematic review of access to rehabilitation for people with disabilities in low-and middle-income countries. Int J Environ Res Public Health. 2018;15(10):2165. https://doi.org/10.3390/ijerph15102165 https://doi.org/10.3390/ijerph15102165... ^,³⁶36. Pelleboer-Gunnink HA, Van Oorsouw WMWJ, Van Weeghel J, Embregts PJCM. Mainstream health professionals’ stigmatising attitudes towards people with intellectual disabilities: a systematic review. J Intellect Disabil Res. 2017;61(5):411-34. https://doi.org/10.1111/jir.12353 https://doi.org/10.1111/jir.12353... ; failure to schedule appointments³²32. Mlenzana NB, Frantz JM, Rhoda AJ, Eide AH. Barriers to and facilitators of rehabilitation services for people with physical disabilities: a systematic review. Afr J Disabil. 2013;2(1): 22. https://doi.org/10.4102/ajod.v2i1.22 https://doi.org/10.4102/ajod.v2i1.22... ; lack of skills of professionals⁴⁶46. King G, Williams L, Hahn Goldberg S. Family‐oriented services in pediatric rehabilitation: a scoping review and framework to promote parent and family wellness. Child Care Health Dev. 2017;43(3):334-47. https://doi.org/10.1111/cch.12435 https://doi.org/10.1111/cch.12435... ; lack of education initiatives on health services and misunderstanding of rehabilitation by people with disabilities³²32. Mlenzana NB, Frantz JM, Rhoda AJ, Eide AH. Barriers to and facilitators of rehabilitation services for people with physical disabilities: a systematic review. Afr J Disabil. 2013;2(1): 22. https://doi.org/10.4102/ajod.v2i1.22 https://doi.org/10.4102/ajod.v2i1.22... ; lack of personal motivation of professionals³²32. Mlenzana NB, Frantz JM, Rhoda AJ, Eide AH. Barriers to and facilitators of rehabilitation services for people with physical disabilities: a systematic review. Afr J Disabil. 2013;2(1): 22. https://doi.org/10.4102/ajod.v2i1.22 https://doi.org/10.4102/ajod.v2i1.22... ; lack of patience of professionals, lack of empathy, little understanding of disability issues¹⁶16. Breckenridge JP, Devaney J, Kroll T, Lazenbatt A, Taylor J, Bradbury-Jones C. Access and utilisation of maternity care for disabled women who experience domestic abuse: a systematic review. BMC Pregnancy Childbirth. 2014;14:234. https://doi.org/10.1186/1471-2393-14-234 https://doi.org/10.1186/1471-2393-14-234... ^,³⁷37. Homeyard C, Montgomery E, Chinn D, Patelarou E. Current evidence on antenatal care provision for women with intellectual disabilities: a systematic review. Midwifery. 2016;32:45-57. https://doi.org/10.1016/j.midw.2015.10.002 https://doi.org/10.1016/j.midw.2015.10.0... ; lack of resources in the areas of psychology, speech therapy, and neuropsychology³²32. Mlenzana NB, Frantz JM, Rhoda AJ, Eide AH. Barriers to and facilitators of rehabilitation services for people with physical disabilities: a systematic review. Afr J Disabil. 2013;2(1): 22. https://doi.org/10.4102/ajod.v2i1.22 https://doi.org/10.4102/ajod.v2i1.22... ; and fear and anxiety among professionals³⁶36. Pelleboer-Gunnink HA, Van Oorsouw WMWJ, Van Weeghel J, Embregts PJCM. Mainstream health professionals’ stigmatising attitudes towards people with intellectual disabilities: a systematic review. J Intellect Disabil Res. 2017;61(5):411-34. https://doi.org/10.1111/jir.12353 https://doi.org/10.1111/jir.12353... .

Use of the service: individuals, families, communities, and populations
Barriers	Ability to perceive	Ability to seek	Ability to reach	Ability to pay	Ability to engage	Others
Urbanistic			Problem of location of health units²⁹29. Lam N, Leat S J. Reprint of: Barriers to accessing low-vision care: the patient’s perspective. Can J Ophthalmol. 2015;50 Suppl 1:S34-9. https://doi.org/10.1016/j.jcjo.2015.04.007 https://doi.org/10.1016/j.jcjo.2015.04.0... .
Architectural			Organizational, social, and physical barriers to access health services³⁰30. Dunn K, Hughes-McComack L, Cooper SA. Hospital admissions for physical health conditions for people with intellectual disabilities: systematic review. J Appl Res Intellect Disabil. 2018;31 Suppl 1:1-10. https://doi.org/10.1111/jar.12360 https://doi.org/10.1111/jar.12360... .
Transport			Transport difficulties²⁹29. Lam N, Leat S J. Reprint of: Barriers to accessing low-vision care: the patient’s perspective. Can J Ophthalmol. 2015;50 Suppl 1:S34-9. https://doi.org/10.1016/j.jcjo.2015.04.007 https://doi.org/10.1016/j.jcjo.2015.04.0... ^,³²32. Mlenzana NB, Frantz JM, Rhoda AJ, Eide AH. Barriers to and facilitators of rehabilitation services for people with physical disabilities: a systematic review. Afr J Disabil. 2013;2(1): 22. https://doi.org/10.4102/ajod.v2i1.22 https://doi.org/10.4102/ajod.v2i1.22... ^,³³33. Hamilton C, Lovarini M, McCluskey A, Folly de Campos T, Hassett L. Experiences of therapists using feedback-based technology to improve physical function in rehabilitation settings: a qualitative systematic review. Disabil Rehabil. 2019;41(15):1739-50. https://doi.org/10.1080/09638288.2018.1446187 https://doi.org/10.1080/09638288.2018.14... to reach health units, and the cost of transportation²⁹29. Lam N, Leat S J. Reprint of: Barriers to accessing low-vision care: the patient’s perspective. Can J Ophthalmol. 2015;50 Suppl 1:S34-9. https://doi.org/10.1016/j.jcjo.2015.04.007 https://doi.org/10.1016/j.jcjo.2015.04.0... .
Communication			Lack of access to information about their health^27–29, about treatment and health services ^31,34–37, and about reproductive sexual health²¹21. Mheta D, Mashamba-Thompson TP. Barriers and facilitators of access to maternal services for women with disabilities: scoping review protocol. Syst Rev. 2017;6:99. https://doi.org/10.1186/s13643-017-0494-7 https://doi.org/10.1186/s13643-017-0494-... ; and lack of communication³⁷37. Homeyard C, Montgomery E, Chinn D, Patelarou E. Current evidence on antenatal care provision for women with intellectual disabilities: a systematic review. Midwifery. 2016;32:45-57. https://doi.org/10.1016/j.midw.2015.10.002 https://doi.org/10.1016/j.midw.2015.10.0... of the professional with the patient or caregiver²²22. Andresen EM, Peterson-Besse JJ, Krahn GL, Walsh ES, Horner-Johnson W, Iezzoni LI. Pap, mammography, and clinical breast examination screening among women with disabilities: a systematic review. Womens Health Issues. 2013;23(4):205-14. https://doi.org/10.1016/j.whi.2013.04.002 https://doi.org/10.1016/j.whi.2013.04.00... ^,²⁵25. Ziviani J, Feeney R, Rodger S, Watter P. Systematic review of early intervention programmes for children from birth to nine years who have a physical disability. Aust Occup Ther J. 2010;57(4):210-23. https://doi.org/10.1111/j.1440-1630.2010.00850.x https://doi.org/10.1111/j.1440-1630.2010... ^,³⁷37. Homeyard C, Montgomery E, Chinn D, Patelarou E. Current evidence on antenatal care provision for women with intellectual disabilities: a systematic review. Midwifery. 2016;32:45-57. https://doi.org/10.1016/j.midw.2015.10.002 https://doi.org/10.1016/j.midw.2015.10.0... ^,³⁸38. Robertson J, Hatton C, Emerson E, Baines S. The impact of health checks for people with intellectual disabilities: an updated systematic review of evidence. Res Dev Disabil. 2014;35(10):2450-62. https://doi.org/10.1016/j.ridd.2014.06.007 https://doi.org/10.1016/j.ridd.2014.06.0... .
Attitudinal	Lack of access to family planning services and prenatal and postnatal services²¹21. Mheta D, Mashamba-Thompson TP. Barriers and facilitators of access to maternal services for women with disabilities: scoping review protocol. Syst Rev. 2017;6:99. https://doi.org/10.1186/s13643-017-0494-7 https://doi.org/10.1186/s13643-017-0494-... ; insufficient access to care services for children²⁵25. Ziviani J, Feeney R, Rodger S, Watter P. Systematic review of early intervention programmes for children from birth to nine years who have a physical disability. Aust Occup Ther J. 2010;57(4):210-23. https://doi.org/10.1111/j.1440-1630.2010.00850.x https://doi.org/10.1111/j.1440-1630.2010... ; lack of access to health services²⁸28. Rose A, Rosewilliam S, Soundy A. Shared decision making within goal setting in rehabilitation settings: a systematic review. Patient Educ Couns. 2017;100(1):65-75. https://doi.org/10.1016/j.pec.2016.07.030 https://doi.org/10.1016/j.pec.2016.07.03... ; feeling of abandonment by caregivers regarding the treatment of users³¹31. Zhou H, Roberts P, Dhaliwal S, Della P. Transitioning adolescent and young adults with chronic disease and/or disabilities from paediatric to adult care services: an integrative review. J Clin Nurs. 2016;25(21-22):3113-30. https://doi.org/10.1111/jocn.13326 https://doi.org/10.1111/jocn.13326... ; discrimination against health service providers^{14,16,34–36}; and lack of patient support in the rehabilitation process³²32. Mlenzana NB, Frantz JM, Rhoda AJ, Eide AH. Barriers to and facilitators of rehabilitation services for people with physical disabilities: a systematic review. Afr J Disabil. 2013;2(1): 22. https://doi.org/10.4102/ajod.v2i1.22 https://doi.org/10.4102/ajod.v2i1.22... .	Fear and anxiety regarding the treatment of children with disabilities²⁰20. Marrocco A, Krouse HJ. Obstacles to preventive care for individuals with disability: implications for nurse practitioners. J Am Assoc Nurse Pract. 2017;29(5):282-93. https://doi.org/10.1002/2327-6924.12449 https://doi.org/10.1002/2327-6924.12449... ; lack of professional support²²22. Andresen EM, Peterson-Besse JJ, Krahn GL, Walsh ES, Horner-Johnson W, Iezzoni LI. Pap, mammography, and clinical breast examination screening among women with disabilities: a systematic review. Womens Health Issues. 2013;23(4):205-14. https://doi.org/10.1016/j.whi.2013.04.002 https://doi.org/10.1016/j.whi.2013.04.00... ; limited access to psychological support and little or no community-based psychiatric support¹⁸18. Balogh R, McMorris CA, Lunsky Y, Ouellette‐Kuntz H, Bourne L, Colantonio A, et al. Organising healthcare services for persons with an intellectual disability. Cochrane Database Syst Rev. 2016;(4):CD007492. https://doi.org/10.1002/14651858.CD007492.pub2 https://doi.org/10.1002/14651858.CD00749... ; difficulty in finding physicians willing to care for severely disabled and complex patients¹⁹19. Brown M, Macarthur J, Higgins A, Chouliara Z. Transitions from child to adult health care for young people with intellectual disabilities: a systematic review. J Adv Nurs. 2019;75(11):2418-34. https://doi.org/10.1111/jan.13985 https://doi.org/10.1111/jan.13985... ; and difficulty in finding health services that they need¹⁸18. Balogh R, McMorris CA, Lunsky Y, Ouellette‐Kuntz H, Bourne L, Colantonio A, et al. Organising healthcare services for persons with an intellectual disability. Cochrane Database Syst Rev. 2016;(4):CD007492. https://doi.org/10.1002/14651858.CD007492.pub2 https://doi.org/10.1002/14651858.CD00749... ^,¹⁹19. Brown M, Macarthur J, Higgins A, Chouliara Z. Transitions from child to adult health care for young people with intellectual disabilities: a systematic review. J Adv Nurs. 2019;75(11):2418-34. https://doi.org/10.1111/jan.13985 https://doi.org/10.1111/jan.13985... .				Lack of community awareness regarding disability³²32. Mlenzana NB, Frantz JM, Rhoda AJ, Eide AH. Barriers to and facilitators of rehabilitation services for people with physical disabilities: a systematic review. Afr J Disabil. 2013;2(1): 22. https://doi.org/10.4102/ajod.v2i1.22 https://doi.org/10.4102/ajod.v2i1.22... .
Technological
Others			Long waiting period for hospital visits after referral³⁸38. Robertson J, Hatton C, Emerson E, Baines S. The impact of health checks for people with intellectual disabilities: an updated systematic review of evidence. Res Dev Disabil. 2014;35(10):2450-62. https://doi.org/10.1016/j.ridd.2014.06.007 https://doi.org/10.1016/j.ridd.2014.06.0... .	Lack of health insurance and inability to pay any service expenses¹⁸18. Balogh R, McMorris CA, Lunsky Y, Ouellette‐Kuntz H, Bourne L, Colantonio A, et al. Organising healthcare services for persons with an intellectual disability. Cochrane Database Syst Rev. 2016;(4):CD007492. https://doi.org/10.1002/14651858.CD007492.pub2 https://doi.org/10.1002/14651858.CD00749... ^,²⁰20. Marrocco A, Krouse HJ. Obstacles to preventive care for individuals with disability: implications for nurse practitioners. J Am Assoc Nurse Pract. 2017;29(5):282-93. https://doi.org/10.1002/2327-6924.12449 https://doi.org/10.1002/2327-6924.12449... ^,²⁵25. Ziviani J, Feeney R, Rodger S, Watter P. Systematic review of early intervention programmes for children from birth to nine years who have a physical disability. Aust Occup Ther J. 2010;57(4):210-23. https://doi.org/10.1111/j.1440-1630.2010.00850.x https://doi.org/10.1111/j.1440-1630.2010... ; and financial difficulties^{14,16,34–36}.	Lack of involvement in making decisions about their health²⁸28. Rose A, Rosewilliam S, Soundy A. Shared decision making within goal setting in rehabilitation settings: a systematic review. Patient Educ Couns. 2017;100(1):65-75. https://doi.org/10.1016/j.pec.2016.07.030 https://doi.org/10.1016/j.pec.2016.07.03... .	Lack of request for and performance of preventive tests and care²⁰20. Marrocco A, Krouse HJ. Obstacles to preventive care for individuals with disability: implications for nurse practitioners. J Am Assoc Nurse Pract. 2017;29(5):282-93. https://doi.org/10.1002/2327-6924.12449 https://doi.org/10.1002/2327-6924.12449... and lack of caregivers for adults with physical disabilities³⁹39. Lawang W, Horey D, Blackford J, Sunsern R, Riewpaiboon W. Support interventions for caregivers of physically disabled adults: a systematic review. Nurs Health Sci. 2013;15(4):534-45. https://doi.org/10.1111/nhs.12063 https://doi.org/10.1111/nhs.12063... .

Service provision: systems, institutions, organizations, and health providers
Barriers	Approachability	Acceptability	Availability and accommodation	Affordability	Appropriateness	Others
Urbanistic			Poor access to buildings; difficulty in transporting wheelchairs⁴¹41. Bray N, Noyes J, Edwards RT, Harris N. Wheelchair interventions, services and provision for disabled children: a mixed-method systematic review and conceptual framework. BMC Health Serv Res. 2014;14:309. https://doi.org/10.1186/1472-6963-14-309 https://doi.org/10.1186/1472-6963-14-309... ; physical barriers to care¹⁶16. Breckenridge JP, Devaney J, Kroll T, Lazenbatt A, Taylor J, Bradbury-Jones C. Access and utilisation of maternity care for disabled women who experience domestic abuse: a systematic review. BMC Pregnancy Childbirth. 2014;14:234. https://doi.org/10.1186/1471-2393-14-234 https://doi.org/10.1186/1471-2393-14-234... ; and accessibility difficulties⁴³43. Lindsay S, Kingsnorth S, Mcdougall C, Keating H. A systematic review of self-management interventions for children and youth with physical disabilities. Disabil Rehabil. 2014;36(4):276-88. https://doi.org/10.3109/09638288.2013.785605 https://doi.org/10.3109/09638288.2013.78... .		Distant health units¹⁸18. Balogh R, McMorris CA, Lunsky Y, Ouellette‐Kuntz H, Bourne L, Colantonio A, et al. Organising healthcare services for persons with an intellectual disability. Cochrane Database Syst Rev. 2016;(4):CD007492. https://doi.org/10.1002/14651858.CD007492.pub2 https://doi.org/10.1002/14651858.CD00749... ^,²⁰20. Marrocco A, Krouse HJ. Obstacles to preventive care for individuals with disability: implications for nurse practitioners. J Am Assoc Nurse Pract. 2017;29(5):282-93. https://doi.org/10.1002/2327-6924.12449 https://doi.org/10.1002/2327-6924.12449... .
Architectural			Poor parking facilities for disabled people, community and social environments generally unsuitable for wheelchair access⁴¹41. Bray N, Noyes J, Edwards RT, Harris N. Wheelchair interventions, services and provision for disabled children: a mixed-method systematic review and conceptual framework. BMC Health Serv Res. 2014;14:309. https://doi.org/10.1186/1472-6963-14-309 https://doi.org/10.1186/1472-6963-14-309... , and accessibility difficulties⁴³43. Lindsay S, Kingsnorth S, Mcdougall C, Keating H. A systematic review of self-management interventions for children and youth with physical disabilities. Disabil Rehabil. 2014;36(4):276-88. https://doi.org/10.3109/09638288.2013.785605 https://doi.org/10.3109/09638288.2013.78... .
Transport			Lack of reliable and accessible transport for users to arrive at consultations²⁰20. Marrocco A, Krouse HJ. Obstacles to preventive care for individuals with disability: implications for nurse practitioners. J Am Assoc Nurse Pract. 2017;29(5):282-93. https://doi.org/10.1002/2327-6924.12449 https://doi.org/10.1002/2327-6924.12449... ^,²²22. Andresen EM, Peterson-Besse JJ, Krahn GL, Walsh ES, Horner-Johnson W, Iezzoni LI. Pap, mammography, and clinical breast examination screening among women with disabilities: a systematic review. Womens Health Issues. 2013;23(4):205-14. https://doi.org/10.1016/j.whi.2013.04.002 https://doi.org/10.1016/j.whi.2013.04.00... ^,²⁵25. Ziviani J, Feeney R, Rodger S, Watter P. Systematic review of early intervention programmes for children from birth to nine years who have a physical disability. Aust Occup Ther J. 2010;57(4):210-23. https://doi.org/10.1111/j.1440-1630.2010.00850.x https://doi.org/10.1111/j.1440-1630.2010... .
Communication	Lack of communication on the part of professionals³¹31. Zhou H, Roberts P, Dhaliwal S, Della P. Transitioning adolescent and young adults with chronic disease and/or disabilities from paediatric to adult care services: an integrative review. J Clin Nurs. 2016;25(21-22):3113-30. https://doi.org/10.1111/jocn.13326 https://doi.org/10.1111/jocn.13326... ^,⁴⁴44. O’Halloran R, Grohn B, Worrall L. Environmental factors that influence communication for patients with a communication disability in acute hospital stroke units: a qualitative metasynthesis. Arch Phys Med Rehabil. 2012;93 (1 Suppl):S77-85. https://doi.org/10.1016/j.apmr.2011.06.039 https://doi.org/10.1016/j.apmr.2011.06.0... ; communication barriers between professionals and patients and between the health team itself¹⁶16. Breckenridge JP, Devaney J, Kroll T, Lazenbatt A, Taylor J, Bradbury-Jones C. Access and utilisation of maternity care for disabled women who experience domestic abuse: a systematic review. BMC Pregnancy Childbirth. 2014;14:234. https://doi.org/10.1186/1471-2393-14-234 https://doi.org/10.1186/1471-2393-14-234... ^,³²32. Mlenzana NB, Frantz JM, Rhoda AJ, Eide AH. Barriers to and facilitators of rehabilitation services for people with physical disabilities: a systematic review. Afr J Disabil. 2013;2(1): 22. https://doi.org/10.4102/ajod.v2i1.22 https://doi.org/10.4102/ajod.v2i1.22... ^,³⁴34. Bright T, Wallace S, Kuper H. A systematic review of access to rehabilitation for people with disabilities in low-and middle-income countries. Int J Environ Res Public Health. 2018;15(10):2165. https://doi.org/10.3390/ijerph15102165 https://doi.org/10.3390/ijerph15102165... ; language and cultural comprehension barriers³⁵35. Robertson J, Raghavan R, Emerson E, Baines S, Hatton C. What do we know about the health and healthcare of people with intellectual disabilities from minority ethnic groups in the United Kingdom? A systematic review. J Appl Res Intellect Disabil. 2019;32(6):1310-34. https://doi.org/10.1111/jar.12630 https://doi.org/10.1111/jar.12630... ; and lack of information and educational interventions directed to users⁴³43. Lindsay S, Kingsnorth S, Mcdougall C, Keating H. A systematic review of self-management interventions for children and youth with physical disabilities. Disabil Rehabil. 2014;36(4):276-88. https://doi.org/10.3109/09638288.2013.785605 https://doi.org/10.3109/09638288.2013.78... .
Attitudinal	Lack of education initiatives on health services and misunderstanding of rehabilitation by people with disabilities³²32. Mlenzana NB, Frantz JM, Rhoda AJ, Eide AH. Barriers to and facilitators of rehabilitation services for people with physical disabilities: a systematic review. Afr J Disabil. 2013;2(1): 22. https://doi.org/10.4102/ajod.v2i1.22 https://doi.org/10.4102/ajod.v2i1.22... .		Long waiting time for care⁴¹41. Bray N, Noyes J, Edwards RT, Harris N. Wheelchair interventions, services and provision for disabled children: a mixed-method systematic review and conceptual framework. BMC Health Serv Res. 2014;14:309. https://doi.org/10.1186/1472-6963-14-309 https://doi.org/10.1186/1472-6963-14-309... ; failure to schedule consultations³²32. Mlenzana NB, Frantz JM, Rhoda AJ, Eide AH. Barriers to and facilitators of rehabilitation services for people with physical disabilities: a systematic review. Afr J Disabil. 2013;2(1): 22. https://doi.org/10.4102/ajod.v2i1.22 https://doi.org/10.4102/ajod.v2i1.22... ; lack of personal motivation of professionals³²32. Mlenzana NB, Frantz JM, Rhoda AJ, Eide AH. Barriers to and facilitators of rehabilitation services for people with physical disabilities: a systematic review. Afr J Disabil. 2013;2(1): 22. https://doi.org/10.4102/ajod.v2i1.22 https://doi.org/10.4102/ajod.v2i1.22... ; lack of patience of professionals; and lack of empathy and little understanding of disability issues¹⁶16. Breckenridge JP, Devaney J, Kroll T, Lazenbatt A, Taylor J, Bradbury-Jones C. Access and utilisation of maternity care for disabled women who experience domestic abuse: a systematic review. BMC Pregnancy Childbirth. 2014;14:234. https://doi.org/10.1186/1471-2393-14-234 https://doi.org/10.1186/1471-2393-14-234... ^,³⁷37. Homeyard C, Montgomery E, Chinn D, Patelarou E. Current evidence on antenatal care provision for women with intellectual disabilities: a systematic review. Midwifery. 2016;32:45-57. https://doi.org/10.1016/j.midw.2015.10.002 https://doi.org/10.1016/j.midw.2015.10.0... .		Lack of training and inadequate skills of professionals⁴⁶46. King G, Williams L, Hahn Goldberg S. Family‐oriented services in pediatric rehabilitation: a scoping review and framework to promote parent and family wellness. Child Care Health Dev. 2017;43(3):334-47. https://doi.org/10.1111/cch.12435 https://doi.org/10.1111/cch.12435... ; negative attitude and lack of coordinated care from professionals¹⁸18. Balogh R, McMorris CA, Lunsky Y, Ouellette‐Kuntz H, Bourne L, Colantonio A, et al. Organising healthcare services for persons with an intellectual disability. Cochrane Database Syst Rev. 2016;(4):CD007492. https://doi.org/10.1002/14651858.CD007492.pub2 https://doi.org/10.1002/14651858.CD00749... ^,²⁰20. Marrocco A, Krouse HJ. Obstacles to preventive care for individuals with disability: implications for nurse practitioners. J Am Assoc Nurse Pract. 2017;29(5):282-93. https://doi.org/10.1002/2327-6924.12449 https://doi.org/10.1002/2327-6924.12449... ; failures of health systems to respond adequately to the treatable morbidity identified⁴⁰40. Robertson J, Roberts H, Emerson E, Turner S, Greig R. The impact of health checks for people with intellectual disabilities: a systematic review of evidence. J Intellect Disabil Res. 2011;55(11):1009-19. https://doi.org/10.1111/j.1365-2788.2011.01436.x https://doi.org/10.1111/j.1365-2788.2011... ; lack of care for secondary health care²⁶26. Oral A, Rapidi CA, Votava J, Roussos N, Michail X, Kujawa J, et al. Evidence based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for ageing people with disabilities. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med. 2017;53(5):802-11. https://doi.org/10.23736/S1973-9087.17.04864-X https://doi.org/10.23736/S1973-9087.17.0... ; lack of training and skills necessary for professionals and fragmentation of the health system²2. Organização Mundial da Saúde; Banco Mundial. Relatório mundial sobre a deficiência (World Report on Disability). Lexicus Serviços Linguísticos, tradutor. São Paulo: Secretaria de Estado dos Direitos da Pessoa com Deficiência; 2011 [cited 2021 Jan 20]. Available from: https://apps.who.int/iris/bitstream/handle/10665/44575/9788564047020_por.pdf. https://apps.who.int/iris/bitstream/hand... ^,⁴²42. Liebel DV, Friedman B, Watson NM, Powers BA. Review of nurse home visiting interventions for community-dwelling older persons with existing disability. Med Care Res Rev. 2009;66(2):119-46. https://doi.org/10.1177/1077558708328815 https://doi.org/10.1177/1077558708328815... ; lack of social support and discrimination⁴³43. Lindsay S, Kingsnorth S, Mcdougall C, Keating H. A systematic review of self-management interventions for children and youth with physical disabilities. Disabil Rehabil. 2014;36(4):276-88. https://doi.org/10.3109/09638288.2013.785605 https://doi.org/10.3109/09638288.2013.78... .
Technological			Inadequate procedures for the treatment and maintenance of assistive products⁴¹41. Bray N, Noyes J, Edwards RT, Harris N. Wheelchair interventions, services and provision for disabled children: a mixed-method systematic review and conceptual framework. BMC Health Serv Res. 2014;14:309. https://doi.org/10.1186/1472-6963-14-309 https://doi.org/10.1186/1472-6963-14-309... .	Lack of funding for purchasing devices needed for treatment⁴⁴44. O’Halloran R, Grohn B, Worrall L. Environmental factors that influence communication for patients with a communication disability in acute hospital stroke units: a qualitative metasynthesis. Arch Phys Med Rehabil. 2012;93 (1 Suppl):S77-85. https://doi.org/10.1016/j.apmr.2011.06.039 https://doi.org/10.1016/j.apmr.2011.06.0... ; and barriers in the financing of rehabilitation⁴⁵45. Pereira S, Graham JR, Shahabaz A, Salter K, Foley N, Meyer M, et al. Rehabilitation of individuals with severe stroke: synthesis of best evidence and challenges in implementation. Top Stroke Rehabil. 2012;19(2):122-31. https://doi.org/10.1310/tsr1902-122 https://doi.org/10.1310/tsr1902-122... and technologies³³33. Hamilton C, Lovarini M, McCluskey A, Folly de Campos T, Hassett L. Experiences of therapists using feedback-based technology to improve physical function in rehabilitation settings: a qualitative systematic review. Disabil Rehabil. 2019;41(15):1739-50. https://doi.org/10.1080/09638288.2018.1446187 https://doi.org/10.1080/09638288.2018.14... .	Barrier to the use of technology by therapists and lack of training and/or resources to support the use of technology in the practice³³33. Hamilton C, Lovarini M, McCluskey A, Folly de Campos T, Hassett L. Experiences of therapists using feedback-based technology to improve physical function in rehabilitation settings: a qualitative systematic review. Disabil Rehabil. 2019;41(15):1739-50. https://doi.org/10.1080/09638288.2018.1446187 https://doi.org/10.1080/09638288.2018.14... .
Others			Fear and anxiety among professionals³⁶36. Pelleboer-Gunnink HA, Van Oorsouw WMWJ, Van Weeghel J, Embregts PJCM. Mainstream health professionals’ stigmatising attitudes towards people with intellectual disabilities: a systematic review. J Intellect Disabil Res. 2017;61(5):411-34. https://doi.org/10.1111/jir.12353 https://doi.org/10.1111/jir.12353... .	Accessibility difficulties and financial constraints⁴³43. Lindsay S, Kingsnorth S, Mcdougall C, Keating H. A systematic review of self-management interventions for children and youth with physical disabilities. Disabil Rehabil. 2014;36(4):276-88. https://doi.org/10.3109/09638288.2013.785605 https://doi.org/10.3109/09638288.2013.78... .	Insufficient time for consultation¹⁸18. Balogh R, McMorris CA, Lunsky Y, Ouellette‐Kuntz H, Bourne L, Colantonio A, et al. Organising healthcare services for persons with an intellectual disability. Cochrane Database Syst Rev. 2016;(4):CD007492. https://doi.org/10.1002/14651858.CD007492.pub2 https://doi.org/10.1002/14651858.CD00749... ^,²⁰20. Marrocco A, Krouse HJ. Obstacles to preventive care for individuals with disability: implications for nurse practitioners. J Am Assoc Nurse Pract. 2017;29(5):282-93. https://doi.org/10.1002/2327-6924.12449 https://doi.org/10.1002/2327-6924.12449... ; difficulty in timely access to the appropriate services²⁷27. Cohen E, Jovcevska V, Kuo DZ, Mahant S. Hospital-based comprehensive care programs for children with special health care needs: a systematic review. Arch Pediatr Adolesc Med. 2011;165(6):554-61. https://doi.org/10.1001/archpediatrics.2011.74 https://doi.org/10.1001/archpediatrics.2... ; barriers to performing health tests³⁸38. Robertson J, Hatton C, Emerson E, Baines S. The impact of health checks for people with intellectual disabilities: an updated systematic review of evidence. Res Dev Disabil. 2014;35(10):2450-62. https://doi.org/10.1016/j.ridd.2014.06.007 https://doi.org/10.1016/j.ridd.2014.06.0... ; discrimination from the health service provider³⁴34. Bright T, Wallace S, Kuper H. A systematic review of access to rehabilitation for people with disabilities in low-and middle-income countries. Int J Environ Res Public Health. 2018;15(10):2165. https://doi.org/10.3390/ijerph15102165 https://doi.org/10.3390/ijerph15102165... ^,³⁶36. Pelleboer-Gunnink HA, Van Oorsouw WMWJ, Van Weeghel J, Embregts PJCM. Mainstream health professionals’ stigmatising attitudes towards people with intellectual disabilities: a systematic review. J Intellect Disabil Res. 2017;61(5):411-34. https://doi.org/10.1111/jir.12353 https://doi.org/10.1111/jir.12353... ; lack of resources in the areas of psychology, speech therapy, and neuropsychology³²32. Mlenzana NB, Frantz JM, Rhoda AJ, Eide AH. Barriers to and facilitators of rehabilitation services for people with physical disabilities: a systematic review. Afr J Disabil. 2013;2(1): 22. https://doi.org/10.4102/ajod.v2i1.22 https://doi.org/10.4102/ajod.v2i1.22... ; lack of policy-oriented self-care and health promotion⁴³43. Lindsay S, Kingsnorth S, Mcdougall C, Keating H. A systematic review of self-management interventions for children and youth with physical disabilities. Disabil Rehabil. 2014;36(4):276-88. https://doi.org/10.3109/09638288.2013.785605 https://doi.org/10.3109/09638288.2013.78... ; limited availability of trained professionals and lack of support⁴³43. Lindsay S, Kingsnorth S, Mcdougall C, Keating H. A systematic review of self-management interventions for children and youth with physical disabilities. Disabil Rehabil. 2014;36(4):276-88. https://doi.org/10.3109/09638288.2013.785605 https://doi.org/10.3109/09638288.2013.78... .

[1] Correspondence: Karina Aparecida Padilha Clemente Av. Dr. Arnaldo, 455 - Cerqueira César 01246-903 São Paulo, SP, Brasil E-mail: karinaapclemente@yahoo.com.br

Brasil

Brasil

Barriers to the access of people with disabilities to health services: a scoping review

ABSTRACT

OBJECTIVE

METHODS

RESULTS

CONCLUSIONS