White Sian, Kuper Hannah, Itimu-Phiri Ambumulire, Holm Rochelle, Biran Adam
Department for Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, United Kingdom.
International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, United Kingdom.
PLoS One. 2016 May 12;11(5):e0155043. doi: 10.1371/journal.pone.0155043. eCollection 2016.
Globally, millions of people lack access to improved water, sanitation and hygiene (WASH). Disabled people, disadvantaged both physically and socially, are likely to be among those facing the greatest inequities in WASH access. This study explores the WASH priorities of disabled people and uses the social model of disability and the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework to look at the relationships between impairments, contextual factors and barriers to WASH access. 36 disabled people and 15 carers from urban and rural Malawi were purposively selected through key informants. The study employed a range of qualitative methods including interviews, emotion mapping, free-listing of priorities, ranking, photo voice, observation and WASH demonstrations. A thematic analysis was conducted using nVivo 10. WASH access affected all participants and comprised almost a third of the challenges of daily living identified by disabled people. Participants reported 50 barriers which related to water and sanitation access, personal and hand hygiene, social attitudes and participation in WASH programs. No two individuals reported facing the same set of barriers. This study found that being female, being from an urban area and having limited wealth and education were likely to increase the number and intensity of the barriers faced by an individual. The social model proved useful for classifying the majority of barriers. However, this model was weaker when applied to individuals who were more seriously disabled by their body function. This study found that body function limitations such as incontinence, pain and an inability to communicate WASH needs are in and of themselves significant barriers to adequate WASH access. Understanding these access barriers is important for the WASH sector at a time when there is a global push for equitable access.
在全球范围内,数以百万计的人无法获得经过改善的水、环境卫生和个人卫生服务(WASH)。身体和社会上处于不利地位的残疾人很可能是在获得WASH服务方面面临最大不公平的人群之一。本研究探讨了残疾人的WASH优先事项,并使用残疾社会模型以及世界卫生组织的《国际功能、残疾和健康分类》(ICF)框架来研究损伤、背景因素与获得WASH服务的障碍之间的关系。通过关键信息提供者有目的地从马拉维城乡地区选取了36名残疾人及15名照料者。该研究采用了一系列定性方法,包括访谈、情感映射、优先事项自由列举、排序、照片发声、观察以及WASH示范。使用nVivo 10进行了主题分析。获得WASH服务影响了所有参与者,并且几乎占残疾人所确定的日常生活挑战的三分之一。参与者报告了50个与获得水和卫生设施、个人及手部卫生、社会态度以及参与WASH项目相关的障碍。没有两个人报告面临相同的障碍组合。本研究发现,女性、来自城市地区、财富和教育有限可能会增加个人面临的障碍数量和严重程度。社会模型被证明有助于对大多数障碍进行分类。然而,当应用于身体功能残疾更严重的个体时,该模型的作用就较弱。本研究发现,诸如大小便失禁、疼痛以及无法表达WASH需求等身体功能限制本身就是获得充分WASH服务的重大障碍。在全球推动公平获得WASH服务之际,了解这些获得服务的障碍对WASH部门而言很重要。