Farrar Mitchell, Niraula Yeti Raj, Pryor Wesley
Leading Edge Prosthetics, Murarrie, Australia.
Humanity and Inclusion, Prosthetics Orthotics Society Nepal, Kathmandu, Nepal.
Disabil Rehabil. 2023 Apr;45(7):1229-1238. doi: 10.1080/09638288.2022.2057599. Epub 2022 Apr 6.
Evidence of effective strategies to improve access to assistive technology (AT) like prostheses is limited, especially in rural and remote areas of low- and middle-income countries where unmet needs are the greatest. This study aimed to identify barriers and facilitators to accessing prosthetic services in rural areas of western Nepal and explore strategies to improve access from the perspective of local stakeholders.
Semi-structured interviews were conducted with 13 service providers and consumers. Barriers and facilitators of access were highlighted and potential solutions to overcome access barriers were explored using thematic analysis of transcripts.
Six themes concerning barriers and facilitators arose: awareness and literacy of prosthetic services, attitudes and belief systems, financial supports, geographical access, health system and referral processes, as well as service provider capacity and regulation. Six themes regarding potential solutions were also identified: awareness campaigns, procurement pathways, referral pathways, subsidised and shared costs of AT, professional support networks and development opportunities, as well as task shifting and sharing.
While facilitating interventions support access to prosthetic services, they remain insufficient to overcome several barriers that continue to inhibit this access. Nevertheless, real opportunities to alleviate barriers and address the unmet need exist and must be explored.Implications For RehabilitationIt is advised that rehabilitation professionals, particularly those delivering prosthetic services in rural and remote settings of Nepal, consider piloting alternative service delivery strategies which utilise resources accessible to them in order to overcome several existing barriers to AT access e.g., task shifting.Rehabilitation professionals in Nepal have the opportunity to support others working in low-resources settings to expand professional development opportunities through online and digital platforms.Gathering and sharing data on the current state of prosthetic and AT service delivery within Nepal is highly valuable to the development of the prosthetic rehabilitation profession and ultimately equity in access to appropriate AT.Proposed interventions identified within this study can potentially serve to guide stakeholders in rural and remote settings of other LMICs in developing strategies to overcome barriers to AT access suitable to their context.
改善假肢等辅助技术获取途径的有效策略的证据有限，尤其是在低收入和中等收入国家的农村和偏远地区，这些地区未满足的需求最大。本研究旨在确定尼泊尔西部农村地区获取假肢服务的障碍和促进因素，并从当地利益相关者的角度探索改善获取途径的策略。
对13名服务提供者和消费者进行了半结构化访谈。通过对访谈记录进行主题分析，突出了获取服务的障碍和促进因素，并探索了克服获取障碍的潜在解决方案。
出现了六个关于障碍和促进因素的主题：假肢服务的认知和文化水平、态度和信仰体系、财政支持、地理可达性、卫生系统和转诊流程，以及服务提供者的能力和监管。还确定了六个关于潜在解决方案的主题：宣传活动、采购途径、转诊途径、辅助技术的补贴和共享成本、专业支持网络和发展机会，以及任务转移和分担。
虽然促进性干预措施有助于获取假肢服务，但仍不足以克服继续阻碍这种获取的若干障碍。然而，减轻障碍和满足未满足需求的实际机会是存在的，必须加以探索。
对康复的启示
建议康复专业人员，特别是在尼泊尔农村和偏远地区提供假肢服务的人员，考虑试点替代服务提供策略，利用他们可获得的资源来克服辅助技术获取方面的若干现有障碍，例如任务转移。
尼泊尔的康复专业人员有机会通过在线和数字平台支持其他在资源匮乏环境中工作的人员扩大专业发展机会。
收集和分享尼泊尔假肢和辅助技术服务提供现状的数据对于假肢康复专业的发展以及最终实现获得适当辅助技术的公平性非常有价值。
本研究中确定的拟议干预措施可能有助于指导其他低收入和中等收入国家农村和偏远地区的利益相关者制定适合其背景的克服辅助技术获取障碍的策略。
