Addressing transport safety and accessibility for people with a disability in developing countries: a formative evaluation of the Journey Access Tool in Cambodia

Abstract

Background: The intersection between health, disability and transport has significant practical challenges for people with a disability living in low- and middle-income countries (LMICs), where road infrastructure is poor and travel unsafe. Lack of transport access to health, education, employment and other services impedes achievement of the Sustainable Development Goals and affects quality of life. The Journey Access Tool (JAT) combines access audit and road safety audit approaches to identify barriers to transport on journeys taken by people with a disability. To be useful and effective, it must fit the expectations of people with a disability (be acceptable) and be feasible for use in different settings (adoptable). Accordingly, a formative evaluation process was undertaken in Phnom Penh, Cambodia.Objectives: To undertake a formative evaluation of the JAT using an iterative process to tailor the tool, pilot its use by people with a disability, and develop a template for its implementation in other LMICs.Methods: An iterative process of consultation and three pilots was undertaken. Participants were people with a disability who undertook journeys with a public transport component accompanied by assistants. Focus groups were held after each pilot, and results were integrated into JAT revisions.Results: Issues of terminology were resolved early, as were process issues related to the length of time taken to complete the JAT. Interpersonal issues were more difficult to address, with assistants tending to exceed their role and record their own comments. Use of the tool provided rich information on barriers.Conclusions: The JAT was both acceptable and adoptable for people with a disability and other stakeholders, and the experience gained will facilitate adaptation of the tool to new settings. The tool has significant potential to shape and support advocacy for change and engagement with transport services and also health, education, employment and other services.

Disability, Mobility and Transport in Low- and Middle-Income Countries: A Thematic Review

“…The authors caution that while the tools were overall a success in the trial, the interventions and interpersonal dynamics (e.g., the personal assistants, interpreters and relations of the people with disabilities) were more difficult to address, as there was a tendency for care givers and assistants to speak on behalf of the person with a disability or interpret their views, risking skewing the data. Key messages may also be overlaid or misinterpreted through the interventions of (often well-meaning) others [61]. Though the tool is only at the trial stage, these findings illustrate the crux of the debates about accessible transport provision: the extent to which it is the transport system itself, or wider systemic issues, that create the biggest barriers for people with disabilities.…”

A Pragmatic Approach to Qualitative Formative Evaluation of an Integrated Primary Care Program in Togo, West Africa

“…Not having transcription and translation services identified and the administrative delays in setting up the work contributed to the long delay in analysis and providing data to the implementation team Qualitative methods are becoming more popular in implementation research generally and formative evaluation is an effective and straightforward approach to incorporate the type of detail that qualitative data can provide. Researchers in Cambodia successfully used iterative ethnographic and focus group formative evaluation data to understand acceptability and adoption of a tool designed to improve transportation for persons with disabilities (King et al, 2018). Explicitly focused on iterative stakeholder engagement, the team used formative evaluation to adapt the evidence-based tool to the Cambodian context.…”

Rural Transportation Infrastructure in Low- and Middle-Income Countries: A Review of Impacts, Implications, and Interventions

“…In many circumstances, time is a more accurate metric for measuring access, as it considers the details of travel more closely [77,78,84,89,91,103,106]. The mode of travel and the status of transportation infrastructure are critically important factors that influence the amount of time required for access [82,86,102,[107][108][109]. Many poor rural families do not own vehicles, cannot afford to hire vehicles [110] and are not within reach of public transportation systems that typically only follow patterns of commerce [90].…”

“…Lastly, disadvantaged groups within communities, such as those living with disabilities, should be prioritized, as evidence shows that people living with disabilities experience geographic barriers to healthcare acutely [103,104,[140][141][142][143]. Research from Thailand found that physical disabilities severely limited people's movement, unless they could afford to hire transportation, which was rarely possible [109]. However, future research should include expanding upon the examination of mobility, health, and disabilities, to support inclusive transportation infrastructure interventions and address the needs of disabled community members directly.…”