“Sex Should Not be Part of the Lives of Persons with Disabilities, but They Are Human Beings too”: Perceptions of Healthcare Providers and Factors Affecting Service Delivery in Ghana

Abstract

Persons with disabilities (PwDs) constitute about 16% of the global population and face many challenges in every society, including access to sexual and reproductive healthcare. The attitudes of healthcare providers (HPs) exert a major influence on PwDs accessing sexual and reproductive healthcare (SRH). A sequential explanatory mixed methods design was used to investigate the attitudes and perceptions of HPs towards PwDs and SRH delivery in Ghana’s Ashanti region. Quantitative data analysis indicated that overall, 82% of HPs had received information on disability-related issues and had relatively positive attitude towards PwDs, which varied across sub-scales of the Attitude Towards Disability score and associated with their sociodemographic characteristics. HPs faced several challenges in SRH services delivery to PwDs, which included a lack of funding and training, and inadequate staff. Inductive thematic analysis of the qualitative data revealed eight overarching themes. The findings revealed that HPs had prejudice about the mental and sexual health abilities of PwDs. Inadequate skill set, inadequate resources, and limited funding were major challenges identified. Nonetheless, compassion and benevolence towards PwDs, improvision, economic and educational support, awareness creation, and referrals were strategies adopted to overcome these challenges. Mandatory training of HPs is recommended to ensure improved SRH service delivery to PwDs. Future research could explore the perceptions and coping strategies of PwDs.

Sexual lives and reproductive health outcomes among persons with disabilities: a mixed-methods study in two districts of Ghana

“…Exclusion criteria were: a) under 18 years old, b) multiple disabilities, c) disabilities other than physical or visual impairment, and d) refusal to participate. More details regarding the study area and the inclusion and exclusion criteria can be found in previous studies [ 28 , 43 ].…”

“…In the present study, outcomes consist of self-reported SRH issues among PwDs, including STIs, unintended and unwanted pregnancies, pregnancy termination, unsafe abortion, self-rated SRH, and experience of violence or abuse [ 42 ]. The model has been previously applied and explained in detail [ 28 , 43 ]. The rationale for using this framework for the current study is that it captures the complex and multifaceted factors influencing the sexual experiences, behaviour, and reproductive health outcomes of PwDs.…”

A mixed-methods study of the awareness and functionality of sexual and reproductive health services among persons with disability in Ghana

“…The study focused on those with visual/seeing (4%) and physical impairment/walking (3.6%) which were the most common types of disabilities in this area, with more PwDs living in urban (9.5%) than rural (6.5%) areas. Details of the study area have been published elsewhere [ 38 ]. The inclusion criteria for participant selection were (a) being 18 years or older, and (b) having either physical or visual impairment.…”

“…System characteristics pertain to the organization of systems, such as hospitals or healthcare provider networks, and their interactions, which collectively shape an individual's health [ 37 ]. A diagram showing the various components of the model and its detailed description have previously been published [ 38 , 39 ]. This current study focused specifically on three aspects of the framework: system characteristics, client characteristics, and interventions.…”

“…Therefore, access to SRH information is achieved when healthcare resources align with individual healthcare needs and are appropriately delivered by HPs [ 34 ]. This framework is considered ideal for the present study, as it has been validated [ 36 ] and utilised across various settings and populations [ 38 , 39 , 42 ].…”