Unmet Needs and Use of Assistive Products in Two Districts of Bangladesh: Findings from a Household Survey

Abstract

Access to assistive products (AP) is an under-researched public health issue. Using an adaptation of a draft World Health Organization tool—the ‘Assistive Technology Assessment—Needs (ATA-N)’ for measuring unmet needs and use of AP, we aimed to understand characteristics of AP users, self-reported needs and unmet needs for AP, and current access patterns in Bangladesh. The ATA-N was incorporated in a Rapid Assessment of Disability (RAD), a population-based survey to estimate prevalence and correlates of disability. In each of two unions of Kurigram and Narsingdi districts, 60 clusters of 50 people each aged two years and older were selected using a two-staged cluster random sampling process, of whom, 4250 (59% Female; 41% Male) were adults, including 333 using AP. We estimate 7.1% of the studied population used any AP. AP use is positively associated with age and self-reported functional difficulty. The proportion of people using AP is higher for mobility than for sensory and cognitive difficulties. Of all people with any functional difficulty, 71% self-reported an unmet need for AP. Most products were home or self-made, at low cost, but provided benefits. Needs and unmet needs for AP are high, especially for people with greater functional difficulties. Assessing unmet needs for AP revealed important barriers to scale that can inform policy and practice.

Factors Underlying Unmet Medical Needs: A Cross-Sectional Study

“…As shown in Table A3, the experience of unmet medical needs increased with age, which accords with the findings of previous research [29,30,31]. The rate was particularly high among those in their forties, possibly because this group has less time to access medical services due to their relatively active social lives [19]. The analyses by age offer some support for this, as the need factors that hindered physical accessibility, such as disability and pain, had a larger impact on this phenomenon than did financial reasons among individuals in their forties compared to other age groups (Table 4).…”

“…Numerous influencing factors of unmet medical needs have been identified, and they can be broadly categorized as follows [13]: (1) availability, including long waiting times or unavailable services; (2) accessibility, including financial or transportation barriers; and (3) acceptability, including busyness or ignoring health problems [14]. Past studies on these factors have had different focuses, such as on women [11,15], income and health condition factors [16], the relationship of unmet medical needs with chronic diseases [17], household characteristics [18], costs [19], employment status [20], and habitation factors such as living on an island [21]. However, the factors influencing unmet medical needs will differ according to the characteristics of the health care system; past studies have typically only examined the relevance of individual patient characteristics, without consideration of the factors inherent in the larger health care system.…”

Preliminary steps of the development of a Minimum Uniform Dataset applicable to the international wheelchair sector

“…Outcomes comparable among different settings [2,25,26] with a special emphasis on LMIC [15] are needed to strengthen the evidence on AP. For instance, there is a need to measure the met and unmet need and to monitor and evaluate initiatives longitudinally, including measuring cost-effectiveness to be able to prioritize and promote investment [10,14,[27][28][29][30]. An example is the Assistive Technology Needs Assessment proposed by the World Health Organization (WHO) to measure at a population base the proportion of people who self-identify a need for AP and current AP product satisfaction [28].…”

“…An example is the Assistive Technology Needs Assessment proposed by the World Health Organization (WHO) to measure at a population base the proportion of people who self-identify a need for AP and current AP product satisfaction [28]. This tool, however, is not meant to be used to measure outcomes at multiple time intervals [28]. There is little research to support current wheelchair service delivery recommendations (e.g.…”

“…For instance, there is a need to measure the met and unmet need and to monitor and evaluate initiatives longitudinally, including measuring cost-effectiveness to be able to prioritize and promote investment [ 10 , 14 , 27 – 30 ]. An example is the Assistive Technology Needs Assessment proposed by the World Health Organization (WHO) to measure at a population base the proportion of people who self-identify a need for AP and current AP product satisfaction [ 28 ]. This tool, however, is not meant to be used to measure outcomes at multiple time intervals [ 28 ].…”