BARRIERS TO HEALTH CARE FOR WOMEN WITH

DISABILITIES:Education of Health Care

Providers

Margaret A. Turk, MD

Professor, Physical Medicine & Rehabilitation

SUNY Upstate Medical University - Syracuse

Scope of the Problem• 26 million women with disabilities (WWD)

in the US

• Increasing prevalence with improved care

• WWD among the most disadvantaged (NHISD)– Lower socioeconomic– Less education– Less often married

Scope of the Problem• Estimated 1 million persons with disabilities have contact with

health care providers annually• Providers:

– Physicians and extenders– Nurses– Therapists: PT, OT, SLP– Psychologists– Rehabilitation Counselors– Social service providers– Technicians: phlebotomy,

respiratory, radiology– Etc. . .

Barriers to Health CareReport from WWD

• Difficulty obtaining primary health care, gynecologic services, mental health services, dental care, prescription meds, eyeglasses, fitness

• Experiences in ED and hospital (PWDD Australia)

– Required reliance on personal support– Negative attitudes of staff– Lack of staff skills and knowledge

(Federally funded projects, personal communications, 1996 to present)

(Iacono, 2003)

Barriers to Health CareReport from WWD

• Reasons cited:

– Accessibility - environmental and financial

– Provider education and training

• Attitudes

• Knowledge and skills

(Federally funded projects, personal communications, 1996 to present)

Barriers to Health CareReport from Providers

• Lack of medical knowledge – No formal training undergraduate/graduate – PM&R disability and performance focused– Education through experience/mentors

• Time and reimbursement issues– Time consuming appointments (2-3X)– No compensation for extra time/staff– Interpreter cost > reimbursement

(Personal communicationsand experience)

Barriers to Health CareReport from Providers

• Communication with deaf/hearing loss patients in primary care setting (Ralston, 1996)

– Acknowledge poor communication/understanding– Concerns re: patients trusting them– Level of comfort not patients in practice

• Attitudes re: function & back pain (Rainville,1995)

– Diverse pain attitudes and beliefs– Attitudes and beliefs treatment considerations

Health Care Providers

• Physicians and extenders• Nurses• Therapists: PT, OT, SLP• Psychologists• Social service providers• Rehabilitation Counselors• Technicians: phlebotomy,

respiratory, radiology• Etc.

No educational requirements re: health care for persons with disabilities

Education for ProvidersAttitudes

• Comparison OT, PT, RN (White, 1998)

– OT most positive– Practice setting, age, education no significance

• Comparison OT, Med Tech students (Estes, 1991)

– OT more positive, and most positive last year• Comparison OT, business student (Chan 2002)

– Initial similar attitudes, change after 1st year

Education for ProvidersAttitudes

• Medical student attitudes (US and Canada) (Tervo, 2002)

– Less positive attitudes than norms– Males more negative; previous experience positive

• Rehabilitation Counseling students (Wong, 2004)

– Preferred disability type physical disability > developmental disability > mental illness

• OT students in Hong Kong– Rank order importance attributes: disability type,

history aggressive behaviors, age, employment, gender (Tsang, 2004)

Education for ProvidersAttitudes

• RN attitudes more positive with education– Comparison NP/RN to general population

(Gething, 1992)

– More positive outpatient, peer encounters (Packer, 2000)

– More positive attitude post education (Lindgren, Oermann,1993, 1995)

Education for ProvidersKnowledge

• Existing curricula– Fulfill broad requirements– Leading edge technology– Undergrad/graduate– Competencies

• Curricular reform– Competition – Test vs education– Process– Evaluation

Education for ProvidersKnowledge

• Disability continuum

• Disability specific conditions

• Secondary conditions

• Aging with a disability

• Health perceptions & promotion

• Sexuality and reproductive health

• Enhancing motor performance

• Health care access and administration

Education for ProvidersSkills

• Communication– Cognitive impairment– Hearing loss– General disability

• Positioning• Transfers• General exam• Gynecologic examSource: Alta Bates,

Comprehensive Breast Center

CONCLUSIONS

• Women with disabilities have reported barriers to health care.

• Health care providers acknowledge lack of knowledge and skills in providing care to women with disabilities.

• Attitudes toward persons with disabilities is generally negative, and dependent on disability type, age, and gender.

CONCLUSIONS

• The literature supports the positive effect of contact, experience, and education on professional attitudes toward persons with disabilities.

• Curricula for health care providers do not require education about or competencies re: disabilities in general, and about women with disabilities in particular.