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Assessing Healthcare Access among Physical and Hearing Disabled Persons in Jazan Region, Saudi Arabia

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Title: Assessing Healthcare Access among Physical and Hearing Disabled Persons in Jazan Region, Saudi Arabia
Language: English
Authors: Ahmad Y. Alqassim (ORCID 0000-0002-0170-1437), Anwar M. Makeen, Mohammed S. Mahfouz, Anas E. Ahm, Osama B. Albasheer, Mohammad R. Zaino, Mohammad H. Abutaleb, Maged A. El-Setouhy, Abdullah A. Alharbi, Mohammed A. Muaddi
Source: Journal of Developmental and Physical Disabilities. 2022 34(6):1071-1088.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 18
Publication Date: 2022
Document Type: Journal Articles
Reports - Research
Descriptors: Access to Health Care, Diseases, Mental Health, Health Services, Dental Health, Screening Tests, Family Environment, Primary Health Care, Hypertension, Foreign Countries, Physical Disabilities, Hearing Impairments, Chronic Illness, Diabetes, Drug Therapy, Barriers, Immunization Programs, Physicians, Questionnaires
Geographic Terms: Saudi Arabia
DOI: 10.1007/s10882-022-09838-9
ISSN: 1056-263X
1573-3580
Abstract: Disability constitutes a significant health problem in the Kingdom of Saudi Arabia (KSA). Research assessing the health needs of people with disabilities in KSA is scarce. This study aimed to assess what physical and hearing disable persons need from healthcare services and to investigate difficulties in accessing these services in the Jazan area. A cross-sectional survey was conducted among hearing and physical disable persons between July, 2018, and May, 2019 in Jazan region, KSA using a modified Arabic-translated version of the validated Southampton Needs Assessment Questionnaire (SNAQ). Two hundred and eighty-nine hearing and physical disable persons completed the questionnaire with a response rate of 63%. Around half of the participants encountered difficulty in accessing appropriate healthcare services. More than half had difficulty obtaining mental healthcare, dental care, preventive periodic screening care, or medical care at home. Although 37.6% of the participants had previously received regular chronic disease care for diabetes, hypertension, or asthma, 52% reported difficulty obtaining medicine for such diseases, and 46.5% reported difficulty getting seasonal vaccinations such as the influenza vaccine. Finding specialized doctors or dentists using specialized means of communication was a struggle for over 50% of the participants. There is a need to optimize society for people with physical disabilities and improve access to healthcare facilities.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1430975
Database: ERIC
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  Value: <anid>AN0160076123;jdp01dec.22;2022Nov09.05:57;v2.2.500</anid> <title id="AN0160076123-1">Assessing Healthcare Access Among Physical and Hearing Disabled Persons in Jazan Region, Saudi Arabia </title> <p>Disability constitutes a significant health problem in the Kingdom of Saudi Arabia (KSA). Research assessing the health needs of people with disabilities in KSA is scarce. This study aimed to assess what physical and hearing disable persons need from healthcare services and to investigate difficulties in accessing these services in the Jazan area. A cross-sectional survey was conducted among hearing and physical disable persons between July, 2018, and May, 2019 in Jazan region, KSA using a modified Arabic-translated version of the validated Southampton Needs Assessment Questionnaire (SNAQ). Two hundred and eighty-nine hearing and physical disable persons completed the questionnaire with a response rate of 63%. Around half of the participants encountered difficulty in accessing appropriate healthcare services. More than half had difficulty obtaining mental healthcare, dental care, preventive periodic screening care, or medical care at home. Although 37.6% of the participants had previously received regular chronic disease care for diabetes, hypertension, or asthma, 52% reported difficulty obtaining medicine for such diseases, and 46.5% reported difficulty getting seasonal vaccinations such as the influenza vaccine. Finding specialized doctors or dentists using specialized means of communication was a struggle for over 50% of the participants. There is a need to optimize society for people with physical disabilities and improve access to healthcare facilities.</p> <p>Keywords: Health needs assessment; Disability; Saudi Arabia; Healthcare system; Physical disability; Occupational and Environmental Health</p> <p>Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s10882-022-09838-9.</p> <hd id="AN0160076123-2">Introduction</hd> <p>One billion people around the world experience some form of disability at one point in life. The density of people with disability is increasing, formulating up around 15% of the global population (WHO, [<reflink idref="bib36" id="ref1">36</reflink>]). Markedly, the global prevalence of disability varies significantly between countries extending from less than 1% to up to 30% in some other countries (Mitra & Sambamoorthi, [<reflink idref="bib29" id="ref2">29</reflink>]). This variation in the prevalence of disability between countries can be explained by different factors, such as different definitions of disability and differing methodology (Chala et al., [<reflink idref="bib18" id="ref3">18</reflink>]; Chi et al., [<reflink idref="bib19" id="ref4">19</reflink>]).</p> <p>While health care should be a universal and equitable right to all members of society, it is known that in some countries, particularly in their rural areas, people with disabilities have a higher rate of unmet health needs compared to non-disabled people (McColl et al., [<reflink idref="bib27" id="ref5">27</reflink>]; Moodley & Ross, [<reflink idref="bib30" id="ref6">30</reflink>]; Vergunst et al., [<reflink idref="bib35" id="ref7">35</reflink>]). These issues are of great importance for those living in rural areas as they generally experience different barriers accessing primary health care (Alfaqeeh et al., [<reflink idref="bib11" id="ref8">11</reflink>]; Dew et al., [<reflink idref="bib21" id="ref9">21</reflink>]). These difficulties are further exacerbated for people with disabilities (Lishner et al., [<reflink idref="bib26" id="ref10">26</reflink>]).</p> <p>Disability constitutes a significant health problem in the Kingdom of Saudi Arabia (KSA). Epidemiological research to determine the incidence, prevalence, and pattern of disabilities in KSA is limited (Al-Jadid, [<reflink idref="bib6" id="ref11">6</reflink>]; Al-Odaib & Al-Sedairy, [<reflink idref="bib9" id="ref12">9</reflink>]). This scarcity in the literature is attributable to cultural factors limiting the Saudi population's participation in such research (Al-Gain & Alabdulwahab, [<reflink idref="bib3" id="ref13">3</reflink>]). A recent study reported that the overall prevalence rate of any disability in Saudi Arabia is lower than the global disability prevalence (Bindawas & Vennu, [<reflink idref="bib17" id="ref14">17</reflink>]). A survey conducted by the Saudi General Authority for Statistics found that 7.1% of the Saudi population experienced functional difficulty (General Authority for Statistics, [<reflink idref="bib23" id="ref15">23</reflink>]). Of them, 2.9% experience extreme difficulty, limiting their independence. Different disabilities have been reported in KSA due to the increasing population, the significant shift of socio-demographic characteristics, and increased awareness about disabilities (Al-Jadid, [<reflink idref="bib7" id="ref16">7</reflink>]). Survey findings show the most prevalent of these to be mobility conditions, affecting 4.1% of the total Saudi population and 29.13% of the disabled Saudi population (General Authority for Statistics, [<reflink idref="bib23" id="ref17">23</reflink>]). Visual difficulties were also common, experienced by 4% of Saudis, followed by hearing difficulties (1.4%), difficulties related to communication and comprehension (approximately 1.1% for each) (General Authority for Statistics, [<reflink idref="bib23" id="ref18">23</reflink>]). This was also reported by an earlier study that found physical disability (3%) to be the most common, followed by learning disability (1.8%) (Al-Hazmy et al., [<reflink idref="bib4" id="ref19">4</reflink>]).</p> <p>The causes of disability vary from pregnancy or birth-related causes to idiosyncratic illness or accidents such as falling, work accidents, or road accidents. Cerebral palsy, strokes, and head and spinal cord injuries or trauma are significant causes of chronic disability in KSA (Al-Jadid, [<reflink idref="bib7" id="ref20">7</reflink>]; Al-Shehri et al., [<reflink idref="bib10" id="ref21">10</reflink>]; Robert & Zamzami, [<reflink idref="bib31" id="ref22">31</reflink>]). Disabilities associated with genetic causes or metabolic errors are also prevalent (Al Essa et al., [<reflink idref="bib2" id="ref23">2</reflink>]; El-Mouzan et al., [<reflink idref="bib22" id="ref24">22</reflink>]) owing to the high incidence and prevalence of consanguinity marriages, especially in an area like Jazan where previous studies have tracked a high number of marriages between first-degree relatives without premarital counselling or screening, thus leading to hereditary diseases (AlHamdan et al., [<reflink idref="bib12" id="ref25">12</reflink>]; Milaat et al., [<reflink idref="bib28" id="ref26">28</reflink>]). Al-Hazmy and colleagues also report that disabled parents, later-in-life pregnancies, and mothers who had not received medical care and required vaccination during pregnancy contributed to the prevalence of disability (Al-Hazmy et al., [<reflink idref="bib4" id="ref27">4</reflink>]).</p> <p>As for geographical distribution, the 2017 survey findings show that Riyadh is associated with the highest percentage of the disabled Saudi population (25.13%) while Najran has the lowest (0.87%) (General Authority for Statistics, [<reflink idref="bib23" id="ref28">23</reflink>]). A previous national survey targeting disabled children under 16 found the Jazan area to have the highest ratio (9.9%) while Riyadh had the lowest (4.36%) (Al-Hazmy et al., [<reflink idref="bib4" id="ref29">4</reflink>]). Therefore, healthcare services, including rehabilitation services, are provided in all regions across the KSA. Healthcare services in the KSA are predominantly provided through public sectors via primary healthcare centers or general, central, or specialist hospitals or medical cities for secondary and tertiary care services. The Ministry of Health (MOH) is the primary public sector providing preventative, therapeutic, and rehabilitative healthcare services to most of the population alongside other governmental institutions such as university-affiliated healthcare institutions or those that belong to the ministries of interior, defense, or national security (Almalki et al., [<reflink idref="bib14" id="ref30">14</reflink>]).</p> <p>Rehabilitation services have existed in the KSA since the early 1960s following an outbreak of poliomyelitis that resulted in the paralysis or weakening of children's lower extremities (Al Jadid, [<reflink idref="bib5" id="ref31">5</reflink>]). All MOH hospitals (50 beds or more) have rehabilitation departments providing physiotherapy services for both ambulatory and in-patients. Central hospitals, available in all regions across the kingdom, offer physical, occupational, psychological, speech and language therapy, and orthotic and prosthetic services for persons with disabilities (The Director General of MOH Medical Rehabilitation, [<reflink idref="bib34" id="ref32">34</reflink>]). Comprehensive multidisciplinary state-of-the-art rehabilitation services are provided by rehabilitating specialized hospitals, mainly placed in large cities (leisa et al., [<reflink idref="bib25" id="ref33">25</reflink>]). Such centers of excellence provide comprehensive rehabilitation care for children, adolescents, and adults through a multidisciplinary specialized team comprising physiatrists, rehabilitation nurses, occupational therapists, physical therapists, rehabilitation technology specialists, speech and language therapists, and therapeutic recreation specialists supported by professionals in clinical nutrition, psychology, and social care to provide general or specialized rehabilitation services for people suffering from strokes, traumatic brain injuries, spinal cord injuries, amputations or orthopedic and musculoskeletal concerns (Al Jadid, [<reflink idref="bib5" id="ref34">5</reflink>]; leisa E et al., [<reflink idref="bib25" id="ref35">25</reflink>]).</p> <p>Despite the availability of healthcare services in most regions across the kingdom, there is a need for more access to rehabilitation due to the growing disabled population owing to an increase in road traffic accidents resulting in brain and spinal cord injuries, amputations, and fractures, etc.(Al-Naami et al., [<reflink idref="bib8" id="ref36">8</reflink>]). A recent study assessing the experiences of hospitalized physical therapy clients strongly supported the integration of physical therapy services in the primary care center (Al-Abbad & Madi, [<reflink idref="bib1" id="ref37">1</reflink>]). However, there is a gap in the literature when it comes to the health needs assessment of people with disabilities.</p> <p>Therefore, this study aimed to assess what physical and hearing disabled persons need from healthcare services and to investigate difficulties in accessing these services in the Jazan area.</p> <hd id="AN0160076123-3">Methodology</hd> <p></p> <hd id="AN0160076123-4">Participants</hd> <p>This study was carried out between July, 2018, and May, 2019 in Jazan Province, which is one of 13 administrative provinces in the KSA. It is a densely populated province with more than 1.5 million inhabitants in some 5,000 villages and towns. The study was conducted among hearing and physical disabled persons. All subjects registered in the official disability registry were eligible and included in this investigation. The target sample size was determined using the standard formula:</p> <p> <ephtml> <math display="block" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><mtext>n</mtext><mo>=</mo><mfrac><mrow><msup><mrow><mtext>Z</mtext></mrow><mn>2</mn></msup><mi>π</mi><mtext>(1-</mtext><mi>π</mi><mtext>)</mtext></mrow><msup><mrow><mtext>d</mtext></mrow><mn>2</mn></msup></mfrac></mrow></math> </ephtml> </p> <p>Graph</p> <p>where:</p> <p>n: the sample size.</p> <p>π: The attribute studied.</p> <p>Z: the standardized variable that corresponds to 95% level of confidence.</p> <p>d:the desired marginal error.</p> <p>Z was set 1.96 as 95% and π as 0.5 because we are exploring numerous aspects of disabled people and d was set at,0.05; The calculated sample size was 400 individuals (Daniel & Cross, [<reflink idref="bib20" id="ref38">20</reflink>]). The response rate was 80% and 31 individuals with incomplete data, so the final sample size was 289 respondents.</p> <p>Our sample included hearing and physical disable persons and or their caregivers if necessary. A disabled person was defined as any person unable to control the motion of one or more of their body parts, or any person with a hearing disability ranging from poor hearing to complete deafness. This study depended on the updated registers as a sampling frame for selecting the study participants. The sample was drawn from data list obtained from Jazan Human Resources and Social Development office. The skipping period was determined using the size of the updated sampling frame.</p> <hd id="AN0160076123-5">Materials</hd> <p>A modified Arabic-translated version of the validated Southampton Needs Assessment Questionnaire (SNAQ) was used to interview all selected disabled individuals.</p> <hd id="AN0160076123-6">Procedure</hd> <p>A pre-testing was carried out to check the questionnaire's adequacy and content, sample design, and fieldwork plan. We pre-tested the length of the interview, the identification of the respondents, respondents' perceptions of the questionnaire's contents, the sequences of topics, and field staff adequacy. The pre-testing process was conducted using 25 questionnaires.</p> <p>Data entry and analysis were performed using Statistical Package for the Social Sciences (SPSS). Double data entry was granted to ensure high reliability. Data analysis involved descriptive statistics as well as inferential statistics. Simple tabulation, frequencies, and a Chi-square test were used to test the associations between different variables. In case of significant results of Chi-square test an adjusted Z-test was used to find those proportions that were responsible for getting that significant relationship. ANOVA along with the Tukey's Test (post hoc test) was performed. Binary linear regression was used to evaluate some relationships.</p> <hd id="AN0160076123-7">Design</hd> <p>The current study is an observational cross-sectional survey among physical and Hearing disabled Persons disabled based on systematic random sampling technique.</p> <hd id="AN0160076123-8">Results</hd> <p>A total of 289 respondents participated in the study and completed the questionnaire, constituting a response rate of 72%. Table 1 highlights the demographic characteristics of the participants.</p> <p>Table 1 Demographic characteristics of the participants</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p><bold>Variable</bold></p></th><th align="left"><p>Group</p></th><th align="left"><p>N</p></th><th align="left"><p>%</p></th></tr></thead><tbody><tr><td align="left"><p><bold>Disability type</bold></p></td><td align="left"><p>Physical disability</p></td><td align="left"><p>264</p></td><td align="left"><p>91.3</p></td></tr><tr><td align="left" /><td align="left"><p>Hearing disability</p></td><td align="left"><p>25</p></td><td align="left"><p>8.7</p></td></tr><tr><td align="left"><p><bold>Place of Residence</bold></p></td><td align="left"><p>Rural</p></td><td align="left"><p>77</p></td><td align="left"><p>27.4</p></td></tr><tr><td align="left" /><td align="left"><p>Urban</p></td><td align="left"><p>204</p></td><td align="left"><p>2.6</p></td></tr><tr><td align="left"><p><bold>Gender</bold></p></td><td align="left"><p>Male</p></td><td align="left"><p>214</p></td><td align="left"><p>74</p></td></tr><tr><td align="left" /><td align="left"><p>Female</p></td><td align="left"><p>75</p></td><td align="left"><p>26</p></td></tr><tr><td align="left"><p><bold>Age in years</bold></p></td><td align="left"><p>Less than 15</p></td><td align="left"><p>11</p></td><td align="left"><p>3.8</p></td></tr><tr><td align="left" /><td align="left"><p>15—29</p></td><td align="left"><p>138</p></td><td align="left"><p>47.8</p></td></tr><tr><td align="left" /><td align="left"><p>30—44</p></td><td align="left"><p>105</p></td><td align="left"><p>36.3</p></td></tr><tr><td align="left" /><td align="left"><p>More than 44</p></td><td align="left"><p>35</p></td><td align="left"><p>12.1</p></td></tr><tr><td align="left"><p><bold>Marital Status</bold></p></td><td align="left"><p>Married</p></td><td align="left"><p>140</p></td><td align="left"><p>49.0</p></td></tr><tr><td align="left" /><td align="left"><p>Single</p></td><td align="left"><p>135</p></td><td align="left"><p>47.2</p></td></tr><tr><td align="left" /><td align="left"><p>Divorced</p></td><td align="left"><p>9</p></td><td align="left"><p>3.1</p></td></tr><tr><td align="left" /><td align="left"><p>Widowed</p></td><td align="left"><p>2</p></td><td align="left"><p>0.7</p></td></tr><tr><td align="left"><p><bold>Family Number</bold></p></td><td align="left"><p>Less than 5 person</p></td><td align="left"><p>91</p></td><td align="left"><p>36.3</p></td></tr><tr><td align="left" /><td align="left"><p>6 -10</p></td><td align="left"><p>92</p></td><td align="left"><p>36.7</p></td></tr><tr><td align="left" /><td align="left"><p>11–15</p></td><td align="left"><p>44</p></td><td align="left"><p>17.5</p></td></tr><tr><td align="left" /><td align="left"><p>16 and over</p></td><td align="left"><p>24</p></td><td align="left"><p>9.6</p></td></tr><tr><td align="left"><p><bold>Occupation</bold></p></td><td align="left"><p>Unemployed</p></td><td align="left"><p>145</p></td><td align="left"><p>48.3</p></td></tr><tr><td align="left" /><td align="left"><p>Government employee</p></td><td align="left"><p>99</p></td><td align="left"><p>33.3</p></td></tr><tr><td align="left" /><td align="left"><p>Private sector employee</p></td><td align="left"><p>25</p></td><td align="left"><p>8.4</p></td></tr><tr><td align="left" /><td align="left"><p>Self-employed</p></td><td align="left"><p>12</p></td><td align="left"><p>4</p></td></tr><tr><td align="left" /><td align="left"><p>Other</p></td><td align="left"><p>16</p></td><td align="left"><p>5.4</p></td></tr><tr><td align="left"><p><bold>Educational Level</bold></p></td><td align="left"><p>University and above</p></td><td align="left"><p>117</p></td><td align="left"><p>39.4</p></td></tr><tr><td align="left" /><td align="left"><p>High school</p></td><td align="left"><p>81</p></td><td align="left"><p>27.3</p></td></tr><tr><td align="left" /><td align="left"><p>Intermediate school</p></td><td align="left"><p>27</p></td><td align="left"><p>9.1</p></td></tr><tr><td align="left" /><td align="left"><p>Primary school</p></td><td align="left"><p>15</p></td><td align="left"><p>5.1</p></td></tr><tr><td align="left" /><td align="left"><p>Read and Write</p></td><td align="left"><p>31</p></td><td align="left"><p>10.4</p></td></tr><tr><td align="left" /><td align="left"><p>Illiterate</p></td><td align="left"><p>26</p></td><td align="left"><p>8.6</p></td></tr><tr><td align="left"><p><bold>Monthly Income</bold></p></td><td align="left"><p>Less than $1,350</p></td><td align="left"><p>166</p></td><td align="left"><p>55.9</p></td></tr><tr><td align="left" /><td align="left"><p>$1,351-$2,700</p></td><td align="left"><p>97</p></td><td align="left"><p>32.7</p></td></tr><tr><td align="left" /><td align="left"><p>$2,701-$4000</p></td><td align="left"><p>19</p></td><td align="left"><p>6.4</p></td></tr><tr><td align="left" /><td align="left"><p>More than $4,000</p></td><td align="left"><p>15</p></td><td align="left"><p>5.1</p></td></tr></tbody></table> </ephtml> </p> <p> <sups>*</sups>The question was asked in Saudi Riyals (U$1 = SR3.75)</p> <p>Health care services for disabled people were cross-matched with either physical or hearing disability. We found that those with hearing disabilities experienced more some difficulty finding a dentist in their nearby area (40%) compared to those with physical disabilities (20%), the overall association for disability-type and difficulty in finding a dentist was statistically significant (<emph>X</emph><sups>2</sups>(<reflink idref="bib3" id="ref39">3</reflink>, _I_N_i_ = 259) = 8.9, <emph>P</emph> = 0.019) (Table 2). It was similar in accessing drugs for acute conditions like analgesics and antibiotics for acute infections. Those with hearing loss access such drugs with significantly some difficulty (48%), followed by those with a physical disability (24%), (<emph>X</emph><sups>2</sups>(<reflink idref="bib3" id="ref40">3</reflink>, _I_N_i_ = 259) = 8.9, <emph>P</emph> = 0.018). Entering and leaving medical service venues was more difficult (but not statistically significant) for those with physical disabilities than those experiencing hearing disability (25% versus 12% respectively), although the overall relationship was significant (<emph>X</emph><sups>2</sups>(<reflink idref="bib3" id="ref41">3</reflink>, _I_N_i_ = 263) = 10.5, <emph>P</emph> = 0.015). It was difficult to find a suitable toilet for those with hearing disability (8%), but those with physical disabilities found it very difficult (28%), (<emph>X</emph><sups>2</sups>(<reflink idref="bib3" id="ref42">3</reflink>, _I_N_i_ = 262) = 18.0, <emph>P</emph> = 0.001)<emph>.</emph> It was significantly more difficult to deal with the reception areas or pharmacies for persons with a physical disability compared to those with hearing disability (30% versus 8% respectively, <emph>X</emph><sups>2</sups>(<reflink idref="bib3" id="ref43">3</reflink>, _I_N_i_ = 258) = 10.2, <emph>P</emph> = 0.015). On the other hand, we found that it was significantly easier for physically disabled people in Jazan to obtain support and assistance if they were subjected to violence or abuse (37%) compared to 12% of people with hearing disabilities, (<emph>X</emph><sups>2</sups>(<reflink idref="bib3" id="ref44">3</reflink>, _I_N_i_ = 257) = 8.7, <emph>P</emph> = 0.034). The rest of differences in frequencies for persons with physical disabilities compared to those with hearing disability were statistically not significant (Table 2).</p> <p>Table 2 Difficulties in obtaining health services for persons with disabilities in the Jazan region</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left" /><th align="left" colspan="4"><p>Physical disabilities</p><p>N = 264</p></th><th align="left" colspan="4"><p>Hearing Loss and Deafness</p><p>N = 25</p></th><th align="left"><p>Chi-Square</p><p>Test</p></th></tr><tr><th align="left"><p>Sequence</p></th><th align="left"><p><bold>Statement(</bold>Questions)</p></th><th align="left"><p>No Difficulty</p></th><th align="left"><p>Some Difficulty</p></th><th align="left"><p>Very Difficult</p></th><th align="left"><p>I do not Know</p></th><th align="left"><p>No Difficulty</p></th><th align="left"><p>Some Difficulty</p></th><th align="left"><p>Very Difficult</p></th><th align="left"><p>I do not Know</p></th><th align="left"><p>P-value</p></th></tr></thead><tbody><tr><td align="left" /><td align="left" /><td align="left"><p>%</p></td><td align="left"><p>%</p></td><td align="left"><p>%</p></td><td align="left"><p>%</p></td><td align="left"><p>%</p></td><td align="left"><p>%</p></td><td align="left"><p>%</p></td><td align="left"><p>%</p></td><td char="." align="char" /></tr><tr><td align="left"><p>1</p></td><td align="left"><p>Receiving appropriate health services</p></td><td align="left"><p>39.7</p></td><td align="left"><p>25.6</p></td><td align="left"><p>23.3</p></td><td align="left"><p>11.5</p></td><td align="left"><p>24</p></td><td align="left"><p>48</p></td><td align="left"><p>12</p></td><td align="left"><p>16</p></td><td char="." align="char"><p>0.069</p></td></tr><tr><td align="left"><p>2</p></td><td align="left"><p>Obtaining home health services</p></td><td align="left"><p>28</p></td><td align="left"><p>29.5</p></td><td align="left"><p>26.4</p></td><td align="left"><p>16.1</p></td><td align="left"><p>16</p></td><td align="left"><p>44</p></td><td align="left"><p>28</p></td><td align="left"><p>12</p></td><td char="." align="char"><p>0.410</p></td></tr><tr><td align="left"><p>3</p></td><td align="left"><p>Medical personnel specializing in provision of care</p></td><td align="left"><p>35.2</p></td><td align="left"><p>27.6</p></td><td align="left"><p>23</p></td><td align="left"><p>14.2</p></td><td align="left"><p>20</p></td><td align="left"><p>40</p></td><td align="left"><p>32</p></td><td align="left"><p>8</p></td><td char="." align="char"><p>0.246</p></td></tr><tr><td align="left"><p>4</p></td><td align="left"><p>Obtaining integrated dental services</p></td><td align="left"><p>31</p></td><td align="left"><p>21.5</p></td><td align="left"><p>28</p></td><td align="left"><p>19.5</p></td><td align="left"><p>16</p></td><td align="left"><p>44</p></td><td align="left"><p>28</p></td><td align="left"><p>12</p></td><td char="." align="char"><p>0.081</p></td></tr><tr><td align="left"><p>5</p></td><td align="left"><p>Dentists available for disabled people in the area</p></td><td align="left"><p>30.9</p></td><td align="left"><p>20.1</p></td><td align="left"><p>28.2</p></td><td align="left"><p>20.8</p></td><td align="left"><p>12</p></td><td align="left"><p>40</p></td><td align="left"><p>40</p></td><td align="left"><p>8</p></td><td char="." align="char"><p><bold>0.019</bold></p></td></tr><tr><td align="left"><p>6</p></td><td align="left"><p>Access to mental health services</p></td><td align="left"><p>30.5</p></td><td align="left"><p>30.2</p></td><td align="left"><p>23.3</p></td><td align="left"><p>16</p></td><td align="left"><p>12</p></td><td align="left"><p>48</p></td><td align="left"><p>32</p></td><td align="left"><p>8</p></td><td char="." align="char"><p>0.081</p></td></tr><tr><td align="left"><p>7</p></td><td align="left"><p>Obtaining an antibiotic-analgesic for acute conditions</p></td><td align="left"><p>43.9</p></td><td align="left"><p>24.4</p></td><td align="left"><p>19.5</p></td><td align="left"><p>12.2</p></td><td align="left"><p>20</p></td><td align="left"><p>48</p></td><td align="left"><p>28</p></td><td align="left"><p>4</p></td><td char="." align="char"><p><bold>0.018</bold></p></td></tr><tr><td align="left"><p>8</p></td><td align="left"><p>Obtain care for diabetes, high blood pressure, or asthma</p></td><td align="left"><p>39.3</p></td><td align="left"><p>25.2</p></td><td align="left"><p>19.8</p></td><td align="left"><p>15.6</p></td><td align="left"><p>20</p></td><td align="left"><p>32</p></td><td align="left"><p>32</p></td><td align="left"><p>16</p></td><td char="." align="char"><p>0.196</p></td></tr><tr><td align="left"><p>9</p></td><td align="left"><p>Obtaining medicine for chronic diseases</p></td><td align="left"><p>36.4</p></td><td align="left"><p>30.7</p></td><td align="left"><p>19.9</p></td><td align="left"><p>13</p></td><td align="left"><p>20</p></td><td align="left"><p>44</p></td><td align="left"><p>24</p></td><td align="left"><p>12</p></td><td char="." align="char"><p>0.323</p></td></tr><tr><td align="left"><p>10</p></td><td align="left"><p>Obtaining periodic examination e.g., mammograms or colonoscopies</p></td><td align="left"><p>30.7</p></td><td align="left"><p>24.9</p></td><td align="left"><p>26.1</p></td><td align="left"><p>18.4</p></td><td align="left"><p>16</p></td><td align="left"><p>48</p></td><td align="left"><p>20</p></td><td align="left"><p>16</p></td><td char="." align="char"><p>0.112</p></td></tr><tr><td align="left"><p>11</p></td><td align="left"><p>Getting seasonal vaccinations e.g., influenza</p></td><td align="left"><p>37.2</p></td><td align="left"><p>25.7</p></td><td align="left"><p>19.5</p></td><td align="left"><p>17.6</p></td><td align="left"><p>24</p></td><td align="left"><p>40</p></td><td align="left"><p>20</p></td><td align="left"><p>16</p></td><td char="." align="char"><p>0.416</p></td></tr><tr><td align="left"><p>12</p></td><td align="left"><p>Providing medical clinics with tools</p></td><td align="left"><p>31.7</p></td><td align="left"><p>23.9</p></td><td align="left"><p>29.7</p></td><td align="left"><p>14.7</p></td><td align="left"><p>20</p></td><td align="left"><p>40</p></td><td align="left"><p>24</p></td><td align="left"><p>16</p></td><td char="." align="char"><p>0.317</p></td></tr><tr><td align="left"><p>13</p></td><td align="left"><p>Finding a doctor who uses specialized means of communication</p></td><td align="left"><p>25.6</p></td><td align="left"><p>23.3</p></td><td align="left"><p>28.6</p></td><td align="left"><p>22.5</p></td><td align="left"><p>16</p></td><td align="left"><p>28</p></td><td align="left"><p>36</p></td><td align="left"><p>20</p></td><td char="." align="char"><p>0.668</p></td></tr><tr><td align="left"><p>14</p></td><td align="left"><p>Suitable means of transportation for people with disabilities to the various health service facilities</p></td><td align="left"><p>27</p></td><td align="left"><p>25.1</p></td><td align="left"><p>31.3</p></td><td align="left"><p>16.6</p></td><td align="left"><p>12</p></td><td align="left"><p>44</p></td><td align="left"><p>20</p></td><td align="left"><p>24</p></td><td char="." align="char"><p>0.081</p></td></tr><tr><td align="left"><p>15</p></td><td align="left"><p>Entering and leaving the place of receiving the medical service (a wheelchair included)</p></td><td align="left"><p>34.6</p></td><td align="left"><p>25.1</p></td><td align="left"><p>25.1</p></td><td align="left"><p>15.2</p></td><td align="left"><p>24</p></td><td align="left"><p>24</p></td><td align="left"><p>12</p></td><td align="left"><p>40</p></td><td char="." align="char"><p><bold>0.027</bold></p></td></tr><tr><td align="left"><p>16</p></td><td align="left"><p>It provides equipped toilets for the disabled in medical facilities</p></td><td align="left"><p>32.8</p></td><td align="left"><p>24.8</p></td><td align="left"><p>24.8</p></td><td align="left"><p>17.6</p></td><td align="left"><p>16</p></td><td align="left"><p>24</p></td><td align="left"><p>8</p></td><td align="left"><p>52</p></td><td char="." align="char"><p><bold>0.001</bold></p></td></tr><tr><td align="left"><p>17</p></td><td align="left"><p>Reception areas or pharmacies suitable for the use of persons with disabilities in medical facilities</p></td><td align="left"><p>31.8</p></td><td align="left"><p>18.6</p></td><td align="left"><p>29.8</p></td><td align="left"><p>19.8</p></td><td align="left"><p>24</p></td><td align="left"><p>40</p></td><td align="left"><p>8</p></td><td align="left"><p>28</p></td><td char="." align="char"><p><bold>0.015</bold></p></td></tr><tr><td align="left"><p>18</p></td><td align="left"><p>Availability of health insurance or institutions that accept health insurance</p></td><td align="left"><p>29.3</p></td><td align="left"><p>21.9</p></td><td align="left"><p>22.7</p></td><td align="left"><p>26.2</p></td><td align="left"><p>24</p></td><td align="left"><p>24</p></td><td align="left"><p>28</p></td><td align="left"><p>24</p></td><td char="." align="char"><p>0.895</p></td></tr><tr><td align="left"><p>19</p></td><td align="left"><p>Obtaining support when subjected to violence or abuse</p></td><td align="left"><p>37.4</p></td><td align="left"><p>19.8</p></td><td align="left"><p>23</p></td><td align="left"><p>19.8</p></td><td align="left"><p>12</p></td><td align="left"><p>32</p></td><td align="left"><p>20</p></td><td align="left"><p>36</p></td><td char="." align="char"><p><bold>0.034</bold></p></td></tr><tr><td align="left"><p>20</p></td><td align="left"><p>Availability of a sports venue or gym for disabled people</p></td><td align="left"><p>36.2</p></td><td align="left"><p>14</p></td><td align="left"><p>26.1</p></td><td align="left"><p>23.7</p></td><td align="left"><p>12</p></td><td align="left"><p>16</p></td><td align="left"><p>28</p></td><td align="left"><p>44</p></td><td char="." align="char"><p>0.059</p></td></tr></tbody></table> </ephtml> </p> <p>Principal component analyses gave support to a four-factor solution. The 20 items were then added to the principal component to form a "Barrier to health services" scale. The four extracted principal factors are explained and clarified in Tables 3, 4, and 5.</p> <p>Table 3 Mean scores for people with disabilities and standard deviation for the extracted factors</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Principal factors</p></th><th align="left"><p>Mean</p></th><th align="left"><p>Standard deviation</p></th></tr></thead><tbody><tr><td align="left"><p>F1</p></td><td align="left"><p>18</p></td><td char="." align="char"><p>9.7</p></td></tr><tr><td align="left"><p>F2</p></td><td align="left"><p>12</p></td><td char="." align="char"><p>6.3</p></td></tr><tr><td align="left"><p>F3</p></td><td align="left"><p>18</p></td><td char="." align="char"><p>9.5</p></td></tr><tr><td align="left"><p>F4</p></td><td align="left"><p>12</p></td><td char="." align="char"><p>5.8</p></td></tr></tbody></table> </ephtml> </p> <p>Table 4 Results of ANOVA test for F1 to F4 (health difficulty services) and the given variables</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Principal factors</p></th><th align="left"><p>Variable</p></th><th align="left"><p>Groups</p></th><th align="left"><p>Sum of Squares</p></th><th align="left"><p>d.f</p></th><th align="left"><p>Mean Square</p></th><th align="left"><p>F</p></th><th align="left"><p>P-value</p></th></tr></thead><tbody><tr><td align="left" rowspan="2"><p><bold>F1</bold></p></td><td align="left" rowspan="2"><p>Age category</p></td><td align="left"><p>Between</p></td><td char="." align="char"><p>221.568</p></td><td align="left"><p>3</p></td><td char="." align="char"><p>73.856</p></td><td char="." align="char"><p>3.142</p></td><td align="left"><p>.026</p></td></tr><tr><td align="left"><p>Within</p></td><td char="." align="char"><p>6063.963</p></td><td align="left"><p>258</p></td><td char="." align="char"><p>23.504</p></td><td char="." align="char" /><td align="left" /></tr><tr><td align="left" rowspan="2"><p><bold>F1</bold></p></td><td align="left" rowspan="8"><p>Family number</p></td><td align="left"><p>Between</p></td><td char="." align="char"><p>254.689</p></td><td align="left"><p>3</p></td><td char="." align="char"><p>84.896</p></td><td char="." align="char"><p>3.771</p></td><td align="left"><p>.011</p></td></tr><tr><td align="left"><p>Within</p></td><td char="." align="char"><p>5425.311</p></td><td align="left"><p>241</p></td><td char="." align="char"><p>22.512</p></td><td char="." align="char" /><td align="left" /></tr><tr><td align="left" rowspan="2"><p><bold>F2</bold></p></td><td align="left"><p>Between</p></td><td char="." align="char"><p>79.971</p></td><td align="left"><p>3</p></td><td char="." align="char"><p>26.657</p></td><td char="." align="char"><p>2.656</p></td><td align="left"><p>.049</p></td></tr><tr><td align="left"><p>Within</p></td><td char="." align="char"><p>2438.620</p></td><td align="left"><p>243</p></td><td char="." align="char"><p>10.035</p></td><td char="." align="char" /><td align="left" /></tr><tr><td align="left" rowspan="2"><p><bold>F3</bold></p></td><td align="left"><p>Between</p></td><td char="." align="char"><p>285.547</p></td><td align="left"><p>3</p></td><td char="." align="char"><p>95.182</p></td><td char="." align="char"><p>3.802</p></td><td align="left"><p>.011</p></td></tr><tr><td align="left"><p>Within</p></td><td char="." align="char"><p>6032.616</p></td><td align="left"><p>241</p></td><td char="." align="char"><p>25.032</p></td><td char="." align="char" /><td align="left" /></tr><tr><td align="left" rowspan="2"><p><bold>F4</bold></p></td><td align="left"><p>Between</p></td><td char="." align="char"><p>125.342</p></td><td align="left"><p>3</p></td><td char="." align="char"><p>41.781</p></td><td char="." align="char"><p>3.329</p></td><td align="left"><p>.020</p></td></tr><tr><td align="left"><p>Within</p></td><td char="." align="char"><p>3012.330</p></td><td align="left"><p>240</p></td><td char="." align="char"><p>12.551</p></td><td char="." align="char" /><td align="left" /></tr><tr><td align="left" rowspan="2"><p><bold>F1</bold></p></td><td align="left" rowspan="8"><p>Education level</p></td><td align="left"><p>Between</p></td><td char="." align="char"><p>433.228</p></td><td align="left"><p>5</p></td><td char="." align="char"><p>86.646</p></td><td char="." align="char"><p>3.872</p></td><td align="left"><p>.002</p></td></tr><tr><td align="left"><p>Within</p></td><td char="." align="char"><p>6063.775</p></td><td align="left"><p>271</p></td><td char="." align="char"><p>22.376</p></td><td char="." align="char" /><td align="left" /></tr><tr><td align="left" rowspan="2"><p><bold>F2</bold></p></td><td align="left"><p>Between</p></td><td char="." align="char"><p>124.162</p></td><td align="left"><p>5</p></td><td char="." align="char"><p>24.832</p></td><td char="." align="char"><p>2.464</p></td><td align="left"><p>.033</p></td></tr><tr><td align="left"><p>Within</p></td><td char="." align="char"><p>2741.238</p></td><td align="left"><p>272</p></td><td char="." align="char"><p>10.078</p></td><td char="." align="char" /><td align="left" /></tr><tr><td align="left" rowspan="2"><p><bold>F3</bold></p></td><td align="left"><p>Between</p></td><td char="." align="char"><p>483.870</p></td><td align="left"><p>5</p></td><td char="." align="char"><p>96.774</p></td><td char="." align="char"><p>3.857</p></td><td align="left"><p>.002</p></td></tr><tr><td align="left"><p>Within</p></td><td char="." align="char"><p>6799.307</p></td><td align="left"><p>271</p></td><td char="." align="char"><p>25.090</p></td><td char="." align="char" /><td align="left" /></tr><tr><td align="left" rowspan="2"><p><bold>F4</bold></p></td><td align="left"><p>Between</p></td><td char="." align="char"><p>253.581</p></td><td align="left"><p>5</p></td><td char="." align="char"><p>50.716</p></td><td char="." align="char"><p>4.069</p></td><td align="left"><p>.001</p></td></tr><tr><td align="left"><p>Within</p></td><td char="." align="char"><p>3352.987</p></td><td align="left"><p>269</p></td><td char="." align="char"><p>12.465</p></td><td char="." align="char" /><td align="left" /></tr></tbody></table> </ephtml> </p> <p>Table 5 Summary of regression analysis for variables predicting the difficulty of access to main health services (F1 to F4)</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Health service difficulties</p></th><th align="left"><p>Beta</p></th><th align="left"><p>t</p></th><th align="left"><p>P-value</p></th></tr></thead><tbody><tr><td align="left"><p><bold>F1</bold></p></td><td align="left" /><td char="." align="char" /><td align="left" /></tr><tr><td align="left"><p>Gender, Male</p></td><td align="left"><p>.527</p></td><td char="." align="char"><p>4.217</p></td><td align="left"><p>.000</p></td></tr><tr><td align="left"><p>Marital status, Single</p></td><td align="left"><p>.409</p></td><td char="." align="char"><p>3.481</p></td><td align="left"><p>.001</p></td></tr><tr><td align="left"><p>Blood Pressure/ Cholesterol Medication</p></td><td align="left"><p>.336</p></td><td char="." align="char"><p>2.819</p></td><td align="left"><p>.007</p></td></tr><tr><td align="left"><p>Educational Level, Illiterate</p></td><td align="left"><p>.286</p></td><td char="." align="char"><p>2.274</p></td><td align="left"><p>.028</p></td></tr><tr><td align="left"><p><bold>F2</bold></p></td><td align="left" /><td char="." align="char" /><td align="left" /></tr><tr><td align="left"><p>Medicine taken, Analgesics</p></td><td align="left"><p>.398</p></td><td char="." align="char"><p>3.418</p></td><td align="left"><p>.001</p></td></tr><tr><td align="left"><p>Medicine taken, Diabetic</p></td><td align="left"><p>.353</p></td><td char="." align="char"><p>3.015</p></td><td align="left"><p>.004</p></td></tr><tr><td align="left"><p>Marital status, Single</p></td><td align="left"><p>.289</p></td><td char="." align="char"><p>2.464</p></td><td align="left"><p>.017</p></td></tr><tr><td align="left"><p>Blood Pressure/ Cholesterol Medication</p></td><td align="left"><p>.304</p></td><td char="." align="char"><p>2.544</p></td><td align="left"><p>.014</p></td></tr><tr><td align="left"><p>Disability reason, Accidents</p></td><td align="left"><p>.299</p></td><td char="." align="char"><p>2.555</p></td><td align="left"><p>.014</p></td></tr><tr><td align="left"><p><bold>F3</bold></p></td><td align="left" /><td char="." align="char" /><td align="left" /></tr><tr><td align="left"><p>Marital Status, Married</p></td><td align="left"><p>-.460</p></td><td char="." align="char"><p>-4.383</p></td><td align="left"><p>.000</p></td></tr><tr><td align="left"><p>Place of residence, Rural</p></td><td align="left"><p>.277</p></td><td char="." align="char"><p>2.616</p></td><td align="left"><p>.012</p></td></tr><tr><td align="left"><p>Life activities, Cooking</p></td><td align="left"><p>.244</p></td><td char="." align="char"><p>2.299</p></td><td align="left"><p>.026</p></td></tr><tr><td align="left"><p>Disability reason, Accidents</p></td><td align="left"><p>.290</p></td><td char="." align="char"><p>2.767</p></td><td align="left"><p>.008</p></td></tr><tr><td align="left"><p><bold>F4</bold></p></td><td align="left" /><td char="." align="char" /><td align="left" /></tr><tr><td align="left"><p>Gender, Male</p></td><td align="left"><p>.245</p></td><td char="." align="char"><p>2.413</p></td><td align="left"><p>.020</p></td></tr><tr><td align="left"><p>Walking with Classic Mobi-Walker</p></td><td align="left"><p>.369</p></td><td char="." align="char"><p>3.717</p></td><td align="left"><p>.001</p></td></tr><tr><td align="left"><p>Life activities, Cooking</p></td><td align="left"><p>.327</p></td><td char="." align="char"><p>3.264</p></td><td align="left"><p>.002</p></td></tr><tr><td align="left"><p>Disability reason, Accidents</p></td><td align="left"><p>.411</p></td><td char="." align="char"><p>4.339</p></td><td align="left"><p>.000</p></td></tr></tbody></table> </ephtml> </p> <p>F1 = sum (Q1 to Q6), which were: Appropriate health services, Medical personnel specializing in the provision of care, Obtaining integrated dental services, Dentists' availability for disabled people in the area, and Access to mental health services. F2 = sum (Q7 to Q10), which were: Obtaining an antibiotic-analgesic for acute conditions, obtaining care for diabetes, high blood pressure, or asthma, Obtaining medicines for chronic diseases, Obtaining periodic examination, e.g., mammograms or colonoscopies, and Getting seasonal vaccinations, e.g., for influenza). F3 = sum (Q11 to Q16), which were: Finding a doctor who uses specialized communication, Suitable means of transportation to the various health services facilities, Entering and leaving the medical service venue (a wheelchair included), Patient reception areas or pharmacies providing high-altitude areas suitable for the use of persons with disabilities in medical facilities, Availability of health insurance or institutions that accept health insurance. F4 = sum (Q17 to Q20), which were: Obtaining support when subjected to violence or abuse, Availability of a sports venue or gym for the disabled, receiving appropriate health services for persons with disabilities, Providing medical personnel specializing in providing necessary care for persons with disabilities.</p> <p>Mean value on the F1 scale was 9.74 for all persons with disabilities and 9.51 for F2 scale. F3 scale and F4 scale were lesser with mean values 6.28, 5.79 respectively. Larger scores tend to have more difficulty in getting services.</p> <p>The univariate t-test showed a significant effect of gender on difficulty of access to facilities for people with disabilities at the P <0.05 level for the four factors F1 to F4, respectively: [t(<reflink idref="bib272" id="ref45">272</reflink>) = 4, p <0.001], [t(<reflink idref="bib279" id="ref46">279</reflink>) = 2.6, p = 0.001], [t(<reflink idref="bib278" id="ref47">278</reflink>) = 3.4, p = 0.001] and [t(<reflink idref="bib278" id="ref48">278</reflink>) = 3.3, p = 0.001]. Men with disabilities had more difficulty accessing facilities providing health services.</p> <p>The ANOVA test was used in Table to determine if there were differences between more than two categories and in case if P-Value was less than 0.05 the Tukey's Test (post hoc test) was performed to identify which category was responsible for that difference. The ANOVA test showed that people with disabilities had more difficulty accessing health care services F(<reflink idref="bib3" id="ref49">3</reflink>, 261) = 3.1, P = 0.026). By using Tukey's test it founds that the families with 1 to 10 persons had more difficulty in comparing to those with more than 16 family members. However, age had no effect on other difficulties associated with health care services F2 to F4. The study results indicated that the increased family numbers of disabled people affected negatively all types of health care services, F1 to F4. Disabled people tended to have more difficulty when their families comprised less than six members compared to families with more than ten members; F1 (F(<reflink idref="bib3" id="ref50">3</reflink>,<reflink idref="bib241" id="ref51">241</reflink>) = 3.8, P = 0.011), F2 (F(<reflink idref="bib3" id="ref52">3</reflink>,<reflink idref="bib243" id="ref53">243</reflink>) = 2.3, P = 0.049), F3 (F(<reflink idref="bib3" id="ref54">3</reflink>,<reflink idref="bib241" id="ref55">241</reflink>) = 3.8, P = 0.011), and F4 (F(<reflink idref="bib3" id="ref56">3</reflink>,<reflink idref="bib240" id="ref57">240</reflink>) = 3.3, P = 0.020).</p> <p>These results demonstrated that the education levels of disabled people affected the health care services provided. People with a higher level of education, university level and above, had fewer difficulties in accessing health care services in comparison to primary, reading and writing, secondary level for F1 (F(<reflink idref="bib5" id="ref58">5</reflink>,<reflink idref="bib272" id="ref59">272</reflink>) = 3.9, P = 0.002), F2 (F(<reflink idref="bib5" id="ref60">5</reflink>,<reflink idref="bib272" id="ref61">272</reflink>) = 2.5, P = 0.033), F3 (F(<reflink idref="bib5" id="ref62">5</reflink>,<reflink idref="bib271" id="ref63">271</reflink>) = 3.9, P = 0.002), and F4 (F(<reflink idref="bib5" id="ref64">5</reflink>,<reflink idref="bib269" id="ref65">269</reflink>) = 4.1, P = 0.002).</p> <p>There was no significant difference between urban and rural people with disabilities in accessing health care services (p values for F1 to F4 ranged from 0.2 to 0.8) with regard to type of residence.</p> <p>Factors which do not have a significant effect on their access to health services include occupation (p = 0.2 – 0.7); marital status (p = 0.1 – 0.5); family income (p = 0.1 – 0.4). Variables that predicting the access of the main health services (F1 to F4). Stepwise multiple linear regression was used to analyze the difference in the health care access difficulties experienced by persons with various disabilities (Table 5). Variables (predictors) that had a significant effect in F1, F2, F3, and F4 are shown.</p> <p>The predictors for F1 (gender, marital status, blood pressure / cholesterol medications, and educational level) were positively associated to all risk factors mentioned above. The predictors for F2 (Healthcare access-difficulty) were positive signs for the risk factor –accident as the cause of disability (P = 0.014). The results indicated that more difficulty was experienced by single disable persons to access the health care services package F2, P = 0.017. For people taking medicines like Analgesics, and Diabetes and Blood Pressure/Cholesterol medications, the multiple regression analysis indicated greater difficulty accessing health services, P = 0.001, P = 0.004, and P = 0.014, respectively. For the dependent factor F3, the independent variable "cause of disability" as an accident predicted significant difficulty with P = 0.008 and a rural place of residence with P-Value 0.012. The results showed, regarding F3, that life activities (cooking) increased the difficulty of getting access to the health care services, P = 0.026. However, for those who were married, this difficulty was significantly decreased, P <0.001. The predictors Gender (male), Accident as a cause of disability, walking with a Classic Mobi-Walker, and Cooking were positively correlated with difficulty experienced in accessing health care services, P = 0.020, P <0.001, P <0.001, and P = 0.002, respectively.</p> <hd id="AN0160076123-9">Discussion</hd> <p>This study was designed to investigate difficulties facing physical and hearing disabled people while accessing healthcare services in Jazan area, which is mostly rural, and assess the needs that underlay those difficulties. The present study found that around half the participants encountered difficulties accessing appropriate healthcare services. More than half had difficulty obtaining mental healthcare, dental care, preventive periodic screening care, and medical care at home. Even though 37.6% of the participants used to regularly receive care for chronic diseases such as diabetes, hypertension, or asthma, 52% noted difficulty in obtaining medicines for such diseases, and 46.5% noted difficulty in getting seasonal vaccinations.</p> <p>Finding doctors or dentists specializing in care for disabled people was a struggle for more than half of our participants. This agree with previous studies reported a lack of trained personnel in providing health care for people with disabilities in Saudi Arabia (AlQahtani et al., [<reflink idref="bib15" id="ref66">15</reflink>]; AlSarheed et al., [<reflink idref="bib16" id="ref67">16</reflink>]; Shakespeare et al., [<reflink idref="bib32" id="ref68">32</reflink>]). It has been said that the biggest challenge for people with disabilities is to be heard. This was another concern noted by above 50% of the participants due to the lack of specialized means for communication and a speech therapist shortage in the region (Khoja & Sheeshah, [<reflink idref="bib24" id="ref69">24</reflink>]).</p> <p>Most of the healthcare facilities were described as unaccommodating by 50% of wheelchair users, who also experienced difficulty entering and leaving medical service venues. Similarly, reception areas and pharmacies were deemed unsuitable by 48% of people with disabilities. Toilets were also not adequately equipped for the disabled in such facilities. These findings also mirror those of other studies. Alkawai et al., in their cross-sectional study at one of the advanced medical cities in Riyadh, found nearly half of their patients faced challenges in accessing health care services and were unsatisfied with the services received (Alkawai & Alowayyed, [<reflink idref="bib13" id="ref70">13</reflink>]). Al-Shehri, in her study in a university-affiliated dental hospital in Riyadh, also reported over 50% of their patients with disabilities encountered difficulties in accessing dental care (Sharifa, [<reflink idref="bib33" id="ref71">33</reflink>]).</p> <p>For people with disabilities, transportation provides a vital lifeline to healthcare, employment, and communal living. In this study, transportation proved challenging for over 30% and 20% of people with physical and hearing disabilities, respectively. This is perhaps due to the lack of convenient public transport in the area and the absence of specially adapted vehicles for people with disabilities.</p> <p>This study's findings portray the difficulties of people with physical disabilities in accessing healthcare services in Jazan but should be interpreted cautiously. Data collection among people with disabilities was difficult, as many consider disability something to be hidden, especially in females, as noted by Al-Jadid (Al-Jadid, [<reflink idref="bib6" id="ref72">6</reflink>]). Most Saudi Arabian studies have been done among children, but over 95% of the participants in our study were adults.</p> <p>Performing factor analysis and linear regressions for our data showed that persons with hearing or physical disability who were single, illiterate and had hypertension were more liable to be unable to reach appropriate health and mental health services, specialized medical personnel, integrated dental services, and dentists qualified to deal with disabled people in their area. For those who were how became disabled (hearing or physical) due to accidents, singles, having diabetes and/or hypertension and requiring analgesics were facing higher difficulties in obtaining an antibiotic and /or analgesic for acute conditions, obtaining care for diabetes, high blood pressure, or asthma, obtaining medicines for chronic diseases, obtaining periodic examination, e.g., mammograms or colonoscopies, and getting seasonal vaccinations (e.g., for influenza). On the other hand, male disabled with wheel-chair who became disabled due to accidents where having more difficulties in obtaining support when subjected to violence or abuse, availability of a sports venue or gym for the disabled, receiving appropriate health services for persons with disabilities, approaching medical personnel specialized in providing necessary care for persons with disabilities. Finally, those with disabilities who are married and livening in rural areas were having more difficulties finding a doctor who uses specialized communication, suitable means of transportation to the various health services facilities, entering and leaving the medical service venue (a wheelchair included), patient reception areas or pharmacies providing high-altitude areas suitable for the use of persons with disabilities in medical facilities, and availability of health insurance or institutions that accept health insurance, This would be mostly because of the inefficient primary health care centers in rural areas specially remote ones.</p> <p>Studying access to health services for other disabilities and including that in the annual statistical report of the Ministry of Health is essential to improving the healthcare services in the KSA. A profound training for data collectors was needed that extended the time frame needed for this study. Considering only those registered in the official disability registry in our study would potentially omit others with disabilities but not registered. However, the number of non-registered persons with disabilities would be minimal, since disable persons in the KSA have good financial and other benefits that push them to be registered. Reaching disabled in the KSA is hard, especially among females, since it is a cause of stigma among the community (Al-Jadid, [<reflink idref="bib6" id="ref73">6</reflink>]). For future research, stigma is recommended among disabled persons, especially females with disabilities and their families. Nevertheless, this survey provides a starting point for assessing the unmet needs of people with hearing and visual disabilities.</p> <hd id="AN0160076123-10">Conclusion</hd> <p>Despite efforts made by the Saudi government to improve healthcare access, still most of the disabled persons facing difficulties in reaching these services. Those with less education and singles need more help than others. Those with hearing disabilities should be considered and need more help to live secured life. Disabled persons with chronic diseases should have special centres qualified to deal with their needs. Qualified dentists to deal with disabled should be available to make the life of these people easier.</p> <hd id="AN0160076123-11">Acknowledgements</hd> <p>We would like to thank Jazan University, especially the Deanship of Scientific Research for their funding assistance. We would like to thank the Jazan Human Resources and Social Development office for facilitating our data collection process.</p> <hd id="AN0160076123-12">Funding</hd> <p>This study was partially funded by the Deanship of Scientific Research at Jazan University, Saudi Arabia.</p> <hd id="AN0160076123-13">Data Availability</hd> <p>The datasets generated and/or analyzed during the current study are not publicly available due to privacy/confidentiality concerns. Reasonable requests for access can be made to the corresponding author who will consider any such requests in collaboration with the Jazan Research Ethics Committee.</p> <hd id="AN0160076123-14">Declarations</hd> <p></p> <hd id="AN0160076123-15">Conflict of Interest</hd> <p>Authors have no conflict of interests.</p> <hd id="AN0160076123-16">Ethical Approval</hd> <p>The work was not supported or funded by any drug company. The research involved human participants and was ethically approved by the Jazan Research Ethics Committee (Reference number: REC/13082017–74) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.</p> <hd id="AN0160076123-17">Informed Consent</hd> <p>Written consent forms were read, understood and signed by all participating disabled persons. All participants were informed of their right to not participate or withdraw from the study at any time. All information was kept confidential and was not accessed except for scientific research purposes.</p> <hd id="AN0160076123-18">Supplementary Information</hd> <p>Below is the link to the electronic supplementary material.</p> <p>Graph: Supplementary file1 (DOCX 19 KB)</p> <hd id="AN0160076123-19">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0160076123-20"> <title> References </title> <blist> <bibl id="bib1" idref="ref37" type="bt">1</bibl> <bibtext> Al-Abbad H, Madi S. Perception of tertiary care clients toward the availability of physical therapy service at primary health care centers in Saudi Arabia: A cross-sectional survey. Journal of Physical Therapy Science. 2020; 32; 5: 323-331. 10.1589/jpts.32.323. 32425349. 7192735</bibtext> </blist> <blist> <bibl id="bib2" idref="ref23" type="bt">2</bibl> <bibtext> Al Essa M, Ozand PT, Al-Gain SI. 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  Data: Assessing Healthcare Access among Physical and Hearing Disabled Persons in Jazan Region, Saudi Arabia
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  Label: Authors
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  Data: <searchLink fieldCode="AR" term="%22Ahmad+Y%2E+Alqassim%22">Ahmad Y. Alqassim</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-0170-1437">0000-0002-0170-1437</externalLink>)<br /><searchLink fieldCode="AR" term="%22Anwar+M%2E+Makeen%22">Anwar M. Makeen</searchLink><br /><searchLink fieldCode="AR" term="%22Mohammed+S%2E+Mahfouz%22">Mohammed S. Mahfouz</searchLink><br /><searchLink fieldCode="AR" term="%22Anas+E%2E+Ahm%22">Anas E. Ahm</searchLink><br /><searchLink fieldCode="AR" term="%22Osama+B%2E+Albasheer%22">Osama B. Albasheer</searchLink><br /><searchLink fieldCode="AR" term="%22Mohammad+R%2E+Zaino%22">Mohammad R. Zaino</searchLink><br /><searchLink fieldCode="AR" term="%22Mohammad+H%2E+Abutaleb%22">Mohammad H. Abutaleb</searchLink><br /><searchLink fieldCode="AR" term="%22Maged+A%2E+El-Setouhy%22">Maged A. El-Setouhy</searchLink><br /><searchLink fieldCode="AR" term="%22Abdullah+A%2E+Alharbi%22">Abdullah A. Alharbi</searchLink><br /><searchLink fieldCode="AR" term="%22Mohammed+A%2E+Muaddi%22">Mohammed A. Muaddi</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Developmental+and+Physical+Disabilities%22"><i>Journal of Developmental and Physical Disabilities</i></searchLink>. 2022 34(6):1071-1088.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 18
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2022
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Access+to+Health+Care%22">Access to Health Care</searchLink><br /><searchLink fieldCode="DE" term="%22Diseases%22">Diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Services%22">Health Services</searchLink><br /><searchLink fieldCode="DE" term="%22Dental+Health%22">Dental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Screening+Tests%22">Screening Tests</searchLink><br /><searchLink fieldCode="DE" term="%22Family+Environment%22">Family Environment</searchLink><br /><searchLink fieldCode="DE" term="%22Primary+Health+Care%22">Primary Health Care</searchLink><br /><searchLink fieldCode="DE" term="%22Hypertension%22">Hypertension</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Disabilities%22">Physical Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Hearing+Impairments%22">Hearing Impairments</searchLink><br /><searchLink fieldCode="DE" term="%22Chronic+Illness%22">Chronic Illness</searchLink><br /><searchLink fieldCode="DE" term="%22Diabetes%22">Diabetes</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+Therapy%22">Drug Therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Barriers%22">Barriers</searchLink><br /><searchLink fieldCode="DE" term="%22Immunization+Programs%22">Immunization Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Physicians%22">Physicians</searchLink><br /><searchLink fieldCode="DE" term="%22Questionnaires%22">Questionnaires</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Saudi+Arabia%22">Saudi Arabia</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1007/s10882-022-09838-9
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1056-263X<br />1573-3580
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Disability constitutes a significant health problem in the Kingdom of Saudi Arabia (KSA). Research assessing the health needs of people with disabilities in KSA is scarce. This study aimed to assess what physical and hearing disable persons need from healthcare services and to investigate difficulties in accessing these services in the Jazan area. A cross-sectional survey was conducted among hearing and physical disable persons between July, 2018, and May, 2019 in Jazan region, KSA using a modified Arabic-translated version of the validated Southampton Needs Assessment Questionnaire (SNAQ). Two hundred and eighty-nine hearing and physical disable persons completed the questionnaire with a response rate of 63%. Around half of the participants encountered difficulty in accessing appropriate healthcare services. More than half had difficulty obtaining mental healthcare, dental care, preventive periodic screening care, or medical care at home. Although 37.6% of the participants had previously received regular chronic disease care for diabetes, hypertension, or asthma, 52% reported difficulty obtaining medicine for such diseases, and 46.5% reported difficulty getting seasonal vaccinations such as the influenza vaccine. Finding specialized doctors or dentists using specialized means of communication was a struggle for over 50% of the participants. There is a need to optimize society for people with physical disabilities and improve access to healthcare facilities.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1430975
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1430975
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      – Type: doi
        Value: 10.1007/s10882-022-09838-9
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 18
        StartPage: 1071
    Subjects:
      – SubjectFull: Access to Health Care
        Type: general
      – SubjectFull: Diseases
        Type: general
      – SubjectFull: Mental Health
        Type: general
      – SubjectFull: Health Services
        Type: general
      – SubjectFull: Dental Health
        Type: general
      – SubjectFull: Screening Tests
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      – SubjectFull: Family Environment
        Type: general
      – SubjectFull: Primary Health Care
        Type: general
      – SubjectFull: Hypertension
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Physical Disabilities
        Type: general
      – SubjectFull: Hearing Impairments
        Type: general
      – SubjectFull: Chronic Illness
        Type: general
      – SubjectFull: Diabetes
        Type: general
      – SubjectFull: Drug Therapy
        Type: general
      – SubjectFull: Barriers
        Type: general
      – SubjectFull: Immunization Programs
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      – SubjectFull: Physicians
        Type: general
      – SubjectFull: Questionnaires
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      – SubjectFull: Saudi Arabia
        Type: general
    Titles:
      – TitleFull: Assessing Healthcare Access among Physical and Hearing Disabled Persons in Jazan Region, Saudi Arabia
        Type: main
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            NameFull: Anwar M. Makeen
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              Type: published
              Y: 2022
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            – Type: issn-print
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