Disability disparities: a beginning model.
ABSTRACT This paper presents a model of disability disparities. Though the concept of health disparities is discussed in the health care literature, there is no such model that explicitly addresses disparities in the disability literature. Therefore, this model begins to fill a void in the disability literature. Part of the value of such a model is that it represents an attempt to address the question of why cultural competency is important in the disability arena at this point in the 21st century. The urgency in addressing cultural competency at this time in history is supported by understanding the multiple accountability demands on rehabilitation and disability providers these days, e.g., increasing diversification of the United States population, that render providing effective services to everyone a clear mandate. The author provides a working definition of disability disparity. The disability disparity model is described in terms of its five-domain continuum as well as its macro- and micro-level aspects that are designed to both promote clarity of the concept for researchers and offer practitioners ideas on how to explore the existence of disability disparities in working with specific service recipients. Limitations and strengths of the model are discussed along with suggested next steps in model validation.
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ABSTRACT: Abstract Purpose: This article provides a conceptual framework for understanding healthcare disparities experienced by individuals with disabilities. While health disparities are the result of factors deeply rooted in culture, life style, socioeconomic status, and accessibility of resources, healthcare disparities are a subset of health disparities that reflect differences in access to and quality of healthcare and can be viewed as the inability of the healthcare system to adequately address the needs of specific population groups. Methods: This article uses a narrative method to identify and critique the main conceptual frameworks that have been used in analyzing disparities in healthcare access and quality, and evaluating those frameworks in the context of healthcare for individuals with disabilities. Specific models that are examined include the Aday and Anderson Model, the Grossman Utility Model, the Institute of Medicine (IOM)'s models of Access to Healthcare Services and Healthcare Disparities, and the Cultural Competency model. Results: While existing frameworks advance understandings of disparities in healthcare access and quality, they fall short when applied to individuals with disabilities. Specific deficits include a lack of attention to cultural and contextual factors (Aday and Andersen framework), unrealistic assumptions regarding equal access to resources (Grossman's utility model), lack of recognition or inclusion of concepts of structural accessibility (IOM model of Healthcare Disparities) and exclusive emphasis on supply side of the healthcare equation to improve healthcare disparities (Cultural Competency model). In response to identified gaps in the literature and short-comings of current conceptualizations, an integrated model of disability and healthcare disparities is put forth. Conclusion: We analyzed models of access to care and disparities in healthcare to be able to have an integrated and cohesive conceptual framework that could potentially address issues related to access to healthcare among individuals with disabilities. The Model of Healthcare Disparities and Disability (MHDD) provides a framework for conceptualizing how healthcare disparities impact disability and specifically, how a mismatch between personal and environmental factors may result in reduced healthcare access and quality, which in turn may lead to reduced functioning, activity and participation among individuals with impairments and chronic health conditions. Researchers, health providers, policy makers and community advocate groups who are engaged in devising interventions aimed at reducing healthcare disparities would benefit from the discussions. Implications for Rehabilitation Evaluates the main models of healthcare disparity and disability to create an integrated framework. Provides a comprehensive conceptual model of healthcare disparity that specifically targets issues related to individuals with disabilities. Conceptualizes how personal and environmental factors interact to produce disparities in access to healthcare and healthcare quality. Recognizes and targets modifiable factors to reduce disparities between and within individuals with disabilities.Disability and rehabilitation. 07/2014;
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ABSTRACT: To examine the adequacy of existing service systems in addressing the needs of refugees with disabilities resettled in the U.S.A. A cross-disability group of eight Cambodian and seven Somali refugees were purposively selected to participate in a 2-year qualitative study in the Midwestern U.S.A. Ten disability/refugee service providers and key experts on refugee resettlement were also recruited to participate. Data sources included in-depth interviews, focus groups, participant observations and social network surveys with disabled refugees. Participant observations and semi-structured interviews were also conducted with service providers and key experts. Data were analyzed using coding procedures based on a grounded theory approach. Disabled refugee participants experienced several unmet disability-related needs and limited access to resettlement resources on account of their disability. These findings were associated with refugee service providers having limited awareness of disability rights and resources and a narrow biomedical perspective of disability. Additionally there was a disconnection between refugee and disability service systems resulting from resource limitations within agencies, mistrust between the different service entities, and a lack of cross-cultural nuance among disability service organizations. These findings contribute important insights to the literature on disability disparities. Disabled refugees resettled in the U.S.A. have many unmet needs associated with gaps in-service delivery stemming from disconnections between refugee and disability service systems.Disability and Rehabilitation 01/2012; 34(7):542-52. · 1.54 Impact Factor
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ABSTRACT: The relative lack of standards for collecting data on population subgroups has not only limited our understanding of health disparities, but also impaired our ability to develop policies to eliminate them. This article provides background about past challenges to collecting data by race/ethnicity, primary language, sex, and disability status. It then discusses how passage of the Affordable Care Act has provided new opportunities to improve data-collection standards for the demographic variables of interest and, as such, a better understanding of the characteristics of populations served by the U.S. Health and Human Services (HHS). The new standards have been formally adopted by the Secretary of HHS for application in all HHS-sponsored population health surveys involving self-reporting. The new data-collection standards will not only promote the uniform collection and utilization of demographic data, but also help the country shape future programs and policies to advance public health and to reduce disparities. Expected final online publication date for the Annual Review of Public Health Volume 35 is March 18, 2014. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.Annual Review of Public Health 12/2013; · 3.27 Impact Factor