How can engagement in and access to physical activity be improved for people with disabilities?
Many people with disabilities are not able to engage in the recommended amount of physical activity needed to get the maximum health benefits from exercise. People with disabilities are less likely to be physically active than people without disabilities, partly due to inaccessible environments and partly because of limitations in functioning associated with some impairments. This evidence brief explores how to improve access to and engagement in physical activity among people with disabilities. It makes evidence-based recommendations about how barriers to physical activity for people with disabilities residing in low- and middle-income countries (LMICs) can be overcome. We note that this area should be considered in an impairment-specific way, but because the existing evidence is so limited, it is not currently possible to create different briefs on this topic. More research and synthesis is required in this area, to ensure that recommendations are tailored appropriately to impairment type and age group.
- Educate healthcare providers on the importance of regular physical activity for people with disabilities, and on exercise options for people with different impairment types
- Improve the training of fitness and recreation providers, including in schools, regarding adaptations to equipment and exercises which enable participation in physical activity by people with disabilities
- Make information about where and how to exercise widely available, and normalise physical activity for people with disabilities through awareness campaigns and ‘physical activity for all’ promotions
- Ensure that people with disabilities and their caregivers, where appropriate, can share their experiences, needs, and priorities with health and fitness professionals
- Invest in accessible physical activity programs in communities, ensuring that people with all types of impairments can participate in physical activity in ways that are possible and optimal for them, depending on impairment types
What role can community health workers play in disability services in LMICs?
Community Health Workers (CHWs) are first line community-based health care workers in many low- and middle-income countries (LMIC) contexts, particularly rural ones. They are lay paid workers or volunteers who undergo relatively short training on specific health services. CHW roles can include building relationships between health services and communities, conducting health promotion activities, providing clinical services, and supporting access to specialized care. In LMIC contexts, where diagnosis of disability is often delayed, CHWs can play a key role in screening and linking individuals with disability to care. In addition, they can provide basic disability related community health education and counselling. There is evidence that CHWs can effectively provide services for dementia, and depression (including perinatal depression), and conduct screenings for developmental disabilities and hearing loss. However, CHW programs are often over extended and face conflicting health challenges and priorities, including issues of incentivisation, supervision and program financing.
- Training CHWs to deliver screening, health, and social and emotional education, basic treatment and referral for common disabilities.
- Development of locally contextualized disability screening tools/care guides
- Investment in research on sustainable incorporation of CHWs into the health sector, including research into methods on increasing range of services provision of by CHWs such as disability care.
- Development of national CHW policies
How can mHealth be used to improve the health and functioning of people with disabilities?
The rapid rise in mobile phone use and functionality in recent years has opened new possibilities for increasing access to health information and services for people with disabilities. mHealth is defined by the World Health Organization as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants, and other wireless devices”. It is a component of eHealth, which more broadly applies electronic and communications technology to health service provision. Although there is a rapidly growing literature on mHealth in low- and middle-income countries (LMICs), the evidence for its effectiveness remains mixed, especially for people with disabilities, who may face additional barriers to accessing technology and the internet.
- Design mHealth products and strategies in partnership with people with disabilities and their families
- Adapt mainstream health apps to be accessible and appropriate for people with disabilities
- Address the digital divide, enabling people with disabilities to access technology equitably
- Use mHealth tools as part of multi-component strategies, and integrate them well within existing systems
- Implement measures for data security, safety and quality of interventions
What interventions work to address trauma among people with intellectual disabilities?
People with intellectual disabilities are at higher risk of developing mental health conditions than the general population. People with intellectual disabilities are also more likely to experience traumatic life events than the general population. As such, this population may be at increased risk of the negative sequelae of trauma, including post-traumatic stress. In low- and middle-income countries (LMICs), access to mental health services is constrained, particularly among people with intellectual disabilities. Both facility-based service providers and community-based services are ill-equipped to provide appropriate assessments and responses for trauma exposure among people with intellectual disabilities, and families may lack skills and knowledge to support their loved ones in the face of trauma exposure. This brief discusses the available evidence on trauma interventions for people with intellectual disability.
- Increase the awareness of caregivers and service providers in relation to trauma risk and impact for people with intellectual disabilities
- Strengthen the social inclusion of people with intellectual disabilities and provide enabling environments for their social support and secure, consistent relationships
- Involve people with intellectual disabilities and their caregivers in mainstream community-based trauma interventions as much as is possible, with appropriate modifications to support meaningful inclusion
- Promote access to mental health services at primary care level for people with intellectual disabilities and adapt existing evidence-based interventions for people with intellectual disabilities
How do food insecurity, hunger, and undernutrition affect people with disabilities and how can this problem be addressed?
Food insecurity, hunger, and undernutrition are related phenomena which occur at a high prevalence among people with disabilities in low- and middle-income countries (LMICs). Food insecurity is the lack of regular access to enough safe and nutritious food for proper growth and development. Hunger is the physical consequence of food insecurity, and results from periods when people experience severe food insecurity. Undernutrition results from the insufficient intake of energy and nutrients to meet an individual's needs. Both food insecurity and hunger are driven by the social exclusion of people with disabilities, while undernutrition can be driven both by food insecurity and hunger, and also by the diffiuclties with eating and/or digesting that are associated with some impairments. All of these phenomena are associated with growth and development problems, worsening of existing health conditions, physical weakness, mental health problems, and reduced quality of life. This evidence brief explores these phenomena amongst people with disabilities in LMICs, and provides evidence-based recommendations for remedial action.
- Promote early identification of food insecurity, hunger, and undernutrition among people with disabilities through active screening
- Increase the resources and programmes available to address food insecurity and hunger, and support adequate nutrition and feeding amongst people with disabilities
- Educate frontline workers, caregivers, and family members on the risks of food insecurity, hunger, and undernutrition among people with disabilities, and provide targeted support for adequate nutrition and feeding skills to assist people with disabilities
- Ensure that policy and programming is being developed to address the social determinants of food insecurity, hunger, and undernutrition among people with disabilities
World Health Organization. Water, sanitation, hygiene (WASH) and waste management for the prevention of COVID-19: Updated Technical Note - 2nd Edition (2020)
World Health Organization. Water, sanitation, hygiene and waste management for COVID-19: technical brief (2020)
Hygiene Hub. What do we know in general about disability and WASH access? (2020)
WaterAid. Guidance for creating empowering and inclusive WASH and COVID-19 responses (2020)