DISSERTATION

• Dr.M.Arunkumar.

• 1st year postgraduate

• Department of community medicine,

• SRMC & RI.

GUIDE:

Dr. Pankaj.B.Shah
Professor & HOD
Department of Community Medicine
SRMC & RI.
 TITLE

A Study of Severity of Disability & Physical

,Social ,Economical Barriers and Facilitators in
Accessing Health Care Among Differently
Abled Adults in Selected NGO in Chennai City
 OBJECTIVES

• To Assess the severity of Disability among Differently abled adults in

Selected Non-Governmental Organisation in Chennai city according to

1. Difficulty In Movement.

2. Difficulty In Vision.

3. Difficulty In Hearing.

4. Difficulty In speech

• To Assess the physical Barriers to access the healthcare facility among

Differently abled adults.
 OBJECTIVES Cont…

• To Assess the Social Barrier in accessing Health care facilities

among Differently abled adult.

• To Assess the Economical Barrier in accessing Health care

Facility among Differently abled Adult.

• To Assess the Association between Socio-economic status,

Insurance schemes, Employment status, physical ,social and
economical Barriers to Health care access among Differently
abled adult.
 DISABILITY

• United Nations Convention on the Rights of Persons with

Disabilities (UNCRPD)
Disability results from the interaction between persons with
impairments and attitudinal and environmental barriers that hinders their full
and effective participation in society on an equal basis with others......
Persons with disabilities include those who have long-term physical, mental,
intellectual or sensory impairments which in interaction with various barriers
may hinder their full and effective participation in society on an equal basis
with others.
• There are an estimated 1 billion people in the world living with disabilities.

•In India, the 2011 country census estimated a country-wide

prevalence of 2.2%, using a single disability screening question with
multiple “type of disability” response categories.

• The majority of whom (80%) live in low and middle-income settings.

• People with disabilities are disproportionately over-represented among

the most marginalised in society; evidence suggests that people with
disabilities on average have lower educational attainment, poorer health,
lower economic opportunities and are at increased risk of poverty.
 According to The Rights of Persons with Disabilities Act, 2016
Following are the Disability Conditions Included in RPWD 2016

• Blindness

• Low vision

• Leprosy cured persons

• Hearing Impairment(Deaf and Hard of Hearing)

• Locomotor Disability

• Dwarfism

• Intellectual Disability
 Following are the Disability Conditions Included in RPWD 2016
• Mental Illness

• Autism Spectrum Disorder

• Cerebral Palsy

• Muscular Dystrophy

• Chronic Neurological Condition

• Specific Learning Disabilities

• Multiple Sclerosis
 Following are the Disability Conditions Included in RPWD 2016

• Speech and Language Disabilities

• Thalassemia

• Hemophilia

• Sickle cell Disease

• Multiple Disabilities(Including Deaf and Blindness)

• Acid Attack Victim

• Parkinson’s Disease
 METHODOLOGY
STUDY DESIGN:
1.Quantitative:Cross sectional study
2.Qualitative Assesment

STUDY POPULATION:
Registered Differently abled adult in selected NGO’s in Chennai city

STUDY PERIOD:
2 years
INCLUSION CRITERIA

All Registered Differently abled adult (above 18years)in selected NGO’s for
Differently abled people in Chennai city is to be considered for study

12 Disability conditions according to The Rights of Persons with Disabilities Act,

2016.

Those who given consent for study.

 1. Do not have both arms or both legs; or

2. Are paralysed and are unable to move but crawl; or

3. Are able to move only with the help of walking aids; or

In Movement (Difficulty In Movement) 4. Have acute and permanent problems of joints/muscles that
have resulted in limited movement; or
(Operational Definition from census 2011)
5. Have lost all the fingers or toes or a thumb; or

6. Are not able to move or pick up any small thing placed

nearby; or

7. Have stiffness or tightness in movement; or

8. Have difficulty in balancing and coordinating body

movements; or

9. Have loss of sensation in the body due to paralysis or

leprosy
or any other reason; or

10. Have any deformity of the body part/s like having a hunch
back; or

11.Veryshortstatured(dwarf)

Clinical Examination and Examination Of Central Nervous System Includes Tone,Power,Reflexes,Peripheral

Sensation.
 1. Cannot see at all; or

2. Has no perception of light

evenwiththehelpofspectacles;
or
In seeing (Difficulty in Vision)
3. Has perception of light but has blurred vision even after
(Operational Definition from census 2011) using spectacles, contact lenses etc. A simple test is
whether the person can count the fingers of hand from
a distance of 10 feet in good daylight. Such persons
can however, move independently with the help of
remaining sight; or

4. Can see light but cannot see properly to move about

independently; or

5. Has blurred vision but had no occasion to test if her/his

eyesight would improve after taking corrective
measures.

6. One-eyed person not to be considered as disabled in

Seeing

Clinical Examination and Visual Acuity(Snellen’s Chart)

 1. Cannot hear at all; or

In Hearing (Difficulty In Hearing) 2. Has difficulty in hearing day-to-day

conversational speech
(Operational Definition from census 2011)
(hard of hearing); or

3. If she/he is using a hearing aid.

4. Hearing problem in one ear not to be

considered as having
hearing disability.

Clinical Examination with Tunning Fork (Weber’s test,Rinne’s test)

 1. Can not speak at all or she/he is unable to
speak normally on account of certain
difficulties linked to speech disorder; or

In Speech (Difficulty in speech) 2. Able to speak in single words only and is

not able to speak in
(Operational Definition from census 2011) sentences; or

3. Stammers to such an extent that the

speech is not comprehensible.

Clinical Examination with Screening Tool.

 TOOLS
• Written informed consent for the study participant(both in English and

Tamil)

• A semi-structured interview schedule consisting of:

• Tool Guide for Focus group Discussion and In-depth Interview.

• Video camera for Recording Focus group Discussion and In-Depth

Interview.
 Part A
• Questions related to background details- Age, Sex,
Education, Number of Family members, Total family
Income, Socio-economic status (Modified BG Prasad’s
classification)
• WHO Disability Assessment Schedule 2.0 (WHODAS 2.0)

• Questionnaire to assess Disability severity;

• WHODAS 2.0 covers 6 Domains of Functioning, including:

• Cognition – understanding & communicating

• Mobility– moving & getting around

• Self-care– hygiene, dressing, eating & staying alone

• Getting along– interacting with other people

• Life activities– domestic responsibilities, leisure, work & school

 Part C

Qualitative Assessment

• In-Depth Interview to assess physical, social and

economical barriers and Facillitators To access health care
facility among differently abled people.
 Part D
• Qualitative Assesment-Focus Group Discussion.

• Questions related to lack of social Inclusion and community

participation that Hinders Accessibility to Health care.

• Questions related to Availability of health care facility and

awareness about rehabilitation centres and Medical facilities
among few differently abled adult.

• Questions related to Insurance Schemes and Its

benefits,Locomotor Aids,Job opportunities,Educational
Opportunities that facilitates Accessibility to Health care.
 WHODAS 2.0
PLEASE NOTE: When scoring WHODAS, the following numbers are assigned to responses: 0 = No Difficulty

1 = Mild Difficulty

2 = Moderate Difficulty

3 = Severe Difficulty

4 = Extreme Difficulty or Cannot Do

Understanding and communicating

Concentrating on doing something for ten minutes?

D1.1 0

Remembering to do important things?

D1.2 0

D1.3 Analysing and finding solutions to problems in day-to-day life? 0

Learning a new task, for example, learning how to get to a new place?
D1.4 0

D1.5 Generally understanding what people say? 0

Starting and maintaining a conversation?
D1.6 0

Getting around

Standing for long periods such as 30 minutes?

D2.1 0

D2.2 Standing up from sitting down? 0

Moving around inside your home?
D2.3 0

Getting out of your home?

D2.4 0
Self-care

Washing your whole body?

D3.1 0

D3.2 Getting dressed? 0

D3.3 Eating? 0

Staying by yourself for a few days?

D3.4 0

Getting along with people

Dealing with people you do not know?

D4.1 0

D4.2 Maintaining a friendship? 0

Getting along with people who are close to you?

D4.3 0

D4.4 Making new friends? 0

D4.5 Sexual activities?

 Life activities

D5.1 Taking care of your household responsibilities?

D5.2 Doing most important household tasks well?

Life activities

D5.3 Getting all the household work done that you needed to do?

D5.4 Getting your household work done as quickly as needed?

D5.5 Your day-to-day work/school?

D5.6 Doing your most important work/school tasks well?

D5.7 Getting all the work done that you need to do?

D5.8 Getting your work done as quickly as needed?

Participation in society

D6.1 How much of a problem did you have in joining in community activities (for example, festivities, religious or other activities) in the same way as anyone else can? 0

D6.2 How much of a problem did you have because of barriers or hindrances in the world around you? 0

How much of a problem did you have living with dignity because of the attitudes and actions of others?
D6.3 0

How much time did you spend on your health condition, or its consequences?
D6.4 0

How much have you been emotionally affected by your health condition?
D6.5 0

How much has your health been a drain on the financial resources of you or your family?
D6.6 0

D6.7 How much of a problem did your family have because of your health problems? 0

Howmuchofaproblemdidyouhaveindoingthingsbyyourselfforrelaxationor pleasure?
D6.8 0

Overall Score 0.00%

H1 Overall, in the past 30 days, how many days were these difficulties present?

In the past 30 days, for how many days were you totally unable to carry out your usual activities or work because of any health condition?
H2

In the past 30 days, not counting the days that you were totally unable, for how many days did you cut back or reduce your usual activities or work because of any health
H3
condition?
 Reference
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8. Disability in india2011data.CENSUS OF INDIA 2011

THANK YOU