Browsing by Author "Kuper, Hannah"

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    Exploring the Use of Washington Group Questions to Identify People with Clinical Impairments Who Need Services including Assistive Products: Results from Five Population-Based Surveys
    (2022) Boggs, Dorothy; Kuper, Hannah; Mactaggart, Islay; Bright, Tess; Murthy, Gvs; Hydara, Abba; McCormick, Ian; Tamblay, Natalia; Alvarez, Matias L.; Atijosan-Ayodele, Oluwarantimi; Yonso, Hisem; Foster, Allen; Polack, Sarah
    This study analyses the use of the self-reported Washington Group (WG) question sets as a first stage screening to identify people with clinical impairments, service and assistive product (AP) referral needs using different cut-off levels in four functional domains (vision, hearing, mobility and cognition). Secondary data analysis was undertaken using population-based survey data from five countries, including one national survey (The Gambia) and four regional/district surveys (Cameroon, Chile, India and Turkey). In total 19,951 participants were sampled (range 538-9188 in individual studies). The WG question sets on functioning were completed for all participants alongside clinical impairment assessments/questionnaires. Using the WG "some/worse difficulty" cut-off identified people with mild/worse impairments with variable sensitivity (44-79%) and specificity (73-92%) in three of the domains. At least 64% and 60% of people with mild/worse impairments who required referral for surgical/medical and rehabilitation/AP services, respectively, self-reported "some/worse difficulty", and much fewer reported "a lot/worse difficulty." For moderate/worse impairment, both screening cut-offs improved identification of service/AP need, but a smaller proportion of people with need were identified. In conclusion, WG questions could be used as a first-stage screening option to identify people with impairment and referral needs, but only with moderate sensitivity and specificity.
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    Inclusive health for people with disabilities in Chile: a national health system assessment
    (2025) Rodríguez Gatta, Danae Harmonia; Piriz Tapia, Constanza; Tagle Schmidt, Elvira; Luna Benavides, Jimena Elvira; Vivar Jara, Daniel; Moreno Celis, Rodrigo; Tobar Carrizo, Gonzalo; Vilaró Cáceres, Judit; Heydt, Phyllis; Banks, Lena M.; Kuper, Hannah
    Background Globally, one in six people have disabilities. They often experience health inequities and many of them arise from system-level failures. This study aimed to assess the inclusion of people with disabilities in the health system of Chile and define recommendations for improvement on the basis of the evidence. Methods A health system assessment was conducted between June and November 2023 following the Missing Billion Disability-Inclusive Health Systems Framework and System Level Assessment Toolkit. The assessment was led by the Ministry of Health and conducted by a task team, including organizations of people with disabilities. Mixed methods were used to collect data on nine system-level and service delivery components for a set of 33 indicators, including through a health policy review, systematic review, key informant interviews and a scoping review. Scores were assigned to indicators, components and the overall health system. With this assessment, key recommendations were developed and agreed upon on the basis of a prioritization analysis of impact and feasibility during workshops. Results The Chilean health system was assessed to have a low progress towards disability-inclusive health. Among system-level components, intermediate progress has been made in governance, health financing and data and evidence. However, progress in leadership on disability seems low. Among service delivery components, the accessibility of health facilities and rehabilitation and assistive technology showed the best results. However, there were notable gaps in the autonomy and awareness and ability to afford care by people with disabilities, and the capacity of human resources to support this group. The task team defined priority actions in governance, leadership, and human resources. Conclusions Short-term actions for the country should involve foundational governance on inclusive health, strengthened leadership of people with disabilities, and mandatory training of healthcare workers to improve healthcare access among this population. Future reassessments should be conducted to monitor and evaluate progress on effective healthcare coverage and health status among people with disabilities.