Perspectives of basic wheelchair users on improving their access to wheelchair services in Kenya and Philippines: a qualitative study

• Published in: BMC international health and human rights 2017-08, Vol.17 (1), p.22-22, Article 22
• Main Authors: Williams, Emma, Hurwitz, Elizabeth, Obaga, Immaculate, Onguti, Brenda, Rivera, Adovich, Sy, Tyrone Reden L, Kirby, R Lee, Noon, Jamie, Tanuku, Deepti, Gichangi, Anthony, Bazant, Eva
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Africa; Architectural Accessibility; Asia; Attitude; Chairs; Clinical trials; Content analysis; Developing Countries; Disability; Disabled Persons; Emotions; Environment Design; Female; Guidelines; Health aspects; Health Resources - supply & distribution; Health services; Health Services Accessibility; Health Services Needs and Demand; Humans; Kenya; Low income groups; Male; Middle Aged; Mobility; Participation; People with disabilities; Philippines; Physically disabled persons; Practice guidelines (Medicine); Qualitative; Qualitative analysis; Qualitative Research; Quality of life; Rehabilitation; Repair; Skill development; Social Stigma; Social Support; Spinal cord injuries; Studies; Urban areas; Urban Population; User needs; User training; Wheelchairs; Wheelchairs - statistics & numerical data; Wheelchairs - supply & distribution; Young Adult
• ISSN: 1472-698X; 1472-698X
• DOI: 10.1186/s12914-017-0130-6

The United Nations has called for countries to improve access to mobility devices when needed. The World Health Organization has published guidelines on the provision of manual wheelchairs in less-resourced settings. Yet little is known about the extent to which appropriate wheelchairs are available and provided according to international guidelines. This study's purpose was to describe wheelchair users' experiences receiving services and acquiring wheelchair skills in urban and peri-urban areas of Kenya and the Philippines. Local researchers in Nairobi and Manila interviewed 48 adult basic wheelchair users, with even distribution of those who had and had not received wheelchair services along with their wheelchair. Recordings were transcribed in the local language and translated into English. The study team coded transcripts for predetermined and emergent themes, using Atlas-ti software. A qualitative content analysis approach was taken with the WHO service delivery process as an organizing framework. Wheelchair users frequently described past experiences with ill-fitting wheelchairs and little formal training to use wheelchairs effectively. Through exposure to multiple wheelchairs and self-advocacy, they learned to select wheelchairs suitable for their needs. Maintenance and repair services were often in short supply. Participants attributed shorter duration of wheelchair use to lack of repair. Peer support networks emerged as an important source of knowledge, resources and emotional support. Most participants acknowledged that they received wheelchairs that would have been difficult or impossible for them to pay for, and despite challenges, they were grateful to have some means of mobility. Four themes emerged as critical for understanding the implementation of wheelchair services: barriers in the physical environment, the need for having multiple chairs to improve access, perceived social stigma, and the importance of peer support. Interventions are needed to provide wheelchairs services efficiently, at scale, in an environment facilitating physical access and peer support, and reduced social stigma. Not applicable since this was a descriptive study.