Abstract
Background: Early rehabilitation interventions can significantly mitigate the effects of disabilities in children as they grow older. However, families of children with disabilities (CWDs) in resource-deprived settings face limited opportunities to access rehabilitation services for their children resulting in largely unmet rehabilitation needs.
Aim: This study assessed knowledge of families of CWDs on rehabilitation services and accessibility to services for their children.
Setting: The study was carried out in the selected districts in the Upper West Region, Ghana.
Methods: Families that knew about rehabilitation services and acknowledged their child’s need for one were the subjects of this cross-sectional, quantitative study, using a researcher-administered questionnaire. STATA software was utilised for analysis.
Results: Over half of the participants, 113 (54.85%), attempted to access rehabilitation services for their children, but only 31 (27.18%) were successful. The barriers to access included financial problems (n = 197 [95.63%]), shyness (n = 167 [81.07%]), transportation issues (n = 155 [75.24%]), community discouragement (n = 145 [70.39%]) and the attitudes of healthcare providers (n = 145 [70.39%]). Among those who accessed rehabilitation services, over half reported dissatisfaction with travel distance and associated costs (n = 18 [58.06%]), as well as travel time and wait time for services (n = 15 [48.39%]). Participants with no formal education (adjusted odds ratio [AOR] = 0.22; 95% confidence interval [CI]: 0.07, 0.59) and those who agreed that negative attitudes from health personnel were a barrier to access (AOR = 0.08, 95% CI: 0.00–1.01) were less likely to access rehabilitation services for their children.
Conclusion: The low access to rehabilitation services suggests that many CWDs may miss relevant rehabilitation services that could improve their health outcomes and functioning. Policy interventions are required to facilitate families’ access to rehabilitation services for their children.
Contribution: This study contributes to the literature on rehabilitation care in Ghana and provides a foundation for further research in rehabilitation care in the Upper West Region, as it is the first of its kind conducted in the region.
Keywords: knowledge; accessibility; rehabilitation services; families of children with disabilities; rural setting; Ghana.
Introduction
Globally, 240 million children (one in every 10 children) aged 0–17 years have some form of disability, with 41.1 million living in West and Central Africa (UNICEF 2021). The prevalence of children with disabilities (CWDs) has increased by 15.6% from 2001–2002 to 2010–2011 (Houtrow et al. 2014). In low- and middle-income countries (LMICs), the incidence and prevalence of childhood disabilities are much higher, with about 95% of the world’s CWDs aged below 5 years (Olusanya et al. 2018). The 2021 Population and Housing Census of Ghana showed that about 8% (2 098 138) of Ghanaians, aged 5 years and older have varying degrees of disability (Ghana Statistical Service 2021). This is about three times the percentage recorded in the 2010 Population and Housing Census (Tawiah et al., 2023). Factors such as malnutrition, poverty, poor healthcare systems, child labour, neglect and abuse, wars and some infectious diseases account for the high prevalence of childhood disabilities in LMICs, including Ghana (Scherzer et al., 2012).
Children with disabilities contribute significantly to the global burden of diseases (Lalloo et al. 2020), yet many CWDs remain invisible in LMICs (UNICEF 2020). Rehabilitation services play a pivotal role in ensuring the functionality of CWDs, promoting their independence and full participation in daily activities (Figueiras et al. 2012; Li & Chen 2017; Scherzer et al. 2012). Generally for persons with disabilities and for children under 5 years in particular, accessing rehabilitation services early has become one of the most important ways to restore or compensate for their body functions and improve their quality of life (World Health Organization [WHO] 2017). Early intervention decreases the chances of later complications in children, thereby creating opportunities for their education, employment and social integration in the future (Qi & Wang 2020).
According to the WHO, rehabilitation services include a set of interventions designed to optimise functioning and reduce disability in individuals with health conditions (WHO 2020). Examples of such interventions include assistive device configuration, therapies and rehabilitation training for body posture, balance, neck coordination, manual stretching, massage, walking, self-care and social participation (Montagnini, Javier & Mitchinson 2020). These interventions or services are specific to the needs of the child. For example, rehabilitation for childhood disabilities typically includes physiotherapy, occupational therapy, and speech and language therapy (Cerebral Palsy Guide 2020). The entire rehabilitation process includes experts (i.e., neurologists, orthopaedic surgeons, developmental paediatricians, physiotherapists, occupational therapists, nutritionists, psychologists, and speech and language therapists.
Children with disabilities depend on their families to access rehabilitation services (Asa 2021; Nuri et al. 2020). Families make decisions with and on behalf of their children during the rehabilitation process (Alexandrou 2014) and are therefore required to be aware of and knowledgeable about the rehabilitation services and processes that will aid their children’s rehabilitation journeys (Jansen, Ketelaar & Vermeer 2007). The relevant knowledge areas expected of families include understanding their child’s disability, the availability of rehabilitation specialists and services and key factors to consider when choosing rehabilitation services for their CWDs that will significantly improve their well-being (Visagie, Eide & Mannan 2017; White & Robertson 2015). Evidence from Nicaragua suggests that parents with higher education have a better understanding of their children’s disabilities and frequently access appropriate rehabilitation services for them (Matt 2014).
The right to access rehabilitation services is enshrined in Article 26 of the United Nations Convention on the Rights of Persons with Disabilities (United Nations 2018). Similarly, Section 14 of the Persons with Disability Act (Act 715) of Ghana provides for the establishment of rehabilitation centres in all regions and districts to offer appropriate training, guidance and counselling to persons with disabilities, including children. However, families of CWDs encounter various challenges in seeking rehabilitation services for their children including financial barriers (Devendra et al., 2013; Udeh et al. 2014), stigmatisation from community members and healthcare providers (Martin et al. 2021), inadequate rehabilitation centres and limited resources (United Nations, 2018), long distance to rehabilitation service centres and long waiting times (Bjarnason-Wehrens 2010; Kumurenzi et al. 2015; Saloojee 2011).
In Ghana, there is a paucity of research focussing on access to rehabilitation services for CWDs and their families. Most of the available studies in this context centre on the service providers’ experiences at rehabilitation centres (Adzrago, Doku & Adu-Gyamfi 2018; Christian et al. 2016; Wylie et al. 2020), caregivers’ needs and perspectives of rehabilitation services (Aduful et al. 2023; Bonsu, Salifu Yendork & Antwi 2023). Furthermore, many of these studies, which predominantly occur in cities and at service centres, tend to overlook families who, for various reasons, cannot access rehabilitation service centres. This study was conducted at the community level to investigate the knowledge and access to rehabilitation services among families of CWDs in a predominantly rural region of Ghana.
In this study, rehabilitation services are categorised into physiotherapy (prescription of exercise therapies, movement, therapeutic handling and positioning), occupational therapy (training on performing activities of daily living such as eating, buttoning, holding, mouth cleaning and sitting), speech and language therapy or audiology (testing speech, training a child to pronounce some missing sound, pronunciations of words, testing one’s auditory abilities and prescription of appropriate medicine) and assistive devices (prosthesis, hearing aids, wheelchairs, white canes, eyeglasses, mobility and Braille orientation). We also used information from the Ghana Persons with Disability Act; Act 715, (2006) and the Ghana Statistical Service (2021) to categorise the various disabilities as physical disability (upper, lower limb amputation, fractured or twisted limb), sensory disability (hearing and visual, etc.) and intellectual disability (autism, Down syndrome, speech, etc.) (Ghana Statistical Service 2021; Ghana Persons with Disability Act, Act 715 [2006]).
Research methods and design
Study design and approach
The study adopted a quantitative approach and a cross-sectional design to assess the knowledge and access to rehabilitation services by families of CWDs in the Upper West Region (UWR) of Ghana. This approach facilitated an objective assessment of the study participants’ knowledge and the access barriers to rehabilitation services that can be generalised to settings of similar characteristics. The cross-sectional nature of this study allowed a one-time collection of data, which is faster, cost-effective and can provide useful information on the prevalence of the condition being studied for public health planning (Setia 2016).
The study setting
The study was undertaken in four selected districts: Wa West, Wa Municipal, Jirapa Municipal and Nandom located in the UWR of Ghana. The region covers a land space of 118 476 km2 and shares borders with Burkina Faso to the north, Cote d’Ivoire to the west, the Upper East region of Ghana to the east and the Savana region to the south. The region has a population of 894 326 people, with 9.4% of individuals aged 5 years and older having some form of disability (defined as having difficulty in performing at least one activity) (Ghana Statistical Service 2021). Less than half (46.0%) of the population older than 6 years has received formal education or is currently in school, with 41.7% of these individuals being female (Ghana Statistical Service 2021). The region is equipped with a regional hospital, four polyclinics, three district government hospitals, five private hospitals and five maternity homes. Additionally, there are 72 health centres, 10 clinics and 319 Community-based Health Planning Service (CHPS) compounds (Ghana Health Service, 2023). These health facilities are available across the 11 administrative districts of the region. The population density in the region is 40 persons/km2; however, some districts have a population density of 13 persons/km2, with communities located far apart (Ghana Health Service, 2023).
Study participants’ eligibility
The participants for this study were family members (classified as fathers, mothers, grandparents and others – siblings, aunties, etc.). Therefore, the eligibility for recruiting a family member was that the person must be the first person to attend to the child’s healthcare needs or directly involved in attending to the healthcare needs of the child. The child must not be more than 18 years of age.
In addition, the confirmation of the presence of disability in the child was a requirement. This was done by verifying the hospital folder of each child to confirm the health provider’s diagnosis. In cases where the folder was unavailable, parents of children with visible or identifiable disabilities such as speech impairment, hearing, cerebral palsy, and so on were contacted for recruitment. The research assistants (RAs) recruited for the data collection had previous training in disability-related fields and were further trained to facilitate the identification of disabilities. The three RAs were a Registered General Nurse, a Special Education Teacher and a Disability Practitioner (holder of Bachelor of Science [BSc] Disability and Rehabilitation Studies degree).
Finally, the families were required to be aware of rehabilitation services and recognise that their child with a disability needs a rehabilitation service. This was to ensure that the participants of this study had at least an idea of rehabilitation services and could respond to the survey questionnaire relating to access and access barriers (real or perceived).
Sampling procedure
A community-based survey was conducted in some communities of the selected districts (Wa West, Wa Municipal, Jirapa Municipal and Nandom) using a network approach as the first method. In most of the rural communities, the healthcare providers (who were largely ‘community nurses’) were the first contact persons who referred the research team to families with a child with a disability, and thereafter, the network process continued. However, in communities without a health facility or where the ‘community nurse’ knew no family with a child with a disability, a house-to-house approach was adopted.
Sample size determination
The Cochran’s sample size determination formula was used to estimate the sample size:
where z is the confidence interval of 95%; p is the prevalence of 9.4% (Ghana Statistical Service 2021).
The prevalence of 9.4% represents the proportion of individuals aged 5 years and older with disabilities – defined as having difficulty performing certain activities – within the UWR of Ghana, where this study was conducted:
Taking into account a 10% loss rate, the minimum sample size required was 144. However, efforts were made to collect data from as many families as possible during the study period. Ultimately, 206 participants were recruited after giving their consent to participate.
Questionnaire development and pretesting
The questionnaire was locally developed with keen attention to the culture of the people, taking into consideration the low educational background of the study population. It covered the following thematic areas: knowledge of what rehabilitation services entail, access to and barriers to rehabilitation services, and the level of satisfaction with those services. The section measuring participants’ knowledge provided ‘Yes’ or ‘No’ response options. The aim was to determine whether participants understood what the existing rehabilitation services in their catchment area entail and which services are most suitable for the various disabling conditions listed in this study. The questionnaire used to determine access barriers and satisfaction levels included multiple response options (derived from literature and insights from the local area), allowing participants to select all applicable responses.
The questionnaire was pre-tested among a few (n = 15) families with the same cultural background in the Wa East district. Attention was paid to the translation of the questionnaire into local languages and the use of culturally appropriate terms. The pretesting aimed to ensure the accuracy of the data during the main study and the appropriateness of the questionnaire for measuring the areas investigated.
Data collection methods and procedure
A semi-structured researcher-administered questionnaire was administered via a digital platform (Kobo Collect). Three RAs were trained for data collection, and each is proficient in the local language of the participants (i.e., Waali, Dagaare or Brifor). The translation of the questionnaire into the various local languages was emphasised during the training, with support from selected local individuals.
Data analysis procedure
The data were retrieved from the Kobo Collect server and exported to STATA software for descriptive and inferential analysis. Descriptive analysis was conducted on the demographic data of study respondents, their knowledge of rehabilitation services, and access barriers faced by families of CWDs. A Chi-square test was further carried out to establish associations between the demographic characteristics of the participants and other variables of interest in the study. A significant association was determined at a 95% confidence interval. The results are presented in frequency tables and bar charts.
Ethical considerations
Ethical clearance to conduct this study was obtained from the Kwame Nkrumah University of Science and Technology Committee on Human Research Publication and Ethics (ethical approval number: CHRPE/AP/068/23). Participation in the study was entirely voluntary. Considering the high illiteracy level in the study area, verbal consent was obtained from participants after guiding each individual through the Study Information document in their local language. Participants who could read and understand the information document were provided with hard copies to review and decide whether to give consent or not.
Results
Socio-demographic characteristics of caregivers
In Table 1, 206 participants were involved in the study, the majority of whom were females (n = 145, 70.37%). The average age of the participants was 48.6 years, with a standard deviation (s.d.) of 14.8. Most participants lived in rural areas (n = 152, 73.79%). Mothers constituted 96 (46.60%) of the participants, and 91 (44.2%) lived in households with 6–10 members, making this the largest household size in the study.
| TABLE 1: Socio-demographic characteristics of caregivers (N = 206). |
Concerning the educational level of the caregivers, the majority (n = 157, 76.21%) had no formal education, while 97 (47.09%) were unemployed. Among those who were employed, 72 (34.95%) were farmers. In terms of religion, the majority (n = 139, 67.3%) identified as Christians. Nearly all participants (n = 192, 93.2%) were categorised as having low monthly incomes (see Table 1).
Demographic characteristics of children with disability
Out of the 206 family members involved in the study, the majority 114 (55.3%) had male children. The mean age of the children was 11.9 years, with a s.d. of 11.6 indicating a wide variety of range. The largest proportion of the children 116 (56.3%) were not attending school, and the most prevalent disability type among the children was physical disability, affecting 98 (47.57%) of them (see Table 2).
| TABLE 2: Demographic characteristics of children with disability (N = 206). |
Knowledge of rehabilitation services for the types of disability
Table 3 represents the responses regarding the rehabilitation services required for the disability types categorised in this study. The majority of participants, 195 (94.66%), answered ‘Yes’ to physiotherapy being a rehabilitation service for physical disability, while 190 (92.33%), 198 (96.12%) and 119 (57.77%) answered ‘No’ for occupational therapy, speech and language therapy and assistive devices, respectively, as rehabilitation services for physical disability. Furthermore, 206 (100%) and 193 (93.69%), respectively indicated that physiotherapy and occupational therapy are not rehabilitation services for sensory disability. Nearly equal proportions, 126 (61.17%) and 139 (67.48%), indicated that speech and language therapy and assistive devices are the rehabilitation services needed for children with sensory disabilities.
| TABLE 3: Knowledge on rehabilitation services for disability types. |
For children with intellectual disabilities, most participants – 175 (84.95%), 140 (67.96%) and 171 (83.01%), respectively indicated that they do not require physiotherapy, occupational therapy and assistive devices. However, 133 (64.56%) indicated that they require speech and language therapy services.
Proportion of caregiver demographics on level of knowledge on rehabilitation services
Table 4 shows the distribution of caregivers and their corresponding levels of knowledge about rehabilitation services. A cross-tabulation shows that over half of those aged 20–39 years and those over 60 demonstrated higher knowledge than those aged 40–59 years. Less than half of both males and females exhibited high knowledge levels. Furthermore, a greater proportion of fathers (52.0%) and grandparents (49.0%) were more knowledgeable than mothers (45.0%), while nearly all participants classified as ‘other family members’ (92.0%) showed low knowledge. Quite unexpectedly, a larger proportion of participants in rural areas (53.0%) and those who attained only primary education (64.0%) were found to be more knowledgeable than their counterparts. Additionally, a higher proportion of employed individuals (69.0%) demonstrated greater knowledge than those who were unemployed (20.0%).
| TABLE 4: Proportion of caregiver level of knowledge on rehabilitation services. |
A test of association revealed that the caregiver’s age (p = 0.048), guardian role (p = 0.051), place of residency (p ≤ 0.001) and employment status (p ≤ 0.001) showed statistically significant differences in knowledge levels at a confidence level of 95%.
Access to rehabilitation services for children with disability
The participants were asked direct questions to determine who had tried to access rehabilitation services for their child with a disability. The results revealed that more than half, 113 families (54.85%), had at least attempted to access such services for their CWDs. However, of the 113 families that tried, the majority, 82 (72.82%), were unsuccessful in obtaining the necessary rehabilitation services for their child.
Access barriers to rehabilitation services for children with disability
The barriers to accessing rehabilitation services, as presented in Figure 1 showed that the majority of caregivers strongly agreed that feelings of shyness (81.07%), community discouragement (70.39%) and negative attitudes of healthcare providers (70.39%) were major obstacles. Furthermore, financial problems (95.63%), long distances and transportation issues (75.24%) and the unavailability of services (47.57%) were identified as other significant challenges. However, long waiting times and infrastructural/material barriers were not hindrance to 30.58% of participants in seeking rehabilitation services for their CWDs (see Figure 1).
 |
FIGURE 1: Access barriers to rehabilitation services. |
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Parents/caregivers satisfaction with rehabilitation services for their wards
From Figure 2, the participants’ satisfaction level was assessed among the 31 families that successfully accessed the rehabilitation services their ward needed. The results showed that participants were largely dissatisfied with the rehabilitation services. They expressed significant dissatisfaction with both the direct costs (18 participants, 58.06%) and indirect costs (18 participants, 58.06%), as well as with the distance to the rehabilitation facility (18 participants, 58.06%), travel time (15 participants, 48.39%) and wait time to receive the service (15 participants, 48.39%). Many participants were also dissatisfied with their ability to get access to rehabilitation services when needed (14 participants, 45.16%) and with the physical accessibility of the rehabilitation centres (10 participants, 32.25%). However, nearly half of the participants were reserved about their overall satisfaction with the rehabilitation services (14 participants, 45.16%), the providers’ attitudes (14 participants, 45.16%) and the providers’ ability to explain the child’s condition to the caregiver (15 participants, 48.39%).
 |
FIGURE 2: Level of satisfaction of rehabilitation services. |
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Determinants of level of knowledge of rehabilitation services
In Table 5, only the variables that showed statistical significance with knowledge of rehabilitation services are presented. The study found that participants living in urban areas were less likely to have knowledge of rehabilitation services for their CWD compared to those living in rural areas (odds ratio [OR] = 0.34, 95% CI: 0.12–0.96). Other family members were 4% less likely to have knowledge of rehabilitation services (crude odds ratio [COR] = 0.04, 95% CI: 0.00–0.70).
| TABLE 5: Determinants of level of knowledge. |
After adjusting for all other covariates, individuals living in urban areas were less likely (adjusted odds ratio [AOR] = 0.27, 95% CI: 0.12–0.58) to have knowledge of rehabilitation services compared to those living in rural areas. In addition, Christians were less likely (AOR = 0.45, 95% CI: 0.23–0.86) to have knowledge of rehabilitation services. Participants who have ever received rehabilitation services for their CWD were more likely (AOR = 2.79, 95% CI: 1.34–5.82) to have knowledge of rehabilitation services compared to those who have never received rehabilitation services for their CWD.
Determinants of access to rehabilitation services
In Table 6, participants who strongly disagreed that community discouragement was a barrier to having access to rehabilitation services had increased odds (OR = 151.30, 95% CI: 1.90–12024.09) of accessing rehabilitation services for their CWD. Similarly, participants who strongly agreed that community discouragement were more likely (OR = 4.28, 95% CI: 1.20–15.33) to access rehabilitation services for their CWD compared to those who were undecided. Nonetheless, caregiver age, monthly income, sex, residence, employment status, financial problems, long-distance and transportation issues, infrastructural barriers and feelings of shyness were not statistically significant in relation to access to rehabilitation services.
| TABLE 6: Determinants of access to rehabilitation services. |
After adjusting for other variables, families who had no formal education were less likely to have access to rehabilitation services for their CWD (AOR = 0.22, 95% CI: 0.07–0.59). In addition, participants who strongly disagreed that long waiting times were a barrier were also less likely (AOR = 0.30, 95% CI: 0.13–0.73) to access rehabilitation services for their CWD. Furthermore, participants who agreed or strongly disagreed with health personnel’s negative attitudes were less likely to have access to rehabilitation services for their CWD (AOR = 0.08, 95% CI: 0.00–1.01) and (AOR = 0.17, 95% CI: 0.05–0.62), respectively. Caregivers who strongly agreed that community discouragement was a barrier were more likely to access rehabilitation services for their CWD (AOR = 2.79, 95% CI: 1.25–6.19) compared to those who were undecided.
Discussion
This study investigated the knowledge of family members of CWDs on rehabilitation services for meeting the rehabilitation needs of their wards with disabilities. We also assessed the accessibility of the rehabilitation services to family members for the purpose of meeting the healthcare needs of their wards with disabilities. To the best of our knowledge, this study was the first in the UWR of Ghana, and therefore, serves as the foundation for further studies in the UWR and perhaps, other parts of Ghana and Africa.
The study involved a little over 70% female parents/caregivers. The majority of the caregivers were biological mothers (46.12%) as similarly reported by Danmei (2020) and it also affirms the school of thought that placed women as the primary caretakers of children in many African homes (Waterhouse, Hill & Hinde 2017). A majority (76.21%) of the participants were without formal education as 73.79% of them lived in rural areas. This is typical of the UWR, which is largely rural with a low level of education, especially among women (Ghana Statistical Service 2021). The study also saw the majority of those considered employed as farmers, as it is the easiest form of occupation in rural parts of Ghana. Over half of the CWDs were also out of school as the least importance is given to their education (Owusu et al. 2018). Physical disability was the most prevalent condition among the children.
In this study, the family members were basically asked to identify any of the rehabilitation services they will seek for their children if they have any form of disability (physical, sensory or intellectual disability). Their responses were graded on their knowledge of the rehabilitation services required by CWDs. The majority of them appropriately recognised physiotherapy services as required for their children with physical disabilities. However, many participants did not recognise assistive devices as required for their children with various disabilities except for those with sensory disabilities. Occupational therapy services were the least recognised health need for CWDs. This points to reported evidence of limited availability of rehabilitation services in rural areas (Magaqa, Ariana & Polack 2021), especially, occupational therapy services (Smith & Gallego 2021). This limited availability of rehabilitation services could be a major factor for their limited recognition by family members as needed for their children’s rehabilitation needs.
Furthermore, our analysis has shown the participants’ age as statistically significant with knowledge of the rehabilitation services (p = 0.048), with the younger group being more knowledgeable. Quite unexpectedly, a greater proportion of rural dwellers showed knowledge of the rehabilitation services than the urban dwellers at a significance level of (p ≤ 0.001). Other variables that were statistically significant with the knowledge of rehabilitation services are the participants’ employment status (p ≤ 0.001) and the guardian type (p = 0.051). Unfortunately, the participants’ educational level and their knowledge of the rehabilitation services do not show statistical significance (p = 0.077) as earlier reported by Matt (2014) in Nicaragua. However, participants who ever received rehabilitation services for their wards showed more knowledge of the rehabilitation services, and statistically significant (p = 0.006) at 95% CI. This is supported by Toikko’s (2016) study where service users encounter with, and use of service enhances knowledge acquisition.
The challenges in accessing specialised healthcare services including rehabilitation services as reported in this study are enormous and consistent with previous studies including Magaqa et al. (2021), Smith and Gallego (2021) and Martin et al. (2021). Our study found that over half of the participants (54.85%) made efforts to access at least a rehabilitation service for their wards. Unfortunately, only 27.18% of family members who tried the rehabilitation services were successful. This could be attributed to the numerous challenges or barriers such as financial, attitudinal, unavailability of services, stigma and distance to service centres. This may be worsened by the outmoded traditional beliefs of CWDs being not resourceful, liabilities and associated with shame (Martin et al. 2021; Owusu et al. 2018). This is evident in our study where the majority of family members attributed their failure to access rehabilitation services to shy feelings and discouragement from other people in the community, which is consistent with Martin et al. (2021). This ill behaviour towards persons with disabilities is widespread and exists among healthcare providers as well. Earlier studies reported negative attitudes of healthcare providers towards persons with disabilities and their families as barriers to accessing healthcare services (Agaronnik et al. 2019; Soltani et al. 2017). This was confirmed by 70.39% of our study participants. These attitudes are known for exacerbating the healthcare disparities between CWDs and their counterparts without disabilities (Adugna et al. 2020).
As a largely rural setting, the distance and transportation barriers to accessing rehabilitation services were anticipated and confirmed by 75.24% of our study participants. This finding supports earlier reports of poor road networks coupled with limited availability of vehicles as mobility challenges in most rural areas of Ghana (Afari et al. 2014; Patel et al. 2016). Similarly, in an economically deprived setting, financial challenges to accessing specialised services including rehabilitation services were equally expected. This assertion was confirmed by 95.63% of our study participants and supports earlier studies by Udeh et al. (2014) and Devendra et al. (2013) who reported financial challenges as hindrances to accessing specialised services.
Consistent with other studies (De Vries McClintock et al. 2016; Gal et al. 2010), participants expressed dissatisfaction with the rehabilitation services and/or the processes leading to access or utilisation of these services. Over half of the participants reported being very dissatisfied with the cost implications of seeking rehabilitation services. This dissatisfaction is compounded by the long distances to the rehabilitation service centres and the waiting times before services are provided. These experiences may not only be dissatisfying but also discourage family members from making further efforts to obtain the necessary rehabilitation services for their children. This, in turn, exacerbates the already limited opportunities for CWDs to access health services (Adugna et al. 2020; Kuo et al. 2022). For unknown reasons, most participants refused to comment on the attitude of the rehabilitation professionals.
Conclusion
This study highlighted key challenges in accessing rehabilitation services for CWDs in the UWR of Ghana. Family members expressed dissatisfaction in various areas when seeking rehabilitation care for their wards, citing issues such as cost and distance. These challenges could negatively impact their decisions and efforts to seek rehabilitation services, thereby exacerbating the already limited opportunities available for CWDs to meet their rehabilitation needs.
Furthermore, this research has focussed on the need for policy intervention to increase the number of rehabilitation service centres and funding of the rehabilitation services (perhaps, through the National Health Insurance Scheme) in order to facilitate access to these services for family members and their wards.
Acknowledgements
The authors are grateful to the participants for taking the time to be involved in this study. They would also like to extend their heartfelt thanks to research assistants: Mrs Priscilla Dangyi, Mr Bado Peter and Mr Pius Dery, for their support in data collection.
Competing interests
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
Funding received from the Kwame Nkrumah University of Science and Technology may be affected by the research presented in the enclosed publication. The author has fully disclosed these interests and has implemented an approved plan to manage any potential conflicts arising from their involvement. The terms of these funding arrangements have been reviewed and approved by the affiliated university in accordance with its policy on objectivity in research.
Authors’ contributions
H.V., E.D. and R.T. conceptualised and designed the study. H.V. and R.T. created the questionnaire, supervised the data collection and drafted the article. M.A.Q. analysed the data and wrote the findings. E.D. and M.A.Q. revised and edited the final article. All authors contributed to the final article and approved it for publication.
Funding information
The first author reported receiving funding from the Kwame Nkrumah University of Science and Technology (KNUST) Research Fund (KReF), Office of Grants and Research (Ref. No.: VC/OGR/15).
Data availability
The data associated with this study are available from the corresponding author, H.V., upon request.
Disclaimer
The views and opinions expressed in this article are those of the authors and are the product of professional research. It does not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or that of the publisher. The authors are responsible for this article’s results, findings and content.
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