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Healthcare Delivery of Clinical Preventive Services for People with Disabilities

Draft Comments Apr 17, 2024
Download files for this report here.

  • Studies on barriers and/or facilitators to the receipt of clinical preventive services among people with disabilities are lacking for most preventive services and most types of disability.
  • By far, the largest number of studies on barriers/facilitators have been related to the receipt of breast cancer screening and/or cervical cancer screening.
  • For breast and cervical cancer screening, studies reported on most categories of barriers/facilitators and included all types of disability; for other preventive services, fewer studies reported fewer categories of barrier/facilitator and fewer types of disability.
  • Evidence on interventions to improve the receipt of clinical preventive services among people with disabilities is especially limited, with most studies also related to breast and cervical cancer screening.
  • Limited evidence from three trials found various educational and health advocacy interventions to be associated with increased rates of breast and cervical cancer screening among women with physical disabilities, cognitive/intellectual/developmental disabilities, and serious mental illness.
  • Evidence on interventions to improve the receipt of other preventive services is more limited, with no clear effect of the interventions for any preventive service.

Objectives: The purpose of this review is to (1) document and summarize barriers and facilitators to the receipt of clinical preventive services among people with disabilities; and (2) evaluate the literature on the effectiveness of interventions to improve the receipt of clinical preventive services among people with disabilities.

Data Sources: We performed searches in electronic databases (Ovid®, MEDLINE®, PsycINFO®, Embase®, the Cochrane Central Register of Controlled Trials, and EBSCO CINAHL Plus) from 1990, the year of passage of the Americans with Disabilities Act (ADA), through November, 2023; manual review of reference lists; suggestions from stakeholders; and responses to a Federal Register Notice.

Review Methods: Following the Agency for Healthcare Research and Quality Methods Guide (available at: Methods Guide), the review methods were determined a priori and a protocol was developed through collaboration with Federal partners, Key Informants, and a Technical Expert Panel. We used predefined criteria for independent dual review of abstracts and full-text articles to determine inclusion of studies related to 20 clinical preventive services with Grade A or Grade B recommendations by the U.S. Preventive Services Task Force. We assessed individual studies for general quality (studies of barriers/facilitators) or risk of bias (effectiveness studies) using dual review and criteria specific to the different study designs. Predefined data from studies were abstracted into tables by one reviewer and verified by a second reviewer. Barriers and facilitators were classified into seven general categories (environment-level, person-level, provider-level, healthcare system-level, accessibility of healthcare facility, accessible communication, and policy-level). Barriers/facilitators and interventions were described and presented for each preventive service according to general types of disability (physical, cognitive/intellectual/developmental, sensory, and serious psychiatric/mental illness). Due to high methodological/clinical heterogeneity of the studies and limited available data, we did not assign strength of evidence ratings or conduct meta-analyses.

Results: Of 11,010 references, we included 68 studies – 54 reported on barriers/facilitators and 16 reported on the effectiveness of interventions. For barriers/facilitators and for the effectiveness of interventions, evidence was lacking for most preventive services and generally limited to one or two types of disability for any given preventive service. Studies on barriers/facilitators were related to 10 of the 20 preventive services included in the review, and studies on the effectiveness of interventions were related to 8 of the 20 preventive services. Most evidence was for two preventive services – breast cancer screening and cervical cancer screening. For breast and cervical cancer screening, studies reported on most categories of barriers/facilitators and included all types of disability; for other preventive services, fewer studies reported fewer categories of barrier/facilitator and fewer types of disability. Limited evidence from three trials found various educational and health advocacy interventions to be associated with increased rates of breast and cervical cancer screening among women with physical disabilities, cognitive/intellectual/developmental disabilities, and serious mental illness.

Conclusions: We found limited evidence on barriers and facilitators to the receipt of most clinical preventive services among people with disabilities, and especially limited evidence on interventions to improve the receipt of those preventive services. Most studies were related to breast and cervical cancer screening. The lack of studies for most preventive services and types of disability underscores the need for research to address the substantial gaps in the evidence.

Project Timeline

Healthcare Delivery of Preventive Services for People with Disabilities

Apr 28, 2023
Topic Initiated
Oct 24, 2023
Apr 17, 2024
Draft Comments
Page last reviewed April 2024
Page originally created April 2024

Internet Citation: Draft Comments: Healthcare Delivery of Clinical Preventive Services for People with Disabilities. Content last reviewed April 2024. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.
https://effectivehealthcare.ahrq.gov/products/people-with-disabilities/draft-report

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