Keyword

1 Introduction

In actuality, 1 billion people need assistive technology (AT) to lead productive, inclusive and dignified lives, but only 1 in 10 people globally have access to the AT they need. Access to AT is essential for many people to maintain and improve function, health and well-being, and to participate in education, work and social activities. Among the people who commonly need AT are older people, people with disabilities and people living with chronic conditions. As the world population ages and the prevalence of noncommunicable diseases increases, the need for AT will continue to rise [1, 2].

Few statistics have been systematically gathered in countries to show the demand for AT among national populations and the need that is currently unmet, despite the urgency and the worldwide imperative to enhance access to AT. [3] The AT supply is highly fragmented and almost non-existent in many middle and low-resource settings with limited purchasing power and no service delivery systems. Historically, most of the governments in low/middle-income countries have not prioritized this sector [4].

In low and middle income countries, as most of the Latin American countries, assistive technologies are not universally accessible for a number of reasons, including high costs, limited availability, a lack of governance, inadequate financing, widespread lack of knowledge, and a shortage of staff with the requisite training [5].

In the Dominican Republic, 12.3% of the overall population lives with a disability, according to the 2010 Census on Population and Residence, representing 1 of every 8 people and constituting a total of 1,160,847. Physical and motor disabilities, visual impairments, attention deficit disorder, and auditory impairment are the most prevalent disabilities in the nation [6].

Despite the existence of a legal framework on disability, as in most of the developing countries, in the Dominican Republic there is no comprehensive source of data about the availability of Assistive technology devices. This can be explained with the fact that some of the main providers or leading suppliers of AT products and services are non-state actors, and databases are frequently maintained on an organizational basis with rarely external sharing (as is the case with NGOs) [6,7,8].

Therefore, for AT purchasers, such as governments, UN agencies, and civil society organizations, to decide whether to invest in the infrastructure of the AT supply chain, as well as for AT designers and distributors to identify the populations in need of ATs, data on Dominican AT supply and demand is required.

The purpose of this study is to investigate about the access and use of Assistive products(AP) in the province of Espaillat, in Dominican Republic, as well as the barriers to access and users’ satisfaction with products provided. Furthermore, the study aimed to gain more insight into the methods people use to meet their needs for AT and produce evidence on the strengths and weaknesses of the current system by choosing a target population of community-dwelling individuals attending rehabilitation services provided by the local public healthcare system.

2 Method

With a target demographic of 15 outpatient of a public rehabilitation center, the WHO’s rapid Assistive Technology Assessment tool (rATA) survey [9] was implemented as a stand-alone technique.

The selected rehabilitation center is a public rehabilitation center of Espaillat province, and it is in charge of providing rehabilitation services for people with all kinds of disabilities, including acquired brain damage, spinal cord injury, neurological, orthopedic, rheumatologic, and post-intensive care unit rehabilitation, among many other diseases. According to this viewpoint, its rehabilitation services are responsible for managing all functional domains addressed by the rATA (mobility, vision, hearing, cognition, communication, and self-care).

The study received ethical approval from the Yonsei University Institutional Review Board. All surveys were conducted through face to face interviews in January-February 2023.

3 Result

In total, 15 individual responses (73,3% females; 26,7% males) were collected in the period January-February 2023. Overall, most respondents lived in rural areas (73.3%) and were adults aged 18–64 years (66,7%), followed by adults 65 + years (33.3%). (Table 1) A closer examination of the data revealed that the distribution of AT users across the Espaillat province geographic area was well balanced, with no discernible differences across districts.

Table 1. Demographic data
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The higher use of AP was reported for individuals with a functional limitation in the mobility domain. The most commonly reported AT product in use was the cane (7), followed up by manual wheelchair (3), rollator (2), orthoses for lower limb (2), glasses of low vision (2) and axillary elbow crutches (1) (Table 2).

In terms of the sources to access the AP, they were most commonly obtained from a family member or friends (46.7%) or the private sector (26.6%) followed by the non-government organization (NGO) sector sources (13.3%), while only 6,7% were obtained through the public sector sources or were self-made. The majority of the users (33.3%) paid out-of-pocket for their AP(s) or relied on family/friends (46,7%) and only 13.3 and 6.7% were paid by government funding or a NGO respectively. Most AT users traveled less than 5 km (40%) or 6–25 km (33.3%) to obtain their AP(s) (Table 3).

Table 2. List of used assistive products.
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When asking the users about their satisfaction, the majority (53%) of the users reported being dissatisfied with their AP. And when it comes to the unmet need, the most commonly reported reason was ‘cannot afford’ (40%), followed by AP unavailable (33.3%), lack of time (13.3%), lack of support (6.7%), and AP not suitable (6.7%). (Table 3).

Table 3. Assistive Product Information
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Regarding unmet needs, some users mentioned simply needing a replacement for the same product they were using, but other products such as powered wheelchairs, therapeutic footwear, fall detectors, hearing aids, smart phones/tablets/PDA, GPS locators, chairs for shower/bath/toilet and grab-bars/Handrails were mentioned. (Table 4).

Table 4. List of needed assistive products. (Unmet need)
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4 Discussion

Despite the small sample size, the information gathered provides valuable insight into the use of assistive products in the Dominican Republic. During interviews, it became clear that we were raising awareness of the wide range of products and services that fall under the umbrella term of ‘assistive technology’ as defined by the WHO, and that a large-scale national questionnaire would be of significant benefit in raising population awareness in the Dominican Republic.

The findings of the study highlighted cost-related factors influencing AP access. For example, among AP users, aside from those acquired from a family member or friend, APs were most commonly obtained from private providers and paid out of pocket, and the most frequently reported barrier to AP use was high cost. This suggests a gap in public provision of AP in this setting, which is consistent with studies conducted in other developing countries [10, 11] and indicates that low/no cost AP provision is still limited, despite the presence of some Public institutions and NGOs providing rehabilitation services in Espaillat province. This could be due to these organizations’ limited resources and capacity to deliver at a bigger scale.

When discussing unmet needs, the majority of users only had mobility assistive products and a minority vision products, however products to assist in hearing, communication and personal care were reported as needed, but not currently used, highlighting the small range of AP that the respondents in this population had access to.

Similar to previous research in low and middle income countries, mobility and vision related APs are used more frequently and their unmet is more commonly reported than APs for other functional domains [12]. These results might be explained by a number of variables, such as the accessibility of these services in Espaillat and the population’s stronger knowledge and comprehension of mobility and vision issues in comparison to other areas, given that these functional challenges are generally more evident and well-known.

The reported unmet demands might indicate the need for additional or alternative APs in addition to replacements. This may be due to the high cost, unavailability and the lengthy waits for medical examinations, which push users to utilize products that are defective or simply worn off. Information on how to obtain new prescriptions is also lacking. In addition, because the majority of the items on the funding-approved product lists are mobility aids, many other domains are neglected.

Regarding the access to AT products, the recommendation section revealed a low level of satisfaction. The most common complaint was about the government provision, being considered “insufficient” and “providing low levels of user needs and satisfaction”. Respondents also stated that, after charity, the only option was to obtain the AP from private companies at a very high cost. A number of respondents stated that they had no recommendations to make because they were unfamiliar with the system, emphasizing the lack of awareness and education about APs and their services.

This study had some limitations, such as the small sample size. Another limitation is that the findings of this study cannot be generalized to other settings in the Dominican Republic because the government institutions, private institutions and non-governmental organizations (NGOs) that provide rehabilitation services vary by region. As a result, it is recommended that future surveys be conducted in other parts of the country.

5 Conclusion

Access to AP for disabled people and the elderly should be considered a national priority in order to prevent social inequalities and improve the Dominican population’s quality of life. Costs, lack of information, and product availability all work together to create significant unmet needs, which is a barrier to fair development and the enhancement of general well-being.

The current country’s AP services are not providing the enough coverage. While acknowledging and enhancing existing supply lines, new measures should address the lack of understanding regarding AP.

In order to get the right solutions for the provision of assistive technology in humanitarian contexts, it is needed to develop products that can be easily sourced, environmentally friendly, and easily maintained.

Based on the current findings, actions should be taken to promote the collection of data on AP access in order to determine the current state of AP systems across the country and lay the groundwork for system improvement. Additional research is needed to determine how to fulfill demand in the Dominican Republic in order to solve the huge gap in access to appropriate assistive technology.