Barriers to and facilitators of communication to care for people with sensory disabilities in primary health care: a multilevel study

Condessa, Aline Macarevich; Giordani, Jessye Melgarejo do Amaral; Neves, Matheus; Hugo, Fernando Neves; Hilgert, Juliana Balbinot

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 23 • 2020 • https://doi.org/10.1590/1980-549720200074 copy

Barriers to and facilitators of communication to care for people with sensory disabilities in primary health care: a multilevel study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Objective:

Communication barriers are the main obstacle for people with sensory disabilities (visual and hearing) to access health services. This study aims to describe the presence of facilitators of communication of basic health units in Brazil and to verify its associated factors.

Methods:

Cross-sectional multilevel study, of 38,811 health units in 5,543 municipalities between 2012 and 2013, collected in the National Program for Improving Access and Quality in Primary Care (Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica - PMAQ-AB). The outcome was defined by grouping facilitators of communication (braille material; hearing resources; visual communication; accessible list of service; professionals to welcome users with sensory disabilities). The two levels were structured, using the variables: level I (contextual): macro region, population size, and GDP per capita; and level II (service): extended professional team (psychologist/social worker); service shifts; welcoming room; publishing of service hours; presence of physical access facilitators. Multilevel Poisson regression with hierarchical modeling was used in both stages.

Results:

The presence of facilitators of communication is small in Brazilian health units (32.1%). It is more frequent in the municipalities with a higher GDP (RP = 1.02, 95%CI 0.92 - 1.12) and population size (RP = 1.25, 95%CI 1.02 - 1.52).

Conclusion:

Welcoming users is the main access facilitator and should be the focus of initiatives to improve health care for disabled persons. Universal access with adequate services, removal of communication barriers and encouragement to properly welcome users must be promoted.

Keywords:
Communication barriers; Primary health care; Disabled persons; User embracement

		Facilitators of communication
		Yes	No
		n (%)	n (%)
Facilitators of communication	Professional for welcoming users	8,195 (21.1)	30,616 (78.9)
	List of services for DP	4,200 (10.8)	34,611 (89.2)
	Visual communication of health services	3,336 (8.6)	35,475 (91.4)
	Hearing resources	148 (0.4)	38,663 (99.6)
	Braille	83 (0.2)	38,728 (99.8)
Facilitators of communication (outcomes) Gross Domestic Product*	One or more	12,464 (32.1)	26,346 (67.9)
	1^st tertile	3,426 (26.5)	9,521 (73.5)
	2^nd tertile	3,933 (30.3)	9,026 (69.7)
	3^rd tertile	5,105 (39.6)	7,799 (60.4)
Population size (inhabitants)*	Up to 5,000	757 (31.9)	1,617 (68.1)
	5,001 to10,000	1,099 (29.3)	2,647 (70.7)
	10,001 to 50,000	4,980 (28.5)	12,497 (71.5)
	50,001 to 100,000	1,613 (31.5)	3,503 (68.5)
	100,001 to 500,000	2,392 (36.8)	4,112 (63.2)
	More than 500,000	1,623 (45.2)	1,970 (54.8)
Macroregion*	Northern	685 (21.3)	2,525 (78.7)
	Northeastern	4,063 (27.8)	10,574 (72.2)
	Central-Western	770 (28.5)	1,936 (71.5)
	Southern	2,293 (36.3)	4,021 (63.7)
	Southeastern	4,653 (39.0)	7,290 (61.0)
Extended professional team*	No professional	8,483 (28.5)	21,252 (71.5)
	Psychologist or Social Worker	1,834 (41.4)	2,599 (58.6)
	Psychologist and Social Worker	1,879 (47.1)	2,109 (52.9)
Care model*	Traditional	804 (18.2)	3,612 (81.8)
Care model*	FHS/parameterized	9,228 (33.8)	18,041 (66.2)
Welcoming room*	No	7,700 (26.8)	21,065 (73.2)
Welcoming room*	Yes	4,711 (47.4)	5,223 (52.6)
Facilitators of physical access*	0	550 (74.0)	193 (26.0)
	1	9,488 (79.7)	2,417 (20.3)
	2	6,946 (70.6)	2,888 (29.4)
	3	4,797 (62.4)	2,888 (37.6)
	4	3,264 (54.6)	2,712 (45.4)
	5	1,301 (48.8)	1,366 (51.2)
Service shifts*	1	3,625 (83.6)	710 (16.4)
	2	21,602 (66.3)	10,991 (33.7)
	3	1,119 (59.5)	763 (40.5)
Publishing of service hours*	No	5,169 (22.9)	17,364 (77.1)
Publishing of service hours*	Yes	7,295 (44.8)	8,982 (55.2)

		Adjusted analysis^a				Adjusted analysis^b
		PR	95%CI		p	PR	95%CI		p
GDP	1^st tertile	1				1
	2^nd tertile	1	0.92	1.09	0.99	0.98	0.90	1.07	0.63
	3^rd tertile	1.12	1.01	1.23	0.03	1.02	0.92	1.12	0.76
Population size (inhabitants)	Up to 5,000	1				1
	5,001 to 10,000	0.95	0.85	1.05	0.31	1.03	0.92	1.15	0.64
	10,001 to 50,000	0.94	0.86	1.03	0.19	1.05	0.95	1.15	0.36
	50,001 to 100,000	1.02	0.90	1.15	0.77	1.11	0.98	1.25	0.09
	100,001 to 500,000	1.11	0.98	1.26	0.09	1.18	1.04	1.33	0.01
	More than 500,000	1.32	1.06	1.65	0.01	1.25	1.02	1.52	0.03
Macroregion	Northern	1				1
	Northeastern	1.25	1.11	1.42	0.00	1.27	1.12	1.43	0.00
	Central-Western	1.23	1.05	1.43	0.01	1.11	0.95	1.30	0.20
	Southern	1.5	1.31	1.71	0.00	1.28	1.11	1.47	0.00
	Southeastern	1.67	1.48	1.89	0.00	1.35	1.19	1.53	0.00
Extended professional team	None					1
	Psychologist or Social Worker					1.12	1.06	1.20	0.00
	Psychologist and Social Worker					1.19	1.12	1.27	0.00
Care model	Traditional					1
Care model	FHS					1.50	1.38	1.62	0.00
Welcoming room	No					1
Welcoming room	Yes					1.28	1.22	1.35	0.00
Facilitators of physical access	0					1
	1					0.85	0.72	1.01	0.06
	2					1.06	0.90	1.25	0.51
	3					1.22	1.03	1.43	0.02
	4					1.36	1.15	1.61	0.00
	5					1.41	1.19	1.68	0.00
Service shifts	1					1
	2					1.38	1.27	1.51	0.00
	3					1.45	1.29	1.65	0.00
Publishing of service hours	No					1
Publishing of service hours	Yes					1.56	1.49	1.63	0.00

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[1] Corresponding author: Aline Macarevich Condessa. Rua Professor Cristiano Fischer, 2.138, 1.604, Partenon, CEP: 91410-001, Porto Alegre, RS, Brazil. E-mail: alinemacarevich@yahoo.com.br