A patient self-report Disability Identifier within health service Electronic Medical Records: evaluation of patient, carer and clinician acceptability

A patient self-report Disability Identifier within health service Electronic Medical Records: evaluation of patient, carer and clinician acceptability | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A patient self-report Disability Identifier within health service Electronic Medical Records: evaluation of patient, carer and clinician acceptability Joanne Rowe, Alexandra Devine, Nicole Merrick, Marie Huska, Kristen Morris, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6218627/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Jul, 2025 Read the published version in BMC Health Services Research → Version 1 posted 10 You are reading this latest preprint version Abstract Background: A third of the 5.5 million Australians with a disability require adjustments to access healthcare effectively. Ensuring clinicians have timely information about a patient’s disability and care needs can support more responsive care. Disability Identifiers—brief question sets—offer a practical way to capture this information. However, their use in healthcare remains limited. To address this, a group of clinicians, consumers and researchers from five tertiary and quaternary health services in Victoria, Australia, co-designed and implemented patient self-report Disability Identifier within Electronic Medical Record systems. This paper presents an evaluation of the acceptability of this intervention among patients, carers, and clinicians. Methods: The Disability Identifier questions were integrated into Electronic Medical Record systems across the five health services in March 2023, with the evaluation spanning the first nine months of implementation (1 st March–30 th November 2023). Using a mixed methods convergent parallel design and guided by the Theoretical Framework of Acceptability, we conducted online surveys, interviews, and focus groups with patients, carers, and clinicians. Data analysis explored perspectives and experiences across eight constructs: general acceptability, affective attitude, burden, ethicality, intervention coherence, opportunity costs, self-efficacy, and perceived effectiveness. Results: Survey results indicated strong acceptability of the Disability Identifier questions. Interviews with patients and carers reflected generally positive perceptions of the intervention, with many noting that it signalled a commitment by health services to improving care for people with disability. Clinicians emphasised that, with adequate training and resources, the intervention could raise awareness about disability and contribute towards disability-responsive care. Conclusions: Integrating patient self-reported Disability Identifiers into EMR systems marks a critical step toward improving disability-responsive healthcare. Building trust in Disability Identifiers requires clear communication about their purpose, benefits, and role in improving care while also addressing disability awareness and discrimination in healthcare settings. While continuous evaluation of their use and impact on patient experiences and outcomes is recommended, this research lays the foundation for other jurisdictions to adopt a standardized approach to integrating Disability Identifiers into health data systems. Ultimately, effective use of patient self-report Disability Identifiers has the potential to promote more equitable health outcomes for people with disability. Disability Disability Identifiers Electronic Medical Records Healthcare Universal Access Health Equity Disability Data Acceptability Co-design INTRODUCTION More than 5.5 million Australians live with disability, representing 21% of the national population ( 1 ). Barriers to healthcare access are often encountered by people with disability and contribute to substantial health inequities experienced by this group ( 2 ). For example, people with disability are more likely to experience and prematurely die from non-communicable (e.g. cardio-vascular disease, cancer, mental illness) and communicable diseases (e.g. Tuberculosis, COVID-19)( 2 – 7 ). One in three Australians with disability require adjustments in how care is provided to enable access to healthcare ( 7 ). When this need for assistance or adjustment is not recognised or provided, the health inequities experienced by people with disability are likely to be exacerbated. Providing clinicians access to timely information about patient disability and care needs has the potential to help address health inequities by enabling disability-responsive healthcare ( 2 , 8 ). Identifying and flagging information about patients with disability and their care needs early during healthcare interactions, such as at intake or admission, can help clinicians make informed decisions about necessary adjustments required to improve patient care for the individual ( 9 ). Globally, there are very few examples where Disability Identifiers have been integrated within health service administrative or clinical data sets to inform disability-responsive care or monitor health outcomes ( 10 , 11 ). The United Kingdom’s National Health Service Reasonable Adjustment Flag records a person’s needs and adjustments ( 12 ). Research in the United States is working to evaluate strategies within primary care to document patient communication needs within electronic health records to inform adjustments ( 13 ). In other settings, disability questions, such as the Washington Group Short Set on Disability - designed for use in population-based surveys - have been piloted within local health service admission processes in Cambodia ( 14 ), Paraguay ( 15 ), India & Tanzania ( 16 ) and Bangladesh ( 2 , 10 , 17 ). Within the Australian context, Fortune et al (2023) were engaged by the federal government to undertake work to develop Disability Identifier questions, which have now been included in My Medicare : an online voluntary patient registration system within primary health care (general practice) ( 9 , 18 ). To our knowledge, however, Australian health service and hospitals are yet to routinely collect data within health administration systems to identify individuals with disability ( 9 ). To address this gap, a team of clinicians, consumers, and researchers from five tertiary and quaternary hospitals in Victoria (Australia’s second most populous state) co-designed and integrated a patient self-report Disability Identifier (DI) into their Electronic Medical Record (EMR) systems (see Supplementary File – Section 1). A mixed-methods evaluation was conducted to examine its implementation and early use, assessing the DI’s utility and acceptability over the first nine months following integration (1st March–30th November 2023) ( 19 ). During this period, 20,083 patients completed the DI across the five participating health services (see Supplementary File – Table 1 for details on patient characteristics). This paper focuses specifically on the acceptability of the intervention from the perspectives of patients, carers, and clinicians. Using online surveys, semi-structured interviews, and focus group discussions, we explored experiences of completing the self-report disability questions and factors influencing engagement with the DI. This study addresses the research question: What is the acceptability of the DI from the perspectives of patients, carers, and clinicians? METHODS 2.1 Study design This research adopted a convergent parallel mixed methods study design, guided by the Theoretical Framework of Acceptability (TFA) ( 20 ). Online surveys, qualitative interviews and focus group discussions (FGDs) were collected concurrently and analysed independently. Integration of both quantitative and qualitative results was guided by the TFA as further described below ( 20 ). 2.2 The Theoretical Framework of Acceptability Developed by Sekhon et al (2022), the TFA was specifically developed to enable evaluation of the acceptability of healthcare interventions as perceived and experienced by intervention providers and recipients. It consists of seven inter-connected constructs: i) Affective attitude (how an individual feels about the intervention); ii) Burden (perceived amount of effort that is required to participate in the intervention); iii) Ethicality (extent to which the intervention aligns with an individual’s value system); iv) Coherence (extent to which the individual understands the intervention and how it works); v) Opportunity Costs (extent to which benefits, profits or values must be given up to engage in the intervention); vi) Self-Efficacy (individual’s confidence that they can perform the expected role/behaviours required to participate in the intervention); and vii) Perceived Effectiveness (degree to which the intervention is perceived as likely to achieve its purpose) ( 20 ). 2.3 Ethics statement Ethics approvals for this multi-site study were obtained by the RCH Human Research Ethics Committee (Project HREC/100979/RCHM2023) and Austin Health’s Human Research Ethics (Project HREC 97208/Austin-2023). 2.4 Quantitative methods Online surveys of patients, carers and clinicians Participant eligibility and recruitment Eligibility at Parkville health services for the patient and carer online survey was determined by retrospective audit of EMR data, including those who had responded (Yes/No/Declined to answer) to the primary DI question (Q1) between 29th March – 30th November 2023 and were over 18 years old (n = 10,103). Eligible individuals were invited to complete the survey either via a message on their patient portal (for active users) or postal letter. Invitations included a link to the survey with an embedded Participant Information Statement outlining that completion of the survey implied consent. Eligible Austin Health patients and carers included individuals who had responded Yes to the primary DI question (Q1) between 1st March – 30th November 2023 and were over 18 years old (n = 1,785). They were invited to participate via email or text message. In the absence of a response to initial contact, a single reminder was sent to all potential participants via the same contact mode before being considered lost to follow up. Eligible Parkville Clinicians included those who had completed the DI on or after the 29th March 2023 (n = 972). They were invited to participate via an email that included the study information and a link to the survey, again outlining that consent was implied by completion. Three reminders were sent. Eligible Austin Health staff included those who had completed a patient admission assessment on or after 1st March 2023 (n = 2,540). As above, they were invited to participate via email, with two email reminders sent. Data collection Two online surveys were created to assess i) patient and carer, and ii) clinician perspectives on and experiences of the DI questions and their use within EMR to inform disability-responsive care. The surveys were aligned with a generic TFA survey developed by Sekhon et al (2022). Following review by the research team, the component Ethicality was excluded from the survey due to concerns regarding comprehensibility of the survey item. This construct was therefore not captured in the online survey, however, was explored qualitatively via semi-structured interviews and FGDs. The online surveys were administered electronically via Research Electronic Data Capture (REDCap) ( 21 ). Data analysis Survey data were analysed by generating scores for each of the six TFA constructs examined, as well as generating a single Acceptability score by i) Computing the total mean score of the six TFA constructs, and ii) using the score for the General Acceptability item. Higher mean scores indicate stronger acceptability, including for burden and opportunity cost constructs which were inversely rated in the survey (see Supplementary File Section 3 Tables 2 and 3 ). Responses to open-ended questions included in the surveys were analysed using simple thematic analysis and included in the overall synthesis of findings. 2.5 Qualitative Phase 2.5.1 Qualitative interviews with patients and carers Patient and carer perspectives on and experiences with the DI questions and engaging with the DI process were further explored through semi-structured interviews. Participant eligibility and recruitment Potential participants included existing patients and carers who had completed the online survey and provided consent to be contacted to participate in a follow-up interview. The research team sought to identify a representative sample of participants regarding disability, gender, age and health service (noting only patients accessing Parkville health services participated in this component). Potential participants were invited to participate via their preferred mode of contact (i.e. email or text message). Participant Information Statements were sent via email or discussed via telephone. Informed consent was obtained prior to the interview with capacity to provide consent ascertained via seven Easy English true/false questions. Data collection A date and time to conduct the interview via phone or online platforms (e.g., Zoom, Microsoft Teams) were arranged with interested participants. Patients and carers were asked about their understanding of the questions and how they felt about the intervention, the perceived usefulness and burden, and suggestions for improvement. Interviews lasted for between 30 and 60 minutes. Data analysis Interviews were recorded and transcribed verbatim. Analysis commenced with familiarisation and immersion. Initial coding was completed deductively drawing on the TFA framework, with data categorised under the seven TFA Constructs. Inductive coding was conducted in conjunction with this process with data categorised into emerging codes and sub-categories to document patient/carer perspectives and experiences that did not align specifically with the TFA Constructs. Two researchers (AD, MH) participated in this process independently and via discussion. Ongoing discussions were similarly conducted with the wider research group to contextualise and triangulate findings. 2.5.2 Focus Group Discussions with clinicians FGDs were completed with clinicians at each of the Parkville health services, with the intention to explore the implementation experience from the clinician’s perspective. Participant eligibility and recruitment Clinicians who completed the online survey and provided their information to be contacted regarding participation in a focus group discussion were eligible. Recruitment of clinicians was coordinated through site investigators. A purposive sampling approach was undertaken to achieve diversity of experiences across key clinical groups (Allied Health, Nursing and Medical) at each participating site. Potential participants were invited via email and provided with the Participant Information Statement and Consent form. Data collection Discussions were designed to develop an understanding of barriers and facilitators to the adoption of the DI questions and opportunities to improve their use. FGDs were completed via Zoom. Data analysis FGDs were recorded and transcribed verbatim, before being uploaded into NVivo (v14) for analysis. Two researchers independently coded the data (NM, IG). Data analysis commenced with familiarisation and immersion. Initial coding was completed inductively via an iterative approach, where codes represented the building blocks of the analysis. Codes were organised into content categories and sub-categories and then further analysis used a deductive approach, to understand clinician perspectives in context of the TFA. Three researchers participated in this step (NM, JR, IG) both independently and via discussions between the three researchers and the wider research group, to facilitate deeper engagement with the data, and challenge individual interpretations. RESULTS 3.1 Participant characteristics and demographics A combined total of 1,181 patients and 180 carers completed the online survey (Table 1 ). A total of 221 clinicians completed the clinician online survey (Table 2 ). Nine patients and five carers completed the semi-structured interviews (Table 3 ). Twenty-eight clinicians took part in FGDs (Table 4 ). Table 1 Demographics of Patients and Carers Completing the Online Survey by Hospital RCH n (%) RWH n (%) PMC n (%) RMH n z(%) Austin Health n (%) Total n (%) Survey Respondent Patient 6 (4.7%) 296 (98.7%) 201 (89.7%) 644 (95.6%) 34 (100%) 1,181 (86.8%) Carer** 123 (95.4%) 4 (1.3%) 23 (10.3%) 30 (4.5%) - 180 (13.2%) Gender Male 69 (53.5%) 4 (1.3%) 105 (46.9%) 279 (41.4%) 24 (70.6%) 481 (35%) Female 57 (44.2%) 287 (95.7%) 117 (52.2%) 387 (57.4%) 9 (26.5%) 857 (63%) Gender Diverse 3 (2.3%) 9 (3.0%) 2 (0.9%) 8 (1.2%) 1 (2.9%) 23 (1.2%) Age 0–4 26 (20.2%) - - - - 26 (1.9%) 5–11 60 (46.5%) - - - - 60 (4.4%) 12–17 35 (27.1%) 3 (1.0%) - - - 38 (2.7%) 18–30 8 (6.2%) 48 (16.0%) 6 (2.7%) 67 (9.9%) 4 (11.8%) 133 (9.7%) 31–45 - 197 (65.7%) 26 (11.6%) 127 (18.8%) 3 (8.8%) 353 (26%) 46–64 - 35 (11.7%) 98 (43.8%) 275 (40.8%) 9 (26.5%) 417 (30.6%) 65+ - 17 (5.7%) 94 (42.0%) 205 (30.4%) 18 (52.9%) 334 (24.5%) Disability Yes 90 (69.8%) 95 (31.7%) 104 (46.4%) 397 (58.9%) 29 (85.3%) 715 (52.6%) No 39 (30.2%) 205 (68.3%) 115 (51.3%) 271 (40.2%) 5 (14.7%) 635 (46.6%) Declined to Answer - - 5 (2.2%) 6 (0.9%) - 11 (0.8%) Need for Assistance Yes 58 (64.4%) 39 (41.0%) 28 (26.9%) 156 (39.3%) 20 (69.0%) 301 (41%) No 32 (55.6%) 56 (59.0%) 76 (73.1%) 241 (60.7%) 7 (24.1%) 412 (58%) Unknown - - - - 2 (6.9%) 2 (0.2%) Total 129 (9.5%) 300 (22.0%) 224 (16.5%) 674 (49.5%) 34 (2.5%) 1,361 (100%) * All % are column-wise (Hospital specific). The bottom row shows hospital totals as a proportion of the total data set. ** Note – all demographic data (age, gender, hospital, disability, disability type, assistance needed) relates to the patient for whom they provide care Table 2 Clinician Online Survey Demographics by Hospital RCH n (%) RWH n (%) PMC n (%) RMH n (%) Austin Health n (%) Total n (%) Survey Respondent Discipline Allied Health 1 (5.9%) 1 (3.7%) 1 (25.0%) 19 (38.0%) 12 (9.6%) 34 (15.4%) Medical 3 (17.6%) 3 (11.1%) - - 21 (17.0%) 27 (12.2%) Nursing 13 (76.5%) 16 (59.3%) 3 (75.0%) 31 (62.0%) 79 (64.2%) 142 (64.3%) Other - 7 (25.9%) - - 11 (8.9%) 18 (8.1%) Total 17 (7.7%) 27 (12.2%) 4 (1.8%) 50 (22.6%) 123 (55.7%) 221 (100%) * All % are column-wise (Hospital specific). The bottom row shows hospital totals as a proportion of the total data set. Table 3 Demographics of patients represented in the Patient and Carer semi-structured interviews (n = 14) Number of Patients n (%) Gender Male 3 (21.4) Female 11 (78.6) Gender Diverse - Age 0–17 3 (21.4) 18–30 1 (7.1) 31–45 1 (7.1) 46–64 7 (50) 65+ − (0) Not reported 2 (14.3) Area of difficulty * Seeing 2 (14.3) Hearing − (0) Speaking 2 (14.3) Learning 7 (50) Moving 9 (64.3) Mood 5 (35.7) Complex/ other 2 (14.3) Total 14 (100) *Individuals may have more than one area of difficulty, therefore proportions are not cumulative Table 4 Focus Group Discussion participant demographics (n = 28) Number of participants n (%) Discipline Allied Health 16 (57.1) Medical/ Nursing 10 (35.7) Administration 2 (7.1) Total 28 (100%) 3.2 Acceptability of Disability Identifier intervention Results from the online survey, interviews and FGDs were integrated and are presented below in alignment with the TFA. 3.2.1 General acceptability General Acceptability reflects the extent to which patients, carers and clinicians felt the intervention – in this case integrating self-reported DI questions within EMR and patient portal - is appropriate, feasible and would contribute towards improved processes and outcomes. Results from the online surveys demonstrated a strong General Acceptability mean score of 4.2 out of five across patients, carers and clinicians. Focusing in on our priority target group, i.e. respondents who positively identified as having disability and assistance needed to access health care, filtered to all respondents who recalled answering the DI in a healthcare encounter, we found higher acceptability overall with a General Acceptability mean score of 4.5 out of five (Table 5 ). Table 5 Individual TFA Construct and General Acceptability Scores* All patient & carer Respondents (Mean, CI) Patient & carer priority Sub-Group (Mean, CI) Clinician Respondents (Mean, CI) TFA Constructs Opportunity Cost 4.1 (4.0–4.2) 4.0 (3.8–4.2) 3.6 (3.3–3.9) Intervention Coherence 3.8 (3.8–3.9) 4.0 (3.8–4.2) 4.0 (3.6–4.2) Perceived Effectiveness 3.7 (3.6–3.7) 4.2 (3.9–4.2) 4.0 (3.7–4.2) Self-Efficacy 4.1 (4.0–4.1) 4.0 (3.8–4.2) 3.8 (3.6–4.0) Burden 4.5 (4.4–4.5) 4.1 (3.9–4.3) 4.0 (3.8–4.2) Affective Attitude 3.8 (3.7–3.8) 3.8 (3.6–4.0) 3.6 (3.3–3.9) General Acceptability 4.2 (4.2–4.3) 4.5 (4.3–4.6) 4.2 (4.0–4.4) Overall Acceptability (Percentage) Completely Acceptable 41.9% 52.8% 36.5% Acceptable 42.8% 41.6% 47.3% No Opinion 13.9% 5.6% 14.9% Unacceptable 0.3% 0.0% 1.4% Completely Unacceptable 1.2% 0.0% 0.0% * TFA Mean score interpretation: Very Weak (1.0 to 1.5); Weak (1.6 to 2.5); Moderate (2.6 to 3.5); Strong (3.6 to 4.5); Very Strong (4.6 to 5.0) – i.e., high scores indicate greater acceptability. ^ Priority sub-group represents patients positively identifying with a disability who required assistance to access the health service filtered to patients/carers who recalled answering the DI previously within a health care encounter(n = 89) Overall, patients and carers interviewed generally felt positive about the intervention, citing that it demonstrated that these health services were striving to improve services for people with disability. Nonetheless, most expressed concerns about the capacity to effectively utilise the DI to improve care. I wish that more places asked those kind of questions. … It was positive to feel like people actually cared and were asking such specific questions. But there was also the part of me that was like, I don’t think… that it's actually going to do any good, you know… who will actually look at the [DI responses] ? (Patient interview) Clinicians participating in the FGDs also felt the intervention provided an important opportunity to raise awareness about disability and had the potential to enhance disability-responsive care. They recommended refining the DI questions to better capture wider experiences of disability, including neurodivergence and psychosocial disability. Clinicians also noted the need for more purposeful training on disability and how best to integrate the DI questions in their workflow processes. However, clinicians also raised concerns around the burden of additional training and the time required to effectively utilise the DI in EMR. 3.2.1 Affective attitude – how an individual feels about the intervention Within this construct, the online survey mean scores of 3.8 out of five for patients and carers and 3.6 out of five for clinicians indicate respondents generally felt ‘comfortable’ completing the intervention. While still a moderate to strong score, this construct scored lower compared with other constructs for patients, carers and clinicians. Some survey participants noted that while disability and chronic conditions are complex and difficult to live with, they are comfortable to discuss them or answer questions in relation to them. As difficult as it can sometimes be dealing with both disabilities, I have no difficulty in answering questions about [them]. (Patient survey] Interview participants described feeling positive about having the option to complete the DI questions. The process was highlighted as enabling self-reflection on disability and related needs within the health system, with some prompted to more proactively communicate their needs with clinicians. Subsequent planning with clinicians improved feelings of safety and comfort during engagement with hospital services. Patients and carers were optimistic the intervention would help enhance disability awareness and clinician understanding of required supports. Yet, this was balanced with concern that the information provided would not be consistently utilised by staff, due to heavy workloads and insufficient capacity and resources to provide disability-responsive care. Even so, there was hope that the intervention would lead to better resourcing overtime, contributing to improved patient and carer experiences, along with a more inclusive and skilled healthcare workforce. It is so important for the hospital to be asking these questions to understand what patients with a disability – especially invisible disabilities – need. The challenge is then making sure the hospital can support our needs. Asking is the first step and hopefully helps to better understand the issues we face. (Patient interview) Clinicians agreed that the intervention can enhance awareness and their understanding of patient perspectives on disability. In turn, this can provide a common language for patient and clinician interactions to help identify what reasonable adjustments may improve experiences of care. Nonetheless, clinicians raised concerns that some clinicians may lack the confidence or willingness to ask the questions. I think clinicians find the questions like that uncomfortable. And if they’re uncomfortable often just choose not to ask it. They’re too awkward or uncomfortable and they just like, skim past it. (Clinician FGD) 3.2.2 Burden – the perceived amount of effort that is required to participate in the intervention This construct was reverse scored, with a higher mean score indicating lower perceived burden. Online survey results indicate minimal burden with an overall mean score of 4.0 out of five for clinicians and 4.5 out of five for patients and carers. Patients with disability and carers reported a slightly lower score of 4.1 out of five. Qualitative responses revealed perceived burden was related to time, ease and comfort. Patients and carers generally expressed minimal difficulty and low burden completing the DI questions. I thought the questions were pretty simple … I thought they were stock standard questions when you go to the doctor and they ask you “Do you have asthma”. Like it just kind of felt like that. Like you were just ticking off boxes. Which is fantastic. (Carer interview) A small number of individuals interviewed felt some tension with aspects of the questions. These patients and carers perceived that the intervention would contribute to clinician discomfort and burden, which exacerbated their own experiences of burden. In part, this related to a patient’s own level of comfort in responding to the DI questions, with some highlighting that the questions would have felt more burdensome earlier on in their disability journey. Similarly, a few clinicians expressed concerns around not knowing when to ask and whether it was appropriate given where the patient was on their healthcare journey. I feel that it would be hard for a lot of families, especially with our families of young children, the very beginning some families are still trying to take in the diagnosis for their young person ... then going to the hospital and being asked that (the questions) it might be quite traumatic for them. (Clinician FGD) Clinicians, patients and carers felt having the information embedded within the EMR could reduce the burden on patients to repeat their disability information and the burden associated with hospital administration, including when transitioning between hospitals or paediatric to adult services. I think there’s huge benefit to having the information and being able to access the information quickly or that it’s there and people don’t have to retell their stories, and it’s them articulating their own experience. Not us imposing kind of more diagnostic criteria or something of their experience. (Clinician FGD) However, embedding in the EMR didn’t appear to reduce clinician burden. Integrating the DI questions into clinician workflow and the extra time required to ask the questions was a common concern among clinicians, with some expressing the process doubled-up with information collected during a standard subjective examination. There appeared to be less perceived burden when the DI questions were built into bookings and admissions workflows, and when clinicians had more knowledge of and easier access to the DI questions. The booking screen and flow is quite easy to use. (Clinician FGD) 3.2.4 Ethicality – the extent to which the intervention has good fit with the individual’s value system As described earlier, Ethicality was not measured in the online surveys but was discussed in the interviews and FGDs. Patients and carers perceived that the intent of implementing the intervention was to improve outcomes for people with disability, which strongly resonated with individuals’ value systems. Completing the DI questions was also described as less about individual-level benefit, and more of a way to ‘give-back’ to the hospital and the disability community in promoting disability awareness and inclusion. I’d love it if there was some changes. … to help myself and others. ... But like I said, I try to help as much as I can. I mean, if it doesn't benefit me, it's OK. At least all this information … and get to the bottom of it to help others. … I didn't really think of myself. (Patient interview) Despite this, several patients, carers and clinicians questioned the ethicality of asking for disability-related data when systems, policies and resources are not yet consistently available to provide the supports required to facilitate better care. It's great to have the questions, but if you're not aware, if you don't look at it beforehand or if the intake admin officers are not understanding of the fact that it's there. Or looking at it in advance, then it can feel a bit tokenistic if the questions are being asked, but actually there's no follow through in terms of providing those requirements as well. (Clinician FGD) It is important to ask these questions, but this will only improve health care if staff are looking at and using this information. There needs to be better awareness raising in the health workforce about disability and different needs. (Patient Survey) In relation to the collection and visibility of information on the EMR, clinicians raised some ethical considerations around the need to protect vulnerable patients and balance the value in having information available with concerns about people who access that information potentially not acting in the person’s best interest. While other participants challenged this notion and suggested a need to normalise the conversation and have an openness around disability, rather than hide it due to fears around potential stigma. I’ve got family experience of disability, and I think I would really find it quite offensive seeing someone [a clinician] that will hide it because we think maybe [it will] reflect in a certain way towards you [the patient] … I think it should be open to all, even if that makes us feel a bit uncomfortable in how we think. (Clinician FGD) 3.2.5 Intervention coherence – the extent to which participants understand the intervention and how it works Patients, carers and clinicians generally described the DI questions as easy to understand. This qualitative sentiment was echoed in the online survey results with a mean score of 3.8 out of five among patients and carers and 4.0 out of five for clinicians. Patients with disability and carers of patients with disability demonstrated a mean score 4.0 out of five for intervention coherence. This was great to complete, thanks folks! The wording was succinct to ensure the point, and the questions broad enough to allow flexibility for tailored responses for everyone's needs. (Patient survey) Clinicians expressed consistent knowledge on why the questions are being asked and what the intention is behind having the questions included in the EMR. They recognised the additional benefits of the intervention, such as building rapport with patients, providing learning opportunities on the diversity within disability, and improving patient care. Disability is - it's like a good learning opportunity for people that don't know much about disability in particular. And then, yeah, can understand how to look after people better or in a way that meets their needs and getting them into the right service. (Clinician FGD) Many clinicians understood that the questions are intended to be a patient self-report disability identifier, rather than clinical observation, but expressed that there were simply challenges to using the questions as intended. They're really meant to be done by the patient or from the point of view and in the voice of the patient… I can see why that’s important… For me, that's not especially useful… I'm not usually sitting at a desk with a computer with a patient. I'm usually in a waiting room. I'm having an interaction and well, I'm sitting in a consultation with a clinician who has their computer open, and then I'm going and doing my notes later. So I'm doing… that sort of documentation, usually without the patient with me. (Clinician FGD) Among patients and carers, however, there were differing understandings on what, why and how the DI questions might work. Some recognised it would be routinely asked of all patients. Whereas others felt it was specifically asked of them because they were seen as having disability. I guess it was to find out that I am a person with disability. [To improve] access to medical services within the hospital, be it at admission, during clinical care, and perhaps at discharge, and at any point of care throughout their staying in hospital. Outpatient and inpatient or a through patient. (Patient interview) Why was I asked? ... I don't know. Is it because I have disability? ... I think it was useful to be asked those questions. (Patient interview) Others thought the DI questions were asked by clinicians to assess their mental health, cognition or consistency of responses (i.e. do their responses match what they have responded elsewhere). Similarly, there was some confusion with the DI questions and other question sets perceived as asking similar questions, questioning both the justification of repeatedly being asked for information and whether information was even considered by clinicians. I don't think they read them at all. Because well, it could be one of two things. It could be that they want to make sure that I'm in my right mind and I remember what I told them. … I think a lot of these questions say the same thing. So, I was a bit, not confused, but curious as to why the same questions were asked so many times in different ways. (Patient interview) 3.2.6 Opportunity costs – the extent to which benefits, profits or values must be given up to engage in the intervention This construct was reverse scored, with a higher mean score indicating lower perceived opportunity cost. Online survey results in relation to opportunity costs revealed a mean score of 4.0 out of five for patients and carers. This aligns with qualitative findings that suggest the opportunity to ‘contribute’ to benefitting the future healthcare of people with disability, generally outweighed any costs in not individually benefiting from immediate changes in care. I think that's really going to help going forward hopefully. This [completing the DI] helps the next person that comes through the door with a child that [is non-verbal and relies on carer/advocates]. (Carer interview) Some patients and carers again perceived that the intervention opportunity costs were more likely to be borne by clinicians. Indeed, the online survey mean score for this construct for clinicians was 3.6/ 5. All groups associated opportunity costs to perceived burden and intervention coherence. As such, while clinicians expressed that they feel the questions are useful, their use has not been consistently integrated into their own workflow because of time restraints and existing admin burden. I think as a tool it's quite useful within EMR, but again I think it's that admin burden within clinics… Is potentially where it's stumbling. (Clinician FGD) Some clinicians felt that more training was needed to communicate the value in using the disability identifier questions but also noted the burden of training as a concern. Ultimately, they wanted the process of using the questions to be easier. If there was like an easier way just for like a clinician to, you know, one click… And then, you know, they can see some information of how they need to communicate… or you know if there are any special needs. (Clinician FGD) 3.2.7 Self-efficacy –participant’s confidence that they can perform the behaviour(s) required to participate in the intervention. Patients and carers were asked about how confident they felt in providing responses to the DI questions, with an online survey mean score of 4.1 out of five for this construct. Clinicians were asked about their confidence in asking the questions and using the information, resulting in a mean score of 3.8 out of five. Most patients and carers felt confident in their capacity to respond to the DI questions. Differences did emerge, however, in their level of motivation to do so. Lower levels of motivation related to the perception that the questions did not allow them to adequately describe their experiences of disability and care needs, or that information shared would not be utilised by clinicians or contribute to improvements in care. How do you capture those nuances? … Sometimes it's sort of, it's a bit of a frustrating one, because you want to explain the infinite nuances to the condition, but you know, it's not that people don't want to listen, it's perhaps they don't need to have that information to do what they do. (Patient interview) Greater confidence was associated with longer periods of time with a disability, progressing to the point whereby some participants wanted to share information and their expertise to help themselves, clinicians and other people with disability accessing healthcare. Anticipated improvements in disability awareness - including through the intervention - amongst clinicians, further facilitated self-efficacy confidence to complete the DI questions. If I was to do this survey a couple of years back … I would have felt uncomfortable. I might have not even partaken. … A lot of changes have happened, and that's why it made it a bit easier. And if I can … help you know the situation, people like me as well ... I'm more than happy to take part in it .... Even the doctors over the time. Still the same doctors that I'm seeing, but the new ones that have come as well have made it, I feel like a bit easier to break that barrier. (Patient interview) Indeed, confidence and self-efficacy was higher for some clinicians than others. Some raised issues around not knowing who is responsible for asking the questions, alongside not having the confidence to know when it may or may not be appropriate on someone’s journey, to ask the questions and have conversations about disability and care needs. This confusion was particularly evident when clinicians may have identified a discrepancy in documented diagnosis, a patient’s insight into their condition or how they identify with disability, and their subsequent capacity and/or willingness to respond to the questions as anticipated by clinicians. It's not actually that uncommon that patients don't necessarily have insight into what their needs are… They're happy to disclose physical disabilities. I've had quite a few situations where people have been much more cagey [guarded] around psychosocial stuff. Yeah, mental health stuff. Yeah, because of, you know, historical taboo. (Clinician FGD) While having pre-planned prompts for initiating the conversation increased confidence for clinicians, several still highlighted the need for improved training and support to equip clinicians with the skills to both engage with the intervention and provide the necessary adjustments in care requested by patients. I have not received adequate education about use of the identifier ... More education should occur. (Clinician survey) 3.2.8 Perceived effectiveness – the extent to which the intervention is perceived as likely to achieve its purpose The online survey asked patients and carers whether completing the DI questions provided them with an opportunity to communicate their care needs, with a mean score of 3.7 out of five indicating general acceptance that it would. For patients with a disability and carers of a patient with a disability, this was the highest scoring construct, with a mean score of 4.2 out of five. Clinicians were asked whether the DI provided them with useful information about patients’ disability and care needs, with a mean score of 4.0 out of five reflecting most clinicians agreed with this sentiment. Some patients and carers already felt the DI was contributing to change. One patient described being more proactive in communicating their needs to clinicians. In addition, some carers reported in the survey that they had experienced improved communication about their disability or long-term health condition and related care needs because of the DI questions. We were able to document key information about triggers that can seriously escalate her behaviour and lead to traumatic situations for her, us (parents) and others (e.g. staff). This helped to facilitate better pre-planning and getting us linked to important supports. (Carer survey) Being able to talk through my needs with the nurse was really helpful. Having a plan in place for my clinic appointments helped me to feel much safer to be able to come in . (Patient survey) More broadly, however, most patients and carers acknowledged it was too early to tell if the intervention had led to improved practice. Yet as previously highlighted, the process was still seen as contributing positive change in and of itself. The more that people talk about it, or listen or ask about it, the more the disability doesn't frighten other people. … I think the more that people can indicate that somebody's got something, the more people may be mindful and more kind … I think they’re really, really important because it, I don't know if this is the right word, but it helps triage your situation. (Patient interview) Clinicians highlighted that the language in the screening question itself was well structured, with a focus on function rather than a label. For me – the biggest benefit is the wording of the question because it doesn’t rely on ‘do you identify as disabled?’ language always has a different connotation to 'is there anything in your daily life' – I guess that is the main benefit for me. (Clinician FGD) There were, however, mixed views from clinicians around the DI questions effectiveness in identifying certain disability types. Some clinicians praised the focus on identity and function, while others felt some of the terms used needed greater clarity to achieve meaningful responses. Clinicians also raised whether some of the language used potentially limited recognition for some patient groups, e.g. those with mental health conditions or who experienced chronic or persistent fatigue. It's more tailored for physical disability as opposed to the other side … So it's clinical usefulness then is … less essentially, than for physical. They're just, yeah, not tailored to the more invisible disability as such. (Clinician FGD) Clinicians also expressed some concerns about the accessibility and flow of questions, limiting patient opportunity to complete all sections. In turn, low usage was a barrier to perceived effectiveness. Clinicians suggested keeping the process simple would help promote its use. Not over complicating the communication process. Keeping it simple and I find when you keep the communication process simple for anything like that, people are more likely to pick it up. (Clinician FGD) Regardless, clinicians felt when the information was there, it was considered helpful and viewed as an effective tool. It's just useful and beneficial for me to be able to interact with them better and understand what they need from me, but also what they need from us as a team. (Clinician FGD) Ultimately, patients, carers and clinicians felt that more training on disability, skills to utilise the information, better integration within workflows, and resources to respond accordingly through enhanced disability-responsive care are all required to fully effect the potential of the intervention. Because everybody's so busy … hospitals are so short staffed. That staff don't have time to actually read all the information to be prepared. So, you know, if they had more hands-on deck, then it would be lovely if all the staff knew everything that you had given them. But it's not realistic at the moment in this day and age … nurses are just run off their feet. (Patient interview) DISCUSSION In line with international priorities, integration of patient self-reported Disability Identifiers with health service EMR systems represents a significant step towards enhancing disability-responsive healthcare and equitable health outcomes for people with disability ( 2 , 9 , 22 ). Our evaluation assessing the acceptability of DI integration provides valuable insights into successes and challenges, as well as implications for future practice and policy development. 4.1 Perceived Acceptability and Engagement Patients and carers broadly appreciated the opportunity to provide disability-related information through the DI questions, recognising its potential to enhance disability awareness and accessibility within healthcare services. The DI resonated strongly with individuals’ value systems of respect for people with disability and broader community inclusion. However, uncertainty emerged regarding whether the information provided would be meaningfully utilised by hospital staff, particularly in high-pressure settings such as emergency departments and outpatient clinics. Similarly, and aligning with the wider literature, potential tensions emerged relating to the fact that some individuals with disability - particularly less visible disability – may choose not to share disability-related information due to fear of discrimination ( 11 , 23 ). To build patient and carer trust to engage with the DI, clear communication about the DI’s objectives and benefits is critical. This includes distinguishing its role in current data collection from its evolving potential to further drive more responsive care and outcomes. Arguably even more urgent, is building patient trust in sharing disability-related information, and continual action within healthcare settings to improve disability awareness and address discrimination ( 2 , 22 ). How the clinicians feel about the intervention was viewed from the perspective of benefits, concerns and usefulness. Clinicians generally expressed positive attitudes toward the DI, acknowledging its potential to facilitate more responsive care for people with disability. Clinicians, patients and carers were optimistic that the DI would ultimately decrease the burden associated with completing general hospital administration. However, practical challenges such as workflow integration and administrative burden were noted. Embedding the DI seamlessly into existing EMR workflows is crucial to ensuring its sustainability and effectiveness. Less perceived burden was reported by clinicians when the DI questions were built into bookings and admissions workflows. This theme aligns with higher DI completion rates observed in settings where the DI questions were integrated as a mandatory component of nursing admission questions ( 19 ). 4.2 Training and Awareness Successful implementation of any intervention relies on clinician engagement, which depends on knowledge, confidence, and adequate resources ( 20 , 24 ). A recurrent theme across groups was the need for targeted training to support DI implementation. While some clinicians reported receiving training, others lacked sufficient opportunities to understand the value of the DI, how to integrate it into their practice, and how to initiate meaningful conversations with patients. A lack of awareness about the DI questions and uncertainty around implementation emerged as barriers. Less perceived burden was observed where there was greater knowledge of the DI questions and how to access them in the EMR. Training should therefore focus on promoting awareness of the DI’s objectives, equipping clinicians with the confidence to engage in discussing disability-related topics and offering practical guidance on accessing and using DIs within specific workflows. Crucially, training must also improve clinicians understanding of healthcare adjustments and how to utilise DI data to inform adjustments in healthcare delivery ( 9 , 12 , 13 , 22 ). Concerns regarding training burden must also be managed, potentially through integrating training into existing professional development programs or offering flexible, self-paced learning modules. 4.3 Design and Content Refinements Both clinicians and patients identified opportunities to refine the DI questions to better capture the diversity of disability experiences and ensure inclusivity. Their recommendations highlighted the importance of ensuring DI questions are accessible for people with diverse communication needs (e.g. low vision, low literacy). Patients and carers also highlighted the importance of better capturing experiences related to neurodivergence, psychosocial disabilities, and conditions like chronic fatigue and pain. Clinicians also felt it was important to incorporate mechanisms to document whether questions were completed by the patient or carer directly or with a clinician. These and other changes have been included in the final version of the DI questions (see Supplementary File – Section 4). 4.4 Ethical Implications Ethical considerations emerged, particularly regarding the healthcare system’s capacity to act on the information collected through the DI. To address this, participants stressed the importance of aligning the implementation of the DI with ongoing efforts to build healthcare system capacity for inclusive care. Patients, carers, and clinicians emphasised that the collection of disability data must be accompanied by adequate knowledge, resources, and policies to provide necessary adjustments and supports. Transparent communication about how the data will be used and demonstrating its impact on patient care are essential for maintaining stakeholder confidence. Despite these concerns, participants acknowledged that collecting DI data is a critical first step in understanding and responding to the needs of patients with disability. They recognised that the DI data itself has the potential to inform the development of appropriate policies and practices, ultimately guiding health system improvements to better support people with disability. 4.5 Policy and Practice Implications Findings from this study align with broader evidence on the potential of Disability Identifiers to drive more inclusive and responsive healthcare systems ( 9 , 13 ). Realising this potential requires coordinated efforts involving government, disability stakeholders, and healthcare providers. Key priorities include building capacity to consistently implement, analyse and utilize DI data to evaluate and inform disability-responsive healthcare interventions across settings. Future research should also focus on the effectiveness of DIs to improve care delivery, patient experiences, and outcomes across diverse patient groups. It remains essential to continue to promote co-design approaches to ensure the development and utilisation of DI questions and processes are relevant, inclusive, and reflect the diverse experiences of people with disability within healthcare systems ( 9 ). 4.6 Future Directions Longer-term evaluation is required to assess the DI’s impact on patient outcomes and system performance. Efforts should focus on linking DI data to outcomes, developing strategies to enhance clinician engagement, and addressing systemic barriers to equitable healthcare ( 2 , 9 , 22 , 24 ). By embedding the DI into routine practice and fostering collaborative partnerships, healthcare systems can take significant steps toward achieving disability-inclusive care. Future work should also explore opportunities to scale the DI model to other healthcare settings, promoting consistency and comparability of data across regions. Further investigation is also needed to consider the feasibility and usefulness of adapting the DI for patients under 2-years of age. Australia has made significant advancements in data linkage systems, including through the establishment of the National Disability Data Asset, which aims to bring together data from across Australia to better understand and meet the needs of people with disability ( 25 ). In time, the National Disability Data Asset may provide a platform to link hospital-based DI data with broader datasets, providing valuable insights into healthcare access, service utilisation, and outcomes for people with disability. 4.7 Strengths and Limitations of the Research This study represents one of the first evaluations of a co-designed, self-reported DI integrated into health service EMRs, offering novel insights into its acceptability from multiple perspectives within multiple different hospital settings. The study captured the experiences and perceptions of a broad range of stakeholders, including patients, carers, and clinicians, providing a comprehensive understanding of the DI’s acceptability. Additionally, the study was conducted across diverse hospital settings spanning tertiary and quaternary paediatric and adult care, cancer care, and maternity services. Use of an established framework, the TFA, ensured a structured and rigorous approach to evaluating the intervention, whilst combining quantitative surveys with qualitative interviews and focus groups enriched the findings and enabled triangulation of data. The study focused on acceptability of the DI within the first 9 months of its implementation and did not examine the long-term impact of the DI on patient outcomes, limiting its ability to assess the full potential of the intervention. The findings reflect the early stages of the DI’s implementation, and some challenges identified may diminish over time as processes are refined. Survey participants were self-selected, which may introduce bias as those with strong opinions about the DI were more likely to participate. While the study was conducted across five diverse hospital settings using two different EMR systems: Cerner Powerchart (Oracle Cerner, Austin, TX) and Epic Systems (Verona, WI), caution should be taken when generalising findings to other jurisdictions, settings and systems. Finally, while the online survey was completed across all sites, qualitative patient and carer interviews and FGDs were conducted at the Parkville health services only. CONCLUSION This research paves the way for other jurisdictions seeking to adopt a standardized approach for disability identification. Emphasising continuous evaluation, stakeholder engagement, and leveraging digital health platforms, the DI initiative demonstrates a transformative approach for advancing disability-responsive healthcare and equitable health outcomes for all. Abbreviations DI – Disability Identifier EMR – Electronic Medical Records FGD – Focus Group Discussion PMC - Peter MacCallum Cancer Centre RCH - The Royal Children’s Hospital Melbourne RMH - The Royal Melbourne Hospital RWH - The Royal Women’s Hospital TFA – Theoretical Framework of Acceptability Declarations Ethics approval and consent to participate: In accordance with the National Health and Medical Research Council ethics approvals for this multi-site study were obtained by the RCH Human Research Ethics Committee (Project HREC/100979/RCHM2023) and Austin Health’s Human Research Ethics (Project HREC 97208/Austin-2023). All participants provided consent to participate. All aspects of the study were conducted in adherence with the Declaration of Helsinki. Consent for publication: Not Applicable. Availability of data and materials: Data and materials is not publicly available in line with Ethics approval. Competing interests: The authors declare that they have no competing interests. Funding: This research was supported by funding from the Victorian Government Authors' contributions: Joanne Rowe: Conceptualisation, Methodology, Validation, Analysis, Investigation, Writing – original draft, Project Admin and funding acquisition Alexandra Devine: Conceptualisation, Methodology, Validation, Analysis, Investigation, Writing – original draft Nicole Merrick: Conceptualisation, Methodology, Software, Validation, Analysis, Investigation, Writing – original draft, Marie Huska: Methodology, Validation, Analysis, Investigation, Writing – original draft, Kirsten Morris: Conceptualisation, Methodology, Validation, Investigation, Resources, Writing – review and editing, Project Admin Kath Feely: Conceptualisation, Software: Validation, Resources, Writing – review and editing Ahuva Segal: Software, Validation, Investigation, Resources, Writing – review and editing Louise Mogg: Conceptualisation, Methodology, Resources, Writing – review and editing, Project Admin Jenni Medland: Conceptualisation, Methodology, Resources, Writing – review and editing, Project Admin Rebecca Jamwal: Methodology, Validation, Investigation, Resources, Writing – review and editing Alison Smith: Conceptualisation, Methodology, Resources, Writing – review and editing, Project Admin Maricar Gleich: Methodology, Resources, Writing – review and editing, Project Admin Jeremiah Munakabayo: Formal Quantitative Analysis and data visualisation, review and editing Christine Imms: Conceptualisation, Methodology, Resources, Writing – original draft, Supervision Acknowledgements: We wish to acknowledge and thank Adrienne Fosang and Michelle Shao for review and feedback; Lucinda Russell and Ilianna Ginnis for providing research assistance and Gonzalo Sepulveda Kattan (The Centre for Health Analytics) for supervising the quantitative data analysis. 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Supplementary Files SupplementaryFilePatientselfreportDisabilityIdentifierwithinhealthserviceElectronicMedicalRecordsacceptabilityevaluation.docx Cite Share Download PDF Status: Published Journal Publication published 01 Jul, 2025 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 12 May, 2025 Reviews received at journal 12 Apr, 2025 Reviews received at journal 02 Apr, 2025 Reviewers agreed at journal 29 Mar, 2025 Reviewers agreed at journal 22 Mar, 2025 Reviewers agreed at journal 20 Mar, 2025 Reviewers invited by journal 20 Mar, 2025 Editor assigned by journal 20 Mar, 2025 Submission checks completed at journal 19 Mar, 2025 First submitted to journal 19 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6218627","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":435970409,"identity":"e38b829d-143f-4a99-9eb4-ecac45e10d52","order_by":0,"name":"Joanne Rowe","email":"","orcid":"","institution":"The Royal Children’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Joanne","middleName":"","lastName":"Rowe","suffix":""},{"id":435970410,"identity":"919bdd95-8c19-4e92-879d-832d336580be","order_by":1,"name":"Alexandra 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09:38:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6218627/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6218627/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-025-12974-5","type":"published","date":"2025-07-01T15:58:42+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":86180552,"identity":"b207b829-aab3-46f9-a284-77d32b892b8e","added_by":"auto","created_at":"2025-07-07 16:22:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1893591,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6218627/v1/0aae47bd-0a1c-434a-92ff-7164b425bac2.pdf"},{"id":79597962,"identity":"3cf7d655-4511-447b-a31e-acb5a074919c","added_by":"auto","created_at":"2025-03-31 14:36:23","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":77029,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFilePatientselfreportDisabilityIdentifierwithinhealthserviceElectronicMedicalRecordsacceptabilityevaluation.docx","url":"https://assets-eu.researchsquare.com/files/rs-6218627/v1/5eb340c51a80304528196c8e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eA patient self-report Disability Identifier within health service Electronic Medical Records: evaluation of patient, carer and clinician acceptability\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMore than 5.5\u0026nbsp;million Australians live with disability, representing 21% of the national population (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Barriers to healthcare access are often encountered by people with disability and contribute to substantial health inequities experienced by this group (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). For example, people with disability are more likely to experience and prematurely die from non-communicable (e.g. cardio-vascular disease, cancer, mental illness) and communicable diseases (e.g. Tuberculosis, COVID-19)(\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). One in three Australians with disability require adjustments in how care is provided to enable access to healthcare (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). When this need for assistance or adjustment is not recognised or provided, the health inequities experienced by people with disability are likely to be exacerbated.\u003c/p\u003e \u003cp\u003eProviding clinicians access to timely information about patient disability and care needs has the potential to help address health inequities by enabling disability-responsive healthcare (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Identifying and flagging information about patients with disability and their care needs early during healthcare interactions, such as at intake or admission, can help clinicians make informed decisions about necessary adjustments required to improve patient care for the individual (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlobally, there are very few examples where Disability Identifiers have been integrated within health service administrative or clinical data sets to inform disability-responsive care or monitor health outcomes (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The United Kingdom\u0026rsquo;s National Health Service Reasonable Adjustment Flag records a person\u0026rsquo;s needs and adjustments (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Research in the United States is working to evaluate strategies within primary care to document patient communication needs within electronic health records to inform adjustments (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In other settings, disability questions, such as the Washington Group Short Set on Disability - designed for use in population-based surveys - have been piloted within local health service admission processes in Cambodia (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), Paraguay (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), India \u0026amp; Tanzania (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) and Bangladesh (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWithin the Australian context, Fortune et al (2023) were engaged by the federal government to undertake work to develop Disability Identifier questions, which have now been included in \u003cem\u003eMy Medicare\u003c/em\u003e: an online voluntary patient registration system within primary health care (general practice) (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). To our knowledge, however, Australian health service and hospitals are yet to routinely collect data within health administration systems to identify individuals with disability (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo address this gap, a team of clinicians, consumers, and researchers from five tertiary and quaternary hospitals in Victoria (Australia\u0026rsquo;s second most populous state) co-designed and integrated a patient self-report Disability Identifier (DI) into their Electronic Medical Record (EMR) systems (see Supplementary File \u0026ndash; Section 1). A mixed-methods evaluation was conducted to examine its implementation and early use, assessing the DI\u0026rsquo;s utility and acceptability over the first nine months following integration (1st March\u0026ndash;30th November 2023) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). During this period, 20,083 patients completed the DI across the five participating health services (see Supplementary File \u0026ndash; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for details on patient characteristics).\u003c/p\u003e \u003cp\u003eThis paper focuses specifically on the acceptability of the intervention from the perspectives of patients, carers, and clinicians. Using online surveys, semi-structured interviews, and focus group discussions, we explored experiences of completing the self-report disability questions and factors influencing engagement with the DI. This study addresses the research question: What is the acceptability of the DI from the perspectives of patients, carers, and clinicians?\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design\u003c/h2\u003e \u003cp\u003eThis research adopted a convergent parallel mixed methods study design, guided by the Theoretical Framework of Acceptability (TFA) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Online surveys, qualitative interviews and focus group discussions (FGDs) were collected concurrently and analysed independently. Integration of both quantitative and qualitative results was guided by the TFA as further described below (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 The Theoretical Framework of Acceptability\u003c/h2\u003e \u003cp\u003eDeveloped by Sekhon et al (2022), the TFA was specifically developed to enable evaluation of the acceptability of healthcare interventions as perceived and experienced by intervention providers and recipients. It consists of seven inter-connected constructs: i) Affective attitude (how an individual feels about the intervention); ii) Burden (perceived amount of effort that is required to participate in the intervention); iii) Ethicality (extent to which the intervention aligns with an individual\u0026rsquo;s value system); iv) Coherence (extent to which the individual understands the intervention and how it works); v) Opportunity Costs (extent to which benefits, profits or values must be given up to engage in the intervention); vi) Self-Efficacy (individual\u0026rsquo;s confidence that they can perform the expected role/behaviours required to participate in the intervention); and vii) Perceived Effectiveness (degree to which the intervention is perceived as likely to achieve its purpose) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Ethics statement\u003c/h2\u003e \u003cp\u003e Ethics approvals for this multi-site study were obtained by the RCH Human Research Ethics Committee (Project HREC/100979/RCHM2023) and Austin Health\u0026rsquo;s Human Research Ethics (Project HREC 97208/Austin-2023).\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Quantitative methods\u003c/h2\u003e \u003cp\u003e \u003cb\u003eOnline surveys of patients, carers and clinicians\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eParticipant eligibility and recruitment\u003c/b\u003e \u003c/p\u003e \u003cp\u003eEligibility at Parkville health services for the patient and carer online survey was determined by retrospective audit of EMR data, including those who had responded (Yes/No/Declined to answer) to the primary DI question (Q1) between 29th March \u0026ndash; 30th November 2023 and were over 18 years old (n\u0026thinsp;=\u0026thinsp;10,103). Eligible individuals were invited to complete the survey either via a message on their patient portal (for active users) or postal letter. Invitations included a link to the survey with an embedded Participant Information Statement outlining that completion of the survey implied consent. Eligible Austin Health patients and carers included individuals who had responded Yes to the primary DI question (Q1) between 1st March \u0026ndash; 30th November 2023 and were over 18 years old (n\u0026thinsp;=\u0026thinsp;1,785). They were invited to participate via email or text message. In the absence of a response to initial contact, a single reminder was sent to all potential participants via the same contact mode before being considered lost to follow up.\u003c/p\u003e \u003cp\u003eEligible Parkville Clinicians included those who had completed the DI on or after the 29th March 2023 (n\u0026thinsp;=\u0026thinsp;972). They were invited to participate via an email that included the study information and a link to the survey, again outlining that consent was implied by completion. Three reminders were sent. Eligible Austin Health staff included those who had completed a patient admission assessment on or after 1st March 2023 (n\u0026thinsp;=\u0026thinsp;2,540). As above, they were invited to participate via email, with two email reminders sent.\u003c/p\u003e \u003cp\u003e \u003cb\u003eData collection\u003c/b\u003e \u003c/p\u003e \u003cp\u003eTwo online surveys were created to assess i) patient and carer, and ii) clinician perspectives on and experiences of the DI questions and their use within EMR to inform disability-responsive care. The surveys were aligned with a generic TFA survey developed by Sekhon et al (2022). Following review by the research team, the component Ethicality was excluded from the survey due to concerns regarding comprehensibility of the survey item. This construct was therefore not captured in the online survey, however, was explored qualitatively via semi-structured interviews and FGDs. The online surveys were administered electronically via Research Electronic Data Capture (REDCap) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eData analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eSurvey data were analysed by generating scores for each of the six TFA constructs examined, as well as generating a single Acceptability score by i) Computing the total mean score of the six TFA constructs, and ii) using the score for the General Acceptability item. Higher mean scores indicate stronger acceptability, including for burden and opportunity cost constructs which were inversely rated in the survey (see Supplementary File Section 3 Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Responses to open-ended questions included in the surveys were analysed using simple thematic analysis and included in the overall synthesis of findings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Qualitative Phase\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.5.1 Qualitative interviews with patients and carers\u003c/h2\u003e \u003cp\u003e Patient and carer perspectives on and experiences with the DI questions and engaging with the DI process were further explored through semi-structured interviews.\u003c/p\u003e \u003cp\u003e \u003cb\u003eParticipant eligibility and recruitment\u003c/b\u003e \u003c/p\u003e \u003cp\u003ePotential participants included existing patients and carers who had completed the online survey and provided consent to be contacted to participate in a follow-up interview. The research team sought to identify a representative sample of participants regarding disability, gender, age and health service (noting only patients accessing Parkville health services participated in this component). Potential participants were invited to participate via their preferred mode of contact (i.e. email or text message). Participant Information Statements were sent via email or discussed via telephone. Informed consent was obtained prior to the interview with capacity to provide consent ascertained via seven Easy English true/false questions.\u003c/p\u003e \u003cp\u003e \u003cb\u003eData collection\u003c/b\u003e \u003c/p\u003e \u003cp\u003e A date and time to conduct the interview via phone or online platforms (e.g., Zoom, Microsoft Teams) were arranged with interested participants. Patients and carers were asked about their understanding of the questions and how they felt about the intervention, the perceived usefulness and burden, and suggestions for improvement. Interviews lasted for between 30 and 60 minutes.\u003c/p\u003e \u003cp\u003e \u003cb\u003eData analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eInterviews were recorded and transcribed verbatim. Analysis commenced with familiarisation and immersion. Initial coding was completed deductively drawing on the TFA framework, with data categorised under the seven TFA Constructs. Inductive coding was conducted in conjunction with this process with data categorised into emerging codes and sub-categories to document patient/carer perspectives and experiences that did not align specifically with the TFA Constructs. Two researchers (AD, MH) participated in this process independently and via discussion. Ongoing discussions were similarly conducted with the wider research group to contextualise and triangulate findings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.5.2 Focus Group Discussions with clinicians\u003c/h2\u003e \u003cp\u003eFGDs were completed with clinicians at each of the Parkville health services, with the intention to explore the implementation experience from the clinician\u0026rsquo;s perspective.\u003c/p\u003e \u003cp\u003e \u003cb\u003eParticipant eligibility and recruitment\u003c/b\u003e \u003c/p\u003e \u003cp\u003eClinicians who completed the online survey and provided their information to be contacted regarding participation in a focus group discussion were eligible. Recruitment of clinicians was coordinated through site investigators. A purposive sampling approach was undertaken to achieve diversity of experiences across key clinical groups (Allied Health, Nursing and Medical) at each participating site. Potential participants were invited via email and provided with the Participant Information Statement and Consent form.\u003c/p\u003e \u003cp\u003e \u003cb\u003eData collection\u003c/b\u003e \u003c/p\u003e \u003cp\u003eDiscussions were designed to develop an understanding of barriers and facilitators to the adoption of the DI questions and opportunities to improve their use. FGDs were completed via Zoom.\u003c/p\u003e \u003cp\u003e \u003cb\u003eData analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eFGDs were recorded and transcribed verbatim, before being uploaded into NVivo (v14) for analysis. Two researchers independently coded the data (NM, IG). Data analysis commenced with familiarisation and immersion. Initial coding was completed inductively via an iterative approach, where codes represented the building blocks of the analysis. Codes were organised into content categories and sub-categories and then further analysis used a deductive approach, to understand clinician perspectives in context of the TFA. Three researchers participated in this step (NM, JR, IG) both independently and via discussions between the three researchers and the wider research group, to facilitate deeper engagement with the data, and challenge individual interpretations.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Participant characteristics and demographics\u003c/h2\u003e \u003cp\u003eA combined total of 1,181 patients and 180 carers completed the online survey (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A total of 221 clinicians completed the clinician online survey (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Nine patients and five carers completed the semi-structured interviews (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Twenty-eight clinicians took part in FGDs (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics of Patients and Carers Completing the Online Survey by Hospital\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRCH\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eRWH\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003ePMC\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eRMH\u003c/p\u003e \u003cp\u003en z(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eAustin Health\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSurvey Respondent\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePatient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6 (4.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e296 (98.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e201 (89.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e644 (95.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e34 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e1,181 (86.8%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCarer**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e123 (95.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4 (1.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e23 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e30 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e180 (13.2%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e69 (53.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4 (1.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e105 (46.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e279 (41.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e24 (70.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e481 (35%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e57 (44.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e287 (95.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e117 (52.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e387 (57.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e9 (26.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e857 (63%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGender Diverse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e9 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e8 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e23 (1.2%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e26 (20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e26 (1.9%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u0026ndash;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e60 (46.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e60 (4.4%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35 (27.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e38 (2.7%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e48 (16.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6 (2.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e67 (9.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4 (11.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e133 (9.7%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e197 (65.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e26 (11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e127 (18.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3 (8.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e353 (26%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e46\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e35 (11.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e98 (43.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e275 (40.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e9 (26.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e417 (30.6%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e65+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e17 (5.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e94 (42.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e205 (30.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e18 (52.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e334 (24.5%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eDisability\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e90 (69.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e95 (31.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e104 (46.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e397 (58.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e29 (85.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e715 (52.6%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e39 (30.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e205 (68.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e115 (51.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e271 (40.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5 (14.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e635 (46.6%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDeclined to Answer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e11 (0.8%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNeed for Assistance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e58 (64.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e39 (41.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e28 (26.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e156 (39.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e20 (69.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e301 (41%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e32 (55.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e56 (59.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e76 (73.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e241 (60.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7 (24.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e412 (58%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e2 (0.2%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e129 (9.5%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e300 (22.0%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e224 (16.5%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e674 (49.5%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e34 (2.5%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e1,361 (100%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e* All % are column-wise (Hospital specific). The bottom row shows hospital totals as a proportion of the total data set.\u003c/p\u003e \u003cp\u003e** Note \u0026ndash; all demographic data (age, gender, hospital, disability, disability type, assistance needed) relates to the patient for whom they provide care\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinician Online Survey Demographics by Hospital\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRCH\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eRWH\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003ePMC\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eRMH\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eAustin Health\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSurvey Respondent Discipline\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAllied Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (5.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e19 (38.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e12 (9.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e34 (15.4%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMedical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3 (17.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e3 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e21 (17.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e27 (12.2%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13 (76.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e16 (59.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3 (75.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e31 (62.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e79 (64.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e142 (64.3%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e7 (25.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e11 (8.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e18 (8.1%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e17 (7.7%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e27 (12.2%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e4 (1.8%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e50 (22.6%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e123 (55.7%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e221 (100%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e* All % are column-wise (Hospital specific). The bottom row shows hospital totals as a proportion of the total data set.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics of patients represented in the Patient and Carer semi-structured interviews (n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNumber of Patients\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3 (21.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11 (78.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGender Diverse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3 (21.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e46\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7 (50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e65+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;(0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNot reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (14.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eArea of difficulty *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSeeing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (14.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHearing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;(0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSpeaking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (14.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLearning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7 (50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMoving\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9 (64.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5 (35.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eComplex/ other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (14.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e14 (100)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e*Individuals may have more than one area of difficulty, therefore proportions are not cumulative\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFocus Group Discussion participant demographics (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNumber of participants\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDiscipline\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAllied Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e16 (57.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMedical/ Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10 (35.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdministration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e28 (100%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Acceptability of Disability Identifier intervention\u003c/h2\u003e \u003cp\u003eResults from the online survey, interviews and FGDs were integrated and are presented below in alignment with the TFA.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 General acceptability\u003c/h2\u003e \u003cp\u003eGeneral Acceptability reflects the extent to which patients, carers and clinicians felt the intervention \u0026ndash; in this case integrating self-reported DI questions within EMR and patient portal - is appropriate, feasible and would contribute towards improved processes and outcomes. Results from the online surveys demonstrated a strong General Acceptability mean score of 4.2 out of five across patients, carers and clinicians. Focusing in on our priority target group, i.e. respondents who positively identified as having disability and assistance needed to access health care, filtered to all respondents who recalled answering the DI in a healthcare encounter, we found higher acceptability overall with a General Acceptability mean score of 4.5 out of five (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIndividual TFA Construct and General Acceptability Scores*\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAll patient \u0026amp; carer Respondents (Mean, CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePatient \u0026amp; carer priority Sub-Group\u003c/p\u003e \u003cp\u003e(Mean, CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eClinician Respondents (Mean, CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTFA Constructs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOpportunity Cost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.1 (4.0\u0026ndash;4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.0 (3.8\u0026ndash;4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.6 (3.3\u0026ndash;3.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIntervention Coherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.8 (3.8\u0026ndash;3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.0 (3.8\u0026ndash;4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.0 (3.6\u0026ndash;4.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePerceived Effectiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.7 (3.6\u0026ndash;3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.2 (3.9\u0026ndash;4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.0 (3.7\u0026ndash;4.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSelf-Efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.1 (4.0\u0026ndash;4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.0 (3.8\u0026ndash;4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.8 (3.6\u0026ndash;4.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBurden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.5 (4.4\u0026ndash;4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.1 (3.9\u0026ndash;4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.0 (3.8\u0026ndash;4.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAffective Attitude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.8 (3.7\u0026ndash;3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.8 (3.6\u0026ndash;4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.6 (3.3\u0026ndash;3.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGeneral Acceptability\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e4.2 (4.2\u0026ndash;4.3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e4.5 (4.3\u0026ndash;4.6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e4.2 (4.0\u0026ndash;4.4)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" morerows=\"4\" nameend=\"c5\" namest=\"c1\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eOverall Acceptability (Percentage)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCompletely Acceptable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e41.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e52.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e36.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAcceptable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e41.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e47.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo Opinion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnacceptable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCompletely Unacceptable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e* TFA Mean score interpretation: Very Weak (1.0 to 1.5); Weak (1.6 to 2.5); Moderate (2.6 to 3.5); Strong (3.6 to 4.5); Very Strong (4.6 to 5.0) \u0026ndash; i.e., high scores indicate greater acceptability.\u003c/p\u003e \u003cp\u003e^ Priority sub-group represents patients positively identifying with a disability who required assistance to access the health service filtered to patients/carers who recalled answering the DI previously within a health care encounter(n\u0026thinsp;=\u0026thinsp;89)\u003c/p\u003e \u003cp\u003eOverall, patients and carers interviewed generally felt positive about the intervention, citing that it demonstrated that these health services were striving to improve services for people with disability. Nonetheless, most expressed concerns about the capacity to effectively utilise the DI to improve care.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI wish that more places asked those kind of questions. \u0026hellip; It was positive to feel like people actually cared and were asking such specific questions. But there was also the part of me that was like, I don\u0026rsquo;t think\u0026hellip; that it's actually going to do any good, you know\u0026hellip; who will actually look at the\u003c/em\u003e [DI responses]\u003cem\u003e?\u003c/em\u003e (Patient interview)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eClinicians participating in the FGDs also felt the intervention provided an important opportunity to raise awareness about disability and had the potential to enhance disability-responsive care. They recommended refining the DI questions to better capture wider experiences of disability, including neurodivergence and psychosocial disability. Clinicians also noted the need for more purposeful training on disability and how best to integrate the DI questions in their workflow processes. However, clinicians also raised concerns around the burden of additional training and the time required to effectively utilise the DI in EMR.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 Affective attitude \u0026ndash; how an individual feels about the intervention\u003c/h2\u003e \u003cp\u003eWithin this construct, the online survey mean scores of 3.8 out of five for patients and carers and 3.6 out of five for clinicians indicate respondents generally felt \u0026lsquo;comfortable\u0026rsquo; completing the intervention. While still a moderate to strong score, this construct scored lower compared with other constructs for patients, carers and clinicians. Some survey participants noted that while disability and chronic conditions are complex and difficult to live with, they are comfortable to discuss them or answer questions in relation to them.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eAs difficult as it can sometimes be dealing with both disabilities, I have no difficulty in answering questions about\u003c/em\u003e [them]. (Patient survey]\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e Interview participants described feeling positive about having the option to complete the DI questions. The process was highlighted as enabling self-reflection on disability and related needs within the health system, with some prompted to more proactively communicate their needs with clinicians. Subsequent planning with clinicians improved feelings of safety and comfort during engagement with hospital services.\u003c/p\u003e \u003cp\u003ePatients and carers were optimistic the intervention would help enhance disability awareness and clinician understanding of required supports. Yet, this was balanced with concern that the information provided would not be consistently utilised by staff, due to heavy workloads and insufficient capacity and resources to provide disability-responsive care. Even so, there was hope that the intervention would lead to better resourcing overtime, contributing to improved patient and carer experiences, along with a more inclusive and skilled healthcare workforce.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eIt is so important for the hospital to be asking these questions to understand what patients with a disability \u0026ndash; especially invisible disabilities \u0026ndash; need. The challenge is then making sure the hospital can support our needs. Asking is the first step and hopefully helps to better understand the issues we face.\u003c/em\u003e (Patient interview)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eClinicians agreed that the intervention can enhance awareness and their understanding of patient perspectives on disability. In turn, this can provide a common language for patient and clinician interactions to help identify what reasonable adjustments may improve experiences of care. Nonetheless, clinicians raised concerns that some clinicians may lack the confidence or willingness to ask the questions.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI think clinicians find the questions like that uncomfortable. And if they\u0026rsquo;re uncomfortable often just choose not to ask it. They\u0026rsquo;re too awkward or uncomfortable and they just like, skim past it.\u003c/em\u003e (Clinician FGD)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2 Burden \u0026ndash; the perceived amount of effort that is required to participate in the intervention\u003c/h2\u003e \u003cp\u003eThis construct was reverse scored, with a higher mean score indicating lower perceived burden. Online survey results indicate minimal burden with an overall mean score of 4.0 out of five for clinicians and 4.5 out of five for patients and carers. Patients with disability and carers reported a slightly lower score of 4.1 out of five. Qualitative responses revealed perceived burden was related to time, ease and comfort. Patients and carers generally expressed minimal difficulty and low burden completing the DI questions.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI thought the questions were pretty simple \u0026hellip; I thought they were stock standard questions when you go to the doctor and they ask you \u0026ldquo;Do you have asthma\u0026rdquo;. Like it just kind of felt like that. Like you were just ticking off boxes. Which is fantastic.\u003c/em\u003e (Carer interview)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eA small number of individuals interviewed felt some tension with aspects of the questions. These patients and carers perceived that the intervention would contribute to clinician discomfort and burden, which exacerbated their own experiences of burden. In part, this related to a patient\u0026rsquo;s own level of comfort in responding to the DI questions, with some highlighting that the questions would have felt more burdensome earlier on in their disability journey. Similarly, a few clinicians expressed concerns around not knowing when to ask and whether it was appropriate given where the patient was on their healthcare journey.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI feel that it would be hard for a lot of families, especially with our families of young children, the very beginning some families are still trying to take in the diagnosis for their young person ... then going to the hospital and being asked that (the questions) it might be quite traumatic for them.\u003c/em\u003e (Clinician FGD)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eClinicians, patients and carers felt having the information embedded within the EMR could reduce the burden on patients to repeat their disability information and the burden associated with hospital administration, including when transitioning between hospitals or paediatric to adult services.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI think there\u0026rsquo;s huge benefit to having the information and being able to access the information quickly or that it\u0026rsquo;s there and people don\u0026rsquo;t have to retell their stories, and it\u0026rsquo;s them articulating their own experience. Not us imposing kind of more diagnostic criteria or something of their experience.\u003c/em\u003e (Clinician FGD)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eHowever, embedding in the EMR didn\u0026rsquo;t appear to reduce clinician burden. Integrating the DI questions into clinician workflow and the extra time required to ask the questions was a common concern among clinicians, with some expressing the process doubled-up with information collected during a standard subjective examination. There appeared to be less perceived burden when the DI questions were built into bookings and admissions workflows, and when clinicians had more knowledge of and easier access to the DI questions.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThe booking screen and flow is quite easy to use.\u003c/em\u003e (Clinician FGD)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e\u003cstrong\u003e3.2.4 Ethicality – the extent to which the intervention has good fit with the individual’s value system\u003c/strong\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eAs described earlier, Ethicality was not measured in the online surveys but was discussed in the interviews and FGDs. Patients and carers perceived that the intent of implementing the intervention was to improve outcomes for people with disability, which strongly resonated with individuals’ value systems. Completing the DI questions was also described as less about individual-level benefit, and more of a way to ‘give-back’ to the hospital and the disability community in promoting disability awareness and inclusion.\u003c/p\u003e\n\u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eI’d love it if there was some changes. … to help myself and others. ... But like I said, I try to help as much as I can. I mean, if it doesn't benefit me, it's OK. At least all this information … and get to the bottom of it to help others. … I didn't really think of myself.\u003c/em\u003e (Patient interview)\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eDespite this, several patients, carers and clinicians questioned the ethicality of asking for disability-related data when systems, policies and resources are not yet consistently available to provide the supports required to facilitate better care.\u003c/p\u003e\n\u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eIt's great to have the questions, but if you're not aware, if you don't look at it beforehand or if the intake admin officers are not understanding of the fact that it's there. Or looking at it in advance, then it can feel a bit tokenistic if the questions are being asked, but actually there's no follow through in terms of providing those requirements as well. (Clinician FGD)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIt is important to ask these questions, but this will only improve health care if staff are looking at and using this information. There needs to be better awareness raising in the health workforce about disability and different needs.\u003c/em\u003e (Patient Survey)\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eIn relation to the collection and visibility of information on the EMR, clinicians raised some ethical considerations around the need to protect vulnerable patients and balance the value in having information available with concerns about people who access that information potentially not acting in the person’s best interest. While other participants challenged this notion and suggested a need to normalise the conversation and have an openness around disability, rather than hide it due to fears around potential stigma.\u003c/p\u003e\n\u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eI’ve got family experience of disability, and I think I would really find it quite offensive seeing someone\u003c/em\u003e [a clinician] \u003cem\u003ethat will hide it because we think maybe\u003c/em\u003e [it will] \u003cem\u003ereflect in a certain way towards you\u003c/em\u003e [the patient] \u003cem\u003e… I think it should be open to all, even if that makes us feel a bit uncomfortable in how we think. (Clinician FGD)\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\"\u003e\n \u003ch2\u003e3.2.5 Intervention coherence – the extent to which participants understand the intervention and how it works\u003c/h2\u003e\n \u003cp\u003ePatients, carers and clinicians generally described the DI questions as easy to understand. This qualitative sentiment was echoed in the online survey results with a mean score of 3.8 out of five among patients and carers and 4.0 out of five for clinicians. Patients with disability and carers of patients with disability demonstrated a mean score 4.0 out of five for intervention coherence.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eThis was great to complete, thanks folks! The wording was succinct to ensure the point, and the questions broad enough to allow flexibility for tailored responses for everyone's needs.\u003c/em\u003e (Patient survey)\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eClinicians expressed consistent knowledge on why the questions are being asked and what the intention is behind having the questions included in the EMR. They recognised the additional benefits of the intervention, such as building rapport with patients, providing learning opportunities on the diversity within disability, and improving patient care.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eDisability is - it's like a good learning opportunity for people that don't know much about disability in particular. And then, yeah, can understand how to look after people better or in a way that meets their needs and getting them into the right service.\u003c/em\u003e (Clinician FGD)\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eMany clinicians understood that the questions are intended to be a patient self-report disability identifier, rather than clinical observation, but expressed that there were simply challenges to using the questions as intended.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eThey're really meant to be done by the patient or from the point of view and in the voice of the patient… I can see why that’s important… For me, that's not especially useful… I'm not usually sitting at a desk with a computer with a patient. I'm usually in a waiting room. I'm having an interaction and well, I'm sitting in a consultation with a clinician who has their computer open, and then I'm going and doing my notes later. So I'm doing… that sort of documentation, usually without the patient with me.\u003c/em\u003e (Clinician FGD)\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eAmong patients and carers, however, there were differing understandings on what, why and how the DI questions might work. Some recognised it would be routinely asked of all patients. Whereas others felt it was specifically asked of them because they were seen as having disability.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eI guess it was to find out that I am a person with disability.\u003c/em\u003e [To improve] \u003cem\u003eaccess to medical services within the hospital, be it at admission, during clinical care, and perhaps at discharge, and at any point of care throughout their staying in hospital. Outpatient and inpatient or a through patient.\u003c/em\u003e (Patient interview)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eWhy was I asked? ... I don't know. Is it because I have disability? ... I think it was useful to be asked those questions.\u003c/em\u003e (Patient interview)\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eOthers thought the DI questions were asked by clinicians to assess their mental health, cognition or consistency of responses (i.e. do their responses match what they have responded elsewhere). Similarly, there was some confusion with the DI questions and other question sets perceived as asking similar questions, questioning both the justification of repeatedly being asked for information and whether information was even considered by clinicians.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eI don't think they read them at all. Because well, it could be one of two things. It could be that they want to make sure that I'm in my right mind and I remember what I told them. … I think a lot of these questions say the same thing. So, I was a bit, not confused, but curious as to why the same questions were asked so many times in different ways.\u003c/em\u003e (Patient interview)\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003e3.2.6 Opportunity costs – the extent to which benefits, profits or values must be given up to engage in the intervention\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThis construct was reverse scored, with a higher mean score indicating lower perceived opportunity cost. Online survey results in relation to opportunity costs revealed a mean score of 4.0 out of five for patients and carers. This aligns with qualitative findings that suggest the opportunity to ‘contribute’ to benefitting the future healthcare of people with disability, generally outweighed any costs in not individually benefiting from immediate changes in care.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eI think that's really going to help going forward hopefully. This\u003c/em\u003e [completing the DI] \u003cem\u003ehelps the next person that comes through the door with a child that\u003c/em\u003e [is non-verbal and relies on carer/advocates]. (Carer interview)\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eSome patients and carers again perceived that the intervention opportunity costs were more likely to be borne by clinicians. Indeed, the online survey mean score for this construct for clinicians was 3.6/ 5. All groups associated opportunity costs to perceived burden and intervention coherence. As such, while clinicians expressed that they feel the questions are useful, their use has not been consistently integrated into their own workflow because of time restraints and existing admin burden.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eI think as a tool it's quite useful within EMR, but again I think it's that admin burden within clinics… Is potentially where it's stumbling.\u003c/em\u003e (Clinician FGD)\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eSome clinicians felt that more training was needed to communicate the value in using the disability identifier questions but also noted the burden of training as a concern. Ultimately, they wanted the process of using the questions to be easier.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eIf there was like an easier way just for like a clinician to, you know, one click… And then, you know, they can see some information of how they need to communicate… or you know if there are any special needs.\u003c/em\u003e (Clinician FGD)\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\"\u003e\n \u003ch2\u003e3.2.7 Self-efficacy –participant’s confidence that they can perform the behaviour(s) required to participate in the intervention.\u003c/h2\u003e\n \u003cp\u003ePatients and carers were asked about how confident they felt in providing responses to the DI questions, with an online survey mean score of 4.1 out of five for this construct. Clinicians were asked about their confidence in asking the questions and using the information, resulting in a mean score of 3.8 out of five. Most patients and carers felt confident in their capacity to respond to the DI questions. Differences did emerge, however, in their level of motivation to do so. Lower levels of motivation related to the perception that the questions did not allow them to adequately describe their experiences of disability and care needs, or that information shared would not be utilised by clinicians or contribute to improvements in care.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eHow do you capture those nuances? … Sometimes it's sort of, it's a bit of a frustrating one, because you want to explain the infinite nuances to the condition, but you know, it's not that people don't want to listen, it's perhaps they don't need to have that information to do what they do.\u003c/em\u003e (Patient interview)\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eGreater confidence was associated with longer periods of time with a disability, progressing to the point whereby some participants wanted to share information and their expertise to help themselves, clinicians and other people with disability accessing healthcare. Anticipated improvements in disability awareness - including through the intervention - amongst clinicians, further facilitated self-efficacy confidence to complete the DI questions.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eIf I was to do this survey a couple of years back … I would have felt uncomfortable. I might have not even partaken. … A lot of changes have happened, and that's why it made it a bit easier. And if I can … help you know the situation, people like me as well ... I'm more than happy to take part in it .... Even the doctors over the time. Still the same doctors that I'm seeing, but the new ones that have come as well have made it, I feel like a bit easier to break that barrier.\u003c/em\u003e (Patient interview)\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eIndeed, confidence and self-efficacy was higher for some clinicians than others. Some raised issues around not knowing who is responsible for asking the questions, alongside not having the confidence to know when it may or may not be appropriate on someone’s journey, to ask the questions and have conversations about disability and care needs. This confusion was particularly evident when clinicians may have identified a discrepancy in documented diagnosis, a patient’s insight into their condition or how they identify with disability, and their subsequent capacity and/or willingness to respond to the questions as anticipated by clinicians.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eIt's not actually that uncommon that patients don't necessarily have insight into what their needs are… They're happy to disclose physical disabilities. I've had quite a few situations where people have been much more cagey\u003c/em\u003e [guarded] \u003cem\u003earound psychosocial stuff. Yeah, mental health stuff. Yeah, because of, you know, historical taboo.\u003c/em\u003e (Clinician FGD)\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eWhile having pre-planned prompts for initiating the conversation increased confidence for clinicians, several still highlighted the need for improved training and support to equip clinicians with the skills to both engage with the intervention and provide the necessary adjustments in care requested by patients.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eI have not received adequate education about use of the identifier ... More education should occur.\u003c/em\u003e (Clinician survey)\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003e3.2.8 Perceived effectiveness – the extent to which the intervention is perceived as likely to achieve its purpose\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe online survey asked patients and carers whether completing the DI questions provided them with an opportunity to communicate their care needs, with a mean score of 3.7 out of five indicating general acceptance that it would. For patients with a disability and carers of a patient with a disability, this was the highest scoring construct, with a mean score of 4.2 out of five. Clinicians were asked whether the DI provided them with useful information about patients’ disability and care needs, with a mean score of 4.0 out of five reflecting most clinicians agreed with this sentiment.\u003c/p\u003e\n \u003cp\u003eSome patients and carers already felt the DI was contributing to change. One patient described being more proactive in communicating their needs to clinicians. In addition, some carers reported in the survey that they had experienced improved communication about their disability or long-term health condition and related care needs because of the DI questions.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eWe were able to document key information about triggers that can seriously escalate her behaviour and lead to traumatic situations for her, us (parents) and others (e.g. staff). This helped to facilitate better pre-planning and getting us linked to important supports.\u003c/em\u003e (Carer survey)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eBeing able to talk through my needs with the nurse was really helpful. Having a plan in place for my clinic appointments helped me to feel much safer to be able to come in\u003c/em\u003e. (Patient survey)\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eMore broadly, however, most patients and carers acknowledged it was too early to tell if the intervention had led to improved practice. Yet as previously highlighted, the process was still seen as contributing positive change in and of itself.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eThe more that people talk about it, or listen or ask about it, the more the disability doesn't frighten other people. … I think the more that people can indicate that somebody's got something, the more people may be mindful and more kind … I think they’re really, really important because it, I don't know if this is the right word, but it helps triage your situation.\u003c/em\u003e (Patient interview)\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eClinicians highlighted that the language in the screening question itself was well structured, with a focus on function rather than a label.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eFor me – the biggest benefit is the wording of the question because it doesn’t rely on ‘do you identify as disabled?’ language always has a different connotation to 'is there anything in your daily life' – I guess that is the main benefit for me.\u003c/em\u003e (Clinician FGD)\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eThere were, however, mixed views from clinicians around the DI questions effectiveness in identifying certain disability types. Some clinicians praised the focus on identity and function, while others felt some of the terms used needed greater clarity to achieve meaningful responses. Clinicians also raised whether some of the language used potentially limited recognition for some patient groups, e.g. those with mental health conditions or who experienced chronic or persistent fatigue.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eIt's more tailored for physical disability as opposed to the other side … So it's clinical usefulness then is … less essentially, than for physical. They're just, yeah, not tailored to the more invisible disability as such.\u003c/em\u003e (Clinician FGD)\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eClinicians also expressed some concerns about the accessibility and flow of questions, limiting patient opportunity to complete all sections. In turn, low usage was a barrier to perceived effectiveness. Clinicians suggested keeping the process simple would help promote its use.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eNot over complicating the communication process. Keeping it simple and I find when you keep the communication process simple for anything like that, people are more likely to pick it up.\u003c/em\u003e (Clinician FGD)\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eRegardless, clinicians felt when the information was there, it was considered helpful and viewed as an effective tool.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eIt's just useful and beneficial for me to be able to interact with them better and understand what they need from me, but also what they need from us as a team.\u003c/em\u003e (Clinician FGD)\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eUltimately, patients, carers and clinicians felt that more training on disability, skills to utilise the information, better integration within workflows, and resources to respond accordingly through enhanced disability-responsive care are all required to fully effect the potential of the intervention.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eBecause everybody's so busy … hospitals are so short staffed. That staff don't have time to actually read all the information to be prepared. So, you know, if they had more hands-on deck, then it would be lovely if all the staff knew everything that you had given them. But it's not realistic at the moment in this day and age … nurses are just run off their feet.\u003c/em\u003e (Patient interview)\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn line with international priorities, integration of patient self-reported Disability Identifiers with health service EMR systems represents a significant step towards enhancing disability-responsive healthcare and equitable health outcomes for people with disability (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Our evaluation assessing the acceptability of DI integration provides valuable insights into successes and challenges, as well as implications for future practice and policy development.\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Perceived Acceptability and Engagement\u003c/h2\u003e \u003cp\u003ePatients and carers broadly appreciated the opportunity to provide disability-related information through the DI questions, recognising its potential to enhance disability awareness and accessibility within healthcare services. The DI resonated strongly with individuals\u0026rsquo; value systems of respect for people with disability and broader community inclusion. However, uncertainty emerged regarding whether the information provided would be meaningfully utilised by hospital staff, particularly in high-pressure settings such as emergency departments and outpatient clinics. Similarly, and aligning with the wider literature, potential tensions emerged relating to the fact that some individuals with disability - particularly less visible disability \u0026ndash; may choose not to share disability-related information due to fear of discrimination (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). To build patient and carer trust to engage with the DI, clear communication about the DI\u0026rsquo;s objectives and benefits is critical. This includes distinguishing its role in current data collection from its evolving potential to further drive more responsive care and outcomes. Arguably even more urgent, is building patient trust in sharing disability-related information, and continual action within healthcare settings to improve disability awareness and address discrimination (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHow the clinicians feel about the intervention was viewed from the perspective of benefits, concerns and usefulness. Clinicians generally expressed positive attitudes toward the DI, acknowledging its potential to facilitate more responsive care for people with disability. Clinicians, patients and carers were optimistic that the DI would ultimately decrease the burden associated with completing general hospital administration. However, practical challenges such as workflow integration and administrative burden were noted. Embedding the DI seamlessly into existing EMR workflows is crucial to ensuring its sustainability and effectiveness. Less perceived burden was reported by clinicians when the DI questions were built into bookings and admissions workflows. This theme aligns with higher DI completion rates observed in settings where the DI questions were integrated as a mandatory component of nursing admission questions (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Training and Awareness\u003c/h2\u003e \u003cp\u003eSuccessful implementation of any intervention relies on clinician engagement, which depends on knowledge, confidence, and adequate resources (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). A recurrent theme across groups was the need for targeted training to support DI implementation. While some clinicians reported receiving training, others lacked sufficient opportunities to understand the value of the DI, how to integrate it into their practice, and how to initiate meaningful conversations with patients.\u003c/p\u003e \u003cp\u003eA lack of awareness about the DI questions and uncertainty around implementation emerged as barriers. Less perceived burden was observed where there was greater knowledge of the DI questions and how to access them in the EMR. Training should therefore focus on promoting awareness of the DI\u0026rsquo;s objectives, equipping clinicians with the confidence to engage in discussing disability-related topics and offering practical guidance on accessing and using DIs within specific workflows. Crucially, training must also improve clinicians understanding of healthcare adjustments and how to utilise DI data to inform adjustments in healthcare delivery (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Concerns regarding training burden must also be managed, potentially through integrating training into existing professional development programs or offering flexible, self-paced learning modules.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Design and Content Refinements\u003c/h2\u003e \u003cp\u003eBoth clinicians and patients identified opportunities to refine the DI questions to better capture the diversity of disability experiences and ensure inclusivity. Their recommendations highlighted the importance of ensuring DI questions are accessible for people with diverse communication needs (e.g. low vision, low literacy). Patients and carers also highlighted the importance of better capturing experiences related to neurodivergence, psychosocial disabilities, and conditions like chronic fatigue and pain. Clinicians also felt it was important to incorporate mechanisms to document whether questions were completed by the patient or carer directly or with a clinician. These and other changes have been included in the final version of the DI questions (see Supplementary File \u0026ndash; Section 4).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Ethical Implications\u003c/h2\u003e \u003cp\u003eEthical considerations emerged, particularly regarding the healthcare system\u0026rsquo;s capacity to act on the information collected through the DI. To address this, participants stressed the importance of aligning the implementation of the DI with ongoing efforts to build healthcare system capacity for inclusive care. Patients, carers, and clinicians emphasised that the collection of disability data must be accompanied by adequate knowledge, resources, and policies to provide necessary adjustments and supports. Transparent communication about how the data will be used and demonstrating its impact on patient care are essential for maintaining stakeholder confidence.\u003c/p\u003e \u003cp\u003eDespite these concerns, participants acknowledged that collecting DI data is a critical first step in understanding and responding to the needs of patients with disability. They recognised that the DI data itself has the potential to inform the development of appropriate policies and practices, ultimately guiding health system improvements to better support people with disability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Policy and Practice Implications\u003c/h2\u003e \u003cp\u003eFindings from this study align with broader evidence on the potential of Disability Identifiers to drive more inclusive and responsive healthcare systems (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Realising this potential requires coordinated efforts involving government, disability stakeholders, and healthcare providers. Key priorities include building capacity to consistently implement, analyse and utilize DI data to evaluate and inform disability-responsive healthcare interventions across settings. Future research should also focus on the effectiveness of DIs to improve care delivery, patient experiences, and outcomes across diverse patient groups. It remains essential to continue to promote co-design approaches to ensure the development and utilisation of DI questions and processes are relevant, inclusive, and reflect the diverse experiences of people with disability within healthcare systems (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e4.6 Future Directions\u003c/h2\u003e \u003cp\u003eLonger-term evaluation is required to assess the DI\u0026rsquo;s impact on patient outcomes and system performance. Efforts should focus on linking DI data to outcomes, developing strategies to enhance clinician engagement, and addressing systemic barriers to equitable healthcare (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). By embedding the DI into routine practice and fostering collaborative partnerships, healthcare systems can take significant steps toward achieving disability-inclusive care. Future work should also explore opportunities to scale the DI model to other healthcare settings, promoting consistency and comparability of data across regions. Further investigation is also needed to consider the feasibility and usefulness of adapting the DI for patients under 2-years of age.\u003c/p\u003e \u003cp\u003eAustralia has made significant advancements in data linkage systems, including through the establishment of the National Disability Data Asset, which aims to bring together data from across Australia to better understand and meet the needs of people with disability (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In time, the National Disability Data Asset may provide a platform to link hospital-based DI data with broader datasets, providing valuable insights into healthcare access, service utilisation, and outcomes for people with disability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003e4.7 Strengths and Limitations of the Research\u003c/h2\u003e \u003cp\u003eThis study represents one of the first evaluations of a co-designed, self-reported DI integrated into health service EMRs, offering novel insights into its acceptability from multiple perspectives within multiple different hospital settings. The study captured the experiences and perceptions of a broad range of stakeholders, including patients, carers, and clinicians, providing a comprehensive understanding of the DI\u0026rsquo;s acceptability. Additionally, the study was conducted across diverse hospital settings spanning tertiary and quaternary paediatric and adult care, cancer care, and maternity services. Use of an established framework, the TFA, ensured a structured and rigorous approach to evaluating the intervention, whilst combining quantitative surveys with qualitative interviews and focus groups enriched the findings and enabled triangulation of data.\u003c/p\u003e \u003cp\u003eThe study focused on acceptability of the DI within the first 9 months of its implementation and did not examine the long-term impact of the DI on patient outcomes, limiting its ability to assess the full potential of the intervention. The findings reflect the early stages of the DI\u0026rsquo;s implementation, and some challenges identified may diminish over time as processes are refined.\u003c/p\u003e \u003cp\u003eSurvey participants were self-selected, which may introduce bias as those with strong opinions about the DI were more likely to participate. While the study was conducted across five diverse hospital settings using two different EMR systems: Cerner Powerchart (Oracle Cerner, Austin, TX) and Epic Systems (Verona, WI), caution should be taken when generalising findings to other jurisdictions, settings and systems. Finally, while the online survey was completed across all sites, qualitative patient and carer interviews and FGDs were conducted at the Parkville health services only.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis research paves the way for other jurisdictions seeking to adopt a standardized approach for disability identification. Emphasising continuous evaluation, stakeholder engagement, and leveraging digital health platforms, the DI initiative demonstrates a transformative approach for advancing disability-responsive healthcare and equitable health outcomes for all.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eDI – Disability Identifier\u003c/p\u003e\n\u003cp\u003eEMR – Electronic Medical Records\u003c/p\u003e\n\u003cp\u003eFGD – Focus Group Discussion\u003c/p\u003e\n\u003cp\u003ePMC - Peter MacCallum Cancer Centre\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRCH - The Royal Children’s Hospital Melbourne\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRMH - The Royal Melbourne Hospital\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRWH - The Royal Women’s Hospital\u003c/p\u003e\n\u003cp\u003eTFA – Theoretical Framework of Acceptability\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eIn accordance with the National Health and Medical Research Council ethics approvals for this multi-site study were obtained by the RCH Human Research Ethics Committee (Project HREC/100979/RCHM2023) and Austin Health’s Human Research Ethics (Project HREC 97208/Austin-2023). All participants provided consent to participate. All aspects of the study were conducted in adherence with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot Applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eData and materials is not publicly available in line with Ethics approval.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research was supported by funding from the Victorian Government\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJoanne Rowe: \u0026nbsp; Conceptualisation, Methodology, Validation, Analysis, Investigation, Writing – original draft, Project Admin and funding acquisition\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlexandra Devine: Conceptualisation, Methodology, Validation, Analysis, Investigation, Writing – original draft\u003c/p\u003e\n\u003cp\u003eNicole Merrick: Conceptualisation, Methodology, Software, Validation, Analysis, Investigation, Writing – original draft,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMarie Huska: Methodology, Validation, Analysis, Investigation, Writing – original draft,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eKirsten Morris: Conceptualisation, Methodology, Validation, Investigation, Resources, Writing – review and editing, Project Admin\u003c/p\u003e\n\u003cp\u003eKath Feely: Conceptualisation, Software: Validation, Resources, Writing – review and editing\u003c/p\u003e\n\u003cp\u003eAhuva Segal: Software, Validation, Investigation, Resources, Writing – review and editing\u003c/p\u003e\n\u003cp\u003eLouise Mogg: Conceptualisation, Methodology, Resources, Writing – review and editing, Project Admin\u003c/p\u003e\n\u003cp\u003eJenni Medland: Conceptualisation, Methodology, Resources, Writing – review and editing, Project Admin\u003c/p\u003e\n\u003cp\u003eRebecca Jamwal: Methodology, Validation, Investigation, Resources, Writing – review and editing\u003c/p\u003e\n\u003cp\u003eAlison Smith: Conceptualisation, Methodology, Resources, Writing – review and editing, Project Admin\u003c/p\u003e\n\u003cp\u003eMaricar Gleich: Methodology, Resources, Writing – review and editing, Project Admin\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJeremiah Munakabayo: Formal Quantitative Analysis and data visualisation, review and editing\u003c/p\u003e\n\u003cp\u003eChristine Imms: Conceptualisation, Methodology, Resources, Writing – original draft, Supervision\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe wish to acknowledge and thank Adrienne Fosang and Michelle Shao for review and feedback; Lucinda Russell and Ilianna Ginnis for providing research assistance and Gonzalo Sepulveda Kattan (The Centre for Health Analytics) for supervising the quantitative data analysis.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAustralian Bureau of Statistics. 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Advancing Health Equity And Reducing Health Disparities For People With Disabilities In The United States: Study examines health equity and health disparities for people with disabilities in the United States. Health Affairs. 2022;41(10):1379-86.\u003c/li\u003e\n\u003cli\u003eYang Y, Summers P, Aitken Z, Kavanagh AM, Disney G. All-cause and cause-specific mortality inequalities between people with and without disability: a nationwide data linkage study of 15 million individuals. The Lancet Public Health. 2024;10(1):e11-e9.\u003c/li\u003e\n\u003cli\u003eAustralian Institute of Health and Welfare. Mortality patterns among people using disability support services: 1 July 2013 to 30 June 2018 (Summary report). Canberra: AIHW; 2020.\u003c/li\u003e\n\u003cli\u003eHuq NL, Edmonds T, Baker S, Busija L, Devine A, Fotis K, et al. The rapid assessment of disability-informing the development of an instrument to measure the effectiveness of disability inclusive development through a qualitative study in Bangladesh. Disability, CBR and Inclusive Development. 2013:37-60.\u003c/li\u003e\n\u003cli\u003eFortune N, Bailie J, Gordon J, Plunkett K, Hargrave J, Madden R, Llewellyn G. Developing self-report disability questions for a voluntary patient registration form for general practice in Australia. Australian and New Zealand Journal of Public Health. 2023;47(2):100032.\u003c/li\u003e\n\u003cli\u003eWalmsley S, Devine A, Aitken Z, Kavanagh A, Huska M, Marella M. Monitoring and evaluation of health equity for people with disabilities in low- and middle-income countries: a scoping review protocol Open Society Institute; 2024.\u003c/li\u003e\n\u003cli\u003eMcPherson A, Durham J, Richards N, Gouda H, Rampatige R, Whittaker M. Strengthening health information systems for disability-related rehabilitation in LMICs. Health Policy and Planning. 2017;32(3):384-94.\u003c/li\u003e\n\u003cli\u003eNational Health Services. Reasonable Adjustment Flag 2023 [updated 6 December 2023. Available from: https://digital.nhs.uk/services/reasonable-adjustment-flag#top.\u003c/li\u003e\n\u003cli\u003eMorris M. Implementation of Communication Disability Collection and Accommodations in Primary Care Settings. Colorado2024 [Available from: https://reporter.nih.gov/search/LNoYaSuRU0GxLsxy9xhXKg/project-details/10873203.\u003c/li\u003e\n\u003cli\u003eM\u0026ouml;rchen M, Lewis D. Towards Universal Eye Health: Hospital-based disability-disaggregated data collection in Takeo province, Cambodia. Disability and Health Journal. 2018;11(4):660-4.\u003c/li\u003e\n\u003cli\u003eM\u0026ouml;rchen M, Zambrano O, P\u0026aacute;ez A, Salgado P, Penniecook J, Brandt von Lindau A, Lewis D. Disability-Disaggregated data collection: Hospital-Based application of the Washington group questions in an eye hospital in Paraguay. International Journal of Environmental Research and Public Health. 2019;16(17):3085.\u003c/li\u003e\n\u003cli\u003eJolley E, Thivillier P, Smith F. Sightsavers. Disability disaggregation of data-Baseline report. India and Tanzania. December; 2014.\u003c/li\u003e\n\u003cli\u003eNational Health Services. Health and Care of People with Learning Disabilities, Experimental Statistics 2022 to 2023 England2023 [Available from: https://digital.nhs.uk/data-and-information/publications/statistical/health-and-care-of-people-with-learning-disabilities.\u003c/li\u003e\n\u003cli\u003eAustralian Government. My Medicare: Department of Health and Aging; 2024 [Available from: https://www.health.gov.au/our-work/mymedicare.\u003c/li\u003e\n\u003cli\u003eRowe J, Morris K, Devine A, Merrick N, Segal A, Mogg L, et al. Implementation of Disability Identification in Electronic Medical Records (EMR): Evaluation of Utility and Acceptability. Melbourne; 2024.\u003c/li\u003e\n\u003cli\u003eSekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Services Research. 2017;17:1-13.\u003c/li\u003e\n\u003cli\u003eHarris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)\u0026mdash;a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of biomedical informatics. 2009;42(2):377-81.\u003c/li\u003e\n\u003cli\u003eFortune N, Madden RH, Clifton S. Health and access to health services for people with disability in Australia: data and data gaps. International Journal of Environmental Research and Public Health. 2021;18(21):11705.\u003c/li\u003e\n\u003cli\u003eGoujon N, Devine A, Baker SM, Sprunt B, Edmonds TJ, Booth JK, Keeffe JE. A comparative review of measurement instruments to inform and evaluate effectiveness of disability inclusive development. Disability and rehabilitation. 2014;36(10):804-12.\u003c/li\u003e\n\u003cli\u003eAitken Z, Fortune N, Krnjacki L, Badji S, Disney G, Kavanagh A. Identification of People with Disability in Linked Administrative Data: Methodology Paper. 2021.\u003c/li\u003e\n\u003cli\u003eNational Disability Data Asset. One Asset, Many Potential Uses. Canberra: 2024; 2024 [Available from: https://www.ndda.gov.au/.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Disability, Disability Identifiers, Electronic Medical Records, Healthcare, Universal Access, Health Equity, Disability Data, Acceptability, Co-design","lastPublishedDoi":"10.21203/rs.3.rs-6218627/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6218627/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u0026nbsp;A third of the 5.5 million Australians with a disability require adjustments to access healthcare effectively. Ensuring clinicians have timely information about a patient’s disability and care needs can support more responsive care. Disability Identifiers—brief question sets—offer a practical way to capture this information. However, their use in healthcare remains limited. To address this, a group of clinicians, consumers and researchers from five tertiary and quaternary health services in Victoria, Australia, co-designed and implemented patient self-report Disability Identifier within Electronic Medical Record systems. This paper presents an evaluation of the acceptability of this intervention among patients, carers, and clinicians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u0026nbsp;The Disability Identifier questions were integrated into Electronic Medical Record systems across the five health services in March 2023, with the evaluation spanning the first nine months of implementation (1\u003csup\u003est\u003c/sup\u003e March–30\u003csup\u003eth\u003c/sup\u003e November 2023). Using a mixed methods convergent parallel design and guided by the Theoretical Framework of Acceptability, we conducted online surveys, interviews, and focus groups with patients, carers, and clinicians. Data analysis explored perspectives and experiences across eight constructs: general acceptability, affective attitude, burden, ethicality, intervention coherence, opportunity costs, self-efficacy, and perceived effectiveness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Survey results indicated strong acceptability of the Disability Identifier questions. Interviews with patients and carers reflected generally positive perceptions of the intervention, with many noting that it signalled a commitment by health services to improving care for people with disability. Clinicians emphasised that, with adequate training and resources, the intervention could raise awareness about disability and contribute towards disability-responsive care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u0026nbsp;Integrating patient self-reported Disability Identifiers into EMR systems marks a critical step toward improving disability-responsive healthcare. Building trust in Disability Identifiers requires clear communication about their purpose, benefits, and role in improving care while also addressing disability awareness and discrimination in healthcare settings. While continuous evaluation of their use and impact on patient experiences and outcomes is recommended, this research lays the foundation for other jurisdictions to adopt a standardized approach to integrating Disability Identifiers into health data systems. Ultimately, effective use of patient self-report Disability Identifiers has the potential to promote more equitable health outcomes for people with disability.\u003c/p\u003e","manuscriptTitle":"A patient self-report Disability Identifier within health service Electronic Medical Records: evaluation of patient, carer and clinician acceptability","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-31 14:36:18","doi":"10.21203/rs.3.rs-6218627/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-12T07:29:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-12T19:51:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-02T05:39:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"157379383499238586423330001282878438734","date":"2025-03-29T11:28:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"184228652064469054947787800194368100583","date":"2025-03-22T18:44:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"286951076630952268821848103204686059416","date":"2025-03-20T17:21:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-20T16:53:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-20T09:20:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-19T22:31:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-03-19T22:30:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e7af6e8e-877f-40fb-a8e5-e7c06829fcc8","owner":[],"postedDate":"March 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T16:17:40+00:00","versionOfRecord":{"articleIdentity":"rs-6218627","link":"https://doi.org/10.1186/s12913-025-12974-5","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2025-07-01 15:58:42","publishedOnDateReadable":"July 1st, 2025"},"versionCreatedAt":"2025-03-31 14:36:18","video":"","vorDoi":"10.1186/s12913-025-12974-5","vorDoiUrl":"https://doi.org/10.1186/s12913-025-12974-5","workflowStages":[]},"version":"v1","identity":"rs-6218627","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6218627","identity":"rs-6218627","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}