Desired Preparedness and Attitudes of Health Care Providers Toward Patients with Disabilities: Qualitative Research with Welfare Professionals

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Although Japan recently enacted the Disability Discrimination Law, the concept of reasonable consideration is not widespread. Objectives This study examined the challenges and preferred responses experienced by support professionals accompanying PWDs to medical institutions, aiming to identify effective practices for improving medical visits. Methods Interviews were conducted with 37 welfare professionals in disability services, focusing on their experiences of the issues and effective practices in medical institutions. Data was transcribed and thematic analysis was employed to generate themes by coding specific events or episodes as medical experiences of PWDs. Results Analysis identified four themes: “issues with the response of medical institutions/healthcare staff,” “preferred response of healthcare staff,” “expected response of hospitals,” and “efforts of PWDs and welfare professionals to secure appropriate care.” The following subthemes from “the preferred response of healthcare staff” included “understanding the situation and needs associated with disabilities” and “finding effective communication methods for each patient.” Additionally, a recurring issue was “not respecting the disabled patient as an independent person”. Conclusion The training and education for medical professionals must include provisions required by PWDs, including their culture and values. Welfare professionals are committed to improving healthcare accessibility, emphasizing the importance of collaboration between healthcare and welfare professionals to foster meaningful change. Practice Implication: There is a need for a dissemination training program for medical professionals to understand the issues faced by PWDs, including their subjective experiences and values. Healthcare organizations must accumulate know-how and share knowledge of needs and reasonable accommodations. Trial registration: This study is a descriptive study and not an intervention on human participants. Disability Discrimination Law reasonable accommodation healthcare access Introduction Persons with disabilities (PWDs) face more health risks, comorbidities, poor health outcomes, and higher healthcare needs than individuals without disabilities. 1 – 4 Although the increased life expectancy of PWDs has increased the demand for medical care, their access to healthcare remains limited. 5 , 6 PWDs face several barriers in accessing healthcare. Pharr and Chino 7 summarized these as “structural, financial, personal/cultural barriers,” while Scheer et al. 8 categorized them into “environmental, structural, and process barriers.” Sharby et al. 9 summarized factors influencing healthcare access among PWD as “attitudes of healthcare providers and the public, physical barriers, miscommunication, income level, ethnic/minority status, insurance coverage, and lack of information tailored to PWD.” Lawthers 10 defined barriers to receiving appropriate care as “physical barriers, transportation, communication difficulties, and client and provider attitudes.” Although classifications vary, it is clear that PWDs experience difficulties in accessing health services. They are often excluded from cancer screenings, 11 and face physical barriers to primary care access 12 . Discrimination or avoidance in health services can result in unaddressed needs and deterioration of health outcomes 13 , 14 —a critical situation requiring urgent attention. The UN Convention on the Rights of Persons with Disabilities mandates that signatory countries prohibit discrimination against PWDs and ensure reasonable accommodation. Smith 15 observed that “access to healthcare for PWDs has become a political focal point,” especially in countries with anti-discrimination legislation. However, even in the USA, where the Americans with Disabilities Act (ADA) and the concept of “reasonable accommodation” have been in effect since 1990, many medical professionals remain unaware of the ADA. Clinics managed by administrators unfamiliar with the ADA tend to impose more barriers for PWDs. 7 Consequently, fostering the integration of reasonable accommodation within medical institutions has proven difficult. While Japan has a universal health insurance system and fair access to healthcare, awareness of the importance of equal access to healthcare as a fundamental human right for PWDs remains limited. The Basic Act for Persons with Disabilities, enacted in 1960, included welfare services and protections but focused primarily on service provision rather than human rights. In 2014, Japan ratified the Convention on the Rights of Persons with Disabilities and made various legal amendments, including the 2013 amendment of the Act to Facilitate the Employment of Persons with Disabilities, which incorporated the concept of reasonable accommodation. 16 The 2016 Law on the Elimination of Discrimination against Persons with Disabilities—amended in 2021—mandates that all establishments and institutions provide reasonable accommodation by April 2024. 17 Despite this progress, the concept of reasonable accommodation has yet to gain traction within the medical field, and institutions have not sufficiently acted on these requirements. 18 As such, there is an urgent need to identify necessary improvements. Although research on this issue in Japan is limited, Iwakuma et al. 19 revealed that PWDs tend to face challenges due to disabilities, including a shortage of healthcare providers familiar with their needs and difficulties with insurance transitions at age 65. Furukawa et al. 20 found that individuals with intellectual disabilities encounter difficulties in accessing appropriate medical care and require additional reasonable accommodation in medical institutions. Overall, while information on the challenges faced by PWDs in healthcare settings during the initial stages of reasonable accommodation implementation remains scant in Japan, addressing these issues is essential. Additionally, although the perspectives of PWDs and their families are invaluable in identifying issues common to medical institutions in Japan, drawing on our experience with numerous cases can shed light on the issues confronting Japan’s medical frontline, with the potential for broader applicability. Purpose This study examined the difficulties, challenges, and preferred responses experienced by support professionals while accompanying PWDs to medical institutions. It also sought to identify appropriate responses during such visits. Method Study participants Thirty-six welfare professionals were interviewed: 15 were affiliated with the National Rehabilitation Center, 4 with information services for the visually impaired, 1 with information services for the hearing impaired, and 16 were sign language interpreters. Although we primarily recruited professionals from national institutions that address a range of disabilities, the initial sample did not include enough sign language interpreters with experience in medical examination settings. To address this gap, we added participants from facilities providing information to people with audiovisual disabilities and recruited additional sign language interpreters using snowball sampling. Data collection Interviews were conducted with participants—either individually or in groups—between October 2020 and April 2021. Most interviews were conducted individually; however, some participants indicated that they were more comfortable talking together with their colleagues and were therefore interviewed as a group. Five group interviews involved two participants, and four involved three persons, resulting in 23 interviews in total. The interviews spanned 1,426 minutes, with an average duration of 39.6 minutes per participant. The interviews were conducted by four social researchers (1st, 3rd, 4th, and 5th authors) who are experts in the disability field. Interviews were recorded with participants’ permission, and verbatim transcripts were prepared. Participants—as social workers who accompanied PWDs to medical appointments—recounted instances of both inappropriate and favorable responses they encountered during these visits. The interview items are presented in Table 1 . Table 1: Interview items What types of disabilities have you been involved in supporting? Have you experienced any difficulties in accompanying or coordinating medical visits for people with disabilities that you support? What were they? Have you ever had a positive experience at a medical visit for a person with a disability you support? What was it like? Have you ever assisted a person with a disability with a medical examination or visit? In particular, what do you know about medical examinations for serious illnesses or injuries other than the underlying disability? Are there any other issues that you think are challenges in terms of people with disabilities receiving appropriate medical care? Data Analysis This study analyzed the challenges and factors perceived by welfare professionals accompanying or supporting PWDs during hospital visits. Thematic analysis 21 was employed to generate themes by coding specific events or episodes as medical experiences of PWDs. The analysis followed these steps: Step 1: Verbatim records were uploaded into NVIVO to extract their contents. Step 2: Data were systematically coded in their entirety, highlighting key features and generating initial codes. Step 3: Generated codes were classified into themes or sub-themes by examining similarities between codes. Step 4: Integration and separation of themes and sub-themes were examined and refined, considering both the uniformity within data categories and the heterogeneity between themes. Step 5: Refined themes and sub-themes were named to reflect their essence and defined by identifying their specific characteristics. To ensure reliability and validity and minimize bias in the interpretation and analysis of the data, the first author initially generated the codes, sub-themes, and themes. These were subsequently reviewed and refined by the second author, resolving any disagreements in interpretation. Results Four themes emerged from the data: “issues with the response of medical institutions/healthcare staff,” “preferred response of healthcare staff,” “expected response of hospitals,” and “efforts of PWDs and welfare professionals to secure appropriate care.” Verbatim excerpts, with necessary clarifications added by the researcher, are presented below. Issues with the response of medical institutions and healthcare staff “Issues with the response of medical institutions/healthcare staff” comprised six sub-themes and was highlighted in 109 statements (Table 2 ). Table 2 Sub-themes of “issues with the response of medical institutions/healthcare staff” Sub-themes Number of statements Not respecting the PWD as an independent person 52 Atmosphere in which patients with disabilities feel unwelcome 25 Treating patients with disabilities as vulnerable stereotypes 14 Lack of accumulated methods of dealing with disabilities 16 Clearly discriminatory behavior 2 The most frequently mentioned sub-theme was “not respecting the PWD as an independent person.” Participants recounted instances of health professionals speaking to patients’ assistants or sign language interpreters rather than addressing the patients directly, often treating assistants as guardians or surrogate. This occurred regardless of the type of disability, even among those without speaking difficulties, such as individuals with visual impairments. When I accompany visually impaired patients as a volunteer assistant or friend, hospital staff address me, not the patient. They often speak to the sighted assistant, perhaps unconsciously viewing it as a situation where parents respond on behalf of their child even when the child is present. Regarding the “atmosphere in which patients with disabilities feel unwelcome,” PWDs often sensed an unwelcoming environment due to the facial expressions or tone of medical staff, leading them to refrain from asking questions to doctors or lose the will to communicate their condition. Several interviewees speculated this resulted from prior experiences of disrespect at other medical institutions. If they sense an aura of ‘don't ask,’ they are very sensitive and feel discouraged from speaking. People with disabilities are quick to give up saying what they want to say, aren’t they? When they conclude there's no point in talking about it here, they do not pursue it further and give up on medical treatment immediately. I believe that people with disabilities have a very good eye for people because they have been hospitalized many times, seen many medical staff, and have developed the skill to identify ‘trustworthy’ people. As a result, I think there are many people who are not receiving the treatment they want. “Treating PWDs as vulnerable stereotypes” refers to situations wherein the medical staff did not intend to discriminate against or reject PWDs, but their actions were based on paternalistic judgment. For example, visual or hearing impairments were viewed as a lack of judgment, and excessive protective measures that limited PWDs’ options. “Lack of accumulated methods of dealing with disabilities” refers to situations where risks may arise owing to the lack of alternative approaches, such as communicating with deaf patients at, ophthalmology appointments, preventing ulcers in individuals with cervical spinal cord injuries, transferring a person with high cervical cord injury from a wheelchair, and guiding a person with visual impairment in examination situations, such as those involving patients with involuntary movements. Further, two interviewees highlighted cases of “clearly discriminatory behavior,” although the details of these incidents occurred were not discussed, but they should not have happened. Preferred response of healthcare staff “Preferred response of healthcare staff” comprised three sub-themes reported in 157 statements (Table 3 ). Table 3 Sub-themes of “preferred response of healthcare staff” Sub-themes Number of statements Having a picture of the situation and needs caused by disabilities 97 Finding the best way to communicate with each patient 45 Considering the patient’s will and having an attitude of thinking together, even if there are limitations 16 “Understanding the situation and needs associated with disabilities” was reported in 97 statements addressing various disability-related challenges and requirements Specific examples included understanding that Japanese is a second language for deaf individuals whose first language is sign language, reading important information aloud when providing written explanations to visually impaired persons informing patients that they may choose to write their signature or that of a substitute if they cannot locate the signature box on a form, providing visual aids such as cards for individuals with autism, and ensuring proper care to prevent pressure ulcers for individuals unable to move their bodies. Many participants emphasized the importance of health professionals demonstrating an attitude of trying to understand patients’ difficulties. It is necessary to understand and take into consideration the disability characteristics of people with hearing, vision, physical, and higher brain disorders. In addition, each person with disabilities has different ways of hearing, seeing, sensing, or moving. Therefore, I really want health professionals to have the ability to perceive and the attitude to try to understand how and what the patient in front of them is struggling with. “Finding the best communication methods for each patient” comprised 45 statements highlighting approaches such as verbal communication, interpretation, or written communication for patients with hearing impairments; confirming understanding after interpreters finish translating; encouraging visually impaired persons to record conversations; and using simple options to ascertain preferences from individuals with intellectual disabilities or higher brain dysfunction. Examples of effective practices included health professionals offering detailed explanations to patients and engaging in two-way communication to understand their intentions. I’ve experienced the good case in which the patient was given a detailed explanation, such as the contents of an X-ray examination and when to change their posture, etc., and agreed on cues through a sign language interpreter before undergoing the examination. That helped smooth communication. In another case, there was a doctor who used paper, a whiteboard, and a computer to communicate in writing. Even when the interpreter was with him, he voluntarily wrote down the main points on a piece of paper and finally handed it to the patient. “Considering the patient’s will and having an attitude of thinking together, even if there are limitations” emphasizes the importance of listening to patients, even when they struggle to adequately describe their condition, pain, numbness, or other symptoms, and to jointly consider the necessary actions. If the person has difficulties describing the conditions, it is also hard for the care professional. The patient with severe disability sometimes only expresses to say, ‘I feel something strange,’ and we all don't understand, but it is the person who is in trouble, so it is important for the medical institutions to have an attitude of working and thinking together with them. Expected preparation of hospitals “Expected preparation of hospitals,” comprising three sub-themes, refers to institutional-level environments and practices adopted by hospitals (Table 4 ). Table 4 Sub-themes of “expected response of hospitals” Sub-themes Number of statements Enhancing the personnel and equipment for providing reasonable accommodation 24 Systematically accumulating the skills for providing reasonable accommodation 21 Establishing procedures for understanding patients’ needs, transmitting the information across different sections of the hospital, and providing feedback to patients 21 “Enhancing the personnel and equipment for providing reasonable accommodation” highlights the importance of ensuring wheelchair-accessible spaces, reception machines, and automatic doors that can be reached from a wheelchair without hindrance, facilities for transferring and bathing individuals with cervical cord injuries; and skilled staff capable of supporting people with severe intellectual disabilities. All interviewees acknowledged that not all hospitals could afford such equipment. “Systematically accumulating the skills for providing reasonable accommodation” implies sharing the experiences of caring for PWDs. Examples included knowing that sign language interpreters are available and developing skills for guiding visually impaired patients across hospital sections. Professionals in the disability field welcomed inquiries about how to provide reasonable accommodations. “Establishing procedures for understanding patients’ needs, transmitting the information across different sections of the hospital, and providing feedback to patients” implies methods for PWDs to communicate their needs to hospitals, ensuring this information is shared across departments. Feedback mechanisms were also deemed essential, as miscommunications—such as scheduling longer consultation times for PWDs without informing them—had led to unpleasant experiences. Efforts of persons with disabilities and welfare professionals to secure appropriate care To achieve appropriate care, participants highlighted the efforts of PWDs and welfare professionals to change the behavior and awareness of medical professionals (Table 5 ). Table 5 Sub-themes of “efforts of PWDs with disabilities and welfare professionals to secure appropriate care” Sub-themes Number of statements Explaining the needs and adequate accommodation to the medical professionals 40 Providing support or speaking for the PWDs to express their needs 52 Providing long and holistic support for medical examination and treatment 23 They observed that, to request a response from hospital staff, they must first communicate the needs of PWDs and request reasonable accommodations. Statements that highlighted “explaining the needs and adequate accommodation toward the medical field” referred to the intentionality behind these explanations. A person with low vision who I had attended once had a wordbook with pictures of something like, ‘I see like this,’ ‘I see better with black and white reversal,’ ‘I have tunnel vision.’ When he met the doctor, ‘I have this kind of vision, so when I receive a document, I will look at it with my right eye attached to the paper, but please don't think it is strange.’ He would start by telling the doctor about himself using the word cards, and then, being relatively proactive, he would ask the doctor, 'What does this say?' if he didn't understand something in the document. Welfare professionals also encouraged PWDs to communicate their needs and required accommodations, adjusted power dynamics in paternalistic medical situations, and advocated for PWDs who were unable to express themselves. They demonstrated awareness of various practical methods to facilitate effective communication in everyday scenarios. If the person is unable to communicate directly with medical professionals, the only way is for the care professional to grasp the situation and fully communicate their needs on behalf of the person. In order to do so, it is necessary to have a checklist of items about the patient to be conveyed to the medical staff. “Providing long and holistic support for medical examination and treatment” implies a wide range of support for PWDs during medical care. Some PWDs may need welfare professionals’ support to understand doctors’ advice, while others may need help for self-injection. Due to limited availability of medical information in braille or audio formats, visually impaired patients require welfare professionals to interpret doctors’ written medical advice. Although the specialties and support offered by professionals vary depending on the nature of the disability and the region, collaboration among supporters through a network is essential for providing comprehensive care. As for support, we are trying to create a network, a circle of support. That way, we can continue to provide support even when something is missing in the network. Now, there is an app that can be viewed by supporters as well as the patient; everyone can write and share information with it. Discussion Issues raised by welfare professionals and the corresponding education for medical professionals Participants spoke predominantly about the need for medical professionals to treat PWDs as independent patients, imagine their circumstances, and understand their needs rather than focusing solely on the lack of accessible facilities. This aligns with findings from previous studies. For instance, Harrington et al. 22 surveyed persons with physical disabilities and reported that “perceived deficits in primary care physicians’ knowledge of disability issues seem more prevalent than physical barriers to care.” Lagu et al. 23 highlighted that “the greatest challenge in achieving universal accessibility in healthcare settings may not be the cost but the need for a change in mindset on the part of clinicians and administrators.” Flood 24 noted that “the most significant barriers to safer and better healthcare appear to include ‘invisibility’ of people with intellectual disabilities within health-care systems.” The results of this study are consistent with these findings. Many previous studies have highlighted the need for medical professionals to be trained to address the needs of PWDs. 25 For example, Morrison et al. 26 emphasized teaching “how to coordinate care, access resources, and communicate about disability issues.” Additionally, it is essential to design educational programs that address consequences and cope with the consequences, adopt and adapt cultural competency, and highlight “disability culture.” 27 Miller 28 noted that medical professionals’ understanding of “insights to aspects of living with a disability” is essential for patient-centered communication. Neri and Kroll 29 stressed that healthcare providers and insurance plans should be “disability literate” to reduce barriers to healthcare access. Different expressions such as “disability culture,” “disability literate,” or “insights of living with disabilities” highlight the need for medical professionals to understand the issues faced by PWDs, including their subjective experiences and values. However, how education can integrate these complex subjectivities and values remains under examination, 25 necessitating specific teaching methods to be proposed and evaluated. Respect toward PDWs and awareness of reasonable accommodation Under the theme “issues with the response of medical institution/healthcare staff,” the sub-theme “not respecting the disabled patients as an independent person” was the most frequently cited. This sub-theme highlighted the staff’s attitudes, in that healthcare professionals often communicated with accompanying supporters or families instead of the PWD. Although such attitudes can be considered unconscious actions devoid of malice, many medical professionals are unaware that there is a need for improvement. Treating supporters as decision-makers has been prevalent not only in Japan but also in many other countries. Even in the UK, which has had a disability discrimination law since 1995, Diesfeld 30 observed that paternalistic decision-making is sometimes legitimized as the “best choice,” and Ali et al. 31 highlighted insufficient reasonable adjustments for persons with intellectual disabilities in healthcare. A 2011 survey in the USA revealed that primary care practice administrators’ knowledge of the ADA directly influenced facility barriers, emphasizing the need for “disability training for health professionals.” 7 Another survey in 2020 found that one-third of physicians knew little about their legal responsibilities under the ADA. 32 PWDs are significantly more likely than those without disabilities to feel that physicians do not listen to them, explain treatment options, treat them with respect, spend sufficient time with them, or involve them in treatment decisions. 33 In Japan, laws related to PWDs historically focused on protection and service provision, with the prohibition of discrimination and the requirement for reasonable accommodation only recently introduced 34 through the Law on the Elimination of Discrimination against Persons with Disabilities in 2016. Although the concept of reasonable accommodation has been gradually integrated into public educational institutions, its presence in the medical field remains limited 35 . Few studies have discussed the implementation of reasonable accommodation in medical institutions, with Hyoguchi et al. 18 reporting that pharmacists often did not understand the concept. Educating medical professionals about reasonable accommodation for PWDs is essential in Japan. Accumulation of reasonable accommodation at the organizational level Addressing the diverse needs of PWDs requires not only the preparedness of medical personnel but also an environment in which alternatives can be readily provided; this issue must be addressed by organizations. This study highlighted the need for healthcare organizations to accumulate know-how and share knowledge of needs and reasonable accommodations. Although customization is necessary based on individual needs, various reasonable accommodations can be easily introduced through proactive preparation. These include providing easy-to-read documents, accessible information on medication and procedures, allocating longer appointment slots, offering early appointments for patients with intellectual disabilities, 31 providing audible or braille formats for patients with visual impairment, and arranging sign language interpreters for patients with hearing impairments, 36 signifying reasonable accommodation. 37 , 38 Smith 40 advocated for “disability literacy,” and recommended evaluating healthcare facilities based on feedback from PWDs. Lawthers et al. 10 emphasized that quality care for PWDs requires close collaboration between healthcare systems and social service sectors. The welfare professionals who participated in this study also recognized their roles as advocates or spokespersons for PWDs to communicate their medical care needs. Collaborative efforts in individual cases can lead to faster and more appropriate preparation of reasonable accommodations and effective incorporation of user feedback. Practical Implications From the interviews, welfare professionals strongly expected the medical professionals to know about the needs of PWDs. There is a need to disseminate training programs for medical professionals to understand the issues faced by PWDs, including their subjective experiences and values. Another implication is that healthcare organizations should accumulate know-how and share knowledge of needs and reasonable accommodations, and should not leave it all up to individuals. Limitations and further research This study described barriers and best practices in healthcare services as perceived by disability welfare professionals. These professionals have accumulated extensive experience in supporting PWDs and can provide an overarching view of the challenges they face in medical settings. However, perceptions of welfare professionals and PWDs themselves may differ, and PWDs may encounter distinct challenges when supporters are not present. Therefore, the perspectives of PWDs require careful examination. Another limitation of this study is its focus on challenges within hospitals and clinics, excluding barriers encountered before reaching these institutions. As PWDs face healthcare access barriers at various stages, 39 future studies should investigate scenarios where access to healthcare services is hindered. Conclusion From interviews with 37 welfare professional about the difficulties they experience when accompanying PWDs to medical institutions, four categories emerged: “issues with the response of medical institutions/healthcare staff,” “preferred response of healthcare staff,” “expected response of hospitals,” and “efforts of PWDs and welfare professionals to secure appropriate care.” Subthemes such as “understanding the situation and needs associated with disabilities” and “finding effective communication methods for each patient” were frequently mentioned, suggesting that medical education should include PWDs’ subjective experiences and values. Furthermore, the subthemes “finding effective communication methods for each patient” and “not respecting the disabled patient as an independent person” highlighted the need to raise awareness in the medical field that access to appropriate healthcare for PWDs is a fundamental human right and that providing reasonable accommodations is essential. Declarations Ethics approval and consent to participation This study was conducted in compliance with the ethical guidelines for medical research involving human subjects, and with the approval of the National Cancer Center Research Ethics Review Committee (2020-172) and the National Rehabilitation Center for Persons with Disabilities (2020-081). All participants were informed of the study’s purpose and assured that participation was voluntary, non-participation would not result in any disadvantage and they could withdraw at any time during the course of the study. Researchers explained that the data will be transcribed, anonymized, and analyzed to produce research papers, and would not be used for any other purpose and would be discarded upon study completion. Written consent was obtained from all the participants. Consent for publication As described in previous sections, all the interviewees were informed that their talk would be used to produce research papers, and all the participants gave consent to that. Availability of data and materials The interview data collected in this study are not publicly available. Competing interests The authors declare that they have no competing interests. Funding This study was supported by two research grants awarded to Chikako Yamaki by the Health and Labor Sciences Research [#20EA1014] for conducting the surveys and [#23EA1030] for English editing and publishing. Authors’ contributions Chikako Yamaki was in charge of planning the survey, conducting the interviews, analyzing all the data, and writing this manuscript. Sarasa Kai analyzed all the data together with CY and checked this manuscript. Kumiko Imahashi collaboratively planned the survey, recruited and conducted the interviews, and checked this manuscript. Kai Seino collaboratively planned the survey, recruited and conducted the interviews, and checked this manuscript. Eiji Taira recruited and conducted the interviews and checked this manuscript. Acknowledgements We would like to thank all the welfare professionals who participated as interviewees in this study. References Friebel R, Maynou L. Assessing The Dangers Of A Hospital Stay For Patients With Developmental Disability In England, 2017-19. Health Aff (Millwood). 2022;41:1486–95. DeJong G. Primary care for persons with disabilities. An overview of the problem. Am J Phys Med Rehabil. 1997;76:S2–8. Kinne S, Patrick DL, Doyle DL. Prevalence of secondary conditions among people with disabilities. Am J Public Health. 2004;94:443–5. MENCAP. Treat me right! Better healthcare for people with a learning disability. https://www.mencap.org.uk/sites/default/files/2016-08/treat_me_right.pdf2004:1-36 Iezzoni LI, McKee MM, Meade MA, Morris MA, Pendo E. Have Almost Fifty Years Of Disability Civil Rights Laws Achieved Equitable Care? Health Aff (Millwood). 2022;41:1371–8. Bauer SE, Schumacher JR, Hall A, et al. Disability and physical and communication-related barriers to health care related services among Florida residents: A brief report. Disabil Health J. 2016;9:552–6. Pharr J, Chino M. Predicting barriers to primary care for patients with disabilities: a mixed methods study of practice administrators. Disabil Health J. 2013;6:116–23. Scheer J, Kroll T, Neri MT, Beatty P. Access barriers for persons with disabilities: The consumer's perspective. J Disabil Policy Stud 132003:221–30. Sharby N, Martire K, Iversen MD. Decreasing health disparities for people with disabilities through improved communication strategies and awareness. Int J Environ Res Public Health. 2015;12:3301–16. Lawthers AG, Pransky GS, Peterson LE, Himmelstein JH. Rethinking quality in the context of persons with disability. Int J Qual Health Care. 2003;15:287–99. Saito T, Imahashi K, Yamaki C. Use of General Health Examination and Cancer Screening among People with Disability Who Need Support from Others: Analysis of the 2016 Comprehensive Survey of Living Conditions in Japan. Int J Environ Res Public Health 2024;21. Popplewell NT, Rechel BP, Abel GA. How do adults with physical disability experience primary care? A nationwide cross-sectional survey of access among patients in England. BMJ Open. 2014;4:e004714. Temple JB, Stiles JA, Utomo A, Kelaher M, Williams R. Is disability exclusion associated with experiencing an unmet need for health care? Australas J Ageing. 2020;39:112–21. Masuku KP, Moroe N. Merwe, Danielle van der. 'The world is not only for hearing people - It's for all people': The experiences of women who are deaf or hard of hearing in accessing healthcare services in Johannesburg, South Africa. Afr J Disabil 2021;10. Smith DL. Disparities in health care access for women with disabilities in the United States from the 2006 National Health Interview Survey. Disabil Health J. 2008;1:79–88. Hasegawa T. Reasonable Accommodation for Persons with Disabilities in Japan. Japan Labor Rev. 2015;12:21–37. Ban M. Amendment of the Act to Eliminate Discrimination against Persons with Disabilities. New Normalization. Vol. 2024. https://www.dinf.ne.jp/d/2/506.html2021 Hyoguchi N, Kamauchi T, Hoshino M, Kubota T. [Survey of Pharmacists' Knowledge, Actions and Confidence in Medication Education to Patients with Hearing Disabilities]. Yakugaku Zasshi. 2020;140:1295–8. Iwakuma M, Aoki T, Morishita M. Patient experience (PX) among individuals with disabilities in Japan: a mixed-methods study. BMC Prim Care. 2022;23:183. Furukawa S, Nawa N, Yamaoka Y, Fujiwara T. Concerns and needs of people with intellectual disabilities and their caregivers during the COVID-19 pandemic in Japan. J Intellect Disabil. 2024;28:137–56. Boyatzis RE. Transforming Qualitative Information: Thematic Analysis and Code Development. Thousand Oaks: Sage Publication; 1998. Harrington A, Hirsch M, Hammond F, Norton HJ, Bockenek W. Assessment of primary care services and perceived barriers to care in persons with disabilities. Am J Phys Med Rehabil. 2009;88:852–63. Lagu T, Iezzoni LI, Lindenauer PK. The Axes of Access - Improving Care for Patients with Disabilities. N Engl J Med. 2014;370:1847–51. Flood B. Safety of People with Intellectual Disabilities in Hospital. What Can the Hospital Pharmacist Do to Improve Quality of Care? Pharm (Basel). 2017;5. Turk MA, Mitra M. Continued need for disability competence in health care. Disabil Health J. 2022;15:101310. Morrison EH, George V, Mosqueda L. Primary care for adults with physical disabilities: perceptions from consumer and provider focus groups. Fam Med. 2008;40:645–51. Robey KL, Minihan PM, Long-Bellil LM, et al. Teaching health care students about disability within a cultural competency context. Disabil Health J. 2013;6:271–9. Miller SR. A Qualitative Study of the Perspectives of Individuals With Disabilities About Their Health Care Experiences: Implications for Culturally Appropriate Health Care. J Natl Med Assoc. 2012;104:360–5. NERI MT, ROLL TK. Understanding the consequences of access barriers to health care: experiences of adults with disabilities. Disabil Rehabilitation. 2003;25:85–96. Diesfeld K. Disability matters in medical law. J Med Ethics. 2001;27:388–92. Ali A, Scior K, Ratti V, Strydom A, King M, Hassiotis A. Discrimination and other barriers to accessing health care: perspectives of patients with mild and moderate intellectual disability and their carers. PLoS ONE. 2013;8:e70855. Iezzoni LI, Rao SR, Ressalam J, et al. US Physicians' Knowledge About The Americans With Disabilities Act And Accommodation Of Patients With Disability. Health Aff (Millwood). 2022;41:96–104. Smith DL. Disparities in patient-physician communication for persons with a disability from the 2006 Medical Expenditure Panel Survey (MEPS). Disabil Health J. 2009;2:206–15. Nakagawa J, Blanck P. Future of Disability Law in Japan: Employment and Accommodation. Loyola Los Angeles Int Comp Law Rev. 2010;33:173–221. Funakoshi k. Basics of Support for Students with Disabilities in Japanese Higher Education Institutions and Issues of Reasonable Accommodation in Medical Education. Med Educ (Japan). 2024;55:97–81. Mudrick NR, Schwartz MA. Health care under the ADA: a vision or a mirage? Disabil Health J. 2010;3:233–9. Moloney M, Hennessy T, Doody O. Reasonable adjustments for people with intellectual disability in acute care: a scoping review of the evidence. BMJ Open. 2021;11:e039647. Tuffrey-Wijne I, Goulding L, Giatras N, et al. The barriers to and enablers of providing reasonably adjusted health services to people with intellectual disabilities in acute hospitals: evidence from a mixed-methods study. BMJ Open. 2014;4:e004606. Temple JB, Williams R. Multiple health conditions and barriers to healthcare among older Australians: prevalence, reasons and types of barriers. Aust J Prim Health. 2018;24:82–9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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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-7467534","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":554547594,"identity":"cfbbf011-5ab6-4107-971a-596a1144be68","order_by":0,"name":"Chikako Yamaki","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIiWNgGAWjYNCCAxJyMCYz0VqMSdbCkNhAtJP4ZyQ/3fDjjEX6dvbDDxi/VDCwmxPSInEjzexmzw2J3J09aQbMMmcYmC0J2WcgkWB2g+eDRO6GGzwMzJJtDMwGBwhqSf92888HiXQDErTkmN3muSGRANLC+JEYLRJn3pTdljkjYbjhTJrBYYYzEoT9wt+evu3mm2N18gbHDz98+KPCJplgiDEIJCDYh3kYJJINCGrhP4BgM/5gYLAjrGUUjIJRMApGGgAA5IdAnUfSMAsAAAAASUVORK5CYII=","orcid":"","institution":"National Cancer Center","correspondingAuthor":true,"prefix":"","firstName":"Chikako","middleName":"","lastName":"Yamaki","suffix":""},{"id":554547595,"identity":"29e67797-5ca6-4c82-90bb-6ac4db10550d","order_by":1,"name":"Sarasa Kai","email":"","orcid":"","institution":"National Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Sarasa","middleName":"","lastName":"Kai","suffix":""},{"id":554547596,"identity":"ec535d2e-fa77-421b-bd71-8c63988a3eb7","order_by":2,"name":"Kumiko 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10:13:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":837427,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7467534/v1/d9274c8c-1de0-4202-93a2-78a6373af637.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Desired Preparedness and Attitudes of Health Care Providers Toward Patients with Disabilities: Qualitative Research with Welfare Professionals","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePersons with disabilities (PWDs) face more health risks, comorbidities, poor health outcomes, and higher healthcare needs than individuals without disabilities.\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Although the increased life expectancy of PWDs has increased the demand for medical care, their access to healthcare remains limited.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e PWDs face several barriers in accessing healthcare. Pharr and Chino\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e summarized these as \u0026ldquo;structural, financial, personal/cultural barriers,\u0026rdquo; while Scheer et al.\u003csup\u003e8\u003c/sup\u003e categorized them into \u0026ldquo;environmental, structural, and process barriers.\u0026rdquo; Sharby et al.\u003csup\u003e9\u003c/sup\u003e summarized factors influencing healthcare access among PWD as \u0026ldquo;attitudes of healthcare providers and the public, physical barriers, miscommunication, income level, ethnic/minority status, insurance coverage, and lack of information tailored to PWD.\u0026rdquo; Lawthers\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e defined barriers to receiving appropriate care as \u0026ldquo;physical barriers, transportation, communication difficulties, and client and provider attitudes.\u0026rdquo; Although classifications vary, it is clear that PWDs experience difficulties in accessing health services. They are often excluded from cancer screenings,\u003csup\u003e11\u003c/sup\u003e and face physical barriers to primary care access\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Discrimination or avoidance in health services can result in unaddressed needs and deterioration of health outcomes\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u0026mdash;a critical situation requiring urgent attention.\u003c/p\u003e\u003cp\u003eThe UN Convention on the Rights of Persons with Disabilities mandates that signatory countries prohibit discrimination against PWDs and ensure reasonable accommodation. Smith\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e observed that \u0026ldquo;access to healthcare for PWDs has become a political focal point,\u0026rdquo; especially in countries with anti-discrimination legislation. However, even in the USA, where the Americans with Disabilities Act (ADA) and the concept of \u0026ldquo;reasonable accommodation\u0026rdquo; have been in effect since 1990, many medical professionals remain unaware of the ADA. Clinics managed by administrators unfamiliar with the ADA tend to impose more barriers for PWDs.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Consequently, fostering the integration of reasonable accommodation within medical institutions has proven difficult.\u003c/p\u003e\u003cp\u003eWhile Japan has a universal health insurance system and fair access to healthcare, awareness of the importance of equal access to healthcare as a fundamental human right for PWDs remains limited. The Basic Act for Persons with Disabilities, enacted in 1960, included welfare services and protections but focused primarily on service provision rather than human rights. In 2014, Japan ratified the Convention on the Rights of Persons with Disabilities and made various legal amendments, including the 2013 amendment of the Act to Facilitate the Employment of Persons with Disabilities, which incorporated the concept of reasonable accommodation.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e The 2016 Law on the Elimination of Discrimination against Persons with Disabilities\u0026mdash;amended in 2021\u0026mdash;mandates that all establishments and institutions provide reasonable accommodation by April 2024.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Despite this progress, the concept of reasonable accommodation has yet to gain traction within the medical field, and institutions have not sufficiently acted on these requirements.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e As such, there is an urgent need to identify necessary improvements.\u003c/p\u003e\u003cp\u003eAlthough research on this issue in Japan is limited, Iwakuma et al.\u003csup\u003e19\u003c/sup\u003e revealed that PWDs tend to face challenges due to disabilities, including a shortage of healthcare providers familiar with their needs and difficulties with insurance transitions at age 65. Furukawa et al.\u003csup\u003e20\u003c/sup\u003e found that individuals with intellectual disabilities encounter difficulties in accessing appropriate medical care and require additional reasonable accommodation in medical institutions. Overall, while information on the challenges faced by PWDs in healthcare settings during the initial stages of reasonable accommodation implementation remains scant in Japan, addressing these issues is essential. Additionally, although the perspectives of PWDs and their families are invaluable in identifying issues common to medical institutions in Japan, drawing on our experience with numerous cases can shed light on the issues confronting Japan\u0026rsquo;s medical frontline, with the potential for broader applicability.\u003c/p\u003e\n\u003ch3\u003ePurpose\u003c/h3\u003e\n\u003cp\u003eThis study examined the difficulties, challenges, and preferred responses experienced by support professionals while accompanying PWDs to medical institutions. It also sought to identify appropriate responses during such visits.\u003c/p\u003e\u003c/div\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003ch2\u003eStudy participants\u003c/h2\u003e\u003cp\u003eThirty-six welfare professionals were interviewed: 15 were affiliated with the National Rehabilitation Center, 4 with information services for the visually impaired, 1 with information services for the hearing impaired, and 16 were sign language interpreters. Although we primarily recruited professionals from national institutions that address a range of disabilities, the initial sample did not include enough sign language interpreters with experience in medical examination settings. To address this gap, we added participants from facilities providing information to people with audiovisual disabilities and recruited additional sign language interpreters using snowball sampling.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eInterviews were conducted with participants\u0026mdash;either individually or in groups\u0026mdash;between October 2020 and April 2021. Most interviews were conducted individually; however, some participants indicated that they were more comfortable talking together with their colleagues and were therefore interviewed as a group. Five group interviews involved two participants, and four involved three persons, resulting in 23 interviews in total. The interviews spanned 1,426 minutes, with an average duration of 39.6 minutes per participant. The interviews were conducted by four social researchers (1st, 3rd, 4th, and 5th authors) who are experts in the disability field. Interviews were recorded with participants\u0026rsquo; permission, and verbatim transcripts were prepared.\u003c/p\u003e\u003cp\u003eParticipants\u0026mdash;as social workers who accompanied PWDs to medical appointments\u0026mdash;recounted instances of both inappropriate and favorable responses they encountered during these visits. The interview items are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003eTable 1: Interview items\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 586px;\"\u003e\n \u003cul start=\"50\"\u003e\n \u003cli\u003eWhat types of disabilities have you been involved in supporting?\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 586px;\"\u003e\n \u003cul start=\"50\"\u003e\n \u003cli\u003eHave you experienced any difficulties in accompanying or coordinating medical visits for people with disabilities that you support? What were they?\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 586px;\"\u003e\n \u003cul start=\"50\"\u003e\n \u003cli\u003eHave you ever had a positive experience at a medical visit for a person with a disability you support? What was it like?\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 586px;\"\u003e\n \u003cul start=\"50\"\u003e\n \u003cli\u003eHave you ever assisted a person with a disability with a medical examination or visit? In particular, what do you know about medical examinations for serious illnesses or injuries other than the underlying disability?\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 586px;\"\u003e\n \u003cul start=\"50\"\u003e\n \u003cli\u003eAre there any other issues that you think are challenges in terms of people with disabilities receiving appropriate medical care?\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eThis study analyzed the challenges and factors perceived by welfare professionals accompanying or supporting PWDs during hospital visits. Thematic analysis\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e was employed to generate themes by coding specific events or episodes as medical experiences of PWDs. The analysis followed these steps:\u003c/p\u003e\u003cp\u003eStep 1: Verbatim records were uploaded into NVIVO to extract their contents.\u003c/p\u003e\u003cp\u003eStep 2: Data were systematically coded in their entirety, highlighting key features and generating initial codes.\u003c/p\u003e\u003cp\u003eStep 3: Generated codes were classified into themes or sub-themes by examining similarities between codes.\u003c/p\u003e\u003cp\u003eStep 4: Integration and separation of themes and sub-themes were examined and refined, considering both the uniformity within data categories and the heterogeneity between themes.\u003c/p\u003e\u003cp\u003eStep 5: Refined themes and sub-themes were named to reflect their essence and defined by identifying their specific characteristics.\u003c/p\u003e\u003cp\u003eTo ensure reliability and validity and minimize bias in the interpretation and analysis of the data, the first author initially generated the codes, sub-themes, and themes. These were subsequently reviewed and refined by the second author, resolving any disagreements in interpretation.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFour themes emerged from the data: \u0026ldquo;issues with the response of medical institutions/healthcare staff,\u0026rdquo; \u0026ldquo;preferred response of healthcare staff,\u0026rdquo; \u0026ldquo;expected response of hospitals,\u0026rdquo; and \u0026ldquo;efforts of PWDs and welfare professionals to secure appropriate care.\u0026rdquo; Verbatim excerpts, with necessary clarifications added by the researcher, are presented below.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eIssues with the response of medical institutions and healthcare staff\u003c/h2\u003e\u003cp\u003e\u0026ldquo;Issues with the response of medical institutions/healthcare staff\u0026rdquo; comprised six sub-themes and was highlighted in 109 statements (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\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\u003eSub-themes of \u0026ldquo;issues with the response of medical institutions/healthcare staff\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSub-themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of statements\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot respecting the PWD as an independent person\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAtmosphere in which patients with disabilities feel unwelcome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTreating patients with disabilities as vulnerable stereotypes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLack of accumulated methods of dealing with disabilities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClearly discriminatory behavior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\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\u003eThe most frequently mentioned sub-theme was \u0026ldquo;not respecting the PWD as an independent person.\u0026rdquo; Participants recounted instances of health professionals speaking to patients\u0026rsquo; assistants or sign language interpreters rather than addressing the patients directly, often treating assistants as guardians or surrogate. This occurred regardless of the type of disability, even among those without speaking difficulties, such as individuals with visual impairments.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWhen I accompany visually impaired patients as a volunteer assistant or friend, hospital staff address me, not the patient. They often speak to the sighted assistant, perhaps unconsciously viewing it as a situation where parents respond on behalf of their child even when the child is present.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eRegarding the \u0026ldquo;atmosphere in which patients with disabilities feel unwelcome,\u0026rdquo; PWDs often sensed an unwelcoming environment due to the facial expressions or tone of medical staff, leading them to refrain from asking questions to doctors or lose the will to communicate their condition. Several interviewees speculated this resulted from prior experiences of disrespect at other medical institutions.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIf they sense an aura of \u0026lsquo;don't ask,\u0026rsquo; they are very sensitive and feel discouraged from speaking. People with disabilities are quick to give up saying what they want to say, aren\u0026rsquo;t they? When they conclude there's no point in talking about it here, they do not pursue it further and give up on medical treatment immediately. I believe that people with disabilities have a very good eye for people because they have been hospitalized many times, seen many medical staff, and have developed the skill to identify \u0026lsquo;trustworthy\u0026rsquo; people. As a result, I think there are many people who are not receiving the treatment they want.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;Treating PWDs as vulnerable stereotypes\u0026rdquo; refers to situations wherein the medical staff did not intend to discriminate against or reject PWDs, but their actions were based on paternalistic judgment. For example, visual or hearing impairments were viewed as a lack of judgment, and excessive protective measures that limited PWDs\u0026rsquo; options.\u003c/p\u003e\u003cp\u003e\u0026ldquo;Lack of accumulated methods of dealing with disabilities\u0026rdquo; refers to situations where risks may arise owing to the lack of alternative approaches, such as communicating with deaf patients at, ophthalmology appointments, preventing ulcers in individuals with cervical spinal cord injuries, transferring a person with high cervical cord injury from a wheelchair, and guiding a person with visual impairment in examination situations, such as those involving patients with involuntary movements.\u003c/p\u003e\u003cp\u003eFurther, two interviewees highlighted cases of \u0026ldquo;clearly discriminatory behavior,\u0026rdquo; although the details of these incidents occurred were not discussed, but they should not have happened.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePreferred response of healthcare staff\u003c/h3\u003e\n\u003cp\u003e\u0026ldquo;Preferred response of healthcare staff\u0026rdquo; comprised three sub-themes reported in 157 statements (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\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\u003eSub-themes of \u0026ldquo;preferred response of healthcare staff\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSub-themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of statements\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHaving a picture of the situation and needs caused by disabilities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e97\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFinding the best way to communicate with each patient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConsidering the patient\u0026rsquo;s will and having an attitude of thinking together, even if there are limitations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\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\u0026ldquo;Understanding the situation and needs associated with disabilities\u0026rdquo; was reported in 97 statements addressing various disability-related challenges and requirements Specific examples included understanding that Japanese is a second language for deaf individuals whose first language is sign language, reading important information aloud when providing written explanations to visually impaired persons informing patients that they may choose to write their signature or that of a substitute if they cannot locate the signature box on a form, providing visual aids such as cards for individuals with autism, and ensuring proper care to prevent pressure ulcers for individuals unable to move their bodies. Many participants emphasized the importance of health professionals demonstrating an attitude of trying to understand patients\u0026rsquo; difficulties.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIt is necessary to understand and take into consideration the disability characteristics of people with hearing, vision, physical, and higher brain disorders. In addition, each person with disabilities has different ways of hearing, seeing, sensing, or moving. Therefore, I really want health professionals to have the ability to perceive and the attitude to try to understand how and what the patient in front of them is struggling with.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e \u0026ldquo;Finding the best communication methods for each patient\u0026rdquo; comprised 45 statements highlighting approaches such as verbal communication, interpretation, or written communication for patients with hearing impairments; confirming understanding after interpreters finish translating; encouraging visually impaired persons to record conversations; and using simple options to ascertain preferences from individuals with intellectual disabilities or higher brain dysfunction. Examples of effective practices included health professionals offering detailed explanations to patients and engaging in two-way communication to understand their intentions.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI\u0026rsquo;ve experienced the good case in which the patient was\u003c/em\u003e given a detailed explanation, such as \u003cem\u003ethe contents of an X-ray examination and when to change their posture, etc., and agreed on cues through a sign language interpreter before undergoing the examination. That helped smooth communication. In another case, there was a doctor who used paper, a whiteboard, and a computer to communicate in writing. Even when the interpreter was with him, he voluntarily wrote down the main points on a piece of paper and finally handed it to the patient.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;Considering the patient\u0026rsquo;s will and having an attitude of thinking together, even if there are limitations\u0026rdquo; emphasizes the importance of listening to patients, even when they struggle to adequately describe their condition, pain, numbness, or other symptoms, and to jointly consider the necessary actions.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIf the person has difficulties describing the conditions, it is also hard for the care professional. The patient with severe disability sometimes only expresses to say, \u0026lsquo;I feel something strange,\u0026rsquo; and we all don't understand, but it is the person who is in trouble, so it is important for the medical institutions to have an attitude of working and thinking together with them.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eExpected preparation of hospitals\u003c/h3\u003e\n\u003cp\u003e\u0026ldquo;Expected preparation of hospitals,\u0026rdquo; comprising three sub-themes, refers to institutional-level environments and practices adopted by hospitals (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\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\u003eSub-themes of \u0026ldquo;expected response of hospitals\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSub-themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNumber of statements\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnhancing the personnel and equipment for providing reasonable accommodation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSystematically accumulating the skills for providing reasonable accommodation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEstablishing procedures for understanding patients\u0026rsquo; needs, transmitting the information across different sections of the hospital, and providing feedback to patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;Enhancing the personnel and equipment for providing reasonable accommodation\u0026rdquo; highlights the importance of ensuring wheelchair-accessible spaces, reception machines, and automatic doors that can be reached from a wheelchair without hindrance, facilities for transferring and bathing individuals with cervical cord injuries; and skilled staff capable of supporting people with severe intellectual disabilities. All interviewees acknowledged that not all hospitals could afford such equipment.\u003c/p\u003e\u003cp\u003e\u0026ldquo;Systematically accumulating the skills for providing reasonable accommodation\u0026rdquo; implies sharing the experiences of caring for PWDs. Examples included knowing that sign language interpreters are available and developing skills for guiding visually impaired patients across hospital sections. Professionals in the disability field welcomed inquiries about how to provide reasonable accommodations.\u003c/p\u003e\u003cp\u003e\u0026ldquo;Establishing procedures for understanding patients\u0026rsquo; needs, transmitting the information across different sections of the hospital, and providing feedback to patients\u0026rdquo; implies methods for PWDs to communicate their needs to hospitals, ensuring this information is shared across departments. Feedback mechanisms were also deemed essential, as miscommunications\u0026mdash;such as scheduling longer consultation times for PWDs without informing them\u0026mdash;had led to unpleasant experiences.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eEfforts of persons with disabilities and welfare professionals to secure appropriate care\u003c/h2\u003e\u003cp\u003eTo achieve appropriate care, participants highlighted the efforts of PWDs and welfare professionals to change the behavior and awareness of medical professionals (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\u003eSub-themes of \u0026ldquo;efforts of PWDs with disabilities and welfare professionals to secure appropriate care\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSub-themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of statements\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExplaining the needs and adequate accommodation to the medical professionals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProviding support or speaking for the PWDs to express their needs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProviding long and holistic support for medical examination and treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23\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\u003eThey observed that, to request a response from hospital staff, they must first communicate the needs of PWDs and request reasonable accommodations. Statements that highlighted \u0026ldquo;explaining the needs and adequate accommodation toward the medical field\u0026rdquo; referred to the intentionality behind these explanations.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA person with low vision who I had attended once had a wordbook with pictures of something like, \u0026lsquo;I see like this,\u0026rsquo; \u0026lsquo;I see better with black and white reversal,\u0026rsquo; \u0026lsquo;I have tunnel vision.\u0026rsquo; When he met the doctor, \u0026lsquo;I have this kind of vision, so when I receive a document, I will look at it with my right eye attached to the paper, but please don't think it is strange.\u0026rsquo; He would start by telling the doctor about himself using the word cards, and then, being relatively proactive, he would ask the doctor, 'What does this say?' if he didn't understand something in the document.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWelfare professionals also encouraged PWDs to communicate their needs and required accommodations, adjusted power dynamics in paternalistic medical situations, and advocated for PWDs who were unable to express themselves. They demonstrated awareness of various practical methods to facilitate effective communication in everyday scenarios.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIf the person is unable to communicate directly with medical professionals, the only way is for the care professional to grasp the situation and fully communicate their needs on behalf of the person. In order to do so, it is necessary to have a checklist of items about the patient to be conveyed to the medical staff.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;Providing long and holistic support for medical examination and treatment\u0026rdquo; implies a wide range of support for PWDs during medical care. Some PWDs may need welfare professionals\u0026rsquo; support to understand doctors\u0026rsquo; advice, while others may need help for self-injection. Due to limited availability of medical information in braille or audio formats, visually impaired patients require welfare professionals to interpret doctors\u0026rsquo; written medical advice. Although the specialties and support offered by professionals vary depending on the nature of the disability and the region, collaboration among supporters through a network is essential for providing comprehensive care.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAs for support, we are trying to create a network, a circle of support. That way, we can continue to provide support even when something is missing in the network. Now, there is an app that can be viewed by supporters as well as the patient; everyone can write and share information with it.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eIssues raised by welfare professionals and the corresponding education for medical professionals\u003c/h2\u003e\u003cp\u003eParticipants spoke predominantly about the need for medical professionals to treat PWDs as independent patients, imagine their circumstances, and understand their needs rather than focusing solely on the lack of accessible facilities. This aligns with findings from previous studies. For instance, Harrington et al.\u003csup\u003e22\u003c/sup\u003e surveyed persons with physical disabilities and reported that \u0026ldquo;perceived deficits in primary care physicians\u0026rsquo; knowledge of disability issues seem more prevalent than physical barriers to care.\u0026rdquo; Lagu et al.\u003csup\u003e23\u003c/sup\u003e highlighted that \u0026ldquo;the greatest challenge in achieving universal accessibility in healthcare settings may not be the cost but the need for a change in mindset on the part of clinicians and administrators.\u0026rdquo; Flood\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e noted that \u0026ldquo;the most significant barriers to safer and better healthcare appear to include \u0026lsquo;invisibility\u0026rsquo; of people with intellectual disabilities within health-care systems.\u0026rdquo; The results of this study are consistent with these findings.\u003c/p\u003e\u003cp\u003eMany previous studies have highlighted the need for medical professionals to be trained to address the needs of PWDs.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e For example, Morrison et al.\u003csup\u003e26\u003c/sup\u003e emphasized teaching \u0026ldquo;how to coordinate care, access resources, and communicate about disability issues.\u0026rdquo; Additionally, it is essential to design educational programs that address consequences and cope with the consequences, adopt and adapt cultural competency, and highlight \u0026ldquo;disability culture.\u0026rdquo;\u003csup\u003e27\u003c/sup\u003e Miller\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e noted that medical professionals\u0026rsquo; understanding of \u0026ldquo;insights to aspects of living with a disability\u0026rdquo; is essential for patient-centered communication. Neri and Kroll\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e stressed that healthcare providers and insurance plans should be \u0026ldquo;disability literate\u0026rdquo; to reduce barriers to healthcare access. Different expressions such as \u0026ldquo;disability culture,\u0026rdquo; \u0026ldquo;disability literate,\u0026rdquo; or \u0026ldquo;insights of living with disabilities\u0026rdquo; highlight the need for medical professionals to understand the issues faced by PWDs, including their subjective experiences and values. However, how education can integrate these complex subjectivities and values remains under examination,\u003csup\u003e25\u003c/sup\u003e necessitating specific teaching methods to be proposed and evaluated.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eRespect toward PDWs and awareness of reasonable accommodation\u003c/h2\u003e\u003cp\u003eUnder the theme \u0026ldquo;issues with the response of medical institution/healthcare staff,\u0026rdquo; the sub-theme \u0026ldquo;not respecting the disabled patients as an independent person\u0026rdquo; was the most frequently cited. This sub-theme highlighted the staff\u0026rsquo;s attitudes, in that healthcare professionals often communicated with accompanying supporters or families instead of the PWD. Although such attitudes can be considered unconscious actions devoid of malice, many medical professionals are unaware that there is a need for improvement.\u003c/p\u003e\u003cp\u003eTreating supporters as decision-makers has been prevalent not only in Japan but also in many other countries. Even in the UK, which has had a disability discrimination law since 1995, Diesfeld\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e observed that paternalistic decision-making is sometimes legitimized as the \u0026ldquo;best choice,\u0026rdquo; and Ali et al.\u003csup\u003e31\u003c/sup\u003e highlighted insufficient reasonable adjustments for persons with intellectual disabilities in healthcare. A 2011 survey in the USA revealed that primary care practice administrators\u0026rsquo; knowledge of the ADA directly influenced facility barriers, emphasizing the need for \u0026ldquo;disability training for health professionals.\u0026rdquo;\u003csup\u003e7\u003c/sup\u003e Another survey in 2020 found that one-third of physicians knew little about their legal responsibilities under the ADA.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e PWDs are significantly more likely than those without disabilities to feel that physicians do not listen to them, explain treatment options, treat them with respect, spend sufficient time with them, or involve them in treatment decisions.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn Japan, laws related to PWDs historically focused on protection and service provision, with the prohibition of discrimination and the requirement for reasonable accommodation only recently introduced \u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e through the Law on the Elimination of Discrimination against Persons with Disabilities in 2016. Although the concept of reasonable accommodation has been gradually integrated into public educational institutions, its presence in the medical field remains limited\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. Few studies have discussed the implementation of reasonable accommodation in medical institutions, with Hyoguchi et al.\u003csup\u003e18\u003c/sup\u003e reporting that pharmacists often did not understand the concept. Educating medical professionals about reasonable accommodation for PWDs is essential in Japan.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eAccumulation of reasonable accommodation at the organizational level\u003c/h2\u003e\u003cp\u003eAddressing the diverse needs of PWDs requires not only the preparedness of medical personnel but also an environment in which alternatives can be readily provided; this issue must be addressed by organizations. This study highlighted the need for healthcare organizations to accumulate know-how and share knowledge of needs and reasonable accommodations.\u003c/p\u003e\u003cp\u003eAlthough customization is necessary based on individual needs, various reasonable accommodations can be easily introduced through proactive preparation. These include providing easy-to-read documents, accessible information on medication and procedures, allocating longer appointment slots, offering early appointments for patients with intellectual disabilities,\u003csup\u003e31\u003c/sup\u003e providing audible or braille formats for patients with visual impairment, and arranging sign language interpreters for patients with hearing impairments,\u003csup\u003e36\u003c/sup\u003e signifying reasonable accommodation.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e Smith\u003csup\u003e40\u003c/sup\u003e advocated for \u0026ldquo;disability literacy,\u0026rdquo; and recommended evaluating healthcare facilities based on feedback from PWDs. Lawthers et al.\u003csup\u003e10\u003c/sup\u003e emphasized that quality care for PWDs requires close collaboration between healthcare systems and social service sectors. The welfare professionals who participated in this study also recognized their roles as advocates or spokespersons for PWDs to communicate their medical care needs. Collaborative efforts in individual cases can lead to faster and more appropriate preparation of reasonable accommodations and effective incorporation of user feedback.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003ePractical Implications\u003c/h2\u003e\u003cp\u003eFrom the interviews, welfare professionals strongly expected the medical professionals to know about the needs of PWDs. There is a need to disseminate training programs for medical professionals to understand the issues faced by PWDs, including their subjective experiences and values. Another implication is that healthcare organizations should accumulate know-how and share knowledge of needs and reasonable accommodations, and should not leave it all up to individuals.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eLimitations and further research\u003c/h2\u003e\u003cp\u003eThis study described barriers and best practices in healthcare services as perceived by disability welfare professionals. These professionals have accumulated extensive experience in supporting PWDs and can provide an overarching view of the challenges they face in medical settings. However, perceptions of welfare professionals and PWDs themselves may differ, and PWDs may encounter distinct challenges when supporters are not present. Therefore, the perspectives of PWDs require careful examination.\u003c/p\u003e\u003cp\u003eAnother limitation of this study is its focus on challenges within hospitals and clinics, excluding barriers encountered before reaching these institutions. As PWDs face healthcare access barriers at various stages,\u003csup\u003e39\u003c/sup\u003e future studies should investigate scenarios where access to healthcare services is hindered.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFrom interviews with 37 welfare professional about the difficulties they experience when accompanying PWDs to medical institutions, four categories emerged: \u0026ldquo;issues with the response of medical institutions/healthcare staff,\u0026rdquo; \u0026ldquo;preferred response of healthcare staff,\u0026rdquo; \u0026ldquo;expected response of hospitals,\u0026rdquo; and \u0026ldquo;efforts of PWDs and welfare professionals to secure appropriate care.\u0026rdquo; Subthemes such as \u0026ldquo;understanding the situation and needs associated with disabilities\u0026rdquo; and \u0026ldquo;finding effective communication methods for each patient\u0026rdquo; were frequently mentioned, suggesting that medical education should include PWDs\u0026rsquo; subjective experiences and values. Furthermore, the subthemes \u0026ldquo;finding effective communication methods for each patient\u0026rdquo; and \u0026ldquo;not respecting the disabled patient as an independent person\u0026rdquo; highlighted the need to raise awareness in the medical field that access to appropriate healthcare for PWDs is a fundamental human right and that providing reasonable accommodations is essential.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participation\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in compliance with the ethical guidelines for medical research involving human subjects, and with the approval of the National Cancer Center Research Ethics Review Committee (2020-172) and the National Rehabilitation Center for Persons with Disabilities (2020-081).\u003c/p\u003e\n\u003cp\u003eAll participants were informed of the study\u0026rsquo;s purpose and assured that participation was voluntary, non-participation would not result in any disadvantage and they could withdraw at any time during the course of the study. Researchers explained that the data will be transcribed, anonymized, and analyzed to produce research papers, and would not be used for any other purpose and would be discarded upon study completion. Written consent was obtained from all the participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs described in previous sections, all the interviewees were informed that their talk would be used to produce research papers, and all the participants gave consent to that.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe interview data collected in this study are not publicly available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by two research grants awarded to Chikako Yamaki by the Health and Labor Sciences Research [#20EA1014] for conducting the surveys and [#23EA1030] for English editing and publishing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026rsquo; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChikako Yamaki was in charge of planning the survey, conducting the interviews, analyzing all the data, and writing this manuscript.\u003c/p\u003e\n\u003cp\u003eSarasa Kai analyzed all the data together with CY and checked this manuscript.\u003c/p\u003e\n\u003cp\u003eKumiko Imahashi collaboratively planned the survey, recruited and conducted the interviews, and checked this manuscript.\u003c/p\u003e\n\u003cp\u003eKai Seino collaboratively planned the survey, recruited and conducted the interviews, and checked this manuscript.\u003c/p\u003e\n\u003cp\u003eEiji Taira recruited and conducted the interviews and checked this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the welfare professionals who participated as interviewees in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFriebel R, Maynou L. Assessing The Dangers Of A Hospital Stay For Patients With Developmental Disability In England, 2017-19. Health Aff (Millwood). 2022;41:1486\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDeJong G. Primary care for persons with disabilities. An overview of the problem. Am J Phys Med Rehabil. 1997;76:S2\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKinne S, Patrick DL, Doyle DL. Prevalence of secondary conditions among people with disabilities. Am J Public Health. 2004;94:443\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMENCAP. Treat me right! Better healthcare for people with a learning disability. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mencap.org.uk/sites/default/files/2016-08/treat_me_right.pdf2004:1-36\u003c/span\u003e\u003cspan address=\"https://www.mencap.org.uk/sites/default/files/2016-08/treat_me_right.pdf2004:1-36\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIezzoni LI, McKee MM, Meade MA, Morris MA, Pendo E. Have Almost Fifty Years Of Disability Civil Rights Laws Achieved Equitable Care? Health Aff (Millwood). 2022;41:1371\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBauer SE, Schumacher JR, Hall A, et al. Disability and physical and communication-related barriers to health care related services among Florida residents: A brief report. Disabil Health J. 2016;9:552\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePharr J, Chino M. Predicting barriers to primary care for patients with disabilities: a mixed methods study of practice administrators. Disabil Health J. 2013;6:116\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eScheer J, Kroll T, Neri MT, Beatty P. Access barriers for persons with disabilities: The consumer's perspective. J Disabil Policy Stud 132003:221\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSharby N, Martire K, Iversen MD. Decreasing health disparities for people with disabilities through improved communication strategies and awareness. Int J Environ Res Public Health. 2015;12:3301\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLawthers AG, Pransky GS, Peterson LE, Himmelstein JH. Rethinking quality in the context of persons with disability. Int J Qual Health Care. 2003;15:287\u0026ndash;99.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSaito T, Imahashi K, Yamaki C. Use of General Health Examination and Cancer Screening among People with Disability Who Need Support from Others: Analysis of the 2016 Comprehensive Survey of Living Conditions in Japan. Int J Environ Res Public Health 2024;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePopplewell NT, Rechel BP, Abel GA. How do adults with physical disability experience primary care? A nationwide cross-sectional survey of access among patients in England. BMJ Open. 2014;4:e004714.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTemple JB, Stiles JA, Utomo A, Kelaher M, Williams R. Is disability exclusion associated with experiencing an unmet need for health care? Australas J Ageing. 2020;39:112\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMasuku KP, Moroe N. Merwe, Danielle van der. 'The world is not only for hearing people - It's for all people': The experiences of women who are deaf or hard of hearing in accessing healthcare services in Johannesburg, South Africa. Afr J Disabil 2021;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSmith DL. Disparities in health care access for women with disabilities in the United States from the 2006 National Health Interview Survey. Disabil Health J. 2008;1:79\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHasegawa T. Reasonable Accommodation for Persons with Disabilities in Japan. Japan Labor Rev. 2015;12:21\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBan M. Amendment of the Act to Eliminate Discrimination against Persons with Disabilities. \u003cem\u003eNew Normalization.\u003c/em\u003e Vol. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.dinf.ne.jp/d/2/506.html2021\u003c/span\u003e\u003cspan address=\"https://www.dinf.ne.jp/d/2/506.html2021\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHyoguchi N, Kamauchi T, Hoshino M, Kubota T. [Survey of Pharmacists' Knowledge, Actions and Confidence in Medication Education to Patients with Hearing Disabilities]. Yakugaku Zasshi. 2020;140:1295\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIwakuma M, Aoki T, Morishita M. Patient experience (PX) among individuals with disabilities in Japan: a mixed-methods study. BMC Prim Care. 2022;23:183.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFurukawa S, Nawa N, Yamaoka Y, Fujiwara T. Concerns and needs of people with intellectual disabilities and their caregivers during the COVID-19 pandemic in Japan. J Intellect Disabil. 2024;28:137\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBoyatzis RE. Transforming Qualitative Information: Thematic Analysis and Code Development. Thousand Oaks: Sage Publication; 1998.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHarrington A, Hirsch M, Hammond F, Norton HJ, Bockenek W. Assessment of primary care services and perceived barriers to care in persons with disabilities. Am J Phys Med Rehabil. 2009;88:852\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLagu T, Iezzoni LI, Lindenauer PK. The Axes of Access - Improving Care for Patients with Disabilities. N Engl J Med. 2014;370:1847\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFlood B. Safety of People with Intellectual Disabilities in Hospital. What Can the Hospital Pharmacist Do to Improve Quality of Care? Pharm (Basel). 2017;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTurk MA, Mitra M. Continued need for disability competence in health care. Disabil Health J. 2022;15:101310.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMorrison EH, George V, Mosqueda L. Primary care for adults with physical disabilities: perceptions from consumer and provider focus groups. Fam Med. 2008;40:645\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRobey KL, Minihan PM, Long-Bellil LM, et al. Teaching health care students about disability within a cultural competency context. Disabil Health J. 2013;6:271\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMiller SR. A Qualitative Study of the Perspectives of Individuals With Disabilities About Their Health Care Experiences: Implications for Culturally Appropriate Health Care. J Natl Med Assoc. 2012;104:360\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNERI MT, ROLL TK. Understanding the consequences of access barriers to health care: experiences of adults with disabilities. Disabil Rehabilitation. 2003;25:85\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDiesfeld K. Disability matters in medical law. J Med Ethics. 2001;27:388\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAli A, Scior K, Ratti V, Strydom A, King M, Hassiotis A. Discrimination and other barriers to accessing health care: perspectives of patients with mild and moderate intellectual disability and their carers. PLoS ONE. 2013;8:e70855.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIezzoni LI, Rao SR, Ressalam J, et al. US Physicians' Knowledge About The Americans With Disabilities Act And Accommodation Of Patients With Disability. Health Aff (Millwood). 2022;41:96\u0026ndash;104.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSmith DL. Disparities in patient-physician communication for persons with a disability from the 2006 Medical Expenditure Panel Survey (MEPS). Disabil Health J. 2009;2:206\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNakagawa J, Blanck P. Future of Disability Law in Japan: Employment and Accommodation. Loyola Los Angeles Int Comp Law Rev. 2010;33:173\u0026ndash;221.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFunakoshi k. Basics of Support for Students with Disabilities in Japanese Higher Education Institutions and Issues of Reasonable Accommodation in Medical Education. Med Educ (Japan). 2024;55:97\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMudrick NR, Schwartz MA. Health care under the ADA: a vision or a mirage? Disabil Health J. 2010;3:233\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoloney M, Hennessy T, Doody O. Reasonable adjustments for people with intellectual disability in acute care: a scoping review of the evidence. BMJ Open. 2021;11:e039647.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTuffrey-Wijne I, Goulding L, Giatras N, et al. The barriers to and enablers of providing reasonably adjusted health services to people with intellectual disabilities in acute hospitals: evidence from a mixed-methods study. BMJ Open. 2014;4:e004606.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTemple JB, Williams R. Multiple health conditions and barriers to healthcare among older Australians: prevalence, reasons and types of barriers. Aust J Prim Health. 2018;24:82\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Disability Discrimination Law, reasonable accommodation, healthcare access","lastPublishedDoi":"10.21203/rs.3.rs-7467534/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7467534/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eEnsuring access to healthcare for persons with disabilities (PWDs) is an important issue and is being addressed in many countries. Although Japan recently enacted the Disability Discrimination Law, the concept of reasonable consideration is not widespread.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eThis study examined the challenges and preferred responses experienced by support professionals accompanying PWDs to medical institutions, aiming to identify effective practices for improving medical visits.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eInterviews were conducted with 37 welfare professionals in disability services, focusing on their experiences of the issues and effective practices in medical institutions. Data was transcribed and thematic analysis was employed to generate themes by coding specific events or episodes as medical experiences of PWDs.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAnalysis identified four themes: \u0026ldquo;issues with the response of medical institutions/healthcare staff,\u0026rdquo; \u0026ldquo;preferred response of healthcare staff,\u0026rdquo; \u0026ldquo;expected response of hospitals,\u0026rdquo; and \u0026ldquo;efforts of PWDs and welfare professionals to secure appropriate care.\u0026rdquo; The following subthemes from \u0026ldquo;the preferred response of healthcare staff\u0026rdquo; included \u0026ldquo;understanding the situation and needs associated with disabilities\u0026rdquo; and \u0026ldquo;finding effective communication methods for each patient.\u0026rdquo; Additionally, a recurring issue was \u0026ldquo;not respecting the disabled patient as an independent person\u0026rdquo;.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe training and education for medical professionals must include provisions required by PWDs, including their culture and values. Welfare professionals are committed to improving healthcare accessibility, emphasizing the importance of collaboration between healthcare and welfare professionals to foster meaningful change.\u003c/p\u003e\u003ch2\u003ePractice Implication:\u003c/h2\u003e\u003cp\u003eThere is a need for a dissemination training program for medical professionals to understand the issues faced by PWDs, including their subjective experiences and values. Healthcare organizations must accumulate know-how and share knowledge of needs and reasonable accommodations.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e\u003cp\u003eThis study is a descriptive study and not an intervention on human participants.\u003c/p\u003e","manuscriptTitle":"Desired Preparedness and Attitudes of Health Care Providers Toward Patients with Disabilities: Qualitative Research with Welfare Professionals","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-04 11:22:05","doi":"10.21203/rs.3.rs-7467534/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"750f5e34-62fb-4ae8-b05c-749c52a786e4","owner":[],"postedDate":"December 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-23T10:12:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-04 11:22:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7467534","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7467534","identity":"rs-7467534","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}