Describing Met and Unmet Needs of Access to Assistive Technology Among Outpatients of a Tertiary Care Center of Pathanamthitta District in Kerala, India- Protocol for A Descriptive Pilot Study

Describing Met and Unmet Needs of Access to Assistive Technology Among Outpatients of a Tertiary Care Center of Pathanamthitta District in Kerala, India- Protocol for A Descriptive Pilot Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Method Article Describing Met and Unmet Needs of Access to Assistive Technology Among Outpatients of a Tertiary Care Center of Pathanamthitta District in Kerala, India- Protocol for A Descriptive Pilot Study Sapna Meryl Mani, Anjum John, Rajan K V, Asha George, Sr Dr Betsy, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6064895/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Assistive Technology includes any assistive device or software and essential service, used to improve, maintain, or increase functional capabilities of those with disabilities. Assistive Technology is part of all essential services like the education, employment, fitness, and leisure industry and also activities required to make daily living manageable like self-care, cooking, reading, or listening. Assistive Technology is a fundamental human right. Addressing the unmet need of assistive products is important for achieving the 2030 Sustainable Development Goals. Very few countries have developed effective national Assistive Technology policies or programs. The gap between the “haves” and “have nots” is very wide in the Assistive Technology industry. Objective This research aims to understand the unmet needs and barriers to access to Assistive Technology among a sample of patients attending Otorhinolaryngology, Ophthalmology, PMR and Orthopedic departments in a tertiary care center of Pathanamthitta district in Kerala using the WHO rATA questionnaire and to determine the satisfaction levels with the use of Assistive Technology among the above sample of patients, assessed by the WHO rATA questionnaire.” Methods After Institutional Review Board review and approval, patients from the Ophthalmology, Physical Medicine & Rehabilitation(PMR), and Orthopedics will be identified and those who meet the inclusion criteria selected for the study. In the event that participants cannot be contacted during their hospital visits, they will be asked for willingness to participate in the study, through telephone calls, after explaining the details of the study. The WHO rATA questionnaire will be administered in English/Malayalam( vernacular), with their signed consent. “This questionnaire was developed by the World health organization based on existing questionnaires on disability, rehabilitation, and health system studies in consultation with a group of experts. It is an interview format, population based survey tool with seven sections that collect information on demographics, needs for Assistive Technology, supply, demand and satisfaction, along with recommendations from the public. “( 1 ) Telephonic or direct interview methods will be used to collect data. Results The study will have 40 participants from each of the departments of Otorhinolaryngology, Ophthalmology, Physical Medicine and Rehabilitation, and Orthopedics. After data collection, information will be entered into Excel sheets and analyzed using SPSS 25 software. Numerical variables will be expressed as mean and standard deviations. Categorical variables will be expressed as frequencies with percentages. To study the factors associated with access to Assistive Technology, chi-square tests will be used. This project will have no external funding. We expect to have the results ready by December 2024. Conclusions We plan to disseminate the summarized information collected through this study to regional public health conferences and also publish the results of our study in journals. At the same time, we hope to inform the administrators of our hospital about our findings so they can make informed policy decisions for people who require Assistive Technology. Trial registration Not applicable Assistive Technology Disability needs barriers satisfaction access Project Summary Assistive Technology includes any assistive device or software that is used to improve, maintain, or increase the functional capabilities of those with disabilities. Assistive Technology is a fundamental human right. Addressing the unmet need of assistive products is important for achieving The 2030 Sustainable Development Goals aim at addressing the unmet need of assisted technology products. Very few countries have developed effective national Assistive Technology policies or programs. The gap between the “haves” and the “have nots” is very wide in the Assistive Technology industry. This research aims to understand the unmet needs of Assistive Technology in patients attending a tertiary care hospital in Central Kerala, India. who require Assistive Technology from the departments of Otorhinolaryngology. Ophthalmology, PMR, and Orthopedics.A questionnaire will be administered in English/Malayalam( vernacular) or in any language the patient is comfortable with . Telephonic or direct interview methods will be used to collect data. The findings will b e disseminated via summarized information collected through this study and we hope to inform the administrators of our hospital about our findings so they can make informed policy decisions for people who require Assistive Technology. Rationale and Background Information Background : People around the world are afflicted by many conditions. Aging is an inevitable phenomenon affecting every human being. Aging leads to disability and decreased functional ability for many people. In addition, communicable and noncommunicable diseases affect much of the global population. The residual effects of communicable diseases, non-communicable diseases, and aging, are similar. Resources are required to manage the residual consequences of these diseases. The World Health Organization ( WHO) recognises the public health importance of supporting people with disabilities, with functional decline, and their need for Assistive Technology(AT) . AT helps people with disabilities live a fruitful life, integrated in society.(2–4) Assistive Technology (AT) is any item, piece of equipment, software programme or product system that is used to increase, maintain or improve functional capabilities of persons with disabilities.[2] It can range from low-tech pill organizers to high tech special purpose computers. Electronic devices, wheelchairs, walkers, braces, educational software, power lifts, pencil holders, eye- gaze- head trackers are all Assistive Technology. Globally more than 2.5 billion people need AT; with the prediction that more than 3.5 billion people will need at least one AT by 2050, due to aging populations with or without non-communicable diseases.[2]All systems and services that apply scientific knowledge to assistive products( APs), to improve the functioning and independent living of people with functional disabilities are ATs.(2,3) The advantages of “ having technology that assists” are many. Such technology promotes independent living. These devices or supports indemnify the decreasing functional abilities of people, due to various causes. (5,6)Thus people can continue to have healthy, productive, participatory, and fruitful lives, with a role to play in society. Access to appropriate assistive products, in a timely fashion, can help people continue to function as useful members of society without a break. Use of such technologies can help mitigate the long drawn effects of various health conditions and prevent catastrophic outcomes, in the management of various health conditions like using protective footwear can help protect the feet of people with diabetic feet. Being self dependent, they can reduce the load on their human caregivers, with the ability to essentially do what they want, when they want.(7,8) Global Unmet Needs of Assistive Technology The aging of populations is inevitable. The loss of the use of a limb or sensory organ due to any cause, affects a person in a multitude of ways..Though Assistive Technology can, to a certain extent, help, they cannot fully provide/replace the emotional, physical, social, financial, setbacks brought about by disability. Public health systems have to be realigned in order to support aging populations with disabilities in addition to their multiple other needs.Despite the growing need, access to Assistive Technology is limited. The World Health Organization(WHO) has recognized that there is an unmet need for Assistive Technology and unless this issue is addressed, we cannot achieve the Sustainable Development Goals(SDG) targets or those of the Convention of the Rights of Persons with disabilities. (9)The 2030 Agenda for Sustainable Development emphasizes Universal Health Coverage (UHC) to ensure that everyone can access health services at affordable costs. Under the United Nation Convention on the Human Rights of Persons with Disabilities (UNCRPD), access to appropriate AT is a fundamental human right. (7) The World Health Assembly passed a resolution WHA 71.8 advocating for countries to develop, implement, and strengthen policies and put in place programmes to improve access to AT, "leaving no one behind`. This will ensure that people with disabilities, the older population and those affected by chronic diseases are included in the society to live a life of dignity.These mandates were considered essential to achieve Universal Health Coverage.(2) The WHO coordinates the Global Cooperation on Assistive Technology (GATE), a concrete step towards realizing the goals of the UN Convention on the Rights of Persons with Disabilities, Universal Health Coverage and the Sustainable Development Goals. (10)And in 2024, the WHO team is developing guidelines to help countries create their own people-centered AT ecosystems, tailored to the needs of local populations, through evidence-based policy making, provision of resources, improving awareness and accessibility, and training personnel for education and support of people who need AT. (11) Assistive Technology Situation in India Further to these guidelines, a National Essential List of Assistive Products of India was prepared in 2020, under the initiative of the Indian Council of Medical Research, New Delhi, Ministry of Health and Family Welfare, Government of India. A list of 21 essential assistive products was released in 2023, after prolonged debate. (12,13) The exact numbers of people who require Assistive Technology is not fully known in many lower middle income countries like India. The 2011 census in India estimated that 2.2% of the population had some form of disability. Because of the discrepancy between the disability statistics from the census and the disability statistics from World Bank, WHO, UNICEF or other agency estimates, accurate numbers of disabled people in India are not available. Erroneous statistics result in an underestimation in the number of people who need AT in India as a country. This will result in a disordered provision of AT services to the population.(14) Assistive Technology Situation in Kerala, India A study by S. Chandra et al showed that the prevalence of disability is about 2.2 % in Kerala. This study found that though 80% of the people with disability were on medical treatment for the root cause diseases, only about 18% used assistive devices. The devices were owned by 77% of those who used them, in Kerala.(7,15) Prior studies In a study on Assistive Technology on the unmet need in Canada by Anna Beradi et al[11], among the estimated 13.7% of the Canadian population with disabilities, 3,579,580 used some form of AT, mostly, glasses, contact lenses or bathroom aids. The results of the study showed that the most common unmet need was for hearing aids (0.86% of the total population), followed by bathroom aids (0.36%). (7,16) Nearly 10% of wheeled mobility device users identified an unmet need for an unmet need for an additional mobility device, in a study on needs for mobility devices, home modifications and personal assistance among Canadians with disabilities by Edward M Giesbrecht et al. Compared with non-users, they were twice as likely to modify their home with a ramp and three times as likely to install a lift. The unmet need for each type of residence adaptation among wheeled mobility device users was at least double that of non-users. Wheeled mobility device users received assistance with an average of 4.4 activities of daily living, compared with 2.0 for non-users, and reported an average of 1.9 activities for which assistance was needed but not received. About one -in-three relied on paid assistance; out-of-pocket expenses amounting to $10,000 or more annually, compared with 2% among non-users. (17) In a study on the unmet needs of Assistive Technology of independently living older Hispanics with functional limitations, by -Colón , Méndez et al, the studied population had unmet needs for AT devices for cooking, home tasks and home safety. Multiple health conditions and low educational levels were negatively associated with willingness to use AT devices.(18) In a study on the use, non-use and perceived unmet needs of Assistive Technology among Swedish people , by Löfqvist et al, the most common types of AT used were for furnishing/adaptation (35%) and the highest perceived unmet need was for AT for communication( 8%). A higher perceived unmet need was seen among those who lived alone compared with those who lived with others’.(19) A study by Zhang et al used the rATA questionnaire in different country contexts to collect data for a global report on the use, source, payer information, satisfaction, unmet needs, and barriers to Assistive Technology. (1) Similarly, in the Indian context, a study by Senjam et al, demonstrated the unmet needs for Assistive Technology, particularly for those with vision impairments.(7) Senjam et al also reported that the need for AT is not restricted to those with disabilities but even includes older people, or people with chronic diseases. Thus in actuality, those who need AT will be much more than is reported. Growing aging populations and decreasing visual acuity or hearing, musculoskeletal impairment, road traffic injuries, residual effects of stroke, etc will add to the need for AT. The need for AT will never be met completely because of the exponential growth in requirement.(14) Previous research reviewed has shown that people have identified a deficit in the Assistive Technology services they received. Relevance: Very few countries have developed a national Assistive Technology policy or programme. Access to AT is poor in most countries. Even in high income countries, AT are rationed and not included within health and welfare schemes, leading to high out -of -pocket expenditure by users. Lack of access to AT excludes people’s participation in social activities like education, work, or leisure time engagements. The AT industry is limited and specialized, mainly serving high income markets. Funding for disabled people to procure Assistive devices is insufficient with inadequate delivery of devices and deficient procurement of devices, coupled with poor quality and safety standards. Lack of individualized care with inadequate tailoring of devices or technology to patients is noted in many situations. People from low socioeconomic groups have to rely on charity services and donations, which provide low quality, or used products. (20) Rationale : The need for AT is growing especially in low to middle income countries like India. Although there is governmental commitment to the existing disability policy and Act for welfare services, there is still a substantial unmet need in India. (7) Lack of access to AT causes poor and deteriorating health outcomes,and reduction in quality of life by inhibiting participation in society and in various essential activities of daily living like education, work, or leisure, leading to a multitude of societal costs. India is a member state of the WHO, so it has to align with the WHO commitment to improve access to high-quality and affordable AT for persons who need them. Further, the UN Convention on the Rights of Person with Disabilities, which has been ratified by India, pushes states to ensure access to AT at affordable prices.Even though government and other organizations are providing AT for free, it is only in limited number and many of those who are in need of AT have to buy AT services out of their pocket.(7) We plan to address the gap between AT requirements and AT availability in our community by studying a sample of the population. This can help policy makers plan for provision of more Assistive Technology to those who need them. Research Question What are the unmet needs and barriers to access to Assistive Technology among patients attending Otorhinolaryngology, Ophthalmology, PMR and Orthopedic departments in a tertiary care center of Pathanamthitta district of Kerala, India ? What is the level of satisfaction with the use of Assistive Technology among those patients? Aims: To study the unmet needs and barriers to access to Assistive Technology among patients and to assess the satisfaction to the use of Assistive Technology among those patients. Objectives: 1. To determine the unmet needs and barriers to access to Assistive Technology among a sample of patients attending Otorhinolaryngology, Ophthalmology, PMR and Orthopedic departments in a tertiary care center of Pathanamthitta district in Kerala using the WHO rATA questionnaire 2. To determine the satisfaction levels with the use of Assistive Technology among the above sample of patients, assessed by the WHO rATA questionnaire Methodology Study Design The design of the study is a cross-sectional pilot descriptive study. The study design is of a pilot study and the questionnaire is aimed to be tested on a sample of the participants. After the analysis of the pilot study, a major study will be planned. Study Setting : Patients will be recruited from the Otorhinolaryngology, Ophthalmology, Physical Medicine & Rehabilitation, and Orthopedics departments of the Pushpagiri Medical College, which is a medical college situated in Tiruvalla, in Central Kerala of India. Sampling Method Since there was no study with similar objectives, we decided to conduct a pilot study with 40 patients from each of the four departments, who require Assistive Technology. There is no sample size calculation used. We could not calculate a power for the sample size as this is a pilot study. Sample Size: For the pilot study, 40 patients from each of the four departments= 160 Sampling Technique : Convenience sampling method will be used until the sample size is achieved. Since the patients who do actually come to the outpatient department of our private hospital, we have used this number of 40 per department. Inclusion & Exclusion Criteria Inclusion Patients who are identified to use or require Assistive Technology from the 4 departments of our hospital- both outpatients and inpatients. Patients who might or might not be using Assistive Technology at this time Patients who have had contact with the identified 4 departments of our hospital- Ophthalmology, Otorhinolaryngology, Physical Medicine & Rehabilitation, Orthopedics Patients who answer questions on their own. For those unable to answer, a proxy from the family or house will be interviewed. Exclusion Patients from other departments of the hospital Patients from other hospitals Study Period The time taken to recruit and interview participants will be as long as required to achieve the required sample size from each department, after obtaining approval from the Institutional Review Board. Study Tool The rapid Assistant Technology Assessment Tool (rATA) is an interviewer-administered, population-based, validated survey tool, divided into seven sections designed to gather basic information on factors such as demographics,needs,demand and supply, user satisfaction, and recommendations (optional) about Assistive Devices. This tool is used to rapidly assess the need, demand, supply, and user satisfaction of Assistive Devices among the population.This questionnaire was developed by the World Health Organization, based on widely used questionnaires in disability, rehabilitation, and health system studies, and in consultation with global stakeholders in assistive technology, including experts in research, policy making, and program development from both high and low-middle-income countries, and WHO regional and country advisors in disability and health products. The questionnaire was tested in two districts in Bangladesh in 2018, and in Pakistan in 2019. The final rATA questionnaire has been examined for face/construct validity by domain experts. (1) How the rATA tool was developed In 2018, the WHO Assistive Technology Access ( ATA) team proposed the draft rATA questionnaire to collect data on self reported access to AT, recognising the importance of stakeholder participation in creating and using this tool. This tool aimed at finding out AT user understanding of their need, uptake, use of, and benefit from Assistive Technology to identify unmet needs and target health care resources towards those areas. In 2020, after the pilot testing of the questionnaire in Bangladesh and Pakistan, the WHO called for contributions to data collection on access in populations to AT. (1) We will be using this tool in this pilot study translating its elements into Malayalam and back translated into English to ensure that the translation is appropriate. The study team members will be briefed about the tool and how to use it. They will report on issues they faced during the tool implementation for data collection.(21) WHO rATA team contact : We have reached out to the WHO rATA team and they have given us permission to translate the Rapid Assistive Technology Assessment tool to the Malayalam language with appropriate credits. METHOD OF DATA COLLECTION Approval from the Institutional Review Board has been obtained(PIMSRC/E1/388A/87/2023). The data collectors are instructed and trained in the method of data collection and the interview method. Details of the study will be explained to each participant, and written informed consent will be obtained from them. The primary caregivers of those who cannot give consent due to debilitating conditions, will be approached to take consent, to participate in the study. The questionnaire will be administered in English/Malayalam(vernacular) or in any language the patient is comfortable with. Interview method will be used to collect data. Data will be entered onto the data collection sheet( attached). After data collection, information will be entered into Excel sheets and analyzed using SPSS 25 software. Results We are hoping to collect data from 160 participants on the need for AT in the study population( prevalence of met need + prevalence of unmet need). “Prevalence of met need is the proportion of the study population using assistive products that do not need new or additional assistive products. Prevalence of unmet need is the proportion of the study population that needs new or additional assistive products regardless of whether they are using assistive products already or not.”( 1 ) Additionally, met need as a proportion of need will be analyzed. Categories of unmet or net need with regards to the AT will be analyzed- for example visual need for AT, Vs hearing need etc. Barriers to access AT will be analyzed and if there are commonalities they will be grouped. Levels of satisfaction with Assistive Technology will also be studied. ( 1 ) Standardization of Interviews and Training of Interviewers Training will be provided to all data collectors by the principal investigator. Statistical Analysis The study will have 40 participants from each of the departments of Otorhinolaryngology, Ophthalmology, Physical Medicine and Rehabilitation, and Orthopedics. After data collection, information will be entered into Excel sheets. Cleaned data will be analyzed using SPSS 25 software.Most statistical tests assume that data are normally distributed. Hence outliers will fall outside the normal distribution. For this study outliers will be those values that fall outside the 2SD range and they will be removed from the data in order to not affect the values of the summary statistics. During analysis if the data is found to be non- normally distributed, then they will not be identified or removed. Continuous variables will be expressed as mean and standard deviations. Descriptive analyses will be performed to summarize the results, and categorical variables will be expressed as frequencies with percentages. To study the factors associated with Assistive Technology, the chi-square test will be used. Multivariate analyses will be performed to explore predictors of AT usage like sex, age, financial situation and other predictors of AT usage. A p-value of < 0.05 will be set as the level of significance. Evaluation Outcomes OUTCOME MEASUREMENTS 1) Unmet needs and barriers to access to Assistive Technology among patients attending Otorhinolaryngology, Ophthalmology, Physical Medicine and Rehabilitation, and Orthopedic departments of the hospital will be identified. 2) Satisfaction with the use of Assistive Technology among those patients will be noted. OPERATIONAL DEFINITIONS: Assistive technology : Assistive technology includes any assistive device or software that is used to improve, maintain, or increase the functional capabilities of those with disabilities. Assistive products can range from physical products such as wheelchairs, glasses, prosthetic limbs, white canes, and hearing aids to digital solutions such as speech recognition or time management software and captioning. Disability : The result of the interaction of the health condition of a person and various personal and environmental factors that are caused or the result of those interactions. For example, people with Down’s syndrome have unique personal characteristics and interactions with the environment like negative attitudes, inaccessible transportation facilities etc, which make the person disabled. rATA : Rapid Assistive Technology Assessment Need of Assistive Technology : The percentage of clients who are currently in need of at least one or more assistive devices for their functioning difficulties. The prevalence of need is the sum of the prevalence of met needs and unmet needs. Ethics: Approval from the Institutional Review Board has been obtained. Details of the study will be explained to the subject and written informed consent will be obtained from them.The primary caregivers of those who cannot give consent due to debilitating conditions, will be approached to take consent, to participate in the study. Privacy of participants : To protect participant privacy, the collected data will be de-identified. Data sheets and computer files, interview form will be kept safe, in locked cupboards or in password protected files. The information gathered from the research will be published only in summarized forms and will not in most situations be able to be traced back to the participants from which they were extracted. Confidentiality of participants : Data collected will be kept in password protected files accessible only to researchers. No information that is collected will be shared unless permission is expressly granted by the participants through the consent form disclosure. It will not be possible to collect data in a non-identifiable manner but participant identifying information will be handled and disseminated in a responsible manner. To the extent, participant information will be stored in a de-identified manner with the identifiers available only with one researcher. Information from participants will not be disclosed to those unconnected with the research or to unauthorized persons Discussion Results : Policy Implications and scope for future research We hope that through this research’s findings, the hospital community will become aware of the unmet needs for Assisted Technologies and create policies to support people who need such technologies based on their needs. We hope that future research will be encouraged wherein the unmet needs of AT in other departments are studied, along with finding out those patients who fall through the cracks and are not advised Assisted Technologies when they actually might need them. This means there might be a need to educate physicians and other hospital based caregivers about identifying unmet needs and referring patients to suitable agencies or departments which can assist such patients. This project will have no external funding. We expect to have the results ready by December 2024. Strengths and Limitations of the study This study is a cross sectional study and will be conducted among patients of four departments of our hospital. The time taken to reach the sample size is unpredictable as it is not known how many patients with assistive devices we have from each of the four departments. The recruitment process will be time consuming because after explaining the requirements of the study, participants may not be willing to take part because of fear of loss of privacy. They may fear the stigma associated with the use of the assistive devices. Training of the data collectors so that data collection is consistent by different data collectors is another potential limitation of the study. The participant population already uses Assistive Technology, and so the aspect for unmet needs might only be assessed fully if all the population, including those who require Assistive Technology but are currently not using any, are included. In the current scenario, the unmet needs for the second device can only be assessed. Errors that can occur during data collection and data entry Population specification error : A wrong assumption of the sample to be studied can occur. For example, different interviewers may survey different people assuming they are the population under study. In this case, interviewers might interview people outside the Ophthalmology, Otorhinolaryngology, Orthopedics, or Physical Medicine & Rehabilitation departments, who do not yet have assistive devices, under the assumption that the general population is to be surveyed. The rATA questionnaire has been used to survey populations and identify those who need Assistive Technology. This study aims to interview those who have assistive technology or who have been prescribed it already and not a general population. Sample frame error : We plan to survey 160 people who require, have been prescribed, or are using assistive devices, 40 from each of the departments decided on. In case the sample size is not met and 40 people from each department are not obtained within the time frame of the study, a sample frame error can take place. In case of telephonic interviews we might miss out on people whose numbers are not listed with the departments. If we do not get adequate numbers of 40 from each department, within the time frame, we will stop the study in that department and use only the collected data. Selection error : Interviewing only those one is comfortable with can lead to selection errors. In this case since the population under study is narrowly defined, the chances of this error may be minimal. Non-responsive error: When participants do not respond to the questionnaire either during direct interviews, or pick up the telephone, in telephonic interviews, this occurs. In addition if the interviewer visit does not coincide with the patient visit, the patient might be missed. This way the entire sample may not be reached. Measurement (observational) error : In this case, if the rATA questionnaire is not the right tool to get information to meet the objectives of the study, and to arrive at the truth, then measurement errors can occur. As this is a pilot study, we will know when the data is analyzed whether new questions should be added or questions removed or corrected. Biases in the study Data entry errors Transcription errors : Typos, duplication of words, omissions of certain words, names, and numbers while entering data can occur. Vigilance by the investigators and data entry operators will help minimize transcription errors. Transposition errors : When letters and numbers are interchanged or swapped, incorrect sequences can occur. These can be minimized by constantly double checking and cross checking between the data on paper and on the Excel sheets. Such errors can also be caused by wrong coding. One of the strengths of the study is that this is one of the first studies that might have been conducted using the WHO questionnaire on Assistive Technology and as such may be a pioneer study in this domain from the Kerala state of India. This study will help highlight the conditions, the processes, the pros and the cons of procuring assistive devices, and the problems patients have in using them or getting them replaced. Hence the findings can probably be used to make policy decisions. Response bias : Participants may respond inaccurately or falsely to a question. To counter this, the interview will be conducted by trained interviewers in as quick a manner as possible. The rATA questionnaire is a validated, and piloted questionnaire and though the questions are wordy, they are easy to understand and answer. We are hoping this will help reduce bias. We will try to build rapport with the participants by asking neutral questions and building up a friendly atmosphere and with their consent, more questions of a personal nature will be asked. Conclusions We plan to disseminate the summarized information collected through this study through regional public health conferences and also publish the results of our study in journals. At the same time, we hope to inform the administrators of our hospital about our findings so they can make informed policy decisions for people who require Assistive Technology. Abbreviations AT : Assistive Technology GATE : Global Cooperation on Assistive Technology PMR: Physical Medicine and Rehabilitation SDG : Sustainable Development Goals UHC : Universal Health Care UNCRPD : United Nations Convention on the Human Rights of Persons With Disabilities Declarations Acknowledgements Dr. Sapna Meryl Mani is the principal investigator and author of this protocol. She conceived the idea and developed it into a research protocol. Background reading and literature review were done by her. Dr. Anjum John, is the co- principal investigator and author of this protocol. She helped with development of the research protocol, ethics committee submissions, facilitating meetings with team members, and writing up the protocol for journal submission. Dr. K.V. Rajan, is a co-investigator who reviewed the protocol and is collecting data from the department of Otorhinolaryngology. Dr. Asha George, is a co-investigator who reviewed the protocol, and is collecting data from the department of Ophthalmology. Dr. Betsy Tharayil, is a co-investigator who reviewed the protocol and is collecting data from the department of Physical Medicine and Rehabilitation from our hospital. Ms. Reshma V.R is the Biostatistican who contributed to the study design, and methodology part of the protocol. She will do the data analysis, once it is ready. Dr. Aysha Rinda, Dr. Augustine, and Dr. Benjamin David are house surgeons who participate in the study by collecting data from the Physical Medicine and Rehabilitation department. They read through the protocol before it was submitted to the Institutional Review Board. We acknowledge the contributions of Dr. Felix Johns, Head of the Department of Community Medicine in encouraging us to conduct this research, sitting through discussions on methodology and for his suggestions to make changes to the protocol. Conflicts of Interest None Declared. References Website [Internet]. Available from: Zhang W, Eide AH, Pryor W, Khasnabis C, Borg J. Measuring Self-Reported Access to Assistive Technology Using the WHO Rapid Assistive Technology Assessment (rATA) Questionnaire: Protocol for a Multi-Country Study. International Journal of Environmental Research and Public Health. 2021; 18(24):13336. https://doi.org/10.3390/ijerph182413336 Assistive technology [Internet]. [cited 2024 Apr 30]. Available from: https://www.who.int/news-room/fact-sheets/detail/assistive-technology Website [Internet]. Available from: Assistive Technology Industry Association [Internet]. 2015 [cited 2024 Jan 13]. What is AT? Available from: https://www.atia.org/home/at-resources/what-is-at/ Assistive technology [Internet]. [cited 2024 Apr 30]. Available from: https://www.who.int/news-room/fact-sheets/detail/assistive-technology Assistive Technology [Internet]. [cited 2024 Apr 30]. Available from: https://www.who.int/teams/health-product-policy-and-standards/assistive-and-medical-technology/assistive-technology Assistive Technology [Internet]. [cited 2024 Apr 30]. Available from: https://www.who.int/teams/health-product-policy-and-standards/assistive-and-medical-technology/assistive-technology Assistive technology usage, unmet needs and barriers to access: a sub-population-based study in India. The Lancet Regional Health - Southeast Asia [Internet]. 2023 Aug 1 [cited 2024 Apr 29];15:100213. Available from: http://dx.doi.org/10.1016/j.lansea.2023.100213 Website [Internet]. Available from: https://www.un.org/development/desa/disabilities/wp-content/uploads/sites/15/2019/10/Banes.pdf Assistive Technology [Internet]. [cited 2024 Apr 30]. Available from: https://www.who.int/teams/health-product-policy-and-standards/assistive-and-medical-technology/assistive-technology Global Cooperation on Assistive Technology (GATE) [Internet]. [cited 2024 Apr 30]. Available from: https://www.who.int/initiatives/global-cooperation-on-assistive-technology-(gate) Global report on assistive technology [Internet]. [cited 2024 Jan 13]. Available from: https://www.unicef.org/reports/global-report-assistive-technology [No title] [Internet]. [cited 2024 Apr 30]. Available from: https://main.icmr.nic.in/sites/default/files/upload_documents/ICMR_Assistive_Technology_Product_List_WEB.pdf [No title] [Internet]. [cited 2024 Apr 30]. Available from: https://main.icmr.nic.in/sites/default/files/upload_documents/ICMR_Assistive_Technology_Product_List_WEB.pdf Website [Internet]. Available from: (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10391423/) Chanda S, Sekher TV. Identification of Disability for Inclusive Development: Lessons from Disability Census of Kerala, India. SAGE Open [Internet]. 2023 Aug 23 [cited 2024 Apr 30]; Available from: https://journals.sagepub.com/doi/10.1177/21582440231190817 Berardi A, Smith EM, Miller WC. Assistive technology use and unmet need in Canada. Disabil Rehabil Assist Technol [Internet]. 2021 Nov;16(8):851–6. Available from: http://dx.doi.org/10.1080/17483107.2020.1741703 Giesbrecht EM, Smith EM, Mortenson WB, Miller WC. Needs for mobility devices, home modifications and personal assistance among Canadians with disabilities. Health Rep [Internet]. 2017 Aug 16;28(8):9–15. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29044443 Orellano-Colón EM, Rivero-Méndez M, Lizama M, Jutai JW. Assistive technology unmet needs of independent living older Hispanics with functional limitations. Disabil Rehabil Assist Technol [Internet]. 2018 Feb;13(2):194–200. Available from: http://dx.doi.org/10.1080/17483107.2017.1300693 Löfqvist C, Slaug B, Ekström H, Kylberg M, Haak M. Use, non-use and perceived unmet needs of assistive technology among Swedish people in the third age. Disabil Rehabil Assist Technol [Internet]. 2016;11(3):195–201. Available from: http://dx.doi.org/10.3109/17483107.2014.961180 Global Cooperation on Assistive Technology (GATE) [Internet]. [cited 2024 Jan 13]. Available from: https://www.who.int/initiatives/global-cooperation-on-assistive-technology-(gate)#:~:text=The%20Global%20Cooperation%20on%20Assistive,universally%20accessible%20to%20everyone%2C%20everywhere. rapid Assistive Technology Assessment tool (rATA) [Internet]. [cited 2024 Jan 30]. Available from: https://www.who.int/publications/i/item/WHO-MHP-HPS-ATM-2021.1 Senjam SS, Mannan H. Assistive technology: The current perspective in India. Indian J Ophthalmol. 2023 May;7)1(5:1804-1809. doi: 10.4103/IJO.IJO_2652_22. PMID: 37203033; PMCID: PMC10391423. Additional Declarations The authors declare potential competing interests as follows: None to declare 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-6064895","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Method Article","associatedPublications":[],"authors":[{"id":418081090,"identity":"407981ad-b4a2-40a2-b8c6-fd8af9825679","order_by":0,"name":"Sapna Meryl Mani","email":"","orcid":"","institution":"Pushpagiri Institute of Medical Sciences \u0026 Research Centre","correspondingAuthor":false,"prefix":"","firstName":"Sapna","middleName":"Meryl","lastName":"Mani","suffix":""},{"id":418081091,"identity":"06e269ea-46a5-4b0e-9cb7-878c28ea33b6","order_by":1,"name":"Anjum 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14:17:00","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6064895/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6064895/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":76763821,"identity":"781295dd-f520-4c02-9d08-1ce41fb0fb01","added_by":"auto","created_at":"2025-02-20 12:55:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":639150,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6064895/v1/0c5483c0-75cd-43ae-b1d5-af1fce5e4884.pdf"}],"financialInterests":"The authors declare potential competing interests as follows: None to declare","formattedTitle":"\u003cp\u003eDescribing Met and Unmet Needs of Access to Assistive Technology Among Outpatients of a Tertiary Care Center of Pathanamthitta District in Kerala, India- Protocol for A Descriptive Pilot Study\u003c/p\u003e","fulltext":[{"header":"Project Summary","content":"\u003cp\u003eAssistive Technology includes any assistive device or software that is used to improve, maintain, or increase the functional capabilities of those with disabilities. Assistive Technology is a fundamental human right. Addressing the unmet need of assistive products is important for achieving The 2030 Sustainable Development Goals aim at addressing the unmet \u0026nbsp;need of assisted technology products. Very few countries have developed effective national Assistive Technology policies or programs. The gap between the \u0026ldquo;haves\u0026rdquo; and the \u0026ldquo;have nots\u0026rdquo; is very wide in the Assistive Technology industry. This research aims to understand the unmet needs of Assistive Technology in patients attending a tertiary care hospital in Central Kerala, India. who require Assistive Technology from the departments of Otorhinolaryngology. Ophthalmology, PMR, and Orthopedics.A questionnaire will be administered in English/Malayalam( vernacular) or in any language the patient is comfortable with . Telephonic or direct \u0026nbsp;interview methods will be used to collect data. The findings will b\u003cstrong\u003ee\u0026nbsp;\u003c/strong\u003edisseminated via summarized information collected through this study and \u0026nbsp;we hope to inform the administrators of our hospital about our findings so they can make informed policy decisions for people who require Assistive Technology.\u003c/p\u003e"},{"header":"Rationale and Background Information","content":"\u003cp\u003e\u003cstrong\u003eBackground\u0026nbsp;\u003c/strong\u003e: People around the world are afflicted by many conditions. \u0026nbsp; Aging is an inevitable phenomenon affecting every human being. Aging leads to disability and decreased functional ability for many people. In addition, communicable and noncommunicable diseases affect much of the global population. The residual effects of communicable diseases, non-communicable diseases, and aging, are similar. Resources are required to manage \u0026nbsp; the residual consequences of these diseases. The \u0026nbsp;World Health Organization ( WHO) recognises the public health importance of supporting people with disabilities, with \u0026nbsp;functional decline, and their \u0026nbsp;need for Assistive Technology(AT) . AT helps people with disabilities live a fruitful life, integrated in society.(2\u0026ndash;4)\u003c/p\u003e\n\u003cp\u003eAssistive Technology (AT) is any item, piece of equipment, software programme or product system that is used to increase, maintain or improve functional capabilities of persons with disabilities.[2] It can range from low-tech \u0026nbsp; pill organizers to high tech special purpose computers. Electronic devices, wheelchairs, walkers, braces, educational software, power lifts, pencil holders, eye- gaze- head trackers are all \u0026nbsp;Assistive Technology. Globally more than 2.5 billion people need AT; with the prediction that more than \u0026nbsp;3.5 billion people will need at least one AT by 2050, due to \u0026nbsp; aging populations with or without non-communicable diseases.[2]All systems and services that apply \u0026nbsp;scientific knowledge to assistive products( APs), to improve the functioning and independent living of people with functional disabilities are ATs.(2,3)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe advantages of \u0026ldquo; having technology that assists\u0026rdquo; are many. Such technology promotes independent living. These devices or supports \u0026nbsp;indemnify the \u0026nbsp; decreasing functional abilities of people, due to various causes. (5,6)Thus people can continue to have healthy, productive, participatory, and fruitful lives, with a role to play in society. Access to appropriate assistive products, in a timely fashion, can help people continue to function as useful members of society without a break. Use of such technologies can help mitigate the long drawn effects of various health conditions and prevent catastrophic outcomes, in the management of various health conditions like using protective footwear can help protect the feet of people with diabetic feet. Being self dependent, they can reduce the load on their human caregivers, with the ability to essentially do what they want, when they want.(7,8)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGlobal Unmet Needs of Assistive Technology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe aging of populations is inevitable. \u0026nbsp;The loss of the use of a limb or sensory organ due to any cause, affects a person in a multitude of ways..Though Assistive Technology can, to a certain extent, help, they cannot fully provide/replace \u0026nbsp;the emotional, physical, social, financial, setbacks brought about by disability. Public health systems have to be realigned in order to support aging populations with disabilities in addition to \u0026nbsp;their multiple other needs.Despite the growing \u0026nbsp; need, access to Assistive Technology is limited.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe World Health Organization(WHO) has recognized that there is an unmet need for Assistive Technology and unless this issue is addressed, we cannot achieve the Sustainable Development Goals(SDG) targets or those of the Convention of the Rights of Persons with disabilities. (9)The 2030 Agenda for Sustainable Development emphasizes Universal Health Coverage (UHC) to ensure that everyone can access health services at affordable costs. Under the United Nation Convention on the Human Rights of Persons with Disabilities (UNCRPD), access to appropriate AT is a fundamental human right. (7) The World Health Assembly passed a resolution WHA 71.8 advocating \u0026nbsp;for countries to develop, implement, and strengthen policies and put in place programmes to improve access to AT, \u0026quot;leaving no one behind`. This will \u0026nbsp; ensure that \u0026nbsp;people with disabilities, the \u0026nbsp;older population and those affected by chronic diseases are included in the society to live a life of dignity.These mandates were considered essential to achieve Universal Health Coverage.(2)\u003c/p\u003e\n\u003cp\u003eThe WHO coordinates \u0026nbsp;the Global Cooperation on Assistive Technology (GATE), a concrete step towards realizing the goals of the UN Convention on the Rights of Persons with Disabilities, Universal Health Coverage and the Sustainable Development Goals. (10)And in 2024, the WHO team is developing \u0026nbsp; guidelines to help countries create their own people-centered AT ecosystems, tailored to the needs of local populations, through evidence-based policy making, provision of resources, improving awareness and accessibility, and training personnel for education and support of people who need AT. (11)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssistive Technology Situation in India\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFurther to these guidelines, a \u0026nbsp;National Essential List of Assistive Products of India was prepared in 2020, \u0026nbsp;under the initiative of the Indian Council of Medical Research, New Delhi, Ministry of Health and Family Welfare, Government of India. A list of 21 essential assistive products was released in 2023, after prolonged debate. (12,13)\u003c/p\u003e\n\u003cp\u003eThe exact numbers of people who require Assistive Technology is not fully known in many lower middle income countries like India. The 2011 census in India estimated that 2.2% of the population had some form of disability. Because of the discrepancy between the disability statistics from the census and the disability statistics from World Bank, WHO, UNICEF or other agency estimates, accurate numbers of disabled people in India are not available. Erroneous \u0026nbsp;statistics result in an underestimation in the number of people who need AT in India as a country. This will result in a disordered provision of AT services to the population.(14)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssistive Technology Situation in Kerala, India\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA study by S. Chandra et al showed that the prevalence of disability is about 2.2 % in Kerala. This study found that though \u0026nbsp;80% of the people with disability were on medical \u0026nbsp;treatment for the root cause diseases, \u0026nbsp;only about 18% used assistive devices. The devices were owned by 77% of those who used them, in Kerala.(7,15)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrior studies\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn a study on Assistive Technology on the \u0026nbsp;unmet need in Canada by Anna Beradi \u0026nbsp; et al[11], among the estimated 13.7% of the Canadian population with disabilities, 3,579,580 used some form of AT, mostly, glasses, contact lenses or bathroom aids. The results of the study showed that the most common unmet need was for hearing aids (0.86% of the total population), followed by bathroom aids (0.36%). (7,16)\u003c/p\u003e\n\u003cp\u003eNearly 10% of wheeled mobility device users identified an unmet need for an unmet need for an additional mobility device, in a \u0026nbsp;study on needs for mobility devices, home modifications and personal assistance among Canadians with disabilities \u0026nbsp;by Edward M Giesbrecht et al. Compared with non-users, they were twice as likely to modify their home with a ramp and three times as likely to install a lift. The \u0026nbsp;unmet need for each type of residence adaptation among wheeled mobility device users was at least double that of non-users. Wheeled mobility device users received assistance with an average of 4.4 activities of daily living, compared with 2.0 for non-users, and reported an average of 1.9 activities for which assistance was needed but not received. \u0026nbsp;About one -in-three relied on paid assistance; \u0026nbsp;out-of-pocket expenses amounting \u0026nbsp;to $10,000 or more annually, compared with 2% among non-users. (17)\u003c/p\u003e\n\u003cp\u003eIn a study on \u0026nbsp;the unmet needs of Assistive Technology \u0026nbsp;of independently \u0026nbsp;living older Hispanics with functional limitations, by -Col\u0026oacute;n , M\u0026eacute;ndez et al, the studied population had unmet needs for AT devices for cooking, home tasks and home safety. Multiple health conditions and low educational levels were negatively associated with willingness to use AT devices.(18)\u003c/p\u003e\n\u003cp\u003eIn a study on \u0026nbsp;the use, non-use and perceived unmet needs of Assistive Technology among Swedish people , by \u0026nbsp;L\u0026ouml;fqvist et al, the most common types of AT used were for furnishing/adaptation (35%) and the highest perceived unmet need was for \u0026nbsp;AT for communication( 8%). A higher perceived unmet need was seen among those who lived alone compared with those who lived with others\u0026rsquo;.(19)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA study by Zhang et al used the rATA questionnaire in different country contexts to collect data for a global report on the use, source, payer information, satisfaction, unmet needs, and barriers to Assistive Technology. (1)\u003c/p\u003e\n\u003cp\u003eSimilarly, in the Indian context, a study by Senjam et al, demonstrated the unmet needs for Assistive Technology, particularly for those with vision impairments.(7) Senjam et al also reported that the need for AT is not restricted to those with disabilities but even includes older people, or people with chronic diseases. Thus in actuality, those who need AT will be much more than \u0026nbsp;is reported. Growing aging populations and decreasing visual acuity or hearing, musculoskeletal impairment, road traffic injuries, residual effects of stroke, etc will add to the need for AT. The need for AT will never be met completely because of the exponential growth in requirement.(14)\u003c/p\u003e\n\u003cp\u003ePrevious research reviewed has shown that people have identified a deficit in the Assistive Technology services they received.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelevance:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVery few countries have developed a national Assistive Technology policy or programme. Access to AT is poor in most countries. Even in high income countries, AT are rationed and not included within health and welfare schemes, leading to high out -of -pocket expenditure by users. Lack of access to AT excludes people\u0026rsquo;s participation in social \u0026nbsp; activities like education, work, or leisure time engagements.\u003c/p\u003e\n\u003cp\u003eThe AT industry is limited and specialized, mainly serving high income markets. Funding for disabled people to procure Assistive devices is insufficient with inadequate delivery of devices and deficient procurement of devices, coupled \u0026nbsp; with poor quality and safety standards. Lack of individualized care with inadequate \u0026nbsp; tailoring of devices or technology to patients is noted \u0026nbsp;in many situations. People from low socioeconomic groups have to rely on charity services and donations, which provide low quality, or used products. (20)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRationale\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eThe need for AT is growing especially in low to middle income countries like India. Although there is governmental \u0026nbsp; commitment to the existing disability policy and Act for welfare services, there is still a substantial \u0026nbsp; unmet need in India. (7)\u003c/p\u003e\n\u003cp\u003eLack of access to AT causes poor and deteriorating health outcomes,and reduction in quality of life by inhibiting participation in society and in various essential activities of daily living like education, work, or leisure, \u0026nbsp;leading to a multitude of societal costs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIndia is a member state of the WHO, so it has to align with the WHO commitment to improve access to high-quality and affordable AT for persons who need them. Further, the UN Convention on the Rights of Person with Disabilities, which has been ratified by India, pushes states to ensure access to AT at \u0026nbsp; affordable prices.Even though government and other organizations are providing AT for free, it is only in limited number and many of those who are in need of AT have to buy AT services out of their pocket.(7)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe plan to address the gap between AT requirements and AT availability in our community by studying a sample of the population. \u0026nbsp;This can help policy makers plan for provision of more Assistive Technology to those who need them.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Question\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhat are the unmet needs and barriers to access to Assistive Technology among patients attending Otorhinolaryngology, Ophthalmology, PMR and Orthopedic departments in a tertiary care center of Pathanamthitta district of Kerala, India ?\u003c/p\u003e\n\u003cp\u003eWhat is the level of satisfaction with the use of Assistive Technology among those patients?\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAims:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo study the unmet needs and barriers to access to Assistive Technology among patients and to assess the satisfaction to the use of Assistive Technology among those patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. To determine the unmet needs and barriers to access to Assistive Technology among \u0026nbsp;a sample of patients attending Otorhinolaryngology, Ophthalmology, PMR and Orthopedic departments in a tertiary care center of Pathanamthitta district in Kerala using the WHO rATA questionnaire\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. To determine the satisfaction levels with the use of Assistive Technology among the above sample of patients, assessed by the WHO rATA questionnaire\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eStudy Design\u003c/p\u003e\n\u003cp\u003eThe design of the study is a cross-sectional pilot descriptive study. The study design is of a pilot study and the questionnaire is aimed to be tested on a sample of the participants. After the analysis of the pilot study, a major study will be planned.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudy Setting : Patients will be recruited from the Otorhinolaryngology, Ophthalmology, Physical Medicine \u0026amp; Rehabilitation, and Orthopedics departments of the Pushpagiri Medical College, which is a medical college situated in Tiruvalla, in Central Kerala of India.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSampling Method\u003c/p\u003e\n\u003cp\u003eSince there was no study with similar objectives, we decided to conduct a pilot study with 40 patients from each of the \u0026nbsp;four departments, who require Assistive Technology. There is no sample size calculation used. We could not calculate a power for the sample size as this is a pilot study.\u003c/p\u003e\n\u003cp\u003eSample Size: For the pilot study, 40 patients from each of the four departments= 160\u003c/p\u003e\n\u003cp\u003eSampling Technique : Convenience sampling method will be used until the sample size is achieved. Since the patients who do actually come to the outpatient department of our private hospital, we have used this number of 40 per department.\u003c/p\u003e\n\u003cp\u003eInclusion \u0026amp; Exclusion Criteria\u003c/p\u003e\n\u003cp\u003eInclusion\u0026nbsp;\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003ePatients who are identified to use or require Assistive Technology from the 4 departments of our hospital- both outpatients and inpatients.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePatients who might or might not be using Assistive Technology at this time\u003c/li\u003e\n \u003cli\u003ePatients who have had contact with the identified 4 departments of our hospital- Ophthalmology, Otorhinolaryngology, Physical Medicine \u0026amp; Rehabilitation, Orthopedics\u003c/li\u003e\n \u003cli\u003ePatients who answer questions on their own. For those unable to answer, a proxy from the family or house will be interviewed.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eExclusion\u0026nbsp;\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003ePatients from other departments of the hospital\u003c/li\u003e\n \u003cli\u003ePatients from other hospitals\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eStudy Period\u003c/p\u003e\n\u003cp\u003eThe time taken to recruit and interview participants will be as long as required to achieve the required sample size from each department, after obtaining approval from the Institutional Review Board.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudy Tool\u003c/p\u003e\n\u003cp\u003eThe rapid Assistant Technology Assessment Tool (rATA) is an interviewer-administered, population-based, validated \u0026nbsp;survey tool, divided into seven sections designed to gather basic information on factors such as demographics,needs,demand and supply, user satisfaction, and recommendations (optional) about Assistive Devices. This tool is used to rapidly assess \u0026nbsp; the need, demand, supply, and user satisfaction of Assistive Devices among the population.This \u0026nbsp;questionnaire was developed by the World Health Organization, \u0026nbsp;based on widely used questionnaires in disability, rehabilitation, and health system studies, and in consultation with global stakeholders in assistive technology, including experts in research, policy making, and program development from both high and low-middle-income countries, and WHO regional and country advisors in disability and health products. The questionnaire was tested in two districts in Bangladesh in 2018, and in Pakistan in 2019. The final rATA questionnaire has been examined for face/construct validity by domain experts. (1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHow the rATA tool was developed\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn 2018, \u0026nbsp;the WHO Assistive Technology Access ( ATA) team proposed the draft rATA questionnaire to collect data on self reported access to AT, recognising the importance of stakeholder participation in creating and using this tool. This tool aimed at finding out AT user understanding of their need, uptake, use of, and benefit from Assistive Technology to identify unmet needs and target health care resources towards those areas. In 2020, after the pilot testing of the questionnaire in Bangladesh and Pakistan, the WHO called for contributions to data collection on access in populations to AT. (1)\u003c/p\u003e\n\u003cp\u003eWe will be using this tool in this pilot study translating its elements into Malayalam and back translated into English to ensure that the translation is appropriate. The study team members will be briefed about the tool and how to use it. They will report on issues they faced during the tool implementation for data collection.(21)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWHO rATA team contact\u0026nbsp;\u003c/strong\u003e: We have reached out to the WHO rATA team and they have given us permission to translate the Rapid Assistive Technology Assessment tool to the Malayalam language with appropriate credits.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMETHOD OF DATA COLLECTION\u003c/p\u003e\n\u003cp\u003eApproval from the Institutional Review Board \u0026nbsp;has been \u0026nbsp;obtained(PIMSRC/E1/388A/87/2023). The data collectors are instructed and trained in the method of data collection and the interview method.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDetails of the study will be explained to each participant, and written informed consent will be obtained from them.\u003c/p\u003e\n\u003cp\u003eThe primary caregivers of those who cannot give consent due to debilitating conditions, \u0026nbsp;will be approached to take consent, \u0026nbsp;to participate in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe questionnaire will be administered in English/Malayalam(vernacular) or in any language \u0026nbsp;the patient is comfortable with. \u0026nbsp;Interview method will be used to collect data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData will be entered onto the data collection sheet( attached). After data collection, information will be entered into Excel sheets and analyzed using SPSS 25 software.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eWe are hoping to collect data from 160 participants on the need for AT in the study population( prevalence of met need\u0026thinsp;+\u0026thinsp;prevalence of unmet need). \u0026ldquo;Prevalence of met need is the proportion of the study population using assistive products that do not need new or additional assistive products. Prevalence of unmet need is the proportion of the study population that needs new or additional assistive products regardless of whether they are using assistive products already or not.\u0026rdquo;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAdditionally, met need as a proportion of need will be analyzed. Categories of unmet or net need with regards to the AT will be analyzed- for example visual need for AT, Vs hearing need etc. Barriers to access AT will be analyzed and if there are commonalities they will be grouped. Levels of satisfaction with Assistive Technology will also be studied. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eStandardization of Interviews and Training of Interviewers\u003c/p\u003e \u003cp\u003eTraining will be provided to all data collectors by the principal investigator.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe study will have 40 participants from each of the departments of Otorhinolaryngology, Ophthalmology, Physical Medicine and Rehabilitation, and Orthopedics. After data collection, information will be entered into Excel sheets. Cleaned data will be analyzed using SPSS 25 software.Most statistical tests assume that data are normally distributed. Hence outliers will fall outside the normal distribution. For this study outliers will be those values that fall outside the 2SD range and they will be removed from the data in order to not affect the values of the summary statistics. During analysis if the data is found to be non- normally distributed, then they will not be identified or removed.\u003c/p\u003e \u003cp\u003eContinuous variables will be expressed as mean and standard deviations. Descriptive analyses will be performed to summarize the results, and categorical variables will be expressed as frequencies with percentages. To study the factors associated with Assistive Technology, the chi-square test will be used. Multivariate analyses will be performed to explore predictors of AT usage like sex, age, financial situation and other predictors of AT usage. A p-value of \u0026lt;\u0026thinsp;0.05 will be set as the level of significance.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEvaluation Outcomes\u003c/h2\u003e \u003cp\u003eOUTCOME MEASUREMENTS\u003c/p\u003e \u003cp\u003e1) Unmet needs and barriers to access to Assistive Technology among patients attending Otorhinolaryngology, Ophthalmology, Physical Medicine and Rehabilitation, and Orthopedic departments of the hospital will be identified.\u003c/p\u003e \u003cp\u003e2) Satisfaction with the use of Assistive Technology among those patients will be noted.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eOPERATIONAL DEFINITIONS:\u003c/h3\u003e\n\u003cp\u003eAssistive technology : Assistive technology includes any assistive device or software that is used to improve, maintain, or increase the functional capabilities of those with disabilities. Assistive products can range from physical products such as wheelchairs, glasses, prosthetic limbs, white canes, and hearing aids to digital solutions such as speech recognition or time management software and captioning.\u003c/p\u003e \u003cp\u003eDisability : The result of the interaction of the health condition of a person and various personal and environmental factors that are caused or the result of those interactions. For example, people with Down\u0026rsquo;s syndrome have unique personal characteristics and interactions with the environment like negative attitudes, inaccessible transportation facilities etc, which make the person disabled.\u003c/p\u003e \u003cp\u003erATA : Rapid Assistive Technology Assessment\u003c/p\u003e \u003cp\u003eNeed of Assistive Technology : The percentage of clients who are currently in need of at least one or more assistive devices for their functioning difficulties. The prevalence of need is the sum of the prevalence of met needs and unmet needs.\u003c/p\u003e \u003cp\u003eEthics: Approval from the Institutional Review Board has been obtained. Details of the study will be explained to the subject and written informed consent will be obtained from them.The primary caregivers of those who cannot give consent due to debilitating conditions, will be approached to take consent, to participate in the study.\u003c/p\u003e \u003cp\u003ePrivacy of participants : To protect participant privacy, the collected data will be de-identified. Data sheets and computer files, interview form will be kept safe, in locked cupboards or in password protected files. The information gathered from the research will be published only in summarized forms and will not in most situations be able to be traced back to the participants from which they were extracted.\u003c/p\u003e \u003cp\u003eConfidentiality of participants : Data collected will be kept in password protected files accessible only to researchers. No information that is collected will be shared unless permission is expressly granted by the participants through the consent form disclosure. It will not be possible to collect data in a non-identifiable manner but participant identifying information will be handled and disseminated in a responsible manner. To the extent, participant information will be stored in a de-identified manner with the identifiers available only with one researcher. Information from participants will not be disclosed to those unconnected with the research or to unauthorized persons\u003c/p\u003e"},{"header":"Discussion","content":"\u003ch3\u003eResults :\u003c/h3\u003e\n\u003cp\u003ePolicy Implications and scope for future research\u003c/p\u003e \u003cp\u003eWe hope that through this research\u0026rsquo;s findings, the hospital community will become aware of the unmet needs for Assisted Technologies and create policies to support people who need such technologies based on their needs. We hope that future research will be encouraged wherein the unmet needs of AT in other departments are studied, along with finding out those patients who fall through the cracks and are not advised Assisted Technologies when they actually might need them. This means there might be a need to educate physicians and other hospital based caregivers about identifying unmet needs and referring patients to suitable agencies or departments which can assist such patients.\u003c/p\u003e \u003cp\u003eThis project will have no external funding. We expect to have the results ready by December 2024.\u003c/p\u003e\n\u003cp\u003e \u003cb\u003eStrengths and Limitations of the study\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThis study is a cross sectional study and will be conducted among patients of four departments of our hospital. The time taken to reach the sample size is unpredictable as it is not known how many patients with assistive devices we have from each of the four departments.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe recruitment process will be time consuming because after explaining the requirements of the study, participants may not be willing to take part because of fear of loss of privacy. They may fear the stigma associated with the use of the assistive devices.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTraining of the data collectors so that data collection is consistent by different data collectors is another potential limitation of the study.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe participant population already uses Assistive Technology, and so the aspect for unmet needs might only be assessed fully if all the population, including those who require Assistive Technology but are currently not using any, are included. In the current scenario, the unmet needs for the second device can only be assessed.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eErrors that can occur during data collection and data entry\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePopulation specification error : A wrong assumption of the sample to be studied can occur. For example, different interviewers may survey different people assuming they are the population under study. In this case, interviewers might interview people outside the Ophthalmology, Otorhinolaryngology, Orthopedics, or Physical Medicine \u0026amp; Rehabilitation departments, who do not yet have assistive devices, under the assumption that the general population is to be surveyed. The rATA questionnaire has been used to survey populations and identify those who need Assistive Technology. This study aims to interview those who have assistive technology or who have been prescribed it already and not a general population.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSample frame error : We plan to survey 160 people who require, have been prescribed, or are using assistive devices, 40 from each of the departments decided on. In case the sample size is not met and 40 people from each department are not obtained within the time frame of the study, a sample frame error can take place. In case of telephonic interviews we might miss out on people whose numbers are not listed with the departments. If we do not get adequate numbers of 40 from each department, within the time frame, we will stop the study in that department and use only the collected data.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSelection error : Interviewing only those one is comfortable with can lead to selection errors. In this case since the population under study is narrowly defined, the chances of this error may be minimal.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eNon-responsive error: When participants do not respond to the questionnaire either during direct interviews, or pick up the telephone, in telephonic interviews, this occurs. In addition if the interviewer visit does not coincide with the patient visit, the patient might be missed. This way the entire sample may not be reached.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eMeasurement (observational) error : In this case, if the rATA questionnaire is not the right tool to get information to meet the objectives of the study, and to arrive at the truth, then measurement errors can occur. As this is a pilot study, we will know when the data is analyzed whether new questions should be added or questions removed or corrected.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eBiases in the study\u003c/h2\u003e \u003cp\u003e \u003cb\u003eData entry errors\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTranscription errors : Typos, duplication of words, omissions of certain words, names, and numbers while entering data can occur. Vigilance by the investigators and data entry operators will help minimize transcription errors.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTransposition errors : When letters and numbers are interchanged or swapped, incorrect sequences can occur. These can be minimized by constantly double checking and cross checking between the data on paper and on the Excel sheets. Such errors can also be caused by wrong coding.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eOne of the strengths of the study is that this is one of the first studies that might have been conducted using the WHO questionnaire on Assistive Technology and as such may be a pioneer study in this domain from the Kerala state of India.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThis study will help highlight the conditions, the processes, the pros and the cons of procuring assistive devices, and the problems patients have in using them or getting them replaced. Hence the findings can probably be used to make policy decisions.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eResponse bias : Participants may respond inaccurately or falsely to a question. To counter this, the interview will be conducted by trained interviewers in as quick a manner as possible. The rATA questionnaire is a validated, and piloted questionnaire and though the questions are wordy, they are easy to understand and answer. We are hoping this will help reduce bias. We will try to build rapport with the participants by asking neutral questions and building up a friendly atmosphere and with their consent, more questions of a personal nature will be asked.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eWe plan to disseminate the summarized information collected through this study through regional public health conferences and also publish the results of our study in journals. At the same time, we hope to inform the administrators of our hospital about our findings so they can make informed policy decisions for people who require Assistive Technology.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eAT : Assistive Technology\u003c/p\u003e\n\u003cp\u003eGATE : Global Cooperation on Assistive Technology\u003c/p\u003e\n\u003cp\u003ePMR: Physical Medicine and Rehabilitation\u003c/p\u003e\n\u003cp\u003eSDG : Sustainable Development Goals\u003c/p\u003e\n\u003cp\u003eUHC : Universal Health Care\u003c/p\u003e\n\u003cp\u003eUNCRPD : United Nations Convention on the Human Rights of Persons With Disabilities\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr. Sapna Meryl Mani is the principal investigator and author of this protocol. She conceived the idea and developed it into a research protocol. Background reading and literature review were done by her.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDr. Anjum John, is the co- principal investigator and author of this protocol. She helped with development of the research protocol, ethics committee submissions, facilitating meetings with team members, and writing up the protocol for journal submission.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDr. K.V. Rajan, is a co-investigator who reviewed the protocol and is collecting data from the department of Otorhinolaryngology.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDr. Asha George, is a co-investigator who reviewed the protocol, and is collecting data from the department of Ophthalmology.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDr. Betsy Tharayil, is a co-investigator who reviewed the protocol and is collecting data from the department of Physical Medicine and Rehabilitation from our hospital.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMs. Reshma V.R is the Biostatistican who contributed to the study design, and methodology part of the protocol. She will do the data analysis, once it is ready.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDr. Aysha Rinda, Dr. Augustine, and Dr. Benjamin David are house surgeons who participate in the study by collecting data from the Physical Medicine and Rehabilitation department. They read through the protocol before it was submitted to the Institutional Review \u0026nbsp; Board.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe acknowledge the contributions of Dr. Felix Johns, Head of the Department of Community Medicine in encouraging us to conduct this research, sitting through discussions on methodology and for his suggestions to make changes to the protocol.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone Declared.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWebsite [Internet]. Available from: Zhang W, Eide AH, Pryor W, Khasnabis C, Borg J. Measuring Self-Reported Access to Assistive Technology Using the WHO Rapid Assistive Technology Assessment (rATA) Questionnaire: Protocol for a Multi-Country Study. International Journal of Environmental Research and Public Health. 2021; 18(24):13336. https://doi.org/10.3390/ijerph182413336\u003c/li\u003e\n\u003cli\u003eAssistive technology [Internet]. [cited 2024 Apr 30]. Available from: https://www.who.int/news-room/fact-sheets/detail/assistive-technology\u003c/li\u003e\n\u003cli\u003eWebsite [Internet]. Available from: Assistive Technology Industry Association [Internet]. 2015 [cited 2024 Jan 13]. What is AT? Available from: https://www.atia.org/home/at-resources/what-is-at/\u003c/li\u003e\n\u003cli\u003eAssistive technology [Internet]. [cited 2024 Apr 30]. Available from: https://www.who.int/news-room/fact-sheets/detail/assistive-technology\u003c/li\u003e\n\u003cli\u003eAssistive Technology [Internet]. [cited 2024 Apr 30]. Available from: https://www.who.int/teams/health-product-policy-and-standards/assistive-and-medical-technology/assistive-technology\u003c/li\u003e\n\u003cli\u003eAssistive Technology [Internet]. [cited 2024 Apr 30]. Available from: https://www.who.int/teams/health-product-policy-and-standards/assistive-and-medical-technology/assistive-technology\u003c/li\u003e\n\u003cli\u003eAssistive technology usage, unmet needs and barriers to access: a sub-population-based study in India. The Lancet Regional Health - Southeast Asia [Internet]. 2023 Aug 1 [cited 2024 Apr 29];15:100213. Available from: http://dx.doi.org/10.1016/j.lansea.2023.100213\u003c/li\u003e\n\u003cli\u003eWebsite [Internet]. Available from: https://www.un.org/development/desa/disabilities/wp-content/uploads/sites/15/2019/10/Banes.pdf\u003c/li\u003e\n\u003cli\u003eAssistive Technology [Internet]. [cited 2024 Apr 30]. Available from: https://www.who.int/teams/health-product-policy-and-standards/assistive-and-medical-technology/assistive-technology\u003c/li\u003e\n\u003cli\u003eGlobal Cooperation on Assistive Technology (GATE) [Internet]. [cited 2024 Apr 30]. Available from: https://www.who.int/initiatives/global-cooperation-on-assistive-technology-(gate)\u003c/li\u003e\n\u003cli\u003eGlobal report on assistive technology [Internet]. [cited 2024 Jan 13]. Available from: https://www.unicef.org/reports/global-report-assistive-technology\u003c/li\u003e\n\u003cli\u003e[No title] [Internet]. [cited 2024 Apr 30]. Available from: https://main.icmr.nic.in/sites/default/files/upload_documents/ICMR_Assistive_Technology_Product_List_WEB.pdf\u003c/li\u003e\n\u003cli\u003e[No title] [Internet]. [cited 2024 Apr 30]. Available from: https://main.icmr.nic.in/sites/default/files/upload_documents/ICMR_Assistive_Technology_Product_List_WEB.pdf\u003c/li\u003e\n\u003cli\u003eWebsite [Internet]. Available from: (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10391423/)\u003c/li\u003e\n\u003cli\u003eChanda S, Sekher TV. Identification of Disability for Inclusive Development: Lessons from Disability Census of Kerala, India. SAGE Open [Internet]. 2023 Aug 23 [cited 2024 Apr 30]; Available from: https://journals.sagepub.com/doi/10.1177/21582440231190817\u003c/li\u003e\n\u003cli\u003eBerardi A, Smith EM, Miller WC. Assistive technology use and unmet need in Canada. Disabil Rehabil Assist Technol [Internet]. 2021 Nov;16(8):851–6. Available from: http://dx.doi.org/10.1080/17483107.2020.1741703\u003c/li\u003e\n\u003cli\u003eGiesbrecht EM, Smith EM, Mortenson WB, Miller WC. Needs for mobility devices, home modifications and personal assistance among Canadians with disabilities. Health Rep [Internet]. 2017 Aug 16;28(8):9–15. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29044443\u003c/li\u003e\n\u003cli\u003eOrellano-Colón EM, Rivero-Méndez M, Lizama M, Jutai JW. Assistive technology unmet needs of independent living older Hispanics with functional limitations. Disabil Rehabil Assist Technol [Internet]. 2018 Feb;13(2):194–200. Available from: http://dx.doi.org/10.1080/17483107.2017.1300693\u003c/li\u003e\n\u003cli\u003eLöfqvist C, Slaug B, Ekström H, Kylberg M, Haak M. Use, non-use and perceived unmet needs of assistive technology among Swedish people in the third age. Disabil Rehabil Assist Technol [Internet]. 2016;11(3):195–201. Available from: http://dx.doi.org/10.3109/17483107.2014.961180\u003c/li\u003e\n\u003cli\u003eGlobal Cooperation on Assistive Technology (GATE) [Internet]. [cited 2024 Jan 13]. Available from: https://www.who.int/initiatives/global-cooperation-on-assistive-technology-(gate)#:~:text=The%20Global%20Cooperation%20on%20Assistive,universally%20accessible%20to%20everyone%2C%20everywhere.\u003c/li\u003e\n\u003cli\u003erapid Assistive Technology Assessment tool (rATA) [Internet]. [cited 2024 Jan 30]. Available from: https://www.who.int/publications/i/item/WHO-MHP-HPS-ATM-2021.1\u003c/li\u003e\n\u003cli\u003eSenjam SS, Mannan H. Assistive technology: The current perspective in India. Indian J Ophthalmol. 2023 May;7)1(5:1804-1809. doi: 10.4103/IJO.IJO_2652_22. PMID: 37203033; PMCID: PMC10391423.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"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":"Assistive Technology, Disability, needs, barriers, satisfaction, access","lastPublishedDoi":"10.21203/rs.3.rs-6064895/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6064895/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAssistive Technology includes any assistive device or software and essential service, used to improve, maintain, or increase functional capabilities of those with disabilities. Assistive Technology is part of all essential services like the education, employment, fitness, and leisure industry and also activities required to make daily living manageable like self-care, cooking, reading, or listening. Assistive Technology is a fundamental human right. Addressing the unmet need of assistive products is important for achieving the 2030 Sustainable Development Goals. Very few countries have developed effective national Assistive Technology policies or programs. The gap between the \u0026ldquo;haves\u0026rdquo; and \u0026ldquo;have nots\u0026rdquo; is very wide in the Assistive Technology industry.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis research aims to understand the unmet needs and barriers to access to Assistive Technology among a sample of patients attending Otorhinolaryngology, Ophthalmology, PMR and Orthopedic departments in a tertiary care center of Pathanamthitta district in Kerala using the WHO rATA questionnaire and to determine the satisfaction levels with the use of Assistive Technology among the above sample of patients, assessed by the WHO rATA questionnaire.\u0026rdquo;\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAfter Institutional Review Board review and approval, patients from the Ophthalmology, Physical Medicine \u0026amp; Rehabilitation(PMR), and Orthopedics will be identified and those who meet the inclusion criteria selected for the study. In the event that participants cannot be contacted during their hospital visits, they will be asked for willingness to participate in the study, through telephone calls, after explaining the details of the study. The WHO rATA questionnaire will be administered in English/Malayalam( vernacular), with their signed consent. \u0026ldquo;This questionnaire was developed by the World health organization based on existing questionnaires on disability, rehabilitation, and health system studies in consultation with a group of experts. It is an interview format, population based survey tool with seven sections that collect information on demographics, needs for Assistive Technology, supply, demand and satisfaction, along with recommendations from the public. \u0026ldquo;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Telephonic or direct interview methods will be used to collect data.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study will have 40 participants from each of the departments of Otorhinolaryngology, Ophthalmology, Physical Medicine and Rehabilitation, and Orthopedics. After data collection, information will be entered into Excel sheets and analyzed using SPSS 25 software. Numerical variables will be expressed as mean and standard deviations. Categorical variables will be expressed as frequencies with percentages. To study the factors associated with access to Assistive Technology, chi-square tests will be used. This project will have no external funding. We expect to have the results ready by December 2024.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eWe plan to disseminate the summarized information collected through this study to regional public health conferences and also publish the results of our study in journals. At the same time, we hope to inform the administrators of our hospital about our findings so they can make informed policy decisions for people who require Assistive Technology.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e","manuscriptTitle":"Describing Met and Unmet Needs of Access to Assistive Technology Among Outpatients of a Tertiary Care Center of Pathanamthitta District in Kerala, India- Protocol for A Descriptive Pilot Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-20 12:47:22","doi":"10.21203/rs.3.rs-6064895/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":"7ed6eae3-1bb7-4378-8b9a-6e6b4af5d3be","owner":[],"postedDate":"February 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-20T12:47:22+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-20 12:47:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6064895","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6064895","identity":"rs-6064895","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}