Access to Healthcare Experiences for People with Disabilities: A Mixed-Methods Systematic Review and Meta-Synthesis Protocol

Objective(s): To characterize access to healthcare experiences reported by people with disabilities living in the United States since 2014.

Data Sources: An experienced librarian will query PubMed and CINAHL using a search protocol informed by previously published methods for “persons with disabilities (PWD)” and Levesque’s and Souliotis’s conceptual framework for “access to care.” One constraint will be used, publication date 2014-present, to capture experiences following implementation of the most recent healthcare reform.

Study Selection: Search results will be screened independently by two reviewers in two stages, first by title and abstract, then by full text. Discrepancies will be resolved by adjudication in team meetings. Articles that meet the following criteria will be included: empirical research in English, data collected in the United States and from 2014 or later, and includes self- or proxy-reported access to healthcare experiences for PWD.

Data Extraction: Data will be extracted independently by two reviewers and discrepancies adjudicated in team meetings. Data extraction will be piloted prior to initiation. Data extraction includes study characteristics, sample age, gender, race, insurance status, and disability type, and access to care measurement, analyses, and results for PWD. A modified Critical Appraisal Skills Programme will be used to evaluate the quality of included studies.

Data Synthesis: Data will be synthesized using a convergent, integrated approach. Quantitative data will be transformed (‘qualitized’), combined with qualitative data, and analyzed using a Best Fit Framework Synthesis. We will deductively code our data to access to care dimensions and themes identified will be mapped onto the Levesque Access to Care Framework. Data will be independently coded by two trained team members using the software Dedoose. Themes will be interrogated to explore similarities and differences across sample sub-groups (disability type, insurance status, race).

Conclusions: Results will provide an in-depth understanding of access to care experiences for PWD, and inform future research and policies to promote equitable access to care for PWD.

Author(s) Disclosures: Funded in part by the FISA Foundation and National Institutes of Health (K23HD106011).