Barriers for disabled people in Cambodia

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BACKGROUND

 Disability

Concepts of disability have confused social scientists for many years. Researchers have struggled to find operational definitions of disability that are complete, global or stable over time (Grönvik, 2009).It is difficult to specify and measure disability, because it is related to many areas of life and involves interactions between the person and his or her environment. Disability is defined by the World Health Organization (WHO) as « An umbrella term, covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations.Thus, disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which he or she lives” (World Health Organization).In order to address this issue, the World Health Organization (WHO) (World Health Organization,2001) brought together representatives of more than 100 countries, to produce the International Classification of Functioning (ICF) which is a framework for conceptualizing disability. The ICF takes each function of an individual – at body, person or society level – and provides a definition for its operational assessment. It defines disability as “a decrement in each functioning domain”. While the ICF encourages a holistic view of disability and provides a common language to discuss aspects of disability, is not a tool for assessing and measuring disability in daily practice. The ICF is an important framework through which our understanding of the interactions between people and their environment, participation and activities can be enhanced, see Figure 1. It has the potential to be an excellent international development tool that can be used to ensure the inclusion of people with disabilities in health, educational and economic development projects and programs in developing countries (Gallagher, Donovan, Doyle, & Desmond, 2011; Vanleit, 2008).In order to operationalize the ICF, the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire was developed. This is a universal assessment instrument which provides a standardized method for measuring health and disability across cultures. It was developed from a comprehensive set of ICF items that are sufficiently reliable and sensitive to measure the difference made by a given intervention (World Health Organization, 2001).
WHODAS 2.0 covers 6 domains of function:
Cognition – understanding & communicating
Mobility– moving & getting around
Self-care– hygiene, dressing, eating & staying alone
Getting along– interacting with other people
Life activities– domestic responsibilities, leisure, work & school
Participation– joining in community activities

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Disability and poverty

Disability and poverty are believed to operate in a cycle, with each reinforcing the other (Banks, Kuper,& Polack, 2017). Growing evidence suggests that easily preventable illnesses are a common cause of disability, their impact is exacerbated by a lack of basic healthcare facilities (Allotey, Reidpath,Kouamé, & Cummins, 2003). When there is a lack of basic healthcare together with poverty, the risk of being born with an impairment also increases (Singal, 2011). The reverse is also true, and it is commonly accepted that people living in poverty have limited access to basic health care, insufficient and/or unhealthy food, poor sanitation facilities, and an increased risk and likelihood of living and working in hazardous conditions (Singal, 2011). According to Singal (2011) people living in chronic poverty have two important exit routes, namely high dependency on their own labor and formal education, which improves the quality of their labor. When examining these routes in relation to people with disabilities, neither are particularly viable. Establishing small businesses requires capital resources which many lack. Moneylenders do not trust the capacity of disabled people to repay loans, making access to financial credit extremely difficult (Gartrell, 2010).

SUMMARY 
SAMMANFATTNING
TABLE OF CONTENT
ABBREVIATIONS 
1 INTRODUCTION   
2 BACKGROUND
2.1 Disability 
2.2 Disability and poverty
2.3 Activity and participation 
2.4 Cambodia 
2.5 Prosthetic services in Cambodia
2.6 Barriers for disabled people in Cambodia
2.6.1 Physical and accessibility barriers
2.6.2 Attitudinal barriers
2.6.3 Social barriers
3 AIM 
4 MATERIAL AND METHODS 
4.1 Study design 
4.2 Sampling
4.3 Participants
4.4 Data collection
4.5 Trustworthiness 
4.6 Ethical considerations  
5 RESULTS 
5.1 Prosthetic limb 
5.1.1 Ability to move around
5.1.2 Physical environment
5.1.3 Physical discomfort
5.2 Psychosocial environment
5.2.1 Support from others
5.2.2 Need to provide for family
5.2.3 Societal attitudes
5.2.4 Personal attitudes
5.2.5 Poor education and poverty
6 DISCUSSION
6.1 Method discussion
6.1.1 Study design
6.1.2 Recruitment and Sample
6.1.3 Data collection
6.1.4 Data analysis
6.1.5 Saturation
6.2 Result discussion
6.2.1 Demographic information
6.2.2 Prosthetic limb
6.2.3 Psychosocial environment
6.3 Further research 
7 CONCLUSION 
8 SPECIAL THANKS TO
9 CONFLICTS OF INTEREST
10 REFERENCES 
Appendix 1
Appendix 2 
Appendix 3 

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