The health, support needs, access to healthcare services and social exclusion of adults with intellectual disabilities living in rural areas: a rural-urban comparison

Nicholson, Laura (2012) The health, support needs, access to healthcare services and social exclusion of adults with intellectual disabilities living in rural areas: a rural-urban comparison. MD thesis, University of Glasgow.

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Background: Almost all intellectual disabilities research is conducted in urban areas, and very little is known about the population of adults with intellectual disabilities living in rural areas. It is important to know whether there are significant rural-urban differences, in order to provide appropriate services and address inequalities. In particular, the general rural population is known to be disadvantaged with respect to access to healthcare and social exclusion. Adults with intellectual disabilities are also disadvantaged in these areas, and therefore adults with intellectual disabilities living in rural areas may have a double disadvantage.

Method: A sample of adults with intellectual disabilities living in a rural area on the West Coast of Scotland participated in a face-to-face semi-structured interview; their medical notes were also accessed. Demographics, healthcare, access to services, daytime opportunities, access to community facilities, recent contact with others, the quality of personal relationships, and area deprivation by postcode were measured. Data were already available for a pre-existing urban sample. Data were analysed using direct comparison and binary logistic regression.

Results: A representative sample of adults with intellectual disabilities from rural (n=39) and urban (n=633) areas were compared. There were no significant rural-urban differences over a wide range of variables including: age, gender, ethnicity, level of intellectual disabilities, mental ill health and common co-morbidities such as mobility, visual impairment, incontinence and epilepsy. Both direct comparison and binary logistic regression showed the rural sample to have had significantly more contact with primary (Odds Ratio = 4.02, 95% CI 1.56 -10.35, P = 0.004) and secondary health care (OR = 3.93, 95% CI = 1.81 – 8.55, P = 0.001.) Participants from rural areas were significantly more likely to have any regular daytime opportunity (Odds Ratio = 10.8, 95% CI = 2.3 – 51.5) including employment (OR = 22.1, 95% CI = 5.7 - 85.5) and attending resource centres (OR = 6.7, 95% CI = 2.6 – 17.2) than were participants from urban areas. They were also more likely to have been on holiday (OR = 17.8, 95% CI = 4.9 – 60.1); however, were less likely to use community facilities on a regular basis. Participants from urban and rural areas had a similar number of contacts with other people in a wide range of situations, but the quality of relationships may have been less close in rural areas. Finally, rural participants lived in significantly less deprived areas (Mann Whitney U = 7826, Z = -3.675, P ≤ 0.001).

Conclusion: There were no significant demographic and health differences between the rural and urban samples. The study was underpowered with respect to some of these findings, and some results may reflect a Type II error. Nevertheless this is an important negative finding. Contrary to original hypothesis, the rural sample was found to have better access to healthcare services, had better opportunities and lived in less deprived areas than adults with intellectual disabilities living in urban areas. However, the results suggest that the rural sample may not have held such positive or close relationships, and this may be important when considering the subjective experience of social exclusion.

Additional qualitative sub-study: A qualitative sub-study investigated the difficulties experienced with recruitment to the original study. 10 semi-structured telephone interviews were held with professionals who had helped with recruitment. These were transcribed verbatim and anonymised, then analyzed using the Framework approach. A number of themes arose, including participant factors (interview anxiety, worry about negative feedback), the importance of the researcher (using a personal approach, meeting potential participants prior to recruitment) and motivators (enjoyment of the research interview (participant), obtaining a medical assessment (carer)). The themes were then used to generate strategies to improve recruitment to intellectual disabilities research: these include the research team applying a more personal approach, and considering motivators for both participants and carers. The findings of this study have implications in terms of both time and money. However, successful recruitment is essential to intellectual disabilities research, and the results can be used by intellectual disabilities researchers to review and improve their recruitment processes.

Item Type: Thesis (MD)
Qualification Level: Doctoral
Keywords: Intellectual disability, rural, healthcare, social exclusion, access, recruitment
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > R Medicine (General)
Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing
Supervisor's Name: Cooper, Prof. Sally-Ann
Date of Award: 2012
Depositing User: Dr Laura Nicholson
Unique ID: glathesis:2012-3738
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 20 Nov 2012
Last Modified: 10 Dec 2012 14:10

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