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      W-DARE: a three-year program of participatory action research to improve the sexual and reproductive health of women with disabilities in the Philippines

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          Abstract

          Background

          In many contexts, women with disability have less access to sexual and reproductive health information, screening, prevention, and care services than women without disability. Women with disability are also known to be more likely to experience physical and sexual violence than women without disability. In the Philippines, health service providers often have little awareness of the sexual and reproductive experiences of women with disability and limited capacity to provide services in response to their needs. Very limited data are available to inform development of disability-inclusive sexual and reproductive health, and violence prevention and response, services in the country. This paper presents the protocol for W-DARE (Women with Disability taking Action on REproductive and sexual health), a three-year program of participatory action research that aims to improve the sexual and reproductive health of women with disability in the Philippines.

          Design

          W-DARE is a disability-inclusive program that will use mixed methods to 1) increase understanding of factors influencing the sexual and reproductive health of women with disability, and 2) develop, implement and evaluate local interventions to increase supply of and demand for services. W-DARE will generate data on the prevalence of disability in two districts; the wellbeing and community participation of people with and without disability, and identify barriers to community; and describe the sexual and reproductive health needs and experiences, and service-related experiences of women with disability. These data will inform the development and evaluation of interventions aiming to improve access to sexual and reproductive health services, and violence prevention and response services, for women with disability. Local women with disabilities, their representative organisations, and SRH service providers will be involved as members of the research team across all stages of the research.

          Discussion

          This three-year study will provide evidence about factors undermining the sexual and reproductive health of women with disability in a lower-middle income country, and provide new insights about what may be effective in increasing access to services in settings of limited resources. Findings will be relevant across Asia and the Pacific. Analysis of the program will also provide evidence about disability-inclusion in participatory action research approaches.

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          Most cited references16

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          Prevalence and risk of violence against adults with disabilities: a systematic review and meta-analysis of observational studies.

          About 15% of adults worldwide have a disability. These individuals are frequently reported to be at increased risk of violence, yet quantitative syntheses of studies of this issue are scarce. We aimed to quantify violence against adults with disabilities.
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            Field-testing of the rapid assessment of disability questionnaire

            Background The Rapid Assessment of Disability (RAD) questionnaire measures the magnitude and impact of disability and aims to inform the design of disability inclusive development programs. This paper reports the psychometric evaluation of the RAD. Methods The initial version of the RAD comprised five sections: 1) demographics, 2) functioning, 3) rights awareness, 4) well-being, and 5) access to the community. Item functioning and construct validity were assessed in a population-based study in Bangladesh. Data were analysed using descriptive statistics (sections 2 and 5) and Rasch modelling (sections 3 and 4). A subsequent case–control study in Fiji tested the refined questionnaire in a cross-cultural setting and assessed the sensitivity and specificity of the RAD section 2 to identify people with disability. Results 2,057 adults took part in the study (1,855 in Bangladesh and 202 in Fiji). The prevalence of disability estimated using RAD section 2 in Bangladesh was 10.5% (95% CI 8.8-12.2), with satisfactory sensitivity and specificity (62.4% and 81.2%, respectively). Section 3 exhibited multidimensionality and poor differentiation between levels of rights awareness in both Bangladesh (person separation index [PSI] = 0.71) and Fiji (PSI = 0.0), and was unable to distinguish between people with and without disability (Bangladesh p = 0.786, Fiji p = 0.403). This section was subsequently removed from the questionnaire pending re-development. Section 4 had good ability to differentiate between levels of well-being (PSI = 0.82). In both countries, people with disability had significantly worse well-being scores than people without disability (p < 0.001) and also access to all sectors of community except legal assistance, drinking water and toilets (p < 0.001). Conclusions Filed-testing in Bangladesh and Fiji confirmed the psychometric robustness of functioning, well-being, and community access sections of the RAD. Information from the questionnaire can be used to inform and evaluate disability inclusive development programs.
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              The social model of disability.

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                Author and article information

                Contributors
                c.vaughan@unimelb.edu.au
                jeromebzayas@gmail.com
                devinea@unimelb.edu.au
                liz.gill-atkinson@unimelb.edu.au
                marella.m@unimelb.edu.au
                joycevgar@yahoo.com
                krissy.bfish@gmail.com
                jsalgado@likhaan.org
                carolyn.sobritchea@gmail.com
                tedmonds@unimelb.edu.au
                sm.baker@unimelb.edu.au
                ma.jesusa.marco@dlsu.edu.ph
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                29 September 2015
                29 September 2015
                2015
                : 15
                : 984
                Affiliations
                [ ]Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010 Australia
                [ ]Social Development Research Centre, De La Salle University, 2401 Taft Avenue, 1004 Manila, Philippines
                [ ]Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010 Australia
                [ ]WOWLEAP, 73 Edelweiss St., ESLA Urban Homes, Bgy. Sto. Domingo, Cainta, 1900 Rizal Philippines
                [ ]PARE, CAPWD, Bgy. Calamba EcoCenter, Calamba, 6000 Cebu City, Philippines
                [ ]Likhaan Center for Women’s Health, 27 St., Ofelia Subdivision, Ofelia, Project 8, Quezon City, 1106 Metro Manila Philippines
                [ ]University of the Philippines Center for Women’s Studies Foundation, Magsaysay Ave., corner Ylanan St., Diliman, 1101 Quezon City, Philippines
                Article
                2308
                10.1186/s12889-015-2308-y
                4588263
                26419646
                a73e7fae-bf46-4462-af17-42702d59aec6
                © Vaughan et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 17 September 2015
                : 22 September 2015
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2015

                Public health
                disability,sexual and reproductive health,violence,women,participatory action research,disability inclusive research,mixed methods,philippines

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