Patients With Disabilities Report Low Access to Culturally Sensitive Care

Negative is how many patients with disabilities report their interactions with health care professionals (HCPs), particularly the ability to comprehensively understand complex health information when living with a vision, hearing, or cognitive disability, according to research published online today in Annals of Internal Medicine.¹

This lack of culturally sensitive care and research in this area was seen by the authors both before and after² they analyzed 2017 data from the National Health Interview Survey from responses to 3 questions:

• How often were you treated with respect by providers?
• How often did providers give easy-to-understand information?
• How often did providers ask opinions or beliefs about care?

The investigators also classified the disability types included in their analysis according to standard disability questions used in US Census surveys for activity (cognitive, hearing, independent-living, mobility, self-care, and vision). They investigated trends in patients with psychological disabilities (depression, anxiety, or an emotional problem), with other causes of disability, and who had multiple disabilities. Responses to questions were either “always/most of the time” (positive) or “some/none of the time" (negative).

“Previous work has examined patient satisfaction and perceived quality of care,” the authors wrote, “but national data on perceptions of cultural responsiveness among [people with disabilities] remain understudied.”

Overall Findings

The patients with any disability (n = 9919) were significantly older compared with the patients with no disability (n = 50,113); their mean (SD) ages were 59.8 (17.7) vs 45.1 (17.3) years. Most patients in each group were female patients, at 55.0% and 51.2%, respectively, and non-Hispanic White (68.9%) or non-Hispanic Black (13.4%), and non-Hispanic White (62.9%) or Hispanic (16.9%). Seventy-seven percent of the patients reporting disabilities were not currently part of the labor force.

More patients with a disability reported no/previous marriage (54.8%), whereas most patients without a disability were currently married or living with a partner (62.8%). The top education level achieved was high school graduate or higher in 77.8% and 88.8%, respectively. Still, a higher proportion of patients with disabilities reported an income between $0 and $34,999 (45.6% vs 19.5%) compared with more patients without a disability who reported incomes between $35,000 and $74,999 (25.9% vs 25.0%); $75,000 to $99,999 (12.0% vs 7.1%); and at least $100,000 (12.7% vs 11.4%).

Study authors highlight that their data demonstrate the definition culturally sensitive care needs to expand to include disabilities that are not always immediately apparent, such as cognitive or psychological disabilities. | Image Credit: © NINENII-stock.adobe.com

Respect

This component had the highest overall results, but those with disabilities reported overall lower totals compared with patients who did not have a disability. Patients with a mobility disability reported being treated with respect 96.2% of the time vs 97.1%, which was the smallest gap seen. The differences were larger when a patient reported a psychological (93.5% vs 97.2%), hearing (93.9% vs 97.2%), vision (94.1% vs 97.2%), more than 1 (94.3% vs 97.1%), self-care or cognitive (both 94.5% vs 97.2%), independent-living (95.3% vs 97.1%), other (95.8% vs 97.2%), or any (95.2% vs 97.1%) disability.

Received Understandable Information

The totals for this domain were lower than those seen for the respect domain but higher than the results for care beliefs. Patients with a hearing disability had the largest gap with patients without a disability when reporting on receipt level of culturally sensitive care (85.0% vs 93.1%), followed by patient with a vision (86.7% vs 93.1%), cognitive (86.6% vs 93.0%), more than 1 (87.2% vs 93.0%), self-care (87.6% vs 93.1%), independent living (88.4% vs 93.0%), any disability (88.7% vs 92.9%), other (89.9% vs 93.1%), and mobility (89.8% vs 93.0%) disability.

Beliefs About Care

Patients with vision (50.9% vs 58.7%), hearing (51.2% vs 58.7%), or psychological (53.9% vs 58.7%) disabilities exhibited the widest gaps in receipt level of culturally sensitive care compared with their counterparts without a disability, and patients reporting more than 1 (56.3% vs 58.7%), mobility (56.8% vs 58.8%), or self-care (57.9% vs 58.7%) disabilities had the smallest differences. Midrange results were seen for patients who reported an other (55.2% vs 58.7%), cognitive (55.1% vs 58.7%, independent living (56.1% vs 58.8%), or any (55.1% vs 58.9%) disability.

Moving Forward

“Future research should explore the extent to which adverse health care experiences affect health care outcomes,” the authors concluded, “and the effect of interventions involving not only clinician-level training but also system-level policies that enable or incentivize HCPs to provide disability-responsive care.”

They elaborate that their results hold merit because they echo contemporary results that show physicians often perceive patients with disabilities in a detrimental manner.³ In addition, these data demonstrate that the perception of what is considered culturally sensitive care needs to expand to include disabilities that are not always immediately apparent, such as cognitive or psychological disabilities.

References

1. Kakara M, Aysola J. Perceptions of culturally responsive care among people with disabilities. Ann Intern Med. Published online March 3, 2025. Accessed March 3, 2025. doi:10.7326/ANNALS-24-01964

2. Agaronnik N, Campbell EG, Ressalam J, Iezzoni LI. Exploring issues relating to disability cultural competence among practicing physicians. Disabil Health J. 2019;12(3):403-410. doi:10.1016/j.dhjo.2019.01.010

3. Iezzoni LI, Rao SR, Ressalam J, et al. Physicians' perceptions of people with disability and their health care. Health Aff (Millwood). 2021;40(2):297-306. doi:10.1377/hlthaff.2020.01452