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As of 2021, more than one billion people globally need assistive technology – a number that is set to double by 2050. Assistive technology can enable people living with restrictions in their day-to- day lives because of disability, noncommunicable diseases or ageing to be more independent. Broadly speaking, assistive technology can help to alleviate limitations related to the following six functional categories: hearing, vision, mobility, self-care, communication and cognition. In addition to convincing evidence of its cost- effectiveness, assistive technology has the potential to help people living with restrictions due to ageing, disease or disability escape marginalization and become empowered to live the life they want to lead and improve their own quality of life and that of the people around them. Despite these benefits, it is estimated that only 10% of people needing assistive technology currently have access to it, even basic devices such as hearing aids or spectacles. This scoping review aims to provide an overview of what is currently known about the prevalence and coverage of assistive technology in the WHO European Region. It is guided by the following research question: “What is the prevalence of needs, access and coverage of assistive technology and what are facilitators and barriers to access and coverage in the WHO European Region?”. Sixty-two publications included in this review were identified by searching the academic databases Scopus, CINAHL, MEDLINE, PsycINFO and Google Scholar. A further 41 publications were identified by national experts within the WHO European Region. The total number of publications included in the analysis was 103. Relevant information was extracted into a data chart and analysed, using a narrative approach. Evidence regarding the prevalence of needs, access and coverage of assistive technology came from a few countries only, with the number of publications varying between functional categories: 14 for hearing, 12 each for vision and mobility, 11 for communication, six for self-care and two for cognition. Twenty-eight publications included data from national surveys or from nationally representative samples. In these publications, the prevalence of needs for assistive technology varied considerably, within as well as across the functional categories. The prevalence of met and unmet needs also varied between functional categories, with some domains showing a higher prevalence of met needs, such as hearing and vision, while others reported higher levels of unmet needs, such as communication. Overall, caution should be taken when interpreting results related to the prevalence of needs, access and coverage, as data came from a limited number of publications. Another aim of this review was to identify and understand facilitators and barriers to accessing assistive technology. More evidence is available on barriers and facilitators to assistive technology accessibility, affordability and acceptability, compared with evidence on the prevalence of needs, access and coverage of assistive technology. Most of the identified barriers appear common to many countries in the WHO European Region from which data were available. One of the main barriers for accessing assistive technology was related to physical accessibility. For example, in many reviewed publications, the process of applying for assistive technology was described as complicated, bureaucratic and timeconsuming. The assistive technology provision system was also seen as fragmented and lacking in coordination between various delivery mechanisms. Limited knowledge and training of health care professionals, limited information available to potential end users about assistive products, limited funding for assistive technology and the fluctuation in national prescription standards were other barriers that influenced the physical accessibility of assistive technology. In addition, financial affordability and having to pay out of pocket to access and use assistive technology were identified as substantial barriers by many people in the reviewed documents. Some people with assistive technology needs were also afraid of stigmatization from using assistive technology, especially where the use of assistive technology draws attention to otherwise invisible limitations. Generally, the identified barriers and facilitators are mostly in accordance with what other researchers have found, both within and outside the European Region. Nonetheless, they must still be considered in the political, societal and economic context of each country. To conclude, this report provided an evidence synthesis on the prevalence of needs, access and coverage of assistive technology and barriers and facilitators to accessing it. Overall, based on the evidence reviewed, there is a need to provide more data on the prevalence of need, access and coverage of assistive technology in each of the 53 Member States of the WHO European Region (plus Kosovo1 ) and for each functional category. Ideally, this information should be collected in accordance with generally agreed standards regarding the frequency of data collection and reporting, sampling strategies, definitions of functional limitations and the assistive products and age groups to be included. The report also identified several barriers to accessing assistive technology in the Region, including barriers related to the physical accessibility of assistive technology, financial affordability and acceptability of assistive technology by users. All stakeholders, such as policy-makers, health care professionals, assistive technology providers and caregivers, should work together to address these barriers and improve people’s access to assistive technology in the Region. |
