BMJ public health · 2026
Feasibility of implementing a community-based participatory group programme to improve access to healthcare for people with disabilities in Luuka district, Uganda: a mixed-methods pilot study.
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Smythe Tracey, Ssemata Andrew Sentoogo, Menya Abdmagidu, Drazdzewska Joanna, Sondaal Annemijn, Marks Sarah, Iyereget Moses, Mugisa Margaret, Waiswa Peter, Mbazzi Femke Bannink, Kuper Hannah
Аннотация
BACKGROUND: People with disabilities experience substantial barriers to healthcare, yet few community-based interventions have been evaluated to address these inequities in low-resource settings. We assessed the feasibility of Participatory Learning and Action for Disability (PLA-D) groups to improve healthcare access for people with disabilities in Luuka district, Uganda.
METHODS: Pilot-testing of the PLA-D approach was conducted from May 2023 to March 2024, with the establishment of five PLA-D groups in Luuka district, Uganda. The groups were led by trained facilitators and each included approximately 35-48 members (total 204) who met biweekly for a cycle of 11 sessions. Groups identified healthcare access challenges and implemented local solutions. Guided by Bowen's feasibility framework, we assessed acceptability, demand, implementation, practicality and limited-efficacy outcomes through (1) 28 in-depth interviews and five focus group discussions with participants, non-participants and facilitators, (2) monitoring group activities, (3) group observation and (4) 128 baseline and 153 endline quantitative questionnaires of participants with disabilities and caregivers.
RESULTS: PLA-D was acceptable and perceived as relevant by participants, with strong demand for continued group activities. Sessions were delivered largely as intended although facilitator mentoring and logistical support were important for maintaining implementation quality. Convenient meeting times and locations, local organisation, peer support and collective problem-solving supported participation. Participants reported increased knowledge, confidence and collective capacity to seek healthcare and advocate for their needs. Quantitative findings suggested possible improvements in healthcare access among adults with disabilities; however, these findings should be interpreted cautiously given the pilot design and limited statistical power.
CONCLUSIONS: PLA-D was feasible, acceptable and valued by participants in this rural Ugandan setting. The intervention shows promise as a community-based approach to addressing healthcare access barriers for people with disabilities, but future implementation should strengthen facilitation support, health system linkages and scalability planning before larger-scale evaluation.
METHODS: Pilot-testing of the PLA-D approach was conducted from May 2023 to March 2024, with the establishment of five PLA-D groups in Luuka district, Uganda. The groups were led by trained facilitators and each included approximately 35-48 members (total 204) who met biweekly for a cycle of 11 sessions. Groups identified healthcare access challenges and implemented local solutions. Guided by Bowen's feasibility framework, we assessed acceptability, demand, implementation, practicality and limited-efficacy outcomes through (1) 28 in-depth interviews and five focus group discussions with participants, non-participants and facilitators, (2) monitoring group activities, (3) group observation and (4) 128 baseline and 153 endline quantitative questionnaires of participants with disabilities and caregivers.
RESULTS: PLA-D was acceptable and perceived as relevant by participants, with strong demand for continued group activities. Sessions were delivered largely as intended although facilitator mentoring and logistical support were important for maintaining implementation quality. Convenient meeting times and locations, local organisation, peer support and collective problem-solving supported participation. Participants reported increased knowledge, confidence and collective capacity to seek healthcare and advocate for their needs. Quantitative findings suggested possible improvements in healthcare access among adults with disabilities; however, these findings should be interpreted cautiously given the pilot design and limited statistical power.
CONCLUSIONS: PLA-D was feasible, acceptable and valued by participants in this rural Ugandan setting. The intervention shows promise as a community-based approach to addressing healthcare access barriers for people with disabilities, but future implementation should strengthen facilitation support, health system linkages and scalability planning before larger-scale evaluation.