Developing a training on disability for healthcare workers in Uganda: a mixed methods study

Background Approximately 1.3 billion people worldwide face barriers in accessing inclusive healthcare due to disabilities, leading to worse health outcomes, particularly in low and middle-income countries (LMIC). However, there is a lack of training of healthcare workers about disability, both globally and in Uganda. Objectives To use mixed methods to develop a comprehensive training program with standardised elements for healthcare workers in Uganda, focusing on improving their knowledge, attitudes, and skills in providing care for people with disabilities. Methods The Medical Research Council (MRC) approach was employed to guide the development of the training intervention. We conducted an umbrella review to gather relevant literature on disability training for healthcare workers. Interviews were conducted with international experts to gain insights and perspectives on the topic. Additionally, interviews were undertaken with people with disabilities and healthcare workers in Uganda to understand their experiences and needs. A participatory workshop was organised involving key stakeholders, to collaboratively design the training material based on the findings from these data sources. Results Eight review articles examined training programs for healthcare workers on disability. Training settings ranged from specialised clinical settings to non-clinical settings, and the duration and evaluation methods of the training varied widely. Lectures and didactic methods were commonly used, often combined with other approaches such as case studies and simulations. The impact of the training was assessed through healthcare worker reports on attitudes, knowledge, and self-efficacy. Interviews emphasised the importance of involving people with disabilities in the training and improving communication and understanding between healthcare providers and people with disabilities. Five themes for healthcare worker training on disability were generated through the workshop, including responsibilities and rights, communication, informed consent, accommodation, and referral and connection, which were used to guide the development of the curriculum, training materials and training approach Conclusions This study presents a novel approach to develop a training program that aims to enhance healthcare services for people with disabilities in Uganda. The findings offer practical insights for the development of similar programs in LMICs. The effectiveness of the training program will be evaluated through a pilot test, and policy support is crucial for its successful implementation at scale. Key messages: 1. Healthcare workers require training to effectively address the health concerns of people with disabilities, yet this is rarely included in curricula worldwide 2. Uganda recognises the importance of addressing this issue and is taking steps to improve training programs about disability for healthcare workers 3. We used mixed methods to co-develop a comprehensive training program with standardised elements for healthcare workers in Uganda, focusing on improving their knowledge, attitudes, and skills in providing care for people with disabilities. 4. The developed training material could be adapted for healthcare workers in other resource-limited settings, and policy support is needed to ensure its implementation at scale ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This project is funded by the National Institute for Health Research (NIHR) [NIHR Global Research Professorship (Grant Reference Number NIHR301621)] awarded to Prof. Hannah Kuper. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS, the UK Department of Health and Social Care or FCDO. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: All protocols were approved by the Uganda Virus Research Institute research ethics committee (ref: GC/127/904) and the London School of Hygiene & Tropical Medicine (ref: 26715) and the Uganda National Council of Science and Technology (SS1348ES).This study was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants. Written informed consent was obtained from participants (people with disabilities and healthcare workers) who undertook interviews that were conducted in Uganda. Verbal informed consent was obtained from stakeholders, whose interviews were online, and the ethics committee approved this procedure. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The majority of the datasets supporting the conclusions of this article are included within the article and its additional files. However, underlying interview data associated with this study will not be made freely available, as the small number of healthcare worker and people with disabilities makes data potentially identifying. Applications for access to the raw qualitative data for this study should be made via email to the corresponding author, outlining the purpose of the proposed analyses and the data requested. These applications will be reviewed by the LSHTM's data access committee, and if accepted, the requested data will be shared.