Commentary on selection of assistive technology in a context with limited resources

Provision of assistive technology is rising on the global agenda. The international momentum for improving the access to assistive technology has been building since the preparation and adoption of the ‘Standard Rules on the Equalization of Opportunities for Persons with Disabilities’ in 1993, and was further propelled by the adoption of the ‘Convention on the Rights of Persons with Disabilities’ in 2006. With the advent of the World Health Assembly resolution on improving access to assistive technology (WHA 71.8) in 2018, the time has come for States to fulfill their intention and deliver on their promise to make effective and safe assistive products accessible and affordable to those who benefit from them.

Improving access to assistive technology is central to progressing towards universal assistive technology coverage – everywhere everyone receives the assistive technology they need without financial hardship – which is an integral part of Universal Health Coverage.

A crucial aspect of ensuring that everyone receives the assistive technology they need is the selection of the actual assistive product for an individual user. With a hope to contribute to clinical practice and research, particularly to designing research on the selection process, Scherer et al. [1] proposed the Assistive Technology Device (ATD) Selection Framework to model the selection of assistive products. They assumed that the framework would likely be modified over time, representing advances in the understanding of the selection process. They also noted that the framework may vary depending on type of assistive product under consideration.

In an attempt to determine factors perceived by rehabilitation professionals to influence the provision or selection of assistive products to children up to six years of age in South Africa, van Niekerk et al. [2] used the ATD Selection Framework in their deductive thematic analysis of focus group data. Their analysis adds to the validity of the existing components of the ATD Selection Framework as much of their data could be mapped to its three components, see Figure 1.

Figure 1. Proportion of identified instances of ATD Selection Framework components and new themes to the total number of identified instances as reported by van Niekerk et al. [2].

In their analysis, however, van Niekirk et al. noticed that the rehabilitation professionals experienced factors that they could not adequately map to the existing components of the framework (labelled “New themes” in Figure 1). These factors were related particularly to assistive technology, which constituted the third most frequently mentioned theme of factors reportedly influencing provision, see Figure 2.

Figure 2. Proportion of identified instances of themes to the total number of identified instances as reported by van Niekerk et al. [2].

Although the study of van Niekerk et al. did not include other stakeholders than a small group of rehabilitation professionals, and was limited to provision of assistive products to young children in a single country, it underscores the applicability of the ATD Selection Framework in designing research as well as a need to expand its components. Thus, it contributes to fulfilling the hopes of its creators and fulfilling their assumption that the framework needs to be modified in the future.

It could be assumed that some of the factors van Niekirk et al. identified with regards to assistive technology could have been addressed by adequate policies. As this is not the case, we need to recognize the possibility of discrepancies between policies, procurement and practice, i.e., what assistive products should be available according to well-intended policy documents, what assistive products can be and are procured, and what assistive products are actually available to rehabilitation professionals for assessment purposes and for provision to individual users.

The work of van Niekirk et al. sheds some light on factors that influence the selection of assistive products and could serve as an inspiration for research at larger scale in order to identify which factors are most critical in what contexts. Such knowledge is important for States in their efforts to develop and implement strategies that ensure universal assistive technology coverage.

Disclosure statement

The authors report no conflicts of interest.