{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T11:43:06Z","timestamp":1786966986831,"version":"build-2736575974"},"reference-count":36,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T00:00:00Z","timestamp":1695859200000},"content-version":"unspecified","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000278","name":"Department for International Development, UK Government","doi-asserted-by":"publisher","award":["PENDA"],"award-info":[{"award-number":["PENDA"]}],"id":[{"id":"10.13039\/501100000278","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"crossref","award":["NIHR301621"],"award-info":[{"award-number":["NIHR301621"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,8,21]]},"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>On average, people with disabilities face many difficulties in accessing healthcare and experience worse health outcomes. Yet, evidence on how to overcome these barriers is lacking. Participatory approaches are gaining prominence as they can generate low-cost, appropriate and scalable solutions. This study protocol is for the pilot testing of the co-created Participatory Learning and Action for Disability (PLA-D) groups to assess feasibility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will pilot test PLA-D in five groups in Luuka district, Uganda during 2023. Each group will include approximately 20 members (people with disabilities, family members, carers) who will meet every 2\u20133 weeks over a 9\u201311\u2009month period. The groups, guided by a trained facilitator, will identify issues about health and healthcare access and plan and implement locally generated solutions (eg, raising awareness of rights, advocacy and lobbying, establishing health savings and financing schemes). We will collect diverse sources of data to assess feasibility: (1) in-depth interviews and focus group discussions with group participants, non-participants and group facilitators; (2) monitoring of group activities; (3) direct observation of groups and (4) quantitative survey of group participants at baseline and endline. Data analyses will be undertaken to assess feasibility in terms of: acceptability, demand, implementation and practicality. We will develop and refine evaluation tools in preparation for a future trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval for the study has been received by the London School of Hygiene &amp; Tropical Medicine and the Uganda Virus Research Institute ethics committees. Informed consent will be obtained from all study participants, making adaptations for people with disabilities as necessary. We will reach different groups for our dissemination activities, including (1) people with disabilities (eg, community meetings); (2) policy and programme stakeholders in Uganda and international (eg, individual meetings, evidence briefs) and (3) academics (journal articles, conference\/seminar presentations).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-074217","type":"journal-article","created":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T22:31:00Z","timestamp":1695940260000},"page":"e074217","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Is it feasible to implement a community-based participatory group programme to address issues of access to healthcare for people with disabilities in Luuka district Uganda? A study protocol for a mixed-methods pilot study"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8952-0023","authenticated-orcid":false,"given":"Hannah","family":"Kuper","sequence":"first","affiliation":[{"name":"International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew Sentoogo","family":"Ssemata","sequence":"additional","affiliation":[{"name":"MRC\/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3408-7362","authenticated-orcid":false,"given":"Tracey","family":"Smythe","sequence":"additional","affiliation":[{"name":"International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK"},{"name":"Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Drazdzewska","sequence":"additional","affiliation":[{"name":"Women and Children First, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Waiswa","sequence":"additional","affiliation":[{"name":"School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda"},{"name":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Kagurusi","sequence":"additional","affiliation":[{"name":"Amref Health Africa in Uganda, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikey","family":"Rosato","sequence":"additional","affiliation":[{"name":"Women and Children First, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Femke Bannink","family":"Mbazzi","sequence":"additional","affiliation":[{"name":"International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK"},{"name":"MRC\/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,9,28]]},"reference":[{"key":"2025121221264091000_13.9.e074217.1","unstructured":"WHO . Global Report On Health Equity For Persons With Disabilities. Geneva: World Health Organzation, 2022."},{"key":"2025121221264091000_13.9.e074217.2","unstructured":"WHO . World Report on Disability. Geneva: World Health Organisation, 2011."},{"key":"2025121221264091000_13.9.e074217.3","unstructured":"UN . Convention on the rights of persons with disabilities. New York: United Nations; 2006."},{"key":"2025121221264091000_13.9.e074217.4","unstructured":"Kuper H , Heydt P . The missing billion. London: LSHTM; 2019."},{"key":"2025121221264091000_13.9.e074217.5","unstructured":"Missing Billion Initiative and Clinton Health Action Inititiative . Reimagining health systems that expect, accept and connect 1 billion people with disabilities. Missing Billion Initiative and Clinton Health Access Inititiative; 2022."},{"key":"2025121221264091000_13.9.e074217.6","unstructured":"UNDESA . UN flagship report on disability and development. 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