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As discussed in Chapter 1 and Chapter 2, people with disability often experience inadequate healthcare. As a result, they are at high risk for chronic conditions, poor quality of life, and increased morbidity and mortality. Causes of inadequate healthcare for this population have been attributed to many barriers that affect healthcare access. Nurses and other healthcare professionals must be aware of these barriers and either take steps to eliminate them (when possible) or work around them until they can be removed entirely.

The social determinants of health (refer to Chapter 2) are just some factors that affect access to healthcare for this population. There are also generic barriers that affect this population as a whole. The Centers for Disease Control and Prevention (CDC) describes these barriers as factors in an individual’s environment that, through their absence or presence, limit functioning and create disability. They are as follows (CDC, n.d.-a):

  • A physical environment that is not accessible

  • A lack of assistive technology (assistive, adaptive, and rehabilitative devices)

  • Negative attitudes toward disability and people with disability

  • Services, systems, and policies that are either nonexistent or hinder the involvement of all people with a health condition in all areas of life

Experts identify five major categories of barriers. These categories are as follows:

  • Attitudinal barriers

  • Communication barriers

  • Structural and physical barriers

  • Programmatic barriers

  • Transportation barriers

All these barriers are related. Even if only one category of barrier currently exists, that single barrier can cause other barriers. Moreover, addressing one type of barrier may have little effect on access to healthcare if other barriers are not also addressed. For example, even if physical barriers are removed, attitudinal barriers in the form of negative attitudes of healthcare professionals toward those with disability might remain. Finally, barriers often result in a negative snowball effect. For instance, the existence of physical or structural barriers can cause people with disability to be dependent on others, which in turn limits their participation in everyday life (World Health Organization [WHO], 2011).


The most difficult barriers to overcome are attitudinal barriers. These describe the negative attitudes of others, including healthcare professionals, toward people with disability. Examples of attitudinal barriers in healthcare include the following:

  • Negative attitudes toward people with disability, resulting in stereotyping, bias, stigma, prejudice, and discrimination

  • A lack of knowledge about the abilities and strengths of people with disability

  • The assumption that people with disability are dependent, unaware of or uninterested in events around them, and unable to make decisions or otherwise participate in life activities

  • The belief that all health issues that affect people with disability are due to their disability

  • The failure to recognize, prevent, and treat common health issues that affect people with and without disability

  • The assumption that the quality of life of people with ...

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