Measuring Access to Assistive Technology using the WHO rapid Assistive Technology Assessment (rATA) questionnaire in Guatemala: Results from a Population-based Survey

Purpose: Using the World Health Organisation (WHO) rapid Assistive Technology Assessment (rATA) tool, this study aimed to estimate the population level self-reported Assistive Technology use and unmet need in the province of Sololá in Western Guatemala. Method: Sixty-one clusters of 50 people, 2+ years of age, were selected using probability proportional to size sampling. Households within clusters were selected using adapted compact segment sampling. Participants were interviewed using the standardised WHO rATA questionnaire. Results: A total of 2874 persons were interviewed (response rate 94%). The prevalence of self-reported unmet need for at least one assistive product (AP) was 17.1% (95% CI 14.7-19.8), use was 7.4% (95% CI 5.9-9.3) and overall need was 20.3% (95% CI 17.6-23.2). These indicators all increased significantly with increasing age and level of functional difficulty. The three most common APs used in Guatemala were spectacles (5.8%), canes/sticks/tripods/quadripods (0.8%) and pill organisers (0.3%). The most common APs reported as unmet need were spectacles (13.4%), canes/sticks/tripods/quadripods (3.1%) and hearing aids (2.6%). Among assistive product users, most of them (53%) sourced their APs from private providers and paid out of pocket (58%) and the majority (93%) were quite satisfied/very satisfied with their APs. Cost was the most commonly reported barrier to AP use. Conclusion and Implications: There was a high total need and unmet need for APs in the province of Sololá in Guatemala, and lower use of APs. These findings highlight an urgent need to strengthen Assistive Technology provision to improve access in this setting, particularly for older people, and to address cost-related barriers and increase public provision. The findings can be used to raise awareness of the AT needs in the population in Guatemala, including for older people and people with functional difficulties, and to advocate and plan at local and national levels to make APs more accessible