METHODS

A cross-sectional descriptive study was performed with 4044 persons with disabilities living in Barranquilla, Colombia. A probabilistic technique was used to choose the neighborhoods of the five ⁵ locality, basic geostatistical areas administratively and politically dividing the city of Barranquilla (metropolitan, Southeast, Southwest, Historic North, and Riomar) as the observation unit, and a door-to-door active search model was adopted. During the visit, researchers requested that the people with disabilities, caregivers, and/or relatives identify other people with disabilities who were living in Barranquilla. We also had the support of community leaders, community action councils, community participation committees, and per-sons with disabilities organizations.

The persons with disabilities, caregiver, and/or relative previously signed an informed consent form. The study was approved by the Ethics Committee from the University. Data was collected using the Registration for the Location and Characterization of Persons with Disabilities (RLCPD in Spanish) from the National Administrative Department of Statistics (DANE in Spanish). It was used by researchers and healthcare professionals from the district, after they were trained for its utilization, under guidance and supervision of the Ministry of Health and Social Protection of Colombia.

RLCPD has seven components, and for the purpose of this study, the information of the following components was used: Location and housing; Personal identification; Characterization and origin of disability; and Participation in family or community activities. From the Location and housing component, the socioeconomic stratum variable was taken into account, characterized as Stratum 1, Stratum 2, Stratum 3, and Stratum 4; Stratum 1 represented the lower socioeconomic status and 4 the highest. From the Personal identification component, sex and age characteristics were analyzed. From the questionnaire were considered the data function / body structure, limitations in the activity and restrictions on participation.

The information collected was analyzed using the SPSS software package, version 24 (license from the University). A univariate analysis by absolute and relative frequencies distribution and bivariate analysis by binary logistic regression were performed to determine the relationship between the functional impairments and participation restrictions variables, and functional limitations and participation restrictions on the persons with disabilities from the study. The results are represented in percentages, averages. The Odds Ratio and their 95% confidence intervals (CI) adjusted to age and sex was estimated. A statistical significance of p < 0.05 was obtained.

RESULTS

Of the 4044, characterized people with disabilities, 55.9% were men, 41.6% were between 15 and 44 years of age, and 92.9% belonged to the lower socioeconomic stratum. A lower participation in people under 15 years of age was observed (Table 1).

Table 2 shows the analysis of functional impairments, limitations activities and restrictions for the participation from the general population. A higher frequency (96.6%) of limitations activities is observed in intended sensory experiences, such as distinguishing flavors and smells. Further, 94.9% showed limitations for self-care of their body parts, 93.2% showed limitations for eating and 91.2% had personal hygiene limitations related to excretion processes, such as urination. Regarding restrictions on participation, 99% of persons with disabilities or their caregivers described barriers to accessing non-formal learning activities, 98.6% to public activities, and 97.5% to productive activities. The participation that bore fewer restrictions for persons with disabilities were those organized by friends and family; only 49.4% claimed to have restrictions on these in life situations (Table 2).

Table 3 shows that there is higher participation with friends and family with lower neurological disorders [odds ratio (OR), 0.8; 95% CI, 0.7-0.9]. Subjects with functional impairments of the eyes have 1.3 times more possibilities of being restricted to participate within the community (OR, 1.3; 95% CI, 1.1-1.6) and in religious or spiritual activities (OR, 1.3; 95% CI, 1.1-1.5), whereas functional hearing impairments mean higher restrictions on participation with family and friends (OR, 1.2; 95% CI, 1.1-1.5).

Moreover, people with disabilities who have few impairments in the sensory organs of smell, touch, and taste are less restricted to participate with friends and family (OR, 0.60; 95% CI, 0.4-0.8) and in religious or spiritual activities (OR, 0.5; 95% CI, 0.3-0.8). Table 3 also shows that people with cardiopulmonary disorders have 1.5 times more probability of being restricted to participate in religious or spiritual activities (OR, 1.5; 95% CI, 1.2-2). Having less functional mobility impairments in body, hands, arms, and legs contributes to higher participation skin disorders are related to lower participation in formal with family and friends (OR, 0.8; 95% CI, 0.7-0.9). Lastly, learning activities (OR, 3.1; 95% CI, 1.2-9.9) (Table 3).

Table 4 reveals that a lower limitation in exercising the power of reason, particularly thinking, can increase participation in activities with family and friends (OR, 0.8; 95% CI, 0.6-0.9), with the community (OR, 0.7; 95% CI, 0.60.9), religious or spiritual activities (OR, 0.8; 95% CI, 0.70.9), productive activities (OR, 0.4; 95% CI, 0.2-0.8) and public activities (OR, 0.4; 95% CI, 0.2-0.9). The same behavior was observed with the intended sensory experience of seeing; people with disabilities who did report limitations exhibited low participation in religious or spiritual activities (OR, 1.2; 95% CI, 1.1-1-4). Conversely, subjects with speaking limitations have 1.2 times more restrictions to participate in activities with family and friends (OR, 1.2; 95% CI, 1.1-1.4), whereas being able to eat properly facilitates higher participation in activities with family and friends (OR, 0.6; 95% CI, 0.4-0.8).

With regard to self-care activities, limitations for loo-king after personal hygiene in terms of excretion processes and care of body parts lead to restrictions to participate in sports or leisure activities (OR, 1.6; 95% CI, 1.2-2.3). Conversely, people who stated that they were capable of feeding, washing, and dressing themselves participated to a greater extent in activities with family and friends (OR, 0.7; 95% CI, 0.6-0.9), activities within the community (OR, 0.5; 95% CI, 0.4-0.7), religious or spiritual activities (OR, 0.5; 95% CI, 0.4-0.7), and productive activities (OR, 0.2; 95% CI, 0.1-0.5). Moreover, difficulties interacting with other people and the environment and having interpersonal relationships restrict participation in sport or leisure activities (OR, 1.4; 95% CI, 1.2-1.7). Limitations to carry, move, and use objects with the hands lead to 1.3 times more restrictions to participate in community events (OR, 1.3; 95% CI, 1.1-1.7), whereas not having difficulties to walk, run, or jump facilitates participation in non-formal learning activities (OR, 0.4; 95% CI, 0.1-0.8) (Table 4).

DISCUSSION

The results obtained confirm that there is a higher pro-portion of persons with disabilities male population be-tween 15 and 44 years of age; this distribution is different from the one observed in another study ¹⁹, where a higher proportion of disability among women was established. However, the results obtained cancer, HIV, and TB, among others ³. Conversely, an Argentinean study highlighted that 46.9% of the total disability burden in the county is as a result of the increased prevalence of neurological disorders. These authors strongly urge all health authorities, both national and international, to prioritize their actions to prevent neurological disabilities and to have joint efforts to address them in a more efficient manner ²³.

It should be noted that the scientific community generally acknowledges the association that exists between neurological disorders and elevated disability, morbidity, and mortality in populations. These disorders have a significant impact on the functioning of the musculoskeletal system, restricting physical and social abilities and the person's overall health ²⁴. In addition, it has been recognized that neurological deficits greatly limit the level of human functioning and the access to different contexts of social participation, in work, educational, medical and leisure environments, among others ²⁵. This statement is consistent with the results obtained in this study, where 97% and 99% of people with disabilities or their caregivers reported restrictions for participating in different educational and public and productive activities, respectively.

Other authors also suggest that functional limitations related to daily-life activities are the most common limitations in most people with any type of disability or severe chronic disease. This is the case for people over 45 years of age diagnosed with degenerative diseases, such as osteoarthritis. They have higher probabilities of developing disability processes related to limitations in getting up from a chair, walking, and climbing up stairs, among others, in comparison with people who do not have these types of diseases ²⁶.

It is important to highlight that, depending on the type of disability and level of severity, the individual will have a specific type of functional limitation, with the resulting restrictions for participating in different family and social activities ²⁷. In this study, people who had visual disabilities had 1.3 times more probabilities of being restricted to participate in community activities, either social and/or religious, as well as people with hearing or language disabilities, the latter being more restricted in activities with family and friends. These types of impairments result in significant limitations for the people who have them because these organs are the main channels for receiving information and interacting with people and the environment. Therefore, larger efforts are required to help these population groups to adapt to social, work, and daily contexts in order to increase their participation to achieve equal opportunities ²⁸.

Another significant relationship established by this study was the one between cognitive impairment and restrictions on family, community, and work participation, which is evident if we understand that in order to properly develop these roles, it is essential to perform cognitive and thought processes. These will ultimately determine a per-son's exchange of ideas, performance, and learning ^29,30.

Finally, the authors recognize that the current study has some limitations regarding the type of study because we understand that the study's descriptive level cannot prove cause and effect relationships between several variables. Nonetheless, we recognize the need to evaluate other variables related to the barriers in the social environment where persons with disabilities perform their activities, which is possible using other tools already standardized by WHO.

We conclude that there is a close relationship between structural impairment or deficiency and functional limitation with dependence development, and limited familiar, social, and work participation in people with any kind of disability. In line with what other authors have stated, we understand that disabilities go beyond reductionist medical vision and are determined to a greater extent by the existence of environment barriers and structures which are not adapted to the abilities of persons with disabilities, who are subject to marginalization and human-rights violation when these possibilities cannot be found ³¹. Therefore, this type of study becomes a cornerstone for future intervention studies, where it will be possible to demonstrate the impact of comprehensive rehabilitation processes, expressed through social inclusion of the population with disabilities, with equal opportunities, in such a way, that disability is not a barrier to socioeconomic development and the life project of people with disabilities, their families and communities ³² ♦