Examining health service use among adults with cerebral palsy: a mixed-methods approach

Background: Adults with cerebral palsy (CP) experience ongoing health issues from childhood in addition to issues related to ageing. Thus, adults require services and supports to meet their changing needs. However, there is lack of understanding of health services used by adults with CP, this thesis aimed to examine health service use among adults with CP.

Methods: A convergent parallel mixed-methods design was used. Four studies were conducted: a mixed methods systematic review; a secondary analysis of a cross-sectional data; a cross-sectional study using an online survey; and a qualitative study using in-depth semi-structured interviews. The findings were integrated using the Andersen and Newman Model of health care utilisation. The Public and Patient Involvement was integrated throughout this research.

Results: The review identified that adults with CP used a wide-range of medical, rehabilitation and support services. Over a 12 month period general practitioner (84%) was the most commonly used medical services. The analysis of Irish data demonstrated that physiotherapy was most commonly used by 57% of adults. Unmet needs were highest for physiotherapy (23%) and occupational therapy services (13%). In the survey, 90% of adults with CP reported a need for physiotherapy but only 35% received the physiotherapy service they needed. The qualitative study demonstrated that adults experience insufficient care to meet their needs, lack of knowledgeable staff, and health system and environmental barriers to accessing services. The integration of findings found both barriers and facilitators to service use; particularly highlighting inequitable services for adults with CP.

Conclusion: This thesis addressed the knowledge gap in health service use among adults with CP. The findings highlight a need for services for adults with CP across the lifespan, with an appropriate service delivery model regardless of their personal circumstances, secondary diagnosis or CP complications.