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Background <p>Despite Singapore’s robust healthcare infrastructure, adults with intellectual disabilities (AWIDs) and caregivers face insufficient support. Singapore’s multicultural context, ageing population, and income inequality further complicate equitable care. These challenges underscore the need to reassess the healthcare system for this group. Therefore, this study aimed to: (1) catalogue barriers and facilitators affecting health system access and care-seeking for AWIDs, caregivers, and health professionals before intervention; and (2) provide recommendations to address the barriers and enhance facilitators.</p> Methods <p>A qualitative study using focus groups with 19 sectoral professionals and life-event guided interviews with AWID–caregiver dyads or triads (16 AWIDs; 20 caregivers) was conducted to explore viewpoints on care-seeking and health system access. Applied thematic analysis was used in identifying individual or system-level barriers and facilitators through a social constructivist lens.</p> Results <p>Barriers included individual-level challenges such as <i>having problems when faced with sudden or accumulated changes and transitions</i> and the struggle with <i>insufficient financial resources</i>, particularly affected low-income families and was compounded by insufficient subsidies. System-level challenges included the <i>lack of specialised services</i> for AWIDs, which contributed to mismatched care, while <i>fragmented care and limited care provider capability</i> complicated service delivery. Additionally, <i>fear and distrust of the health system</i>, exacerbated access to care-seeking. All barriers are expressed by both groups.</p> <p>Conversely, a facilitator that enhanced individual-level support, such as the <i>usage of informal networks</i>, helped connect AWID and caregivers to appropriate care. System-level support was stressed by both groups including <i>intersectoral collaboration</i> to address complex issues, while the <i>availability of paid support services</i> improved health outcomes and access. Furthermore, <i>unpaid community support organisations</i>, provided essential social care through organised activities. The facilitators highlighted the potential for improving the healthcare landscape through collective efforts and community engagement.</p> Conclusions <p>This study highlights the need for individual-level support, including involving more family members in caregiving, and system-level reforms such as integrated, specialised care, and enhanced advocacy. Across all levels, co-created care plans and regular check-ins are important to identify emerging issues and build trust. Implementing these strategies can help Singapore progress towards a more inclusive and responsive healthcare system for AWIDs.</p>

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Navigating healthcare for adults with intellectual disabilities in Singapore: a qualitative study of barriers and facilitators to healthcare system access and care-seeking

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月3日

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  • Felicia Jia Hui Chan,
  • Muhammad Azamuddin bin Aman,
  • Lucas Jia Rong Puah,
  • Joy Sock Hui Teo,
  • Shiling Chen,
  • Shahmir H. Ali,
  • Alyssa Yenyi Chan,
  • Zoe Jane-Lara Hildon

摘要

Background

Despite Singapore’s robust healthcare infrastructure, adults with intellectual disabilities (AWIDs) and caregivers face insufficient support. Singapore’s multicultural context, ageing population, and income inequality further complicate equitable care. These challenges underscore the need to reassess the healthcare system for this group. Therefore, this study aimed to: (1) catalogue barriers and facilitators affecting health system access and care-seeking for AWIDs, caregivers, and health professionals before intervention; and (2) provide recommendations to address the barriers and enhance facilitators.

Methods

A qualitative study using focus groups with 19 sectoral professionals and life-event guided interviews with AWID–caregiver dyads or triads (16 AWIDs; 20 caregivers) was conducted to explore viewpoints on care-seeking and health system access. Applied thematic analysis was used in identifying individual or system-level barriers and facilitators through a social constructivist lens.

Results

Barriers included individual-level challenges such as having problems when faced with sudden or accumulated changes and transitions and the struggle with insufficient financial resources, particularly affected low-income families and was compounded by insufficient subsidies. System-level challenges included the lack of specialised services for AWIDs, which contributed to mismatched care, while fragmented care and limited care provider capability complicated service delivery. Additionally, fear and distrust of the health system, exacerbated access to care-seeking. All barriers are expressed by both groups.

Conversely, a facilitator that enhanced individual-level support, such as the usage of informal networks, helped connect AWID and caregivers to appropriate care. System-level support was stressed by both groups including intersectoral collaboration to address complex issues, while the availability of paid support services improved health outcomes and access. Furthermore, unpaid community support organisations, provided essential social care through organised activities. The facilitators highlighted the potential for improving the healthcare landscape through collective efforts and community engagement.

Conclusions

This study highlights the need for individual-level support, including involving more family members in caregiving, and system-level reforms such as integrated, specialised care, and enhanced advocacy. Across all levels, co-created care plans and regular check-ins are important to identify emerging issues and build trust. Implementing these strategies can help Singapore progress towards a more inclusive and responsive healthcare system for AWIDs.