Table 3.

Integration of qualitative and quantitative findings.

Theme Barriers	Sub-theme	Quantitative findings	Illustrative qualitative quote	Synthesis
Individual level	Financial challenges	45.5% of the respondents indicated that high cost of SRH is a barrier.	“These days, things are difficult in terms of economic issues (financial constraints). It is not all the time that your partner can get money to support you to access SRH services. You know that most of these things you need to pay before you can access them. So if there is no money what can you do. You only sit down and pray for the Good Lord to heal you.” (Physically Disabled, Kumasi, Female, 33 years)	The findings underscore the need to empower PwDs economically. Additionally, it is crucial to revitalize the National Health Insurance Scheme to facilitate PwDs’ access to SRH services.
Family/community level	Stigma and discrimination	27.3% indicated that stigma and discrimination is a barrier to their use of SRH services.	“You will be there and people will be passing derogatory statements like how can a PwD get pregnant. So, it is not the best.” (Visually Impaired, Offinso, Female, 51 years)	It is crucial to employ a variety of campaign techniques to enhance community and family members’ knowledge of disability issues and the rights of PwDs. One approach is to broadcast a few common stories of PwDs to the general public through suitable channels, or publish them on social media, focusing on the capabilities and sexual rights of PwDs.
Health facility level	Physical barriers	54.6% indicated that disability-unfriendly infrastructure was a barrier to their successful use of SRH services.	“…But there was a point that I had to be carried because the stairs were too high. So, I think that the health facility must think of measures to make the built environment much friendly for PwDs to easily access it”. (Physically Disabled, Offinso, Male, 57 years)	To meet the needs of PwDs, certain health facilities must be renovated to ensure disability-friendly environments. Additionally, accessible design features should be incorporated into the design of new health facilities.
	Long waiting times at health facilities	45.5% agreed that long wait times are a barrier to their use of SRH services.	“Sometimes, at the hospital, if you are not the enlightened type, you will be there and they will serve other people at your expense… leaving you in the queue”. (Visually Impaired, Offinso, Female, 51 years)	As enshrined in the Disability Act 715 of Ghana, the SRH of PwDs should be prioritized, enabling them to access SRH services.
	HPs negative attitude towards PwDs	27.3% indicated that discrimination by health professionals is a barrier.	“…And we the blind they do not want to make time for us, especially when prescribing drugs for us. They do not regard us and want to talk to people who brought us. This affects us. The way they communicate with us is not good. I had a personal experience with the attitude of healthcare providers. The nurse talked to me anyhow and I even reported him to the doctor and the doctor warned him because he was far younger than me”. (Visually Impaired, Kumasi, Male, 45 years) “I remember there was a time I went to the hospital and the doctor was like take this prescription. I heard you have seven children. You do not have money and you have given birth to seven children. I did not reply him because I felt he was not being reasonable. Like I talked about the doctor who said, I do not have money but I have given birth to many children, it is a clear indication of discrimination. So, health providers must desist from such behaviours. They must treat us with utmost respect.” (Physically Disabled, Kumasi, Male, 47 years)	It is important to intensify training for HPs to enhance their understanding of disability. Additionally, efforts should be made to develop appropriate communication skills in order to provide high-quality care to PwDs.
	Lack of privacy	18.2% indicated that lack of privacy was a barrier to their use of SRH services.	“When it is time for consultation, privacy must be adhered to. So, my personal assistant or whoever I am walking with must leave us for you [health professional] to talk to me. But then, they[health professionals] always want to involve them, meaning they do not respect our privacy”. (Visually Impaired, Kumasi, Male, 31 years)	Due to the sensitive nature of SRH issues, the lack of privacy could hinder PwDs from sharing their problems, potentially affecting their treatment and future utilization of services. It is imperative for the government and health facility managers to take pragmatic steps to ensure that the privacy and rights of PwDs are safeguarded during consultations.
Enablers
Individual level	Self-efficacy and knowledge on the importance of SRH services		“…And so, when I went to the hospital and it was confirmed that I was pregnant, I started ANC attendance. I believe that was one of the things that made my pregnancy easier to bear. For the first one month, I was not aware of the pregnancy until I went to the hospital”. (Visually Impaired, Offinso North, Female, 33 years)	The self-efficacy of PwDs should be improved to facilitate easier access to SRH services. It is crucial to provide PwDs with additional SRH informational resources. To educate PwDs about the significance of SRH, the government should support programs specifically tailored to this population.
Family/community level	Support from family members	41.2% agreed that support from care givers enabled them to seek SRH services.	“…. So, it was normal and by God’s grace, I had someone I was going to antenatal bookings with. So, the support I had made my pregnancy days okay and a smooth one for me”. (Visually Impaired, Kumasi, Female, 21 years)	Family members and other significant others should be encouraged to support the daily lives of PwDs, including their access to SRH services. However, it is crucial to educate them about the SRH rights of PwDs. This will enable them to ensure that PwDs are provided with the highest level of privacy during consultations.
Health facility level	HPs positive attitude and preferential treatment	66.2% agreed that healthcare providers’ positive attitudes enabled them to seek SRH services 40.4% indicated that the preferential treatment they received at the health facilities enabled them to seek SRH services.	“To be honest, the health professionals at [Facility Name]were so kind to me when I had my condition. They were so encouraging and supportive. They treated me with a lot of dignity and respect. I think that if all the hospitals were like that, then it will be good”. (Physically Disabled, Kumasi, Male, 45 years) “In fact, when I go to the facility, they even allow me to be cared for first before ‘abled’ people. Some PwDs feel shy to overtake abled people when it comes to seeking healthcare.” (Physically Disabled, Offinso, Male, 46 years)	The positive attitude exhibited by some of the healthcare providers presents an opportunity for behavioral change and professionalism towards service provisions to PwDs.
	National health insurance	64.7% agreed that the NHIS helped them to seek SRH services.	“The health insurance has been effective and useful in helping us prevent and seek early treatment for any sexually transmitted infections. Because you have the insurance, you can easily go to the health facility, and receive comprehensive care”. (Physically Disabled, Offinso, Male, 57 years)	It is important to strengthen the NHIS to ensure that it fulfills its intended purpose of improving healthcare access for the vulnerable in society.