Disability Acceptance and Unmet Healthcare Needs Among Persons with Disabilities in Korea: A Seven-Wave...

Background: Persons with disabilities experience persistent unmet healthcare needs, but the longitudinal interplay between psychological adaptation to disability and healthcare access has rarely been examined using analytic approaches that distinguish stable between-person differences from within-person changes over time. This study investigated the bidirectional longitudinal associations between disability acceptance and unmet healthcare needs over seven years. Methods: We analyzed seven annual waves (2018-2024) of the Korean Disability and Life Dynamics Panel (DLDP), a nationally representative cohort of 6121 newly registered persons with disabilities. Disability acceptance was measured using the 12-item Disability Acceptance Scale (Cronbach's α range: 0.808-0.823), whereas unmet healthcare needs were assessed using a single dichotomous item at each wave. A Random Intercept Cross-Lagged Panel Model (RI-CLPM) was estimated using maximum. Results: The freely estimated RI-CLPM demonstrated good model fit: Comparative Fit Index (CFI) = 0.996; Tucker-Lewis Index (TLI) = 0.994; Root Mean Square Error of Approximation (RMSEA) = 0.026, 90% confidence interval (CI) [0.023, 0.029]; and Standardized Root Mean Square Residual (SRMR) = 0.020. At the trait level, the random intercept correlation between disability acceptance and unmet healthcare needs was statistically significant and negative (r = -0.132, p = 0.001). At the within-person level, cross-lagged associations were small but consistently negative; after false discovery rate correction, four of the twelve cross-lagged paths remained statistically significant. The path from disability acceptance to subsequent unmet healthcare needs was significant at two transitions (Wave 3 to Wave 4: β = -0.057, p = 0.002; Wave 5 to Wave 6: β = -0.065, p = 0.008), whereas the reverse path was significant at two transitions (Wave 2 to Wave 3: β = -0.013, p = 0.008; Wave 6 to Wave 7: β = -0.050, p = 0.008). These transitions coincided with the COVID-19 pandemic and its aftermath, although formal tests comparing pandemic and non-pandemic transitions were not statistically significant. Conclusions: Disability acceptance and unmet healthcare needs were inversely associated at the trait level among Korean persons with disabilities, and reciprocal within-person associations emerged selectively during periods of healthcare system disruption. Healthcare access interventions for persons with disabilities may benefit from integrating psychosocial adaptation support alongside efforts to reduce structural barriers to care.