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Agoalikum S, Acheampong E, Bredu-Darkwa P, Bonah S. The perspectives of caregivers and health service providers on barriers to clubfoot management in Puri-Urban health facility in Ghana. J Child Orthop 2024; 18:450-457. [PMID: 39100976 PMCID: PMC11295365 DOI: 10.1177/18632521241262630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/03/2024] [Indexed: 08/06/2024] Open
Abstract
Purpose Clubfoot is a common disabling condition that is prevalent across all populations. Approximately, one out of 750 children globally suffers from clubfoot, and around 150,000 to 200,000 children are born with clubfoot every year with 80% of the cases occurring in developing countries. Clubfoot can result in mobility impairments when not properly managed and researchers have argued that understanding knowledge and perceptions are key components to early identification and effective management of clubfoot. The study explored the barriers to clubfoot management from the perspectives of caregivers and healthcare providers in Duayaw Nkwanta, Ghana. Methods A total of 26 participants made up of 22 caregivers of children with clubfoot and six healthcare providers were purposively sampled for the study guided by a set of inclusion and exclusion criteria. Qualitative data were collected using a semi-structured interview guide through in-depth face-to-face interviews. Interviews were transcribed and analyzed thematically and presented as findings. Results High cost of treatment, long travel distance, long hours spent at the treatment facility, non-availability of clubfoot treatment services, late reporting of clients for treatment, and non-compliance of parents/caregivers with treatment protocols were identified as the barriers to effective management of clubfoot. Conclusion These findings have substantial implications for current interventions to effectively manage clubfoot in Ghana.
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Affiliation(s)
- Shariphine Agoalikum
- Department of Health Promotion and Disability Studies, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Enoch Acheampong
- Department of Health Promotion and Disability Studies, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Sandra Bonah
- Department of Health Promotion and Disability Studies, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Kalu M, Okoh A, Okeke C, Anieto E, Ibekaku M, Abaraogu U. Qualitative research in physiotherapy: A systematic mapping review of 20 years literature from sub-Saharan Africa. Physiother Theory Pract 2023; 39:704-726. [PMID: 35098872 DOI: 10.1080/09593985.2022.2028952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
STUDY AIM To summarize the current state and quality of qualitative research conducted by physiotherapists in sub-Saharan Africa (SSA). METHODS We systematically searched multiple databases from 2000 to December 2020 and included peer-reviewed qualitative studies conducted by physiotherapists in SSA countries. Two reviewers independently screened citations, extracted data, and assessed the quality of the included studies using the 45-items checklist by Lundgren, and colleagues. Conventional content analysis was employed to create physiotherapy subject areas from the included studies. RESULTS We included 114 studies, a majority of 84 (74%) conducted in South Africa. Included studies were categorized into five subject areas: sports (n = 2), disability (n = 16), professional practice (n = 24), education and training (n = 36), and care provision (n = 36). We rated 74 (65%), 29 (25%), and 11 (10%) of the included research as low reporting quality, moderate- and high reporting quality, respectively. There was a significant lack of reporting on researchers' team characteristics, reflexivity, and member checking. CONCLUSION We conclude that the reporting of published qualitative studies in SSA shows variable quality, albeit mostly low, focused mainly on care provision, education, and training. Physiotherapy-researchers are encouraged to report reflexive practice and member checking when conducting qualitative research.
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Affiliation(s)
- Michael Kalu
- School of Rehabilitation Science, McMaster University, 1400 Main Street West Institute for Applied Health Sciences (IAHS) Building, L8S 1C7 Hamilton, ON Canada
- Emerging Researchers and Professionals in Ageing-African Network, Nigeria
| | - Augustine Okoh
- Emerging Researchers and Professionals in Ageing-African Network, Nigeria
- Faculty of Health Science, McMaster University, 1200 Main Street West, L8N 3Z5, Hamilton ON, Canada
| | - Chukwuebuka Okeke
- Emerging Researchers and Professionals in Ageing-African Network, Nigeria
| | - Ebuka Anieto
- Emerging Researchers and Professionals in Ageing-African Network, Nigeria
- Department of Health and Rehabilitation Sciences, University of Cape Town, 7700 Rondesbosh, Cape Town, South Africa
- Medical Rehabilitation Department, Nnamdi Azikiwe University, Awka Nigeria
| | - Michael Ibekaku
- Emerging Researchers and Professionals in Ageing-African Network, Nigeria
| | - Ukachukwu Abaraogu
- Physiotherapy and Paramedicine School of Health and Life Sciences Glasgow Caledonian University, Cowcaddens Road, GA 0BA Glasgow, Scotland, United Kingdom
- Department of Medical Rehabilitation, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
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Singh S, Mali HS, Jain AK. Contemporary challenges in clubfoot treatment: A quantitative study among Indian parents. J Orthop 2023; 37:5-8. [PMID: 36974087 PMCID: PMC10039109 DOI: 10.1016/j.jor.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 01/25/2023] Open
Abstract
Purpose The studies conducted a decade ago showed that the Ponseti method, suffers from many execution-related issues-particularly in low and middle-income countries including poverty, physical distance, lack of transportation etc. The society has undergone many changes, including improvements in literacy, connectivity (both transport and digital), etc., in the last decade. Therefore, this study is designed to identify the contemporary apprehensions, concerns, and challenges of parents seeking CTEV treatment for their child through the Ponseti Method in India. Methods A descriptive cross-sectional study of 200 parents of the children undergoing treatment at a multi-specialty hospital is carried out using an interview guide. The semi-structured interviews were conducted telephonically and recorded. Results The statistical analysis shows that a male child is presented late than a female child. The physical distance is associated with child discomfort during the casting and bracing phase, with the travel method affecting the follow-up. The increase in travel time may result in increased casts due to a lack of regular follow-up. Parents' income level is also strongly associated with regularity of follow-up and child discomfort during treatment. Conclusions The patients traveling long distances in public transport are the most vulnerable group regardless of gender. The children in such cases are more likely to experience discomfort during the casting and bracing phase with a lack of regular follow-up. Expert doctors and brace unavailability in the local area remain vital challenges for the parents.
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Affiliation(s)
- Shamsher Singh
- Department of Mechanical Engineering, Malaviya National Institute of Technology, Jaipur, India
| | - Harlal Singh Mali
- Department of Mechanical Engineering, Malaviya National Institute of Technology, Jaipur, India
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Pinto D, Agrawal A, Agrawal A, Sinha S, Aroojis A. Factors Causing Dropout From Treatment During the Ponseti Method of Clubfoot Management: The Caregivers' Perspective. J Foot Ankle Surg 2022; 61:730-734. [PMID: 34896010 DOI: 10.1053/j.jfas.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 11/02/2021] [Accepted: 11/10/2021] [Indexed: 02/03/2023]
Abstract
A retrospective comparative study was conducted, aiming to identify factors associated with dropout from clubfoot treatment by Ponseti method in low- and middle-income countries. A prospectively gathered database of patients who received treatment at a high-volume urban clubfoot clinic over 6 years was queried for dropouts. A "dropout" was identified as any child that had not had a visit within 3 weeks of casting, 4 weeks of tenotomy or 6 months of brace follow-up. The second part of the study was a telephonic interview with caregivers of the identified dropouts to ascertain their reasons for discontinuing treatment. Of the 965 patients treated during the study period, there were 155 (16.06%) dropouts-137 (88.38%) during bracing phase and 18 (11.62%) during casting phase. Age at presentation was significantly higher among the dropouts as compared to those who did not dropout (median 9.5 and 7 months for casting and bracing dropouts respectively versus 3.5 months for regular follow-ups, p < .001). No significant correlation was found between patient dropout and sex (p = .061), or laterality (p = .071). Thirty-seven caregivers (23.8%) could be contacted telephonically; including 6 casting and 31 bracing dropouts. The most commonly cited reason for dropout from treatment was lack of family support (75.7%), followed by distance to the clinic (59.5%) and unavailability of transport (54.1%). Sixteen caregivers (43.2%) dropped out on account of migration to another town/state. Maintenance of a meticulous registry with regular update of caregivers' contact details, and interventions to mitigate the identified hurdles can help in reducing treatment dropouts.
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Affiliation(s)
- Deepika Pinto
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | | | | | - Sourabh Sinha
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, India.
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Duran BO, Ungureanu MI. Romanian patients' access to clubfoot treatment services. J Med Life 2022; 15:278-283. [PMID: 35419111 PMCID: PMC8999101 DOI: 10.25122/jml-2021-0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/24/2021] [Indexed: 11/19/2022] Open
Abstract
The number of clubfoot new cases in Romania is on the rise. According to orthopedic research, the Ponseti method is the elective treatment for clubfeet. This paper aims to provide an overview of the current facilitators and barriers in accessing clubfoot treatment services in Romania and to assess the impact of care-related factors on patients’ well-being. Our research shows that nationally, few orthopedic surgeons are using the Ponseti method and most of them are concentrated only in Cluj-Napoca. Moreover, gynecologists, neonatologists, and family physicians were not informed about the initial diagnosis and the current treatment of clubfoot. Primary medical care was significantly postponed in some cases. Moreover, no clubfoot organizations were mentioned by the parents included in the study, and psychological support was provided neither for the parents nor for the children. Based on the results of our study, we conclude that more efforts need to be done for the diagnosis and treatment of children with clubfeet. These include actions which are focused on raising awareness around this abnormality and more well-developed treatment guidelines.
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Affiliation(s)
- Bianca Oana Duran
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania,Center for Health Workforce Research and Policy, Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania,* Corresponding Author: Bianca Oana Duran, Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania. E-mail:
| | - Marius Ionut Ungureanu
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania,Center for Health Workforce Research and Policy, Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
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Abstract
Idiopathic congenital clubfoot is the most common serious musculoskeletal birth defect in the United States and the world. The natural history of the deformity is to persist into adult life with a significant decrease in function and quality of life. The Ponseti method (serial casting, Achilles tenotomy, and bracing of the clubfoot) has become the most effective and accepted treatment of children born with clubfoot worldwide. The treatment is successful, particularly when the Ponseti-trained practitioner (often a pediatric orthopedic surgeon), the primary care clinician, and the family work together to facilitate success. An important factor in the ultimate success of the Ponseti method is parental understanding of the bracing phase. There is a very high rate of recurrent deformity when bracing is not done properly or is stopped prematurely. The importance of positive education and support for the parents to complete the entire treatment protocol cannot be overstated. The goal of treatment is a deformity-free, functional, comfortable foot. Ponseti clubfoot programs have been launched in most countries throughout the world, including many countries with limited resources. Ultimately, the goal is that every infant born with a clubfoot will have access to care with the Ponseti method. This clinical report is intended for medical practitioners who are involved in the care of pediatric patients with clubfoot. Understanding the standard of care will help these practitioners to care for patients and their families.
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Affiliation(s)
- Robert Cady
- Department of Orthopedic Surgery and Pediatrics, Upstate Medical University, Syracuse, New York,Address correspondence to Robert Cady, MD, FAAP. E-mail:
| | - Theresa A. Hennessey
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah,Shriners Hospitals for Children, Salt Lake City, Utah
| | - Richard M. Schwend
- Departments of Orthopedics and Pediatrics, Children’s Mercy Hospital, University of Missouri Kansas City, Kansas City, Kansas,Kansas University Medical Center, Kansas City, Kansas
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Boateng LA. Healthcare-seeking behaviour in reporting of scabies and skin infections in Ghana: A review of reported cases. Trans R Soc Trop Med Hyg 2021; 114:830-837. [PMID: 32853365 DOI: 10.1093/trstmh/traa071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/25/2020] [Accepted: 07/26/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Scabies is a neglected tropical disease. In resource-poor settings, scabies and other skin infections are often unreported to a health centre, or misdiagnosed. Dermatological expertise and training are often lacking. Little is known about patient healthcare-seeking behaviour. This study reviewed diagnosed skin infections reported to urban (Greater Accra) and rural (Oti region) study health centres in Ghana over six months in 2019. METHODS Study staff received classroom and clinical dermatology training. Skin infection diagnoses and anonymised patient information were recorded. Descriptive statistics and spatial analysis described patient demographics, and distance travelled to clinic, noting bypassing of their nearest centre. RESULTS Overall, 385 cases of skin infections were reported across the Greater Accra and Oti study clinics, with 45 scabies cases (11.6%). For scabies, 29 (64.4%) cases were in males. Scabies was the third most common diagnosis, behind bacterial dermatitis (102, 26.5%) and tinea (75, 19.5%). In the rural Oti region, 48.4% of patients bypassed their nearest clinic, travelling a mean 6.2 km further than they theoretically needed to. Females travelled further in comparison to males.
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Sheik-Ali S, Navarro SM, Shaikh H, Keil EJ, Johnson W, Lavy C. The Health Determinants of Accessibility to Clubfoot Treatment in LMICs: A Global Exploration of Barriers and Solutions. Int J MCH AIDS 2021; 10:241-250. [PMID: 34900392 PMCID: PMC8647193 DOI: 10.21106/ijma.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Clubfoot or Congenital Talipes Equinovarus (CTEV) treatment in newborn infants involves simple, non-invasive manipulation and is primarily managed non-surgically if identified early. In low- and middle-income countries (LMICs), less than 15% of patients with CTEV access treatment. This cross-sectional questionnaire study conducted descriptive and regression analysis of institutional reasons for CTEV management in LMICs. METHODS A cross-sectional study was undertaken of 1,489 medical institutions in 62 LMICs. Data were evaluated from the "World Health Organization Situation Analysis tool" database. We analyzed characteristics of institutions that manage and did not manage CTEV. With the use of a multivariate linear regression model, we identified a set of factors linked to referral for non-management of CTEV. RESULTS A total of 72.7% (1,083/1,395) of institutions surveyed did not manage CTEV. The most common reason cited for not managing CTEV was a lack of sufficient skills, 92.1% (668/725, P<0.001). A total of 39.4% (286/725) of institutions also cited a lack of functioning equipment as a reason. Multivariate linear regression analysis showed lack of training, lack of supplies, and lack of functioning equipment were most closely related to non-management of CTEV. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS We identified that failure to manage CTEV may result from a lack of skills and medical equipment. Increasing the capacity of sustainable training programs may reduce the presently available skill deficit in treating CTEV in LMICs and provide improved health outcomes for those with CTEV. While considerable progress has been made in building capacity for the treatment and management of CTEV in LMICs, structured training programs that support conservative manipulative methods to manage CTEV should be initiated globally.
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Affiliation(s)
- Sharaf Sheik-Ali
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
| | - Sergio M Navarro
- Department of Surgery, The University of Minnesota, Minneapolis, Minnesota, USA
| | - Hashim Shaikh
- Department of Orthopedic Surgery, University of Rochester School of Medicine, Rochester, NY, USA
| | - Evan J Keil
- Department of Surgery, The University of Minnesota, Minneapolis, Minnesota, USA
| | - Walter Johnson
- Organisation Mondiale de la Sante, Global Initiative for Emergency & Essential Surgical Care Geneva, Switzerland
| | - Chris Lavy
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford Nuffield Orthopedic Center Oxford, UK
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Qudsi RA, Selzer F, Hill SC, Lerner A, Hippolyte JW, Jacques E, Alexis F, May CJ, Cady RB, Losina E. Clinical outcomes and risk-factor analysis of the Ponseti Method in a low-resource setting: Clubfoot care in Haiti. PLoS One 2019; 14:e0213382. [PMID: 30870447 PMCID: PMC6417735 DOI: 10.1371/journal.pone.0213382] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/19/2019] [Indexed: 12/21/2022] Open
Abstract
Purpose The Ponseti Method has dramatically altered the management of clubfoot, with particular implications for limited-resource settings. We sought to describe outcomes of care and risk factors for sub-optimal results using the Ponseti Method in Haiti. Methods We conducted a records review of patients presenting from 2011–2015 to a CURE Clubfoot clinic in Port-au-Prince, Haiti. We report patient characteristics (demographics and clinical), treatment patterns (cast number/duration and tenotomy rates), and outcomes (relapse and complications). We compared treatment with benchmarks in high-income nations and used generalized linear models to identify risk factors for delayed presentation, increased number of casts, and relapse. Results Amongst 168 children, age at presentation ranged from 0 days (birth) to 4.4 years, 62% were male, 35% were born at home, 63% had bilateral disease, and 46% had idiopathic clubfeet. Prior treatment (RR 6.33, 95% CI 3.18–12.62) was associated with a higher risk of delayed presentation. Risk factors for requiring ≥ 10 casts included having a non-idiopathic diagnosis (RR 2.28, 95% CI 1.08–4.83) and higher Pirani score (RR 2.78 per 0.5 increase, 95% CI 1.17–6.64). Female sex (RR 1.54, 95% CI 1.01–2.34) and higher Pirani score (RR 1.09 per 0.5 increase, 95% CI 1.00–1.17) were risk factors for relapse. Compared to North American benchmarks, children presented later (median 4.1 wks [IQR 1.6–18.1] vs. 1 wk), with longer casting (12.5 wks [SD 9.8] vs. 7.1 wks), and higher relapse (43% vs. 22%). Conclusions Higher Pirani score, prior treatment, non-idiopathic diagnosis, and female sex were associated with a higher risk of sub-optimal outcomes in this low-resource setting. Compared to high-income nations, serial casting began later, with longer duration and higher relapse. Identifying patients at risk for poor outcomes in a low-resource setting can guide counseling, program development, and resource allocation.
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Affiliation(s)
- Rameez A. Qudsi
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Policy and Innovation Evaluation in Orthopedic Treatments Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Faith Selzer
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Policy and Innovation Evaluation in Orthopedic Treatments Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stephen C. Hill
- Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Ariel Lerner
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | | | | | - Francel Alexis
- Department of Orthopaedic Surgery, Adventist Hospital, Diquini, Haiti
| | - Collin J. May
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Robert B. Cady
- Departments of Orthopaedics and Pediatrics, Upstate Medical University, Syracuse, New York, United States of America
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Policy and Innovation Evaluation in Orthopedic Treatments Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
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Drew S, Gooberman-Hill R, Lavy C. What factors impact on the implementation of clubfoot treatment services in low and middle-income countries?: a narrative synthesis of existing qualitative studies. BMC Musculoskelet Disord 2018; 19:72. [PMID: 29499667 PMCID: PMC5834880 DOI: 10.1186/s12891-018-1984-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 02/22/2018] [Indexed: 11/21/2022] Open
Abstract
Background Around 100,000 children are born annually with clubfoot worldwide and 80% live in low and middle-income counties (LMICs). Clubfoot is a condition in which children are born with one or both feet twisted inwards and if untreated it can limit participation in everyday life. Clubfoot can be corrected through staged manipulation of the limbs using the Ponseti method. Despite its efficacy and apparent availability, previous research has identified a number of challenges to service implementation. The aim of this study was to synthesise these findings to explore factors that impact on the implementation of clubfoot services in LMICs and strategies to address them. Understanding these may help practitioners in other settings develop more effective services. Methods Five databases were searched and articles screened using six criteria. Articles were appraised using the Critical Appraisal Skills Programme (CASP) checklist. 11 studies were identified for inclusion. A thematic analysis was conducted. Results Thematic analysis of the included studies showed that a lack of access to resources was a challenge including a lack of casting materials and abduction braces. Difficulties within the working environment included limited space and a need to share treatment space with other clinics. A shortage of healthcare professionals was a concern and participants thought that there was a lack of time to deliver treatment. This was exacerbated by the competing demands on clinicians. Lack of training was seen to impact on standards, including the nurses and midwives attending to the child at birth that were failing to diagnose the condition. Financial constraints were seen to underlie many of these problems. Some participants identified failures in communication and cooperation within the healthcare system such as a lack of awareness of clinics. Strategies to address these issues included means of increasing resource availability and the delivery of targeted training. The use of non-governmental organisations to provide financial support and methods to disseminate best practice were discussed. Conclusions This study identified factors that impact on the implementation of clubfoot services in LMIC settings.Findings may be used to improve service delivery.
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Affiliation(s)
- Sarah Drew
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK.
| | - Rachael Gooberman-Hill
- School of Clinical Sciences, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Christopher Lavy
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK
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Drew S, Lavy C, Gooberman-Hill R. What factors affect patient access and engagement with clubfoot treatment in low- and middle-income countries? Meta-synthesis of existing qualitative studies using a social ecological model. Trop Med Int Health 2016; 21:570-89. [PMID: 26892686 DOI: 10.1111/tmi.12684] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To conduct a systematic synthesis of previous research to identify factors that affect treatment-seeking for clubfoot and community-level interventions to improve engagement in low- and middle-income counties. METHODS A search of five databases was conducted, and articles screened using six criteria. Quality was appraised using the Critical Appraisal Skills Programme checklist. Eleven studies were identified for inclusion. Analysis was informed by a social ecological model, which specifies five inter-related factors that may affect treatment-seeking: intrapersonal, interpersonal, institutional, community or socio-cultural factors and public policy. RESULTS Intrapersonal barriers experienced were a lack of income and additional responsibilities. At the interpersonal level, support from fathers, the extended family and wider community affected on treatment-seeking. Institutional or organisational factors included long distances to treatment centres, insufficient information about treatments and challenges following treatment. Guardians' beliefs about the causes of clubfoot shaped behaviour. At the level of public policy, two-tiered healthcare systems made it difficult for some groups to access timely care. Interventions to address these challenges included counselling sessions, outreach clinics, brace recycling and a range of education programmes. CONCLUSIONS This study identifies factors that affect access and engagement with clubfoot treatment across diverse settings and strategies to address them.
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Affiliation(s)
- Sarah Drew
- Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Christopher Lavy
- Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
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Kumurenzi A, Goliath C, Mji G, Mlenzana N, Joseph C, Stathum S, Rhoda A. Experiences of patients and service providers with out-patient rehabilitation services in a rehabilitation centre in the Western Cape Province. Afr J Disabil 2015; 4:164. [PMID: 28730027 PMCID: PMC5433475 DOI: 10.4102/ajod.v4i1.164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 05/20/2015] [Indexed: 11/24/2022] Open
Abstract
Background Rehabilitation is important for persons with disabilities as it contributes to their sense of autonomy, self-worth and social participation, and improves their quality of life. Improving the quality of rehabilitation services requires the dialogue of patients’ perceptions with those of service providers, in order to recommend informed reform. Objective The objective was to explore the experiences of persons with physical disabilities and service providers, regarding the multi-disciplinary rehabilitation services provided at a community-based out-patient rehabilitation centre. Methods A qualitative, exploratory study design was used to collect the data. A focus group was conducted with conveniently selected persons with physical disabilities. Three in-depth interviews were conducted with purposively selected key informants. All ethical considerations were adhered to during the implementation of the study. Results Patients and service providers had different experiences regarding accessibility to rehabilitation services, and similar experiences with patient education and intensity of rehabilitation. Although the patients experienced that the service providers had sufficient knowledge and skills to manage them, services providers expressed that they lacked certain skills. Conclusions The experiences expressed highlighted the need to improve rehabilitation services in terms of increasing the capacity of service providers and providing transport services for persons with disabilities.
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Affiliation(s)
- Anne Kumurenzi
- Department of Physiotherapy, University of Rwanda, Rwanda
| | - Charlyn Goliath
- Division of Physiotherapy, Stellenbosch University, South Africa
| | - Gubela Mji
- Division of Physiotherapy, Stellenbosch University, South Africa
| | - Nondwe Mlenzana
- Physiotherapy Department, University of the Western Cape, South Africa
| | | | - Sue Stathum
- Division of Physiotherapy, Stellenbosch University, South Africa
| | - Anthea Rhoda
- Physiotherapy Department, University of the Western Cape, South Africa
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