Effectiveness of interventions by non-professional community-level workers or family caregivers to improve outcomes for physical impairments or disabilities in low resource settings: systematic review of task-sharing strategies

A description of functional needs of community-dwelling stroke survivors in Rwanda: a prospective observational cohort study

PURPOSE

Stroke survivors in low- and middle-income countries have different needs compared to those in high-income countries. Our aim was to describe the unmet functional needs of Rwandan stroke survivors at discharge and three months after stroke.

METHODS

A study using an adapted modified Needs Assessment Questionnaire (mNAQ) was conducted at six hospitals in Rwanda. Moderate or severe needs are described using descriptive statistics and logistic regression models.

RESULTS

A total of 337 participants, with a mean age of 61 years, were recruited. Most were female (59%), and 70% had an ischemic stroke, while 71% had hypertension. At discharge, 97% of participants had moderate to severe needs. Follow-up at three months was available for 78% of participants and 22% died. At three months, over 70% of participants continued to have moderate to severe needs.

CONCLUSIONS

Almost all Rwandan stroke survivors have moderate to severe needs and disability at the time of discharge, and for those that survive, over 70% continue to have moderate to severe needs at 3 months. This estimate is much higher than previously reported. Improving functioning in the community is essential for Rwandan stroke survivors.

Practical insights for enhancing primary care rehabilitation services in low-resource contexts

BACKGROUND

 Rehabilitation services are crucial for addressing the growing burden of functioning problems related to chronic conditions in low and middle-income countries. These services, however, remain limited in South Africa and Zimbabwe's primary health care (PHC) settings.

AIM

 To identify recommendations for enhancing the accessibility and quality of rehabilitation services in PHC in South Africa and Zimbabwe from the perspectives of primary care providers (PCPs) and patients.

SETTING

 Ten PHC facilities in the Eastern Cape, South Africa and in Manicaland, Zimbabwe.

METHODS

 A qualitative descriptive study was conducted. Semi-structured interviews were conducted with 37 PCPs and 40 patients. Thematic analysis of transcribed and translated data was done in ATLAS.ti version 22.2.4.

RESULTS

 Five key recommendations emerged: (1) provide rehabilitation services closer to home through facility-based services, outreach, home visits and telerehabilitation; (2) improve patient awareness of rehabilitation through patient education, community engagement and patients actively seeking information; (3) enhance PCPs' knowledge and basic skills in rehabilitation through training and guideline development; (4) improve communication among PHC stakeholders; and (5) advocate for rehabilitation inclusion in leadership, resource allocation and multi-disciplinary teams.

CONCLUSION

 Implementing the identified recommendations could significantly improve the accessibility and quality of rehabilitation services in PHC, aligning with global initiatives to scale up rehabilitation in health systems. Future research should focus on evaluating the implementation and impact of these recommendations.Contribution: The study emphasises the inclusion of PCPs' and end-users' voices in providing practical, context-specific strategies for establishing or strengthening rehabilitation services in low-resource PHC settings.

A qualitative study on rehabilitation services at primary health care: insights from primary health care stakeholders in low-resource contexts

BACKGROUND

The chasm between rehabilitation needs and available rehabilitation services is widening. In most low-resource contexts, there are inadequate rehabilitation professionals at primary health care (PHC), leaving nonrehabilitation primary care providers' (PCPs) and district rehabilitation professionals and managers to address patients' rehabilitation needs. This study explored rehabilitation and non-rehabilitation PCPs' and managers' perspectives on the situation of rehabilitation service provision in PHC settings and the challenges experienced in providing rehabilitation care.

METHODS

In this descriptive, exploratory qualitative study, individual semi-structured interviews and focus group discussions were conducted with purposefully sampled PCPs in Manicaland, Zimbabwe and Eastern Cape, South Africa. The transcripts were analysed thematically using Atlas.ti. version 22.2®.

RESULTS

Thirty-six PCPs (29 nonrehabilitation and 7 rehabilitation) and one district manager participated in the study. The current PHC rehabilitation services in the two low-resource contexts were described as inadequate, if not nonexistent. District rehabilitation professionals attempted to fill the gap through outreach and home visits, but resource limitations, particularly in Zimbabwe, often hampered this strategy. The nonrehabilitation PCPs took on task-shifting roles in the identification, referral, and education of patients with rehabilitation needs in the absence of rehabilitation professionals at PHC. Challenges encountered in providing rehabilitation care at PHC included unsupportive leadership, human resource shortages, lack of comprehensive PHC rehabilitation guidelines, no or delayed rehabilitation referral, lack of clear communication strategies, and users' low demand for PHC rehabilitation.

CONCLUSION

Tailored approaches, including context-specific rehabilitation guidance for existing task-shifting models, increased investment in rehabilitation and increased rehabilitation awareness, are needed to establish basic rehabilitation services in the described contexts because they are mostly absent. Importantly, the PHC systems in which rehabilitation is to be nested need to be strengthened.

The influence of contextual factors on an intervention for people with disabilities from support persons' and health personnel's perspectives: a focus group study

Introduction

Contextual factors influence interventions in healthcare and pose a particular challenge in interventions designed for people with profound intellectual and multiple disabilities (PIMD). Exploring support persons' and health personnel's experience of an intervention may improve our understanding of the influence of contextual factors. Such exploration is important for revealing areas and focus points for future implementations. Therefore, the aim of this study is to explore support persons' and health personnel's experience of contextual factors during involvement in an intervention for people with PIMD.

Methods

This focus group study includes eight groups, comprising a total of 34 support persons and health personnel, at habilitation centres at four regions in central Sweden. Data were analysed inductively using a content analysis approach.

Results

Three themes emerged from the analysis of the informants' perspectives on the contextual factors: (1) structure and support enhances intervention feasibility; (2) an intervention's benefit for people with PIMD increases its acceptability; and (3) being engaged and involved increases support persons' and health personnel's motivation. Our findings show that the implementation of an intervention for people with PIMD should focus on the recipients of the intervention in its context, forming a clear communication plan. A training programme should be provided for the recipients and providers of the intervention.

Discussion

Finally, the implementation process can be facilitated by creating space for staff to contribute and by encouraging participation and ownership for everyone involved. Using a co-design strategy can enable a shared responsibility to solve the identified challenges, while contributing to the development and design of future interventions for people with disabilities.