Health system challenges affecting falls prevention in persons living with HIV: perspectives from physiotherapists in four sub-Saharan regions

Aim:

The aim of this study was to explore the perspectives of physiotherapists in four selected regions of sub-Saharan Africa regarding health system challenges impacting the integration of physiotherapy-led falls prevention services in the primary care of persons living with HIV (PLWH).

Background:

Falls may pose a significant problem among younger PLWH in low- and middle-income countries. Physiotherapists’ role in optimising function and quality of life can do much in the prevention of falls in PLWH and reducing the harm that results. However, falls prevention strategies have not been implemented effectively especially in primary health care settings in sub-Saharan Africa. Physiotherapists’ account of the health system challenges they encounter may provide insights into potential strategies that may be considered in optimising fall prevention for PLWH in poorly resourced settings.

Methods:

A descriptive qualitative study was conducted in selected urban districts in the capital cities of four sub-Saharan African countries. In-depth interviews were conducted with 21 purposively selected physiotherapists involved in the primary care of PLWH. Audio recordings of interviews were transcribed verbatim and analysed using deductive thematic content analysis.

Findings:

The main results are presented in the theme ‘Health care system challenges’ and in nine categories informed by the WHO health system framework: lack of policies and clinical practice guidelines, shortage/Inaccessible falls prevention services, inadequate human resource, physiotherapists not adequately equipped in falls prevention, inaccessible/No facilities for BMD measurement, inefficient data capturing systems, lack of evidence regarding falls among PLWH, unclear physiotherapy role descriptions, inefficient referral system. Physiotherapists highlighted the need for more information and research regarding fall prevention for PLWH, promote their role in the primary care of PLWH and adopt a patient-centred approach to fall prevention.

Internationalising Research Methods Teaching of Undergraduate Health Professionals

OBJECTIVE

The project aims were: (1) identifying the pedagogical impact of collaborative student experience on student understanding of research methods and (2) evaluating the perceived value of providing students with an international perspective on their professional practice.

METHODS

Student cohorts from year 1 of the University of Liverpool (UoL) (n = 80) and year 2 of the Royal Melbourne Institute of Technology University (RMIT) (n = 128) undergraduate Medical Radiation Science degree programmes participated in the intervention as part of their teaching. Students were tasked with designing, deploying, and analysing data from survey-based research projects and invited to provide feedback via an anonymous and voluntary online survey (UoL students) or an equivalent paper-based survey (RMIT students), comprising both quantitative (Likert) and qualitative (open) questions.

RESULTS

Responses were received from 83% of RMIT and 31% of UoL students. Over 42% of respondents enjoyed the opportunity to interact with overseas peers, while 14.7% did not; 40% of respondents felt the intervention helped in their understanding of research methods, whilst 28% indicated it had not. The main positive themes were learning the research process, team working skills, networking opportunities, and understanding cultural differences. Interpreting data were invaluable; only a minority valued the engagement with their overseas counterparts. There was poor engagement with social media.

CONCLUSIONS

Students reported clear value of the innovation for learning research skills and process. The extent of research skills learning supports changes in research activity and culture in the past 10 years. With internationalisation becoming increasingly important in today's health care economy, the degree to which the students identified this aspect of the research as a key learning point highlights the benefits of the active approach. The negative appraisal of the social media support was interpreted as a response to the platform (WhatsApp) and privacy issues with sharing phone numbers.

Instructional practices for evidence-based practice with pre-registration allied health students: a review of recent research and developments

The aim of this study is to update a previous review published in this journal on the effectiveness of teaching and assessment interventions for evidence based practice in health professions, and to determine the extent to which the five recommendations made from that review have been implemented. The Integrating Theory, Evidence and Action method was used to synthesise all published evidence from 2011 to 2015, which addressed instructional practices used for evidence based practice with pre-registration allied health students. Seventeen articles were found to meet the inclusion criteria, and were analysed for both their individual rigour and relationship to the five recommendations. The evidence reviewed in this study was diverse in both its geographical setting and the allied health disciplines represented. Most of the evidence used less rigorous methods, and the evidence base is generally exploratory in nature. To date, the five recommendations regarding instructional practices in this area have been implemented to varying degrees. Many current practices promote social negotiation, collaborative decision-making and collaborative learning, so the social constructivist approach is being adopted. However, the prior knowledge of students is not being assessed as a basis for scaffolding, communication of evidence based practice to varying audiences is rarely addressed and the role of clinicians in the learning of evidence based practice knowledge, skills, beliefs and attitudes remains limited.