Staff perception on including students with physical disabilities at a South African university

Background

International and local policy frameworks on disability promote inclusive higher education practices for students with disabilities (SWD). However, the actual application of these frameworks concerning students with physical disabilities (SWPD) in any School of Health Care Sciences (SHCS) is uncertain in South African universities.

Objectives

This study aimed to explore the perceptions of academic and admission staff on the inclusion of SWPD in SHCS at a South African university. The study was carried out at a University of Health Sciences in South Africa.

Method

A qualitative study in which respondents (n = 12) were interviewed in depth about their perceptions on the inclusion of SWPD in the SHCS. Thematic analysis was used in the data assessment.

Results

The results revealed three main themes: policy discourse, environmental effects on inclusion and SWPD enrolment. Respondents reported the lack of a disability inclusion policy and disability unit to support SWD in general. The respondents also noted that there were environmental challenges that could potentially affect the inclusion of SWPD in SHCS study programmes. Respondents also indicated that there was no SWPD enrolment as the university's current inclusion and/or quota system does not include SWD.

Conclusion

The findings of the study showed a lack of disability inclusion policy, environmental challenges and lack of SWPD enrolment. Based on the study findings, it can be concluded that inclusion of SWPD at this university may be negatively influenced.

Contribution

The study findings contribute to the field of disability and the inclusion of SWPD in higher education institutions (HEIs).

Empowering marginalised groups through co-operative inquiry: Illustrated by a practical example

Background

Cooperative inquiry gives a voice to marginalised groups and breaks down power imbalances which makes it suitable for researching practical issues at community level.

Objectives

The objective of this article is to illustrate how cooperative inquiry can be utilised to empower members of marginalised communities in facilitating social change.

Method

The study setting is in Paarl, Western Cape, South Africa. A cooperative inquiry methodology was used. The inquiry group consisted of wheelchair users (9), their care givers (8), taxi drivers (7) and stakeholders (4). Data collection comprised 16 sessions, alternating between action and reflection. Inductive thematic analysis of data of all the phases was done to ensure that cooperative inquiry gives voice to marginalised communities.

Results

The four themes that is, practical arrangements, understanding process, purpose, bonding and a cohesive group were identified. The themes showed progress from logistics, through individual understanding, to the group becoming one, and working together. Each of these phases is important in the development of a cooperative inquiry.

Conclusion

Cooperative inquiry methodology can bring people together in a positive way to facilitate social change, and developing practical solutions to challenges.

Contribution

Making use of a cooperative inquiry methodology to bring social change, minibus taxi services can be made accessible for wheelchair users. Concepts of social justice and decolonisation were imbued in the methodology.

A qualitative exploration of community mobility experiences of wheelchair users

Background

Freedom of movement, which is dependent on community mobility, is a key contributor to good quality of life and important in the establishment of a person's community identity.

Objective

To describe the community mobility experiences of wheelchair users who lived in a socio-economically challenged setting.

Method

The study setting was Paarl, a peri-urban area of the Western Cape province of South Africa. This article reports findings from phase 1 (a reflection on past community mobility and minibus taxi use experiences) of cycle 1 of a co-operative inquiry. Nine adult wheelchair users, eight caregivers, six minibus taxi drivers, and four community stakeholders participated. Data were collected during a focus group discussion and analysed using inductive thematic analysis.

Results

Four themes, 'Knowledge, attitudes, and actions', 'Natural, manmade and mechanical environmental barriers', 'Health and safety concerns' and 'Poor community participation and quality of life' were identified. The themes showed how difficult an everyday activity like moving around in the community were for wheelchair users, and how that limited their community involvement.

Conclusions

Wheelchair users living in a low-income peri-urban area struggled to participate in community activities meaningful to them because various barriers hampered community wheelchair mobility and minibus taxi use.

Contribution

The findings regarding community mobility struggles and specifically minibus taxi access guided specific recommendations and the further phases and cycles of the co-operative inquiry. The purpose of the co-operative inquiry was to allow co-researchers to find their voice and develop solutions to minibus taxi access for wheelchair users.

Non-use of healthcare services among persons with mobility impairments in Cofimvaba, South Africa

Background

Access to primary health care is a fundamental right for all. However, persons with disabilities are experiencing difficulties when accessing healthcare because of various environmental and personal barriers which may lead to nonuse of such services.

Objectives

This study aimed to identify the challenges leading to non-use of healthcare services among persons with mobility impairments in Cofimvaba.

Method

A descriptive qualitative design using snowball sampling was implemented. Semistructured interviews were conducted in isiXhosa with five participants who stopped accessing healthcare, using a self-developed interview guide. Inductive thematic analysis was used to develop codes and themes from the data.

Results

Study findings revealed major challenges experienced by persons with mobility impairments in accessing healthcare. These included inaccessible roads, geographic inaccessibility, financial accessibility and indirect cost of care, having little or not many health problems, physical infrastructure difficulties within facilities, and attitudinal barriers.

Conclusion

The findings indicated that persons with disabilities are experiencing a combination of structural and environmental challenges which make them stop accessing healthcare.

Contribution

The article shares insights on access challenges that influence non-use of the often-needed healthcare services within the context of rural areas.

A qualitative exploration of the uses of the International Classification of Functioning, Disability and Health at an inpatient neurorehabilitation facility in the Western Cape, South Africa

Purpose of the study: The aim of the study was to describe how healthcare professionals at a neurorehabilitation facility currently use the International Classification of Functioning, Disability and Health (ICF) and to identify further possibilities for its future use.Methods: The study followed an interpretive description approach. Data were collected through four focus group discussions with 21 participants, all health care practitioners, at the study facility. Thematic analysis was conducted by coding the transcripts and generating themes.Findings: Three themes were generated: (1) Current use and gaps in use of the ICF, (2) a non-conducive environment and (3) using the ICF to facilitate holistic, patient-centred management. Current use of the ICF was limited. Gaps in use of the ICF was especially evident in goal setting practices. Goals were generic in nature and did not address participation and the environment. A lack of knowledge, debilitating interpersonal relationships and an unsupportive organisational culture created an environment non-conducive to the implementation of the ICF. Participants felt that the ICF can assist them to work more patient-centred.Conclusion: Participants perceived that the ICF has the potential to improve service delivery at the facility. The implementation process must be well structured, focus on practical use and be supported through an enabling environment created by management.IMPLICATIONS FOR REHABILITATIONThe ICF is not being optimally used in clinical rehabilitation practice, however healthcare practitioners perceive the ICF to have the potential to improve rehabilitation service delivery.Concerted action is required at institutional, interpersonal and individual level to create a conducive environment that facilitates the use of the ICF during rehabilitation service delivery.The ICF can be used to construct a team assessment document that promotes patient-centred goal setting and improves interdisciplinary communication.

Exploring the inclusion of teaching and learning on assistive products in undergraduate curricula of health sciences faculties at three South African Universities

BACKGROUND

Providers must be knowledgeable on policy, systems and products to provide a person centred service and prescribe the most appropriate assistive product for each user.

AIM

This study aimed to determine to what extent teaching and learning on assistive products are included in undergraduate curricula of the Health science faculties at three universities in the Western Cape Province of South Africa.

METHODS

Data were gathered through a cross sectional survey. Fifteen programmes were approached of whom eight participated. Information on teaching on assistive products was sourced from purposively identified key informants, through e-mail questionnaires. Descriptive analysis was done.

RESULTS

A total of 104 assistive products were included in the eight programmes. Manual wheelchairs were the only product for which teaching was underscored by policy guidelines. Handheld mobility devices and wheelchairs were covered by five programmes. Teaching on assistive products for self-care, participation in domestic life, indoor and outdoor activities, employment and leisure was limited. Thirty seven products listed on the GATE List of 50 were taught by at least one of the programmes. Teaching and examination were theoretical in nature and occurred in professional silos. Clinical exposure was often incidental. For many products none of the four service delivery steps were covered.

CONCLUSION

Assistive products were included in all the participating undergraduate programmes. The range of included products and the level of training were insufficient to prepare graduates to effectively address user's needs. Newly appointed graduates will require early in-service training to ensure appropriate assistive product service delivery.Implications for rehabilitationUndergraduate teaching on assistive products is provided in professional silos.Not all products on the GATE APL of 50 are included in under graduate teaching.Teaching does not always ensure a proficiency level that will support graduates to provide an independent AT service.

Pressure ulcer knowledge, beliefs and practices in a group of South Africans with spinal cord injury

Study design

A quantitative, descriptive study using a cross-sectional survey.

Objectives

To describe the pressure ulcer knowledge, beliefs and practices amongst persons with SCI, who received rehabilitation at a Cape Town rehabilitation centre.

Setting

A rehabilitation centre for clients with physical disabilities in Cape Town, South Africa.

Methods

A quantitative, descriptive study, that employed consecutive sampling, was done. Participants included inpatients (n = 30), outpatients (n = 33) and peer supporters (n = 8). Data were collected during April and March 2015 with a questionnaire developed through collating existing questionnaires and adapting it for the study context. This rendered a knowledge score and data on beliefs and practices. The Fisher's exact test was used for comparative analysis (p < 0.05).

Results

The mean combined knowledge score was 42.7%. The majority of participants (88.7%) believed pressure ulcers to be serious and 45% thought they were likely to develop a PU. They believed daily skin checks (80.3%), weight shifting (86%) and limiting sitting time (80.3%) could prevent PU development. Study participants indicated that they did not regularly follow guideline recommended practices like regular pressure relief (51%) (36 participants) or daily skin inspection (38%) (27 participants) and 37% (26 participants) reported being current smokers.

Conclusion

Participants showed a lack of knowledge, which might have affected their pressure ulcer prevention practices negatively. The study findings can be used to assist with the development of a contextually relevant training programme on pressure care.

Perspectives on a mobile application that maps assistive technology resources in Africa

Background

Access to assistive technology (AT) is poor in African countries because of a lack of knowledge, resources, services and products. A mobile application (app), the AT-Info-Map, was developed to map AT availability in southern Africa.

Objectives

This article aimed to describe users’ and suppliers’ perceptions of the AT-Info-Map app.

Method

Qualitative data were collected in Zambia, Botswana, Malawi and Lesotho, through nine focus group discussions with 72 participants. Participants included AT users, AT suppliers and representatives of disability organisations. Data were thematically analysed.

Results

Two broad themes, that is, usefulness of the AT-Info-Map application and technical issues and content, emerged from the data analysis. Subthemes under usefulness focused on the importance of using current technology, convenience of the app, the need for accuracy, responsiveness of supplier to user’s needs, influence on AT market and how the app creates an opportunity for networking. Challenges to download and navigate the app, the need for training in its use, exclusion of those not literate in English and those with visual impairments were subthemes under technical issues and content.

Conclusion

The app was perceived as an important step to increase access to AT for persons with disabilities in less resourced settings. The challenges that emerged from the data analysis have led to the development of a web-based system that will complement or replace the app and improve AT information provision. However, the information provided by the app and website is still only a partial solution to improve AT access in Southern Africa.

Prosthetic use by persons with unilateral transfemoral amputation in a South African setting

BACKGROUND

Due to limitations in provision of prosthetic care in South Africa, a screening tool to select transfemoral prosthetic candidates has been implemented.

OBJECTIVE

To describe prosthetic services, use and mobility of people with transfemoral amputation, identified as prosthetic candidates through the Guidelines for Screening of Prosthetic Candidates: Lower Limb, and to identify variables that might influence prosthetic use and mobility.

DESIGN

Cross-sectional survey.

METHODS

The study population included all adults who received their first prosthesis from the Orthotic and Prosthetic Centre in the Western Cape between 1 June 2011 and 31 December 2014. Data were collected, with an adapted version of the Prosthetic Profile of the Amputee, from 43 participants, through telephonic interviews. Descriptive and inferential analysis, with the chi-square test, was done.

RESULTS

The majority of participants were older than 50 years (77%). Most participants (35; 81%) used their prosthesis; however, only 42% (18) used it daily. A significant association ( p = 0.000) was found between prosthetic rehabilitation and self-reported prosthetic walking distance. Less than half of participants received prosthetic rehabilitation and only 10 (30%) could walk 500 steps and more without resting.

CONCLUSION

Participants used their prosthetic leg, but experienced limitations in frequency of wear and mobility.

CLINICAL RELEVANCE

Current findings showed that participants' prosthetic mobility was curtailed. In less-resourced settings, carefully selecting prosthetic candidates may be necessary to provide access to services. Prosthetic provision is advised to be followed up with prosthetic rehabilitation for favourable mobility outcomes.

Suitability of 'Guidelines for Screening of Prosthetic Candidates: Lower Limb' for the Eastern Cape, South Africa: A qualitative study

Background

Major lower limb amputation has a severe impact on functional mobility. Mobility can be salvaged with a prosthesis, but this is not always the best option. It is often difficult to decide whether to refer someone for a prosthesis or not. A prosthetic screening tool 'Guidelines for Screening of Prosthetic Candidates: Lower Limb' was developed and is used for prosthetic prescription in parts of the Western Cape province of South Africa.

Objectives

This study aimed to explore the suitability of the tool 'Guidelines for Screening of Prosthetic Candidates: Lower Limb' for use in the Eastern Cape province of South Africa.

Method

A qualitative study was conducted with conveniently sampled occupational therapists (OTs) (n = 10), physiotherapists (PTs) (n = 12) and prosthetists (n = 6) in government employment in the Buffalo City Metro Municipality. Participants were trained in the use of the tool and used it for four weeks with patients. Their experiences of the tool were assessed through three focus group discussions with emergent themes being identified during inductive data analysis.

Findings

Participants indicated that the tool could assist with prosthetic prescription, goal setting, communication and teamwork. They thought that the tool was multidisciplinary in nature, comprehensive and practical. Findings showed a lack of teamwork in this study setting. Resistance to change and a lack of time might also hamper implementation of the tool.

Conclusion

The tool can assist with managing the backlog for prostheses and to guide prosthetic prescription in the Eastern Cape province.

Clinical implications

A prosthesis can help to salvage functional mobility after lower limb amputation. However, not all people who had above knee amputation manage to walk with a prosthesis. The tool reported on in this article provides information that can guide prosthetic prescription and rehabilitation goals.

Community integration of adults with disabilities post discharge from an in-patient rehabilitation unit in the Western Cape

INTRODUCTION

Community integration is an important outcome of rehabilitation, because the ultimate focus of rehabilitation is to enable people to participate in their life roles.

AIM

To determine community integration scores achieved by adults with disabilities post discharge from an in-patient rehabilitation centre in the Western Cape Province.

METHOD

Fifty-nine individuals participated in this cross-sectional study. Community integration was determined using the Reintegration to Normal Living Index (RNLI). Descriptive analysis of age, gender, medical diagnosis and RNLI scores was performed. Kruskal-Wallis test and t-tests were used to determine whether there exists any relationship between age, gender, medical diagnosis and RNLI scores (p < 0.05).

RESULTS

Participants' mean age was 45 (± 15.9) years. Of the study participants, 54% were women. The most common diagnosis was stroke (41%), followed by spinal cord injury (30%). The mean overall RNLI score was 66.3 (± 25.5). Persons with brain trauma (stroke or head injury) had a mean of 60.9 (±20.3); those with spinal cord injury had a mean of 75.2 (± 25.8) and those with peripheral impairments had a mean of 65.5 (± 30.5). The RNLI domains 'personal relationships' 73.45 (± 31.6) and 'presentation of self' 72.13 (± 35.4) recorded the highest mean scores. The domain 'work or meaningful activities' had the lowest mean score 52.54 (± 35.3). 'Community mobility' (59.9; ± 34.6) and 'recreation' (57.3; ± 37.2) also had mean scores below 60. No statistically significant relationships were found between age, gender and medical diagnosis and RNLI scores.

CONCLUSION

The relatively low mean scores indicate that participants achieved poor community reintegration.

Factors related to environmental barriers experienced by persons with and without disabilities in diverse African settings

This paper explores differences in experienced environmental barriers between individuals with and without disabilities and the impact of additional factors on experienced environmental barriers. Data was collected in 2011–2012 by means of a two-stage cluster sampling and comprised 400–500 households in different sites in South Africa, Sudan Malawi and Namibia. Data were collected through self-report survey questionnaires. In addition to descriptive statistics and simple statistical tests a structural equation model was developed and tested. The combined file comprised 9,307 participants. The Craig Hospital Inventory of Environmental Factors was used to assess the level of environmental barriers. Transportation, the natural environment and access to health care services created the biggest barriers. An exploratory factor analysis yielded support for a one component solution for environmental barriers. A scale was constructed by adding the items together and dividing by number of items, yielding a range from one to five with five representing the highest level of environmental barriers and one the lowest. An overall mean value of 1.51 was found. Persons with disabilities scored 1.66 and persons without disabilities 1.36 (F = 466.89, p < .001). Bivariate regression analyses revealed environmental barriers to be higher among rural respondents, increasing with age and severity of disability, and lower for those with a higher level of education and with better physical and mental health. Gender had an impact only among persons without disabilities, where women report more barriers than men. Structural equation model analysis showed that socioeconomic status was significantly and negatively associated with environmental barriers. Activity limitation is significantly associated with environmental barriers when controlling for a number of other individual characteristics. Reducing barriers for the general population would go some way to reduce the impact of these for persons with activity limitations, but additional and specific adaptations will be required to ensure an inclusive society.

"There is nothing wrong with me": disability invisibility in a rural South African town

BACKGROUND

At a political and academic level, South Africa propagates a rights-based approach to disability. The aim of this paper is to explore how disability is conceptualized by persons with disabilities living in a rural area of South Africa.

METHODS

In keeping with explorative studies, the study utilized a qualitative design in the form of eight case studies. Case study participants were sampled purposively and data were collected through semi-structured interviews. Data were analyzed according to the principles of interpretative phenomenological analysis.

RESULTS

Five themes evolved from the findings. These were no identification with disability, individual approach to disability, the role of personal factors, the role of Christianity as well as attitudes, and support of significant others.

CONCLUSION

Findings showed that there is a need to bridge the divide between rhetoric and reality for these participants whose stories might resonate with those of many other South Africans. Implications for rehabilitation South Africa is seen as a country that has an inclusive approach to disability and approach disability from a human rights angle. The article shows that some South Africans are excluded from the dialog on disability, human rights, access, and health care. Their health and community integration outcomes are left to crippling beliefs about disability, chance and personal attributes. The academic and political rhetoric does not describe the situation of study participants, and by assuming all South Africans are included, it further marginalizes them.

Exploring the interaction of activity limitations with context, systems, community and personal factors in accessing public health care services: A presentation of South African case studies

Background

There are many factors that influence access to public health services, such as the context people live in, the existing health services, and personal, cultural and community factors. People with disabilities (activity limitations), through their experience of health services, may offer a particular understanding of the performance of the health services, thus exposing health system limitations more clearly than perhaps any other health service user.

Aim

This article explores how activity limitations interact with factors related to context, systems, community and personal factors in accessing public health care services in South Africa.

Setting

We present four case studies of people with disabilities from four low-resource diverse contexts in South Africa (rural, semi-rural, farming community and peri-urban) to highlight challenges of access to health services experienced by people with activity limitations in a variety of contexts.

Methods

One case study of a person with disabilities was chosen from each study setting to build evidence using an intensive qualitative case study methodology to elucidate individual and household experiences of challenges experienced by people with activity limitations when attempting to access public health services. In-depth interviews were used to collect data, using an interview guide. The analysis was conducted in the form of a thematic analysis using the interview topics as a starting point.

Results

First, these four case studies demonstrate that equitable access to health services for people with activity limitations is influenced by a complex interplay of a variety of factors for a single individual in a particular context. Secondly, that while problems with access to public health services are experienced by everyone, people with activity limitations are affected in particular ways making them particularly vulnerable in using public health services.

Conclusion

The revitalisation of primary health care and the introduction of national health insurance by the Health Department of South Africa open a window of opportunity for policy makers and policy implementers to revisit and address the areas of access to public health services for people with activity limitations.

Rural South Africans' rehabilitation experiences: Case studies from the Northern Cape Province

BACKGROUND

Rehabilitation is often challenging in South Africa, but South Africans living in remote rural settings might experience unique challenges.

OBJECTIVE

This article interrogates issues of access to rehabilitation in a selected sample from rural South Africa through case studies.

METHOD

This qualitative study utilised a case study design. Eight case studies were done in a purposively sampled rural town in the Northern Cape Province. Data were collected through in-depth interviews. Data were analysed according to the principles of interpretative phenomenological analysis.

RESULTS

The case study participants were not integrated into the community. They experienced higher levels of disability than one would expect from their impairments. Their impairments were not modified. No retraining of function was implemented. Early intervention and childhood development activities were not provided. Participants were not linked with self-help or peer support groups. Provision of assistive devices was challenged. Environmental barriers aggravated the situation.

CONCLUSION

We theorise that one-on-one therapy is not the solution to the rehabilitation needs of persons with disabilities in remote, rural settings. We recommend a move to community-based rehabilitation and transdisciplinary teamwork supported by family members, community health workers and peer mentors. Therapists are ideally situated to explore the feasibility of such programmes and to pilot them in various communities.

Impact of structured wheelchair services on satisfaction and function of wheelchair users in Zimbabwe

BACKGROUND

Providing wheelchairs without comprehensive support services might be detrimental to user satisfaction and function.

OBJECTIVES

This paper compares wheelchair user satisfaction and function before and after implementation of comprehensive wheelchair services, based on the World Health Organization guidelines on wheelchair service provision in less resourced settings, in Zimbabwe.

METHOD

A pre- and post-test study with a qualitative component was done. Quantitative data were collected with the Quebec User Evaluation of Satisfaction with Assistive Technology for adults and children and the 'Functioning Every day with a Wheelchair Questionnaire'. Data were collected from 55 consecutively sampled wheelchair users, who received a new wheelchair in the study period. Qualitative data were collected through two audio recorded focus groups and two case studies and are presented through narrative examples.

RESULTS

The proportion of adult users who were satisfied significantly increased for all wheelchair and service delivery aspects (p = 0.001 - 0.008), except follow-up (p = 0.128). The same was true for children's post-test ratings on all variables assessed (p = 0.001 - 0.04), except training in the use of the device (p = 0.052). The biggest improvement in satisfaction figures were for comfort needs (44.3%), indoor mobility (43.2%), outdoor mobility (37.2%), safe and efficient, independent operation (33.5%) and transport (31.4%). The qualitative data illustrated user satisfaction with wheelchair features and services.

CONCLUSION

The wheelchair service programme resulted in significant positive changes in user satisfaction with the wheelchair, wheelchair services and function. It is recommended that the Zimbabwean government and partner organisations continue to support and develop wheelchair services along these guidelines.

Is any wheelchair better than no wheelchair? A Zimbabwean perspective

BACKGROUND

Within a rights-based paradigm, wheelchairs are essential in the promotion of user autonomy, dignity, freedom, inclusion and participation.

OBJECTIVES

This paper aimed to describe a group of Zimbabwean wheelchair users' satisfaction with wheelchairs, wheelchair services and wheelchair function.

METHOD

A mixed method, descriptive study was done. Quantitative data was collected from 94 consecutively sampled wheelchair users, who accessed wheelchair services at 16 clinics in five Zimbabwean provinces between October 2013 and February 2014, using the Quebec User Evaluation of Satisfaction with Assistive Technology for adults and children and Functioning Every day with a Wheelchair questionnaire. Qualitative data were collected through two focus group discussions (22 participants) and two case studies with participants purposively sampled from those who participated in the quantitative phase.

RESULTS

More than 60% of participants were dissatisfied with the following wheelchair features: durability (78.6%), weight (75.6%), ease of adjustment (69.1%), effectiveness (69.0%), safety (66.7%), reliability (66.7%), and meeting user needs (60.6%). Similarly, more than 66% of participants were dissatisfied with various services aspects: professional services (69.0%), follow-up (67.0%), and service delivery (68.3%). Although 60% of participants agreed that the wheelchair contributed to specific functions, more than 50% of participants indicated that the features of the wheelchair did not allow in- (53.2%) and outdoor (52.7%) mobility.

CONCLUSION

Findings indicate high levels of dissatisfaction with wheelchair features and services, as well as mobility. It is recommended that policy and minimum service standards which incorporate evidence and good practice guidelines for wheelchair services and management of wheelchair donations are developed for Zimbabwe.

Environmental factors influencing participation of stroke survivors in a Western Cape setting

Background

Environmental factors compound or diminish the effects of impairments; therefore they have a direct influence on participation of stroke survivors.

Objectives

To determine environmental barriers and facilitators to participation experienced by a group of stroke survivors in the Western Cape province of South Africa.

Methods

A descriptive, mixed methods study was conducted in 2011. Quantitative data was collected with the International Classification for Functioning, Disability and Health core set for stroke (environmental factors), from 53 stroke survivors, sampled through proportional, stratified, random sampling. Data is presented through graphs and tables. Qualitative data was collected from five purposively sampled participants and thematically analysed.

Results

Under products and technology, participants regarded assets, food, products and technology for daily living, transportation, mobility and communication, and access to buildings as barriers. The physical geography and attitudes of friends and society created further barriers. With regard to services, systems and policies - housing, communication, transport and social services created barriers. Health services, as well as support from health care service providers and family were considered facilitators.

Conclusion

A lack of assets compounded barriers with regard to food, products for daily use, communication and transport. Barriers to participation were exacerbated by a lack of services, systems and implementation of policies focused on the inclusion of people with disabilities, as well as minimal access to assistive devices. Recommendations include provision of assistive devices, structural changes to houses, yards, roads and buildings, lobbying for accessible, affordable public transport, access audits of public buildings, and inclusion of non-governmental organisations and home-based care services in a seamless network of care.

Exploring the impact of wheelchair design on user function in a rural South African setting

BACKGROUND

Wheelchairs provide mobility that can enhance function and community integration. Function in a wheelchair is influenced by wheelchair design.

OBJECTIVES

To explore the impact of wheelchair design on user function and the variables that guided wheelchair prescription in the study setting.

METHOD

A mixed-method, descriptive design using convenience sampling was implemented. Quantitative data were collected from 30 wheelchair users using the functioning every day with a Wheelchair Scale and a Wheelchair Specification Checklist. Qualitative data were collected from ten therapists who prescribed wheelchairs to these users, through interviews. The Kruskal-Wallis test was used to identify relationships, and content analysis was undertaken to identify emerging themes in qualitative data.

RESULTS

Wheelchairs with urban designs were issued to 25 (83%) participants. Wheelchair size, fit, support and functional features created challenges concerning transport, operating the wheelchair, performing personal tasks, and indoor and outdoor mobility. Users using wheelchairs designed for use in semi-rural environments achieved significantly better scores regarding the appropriateness of the prescribed wheelchair than those using wheelchairs designed for urban use (p = <0.01). Therapists prescribed the basic, four-wheel folding frame design most often because of a lack of funding, lack of assessment, lack of skills and user choice.

CONCLUSION

Issuing urban type wheelchairs to users living in rural settings might have a negative effect on users' functional outcomes. Comprehensive assessments, further training and research, on long term cost and quality of life implications, regarding provision of a suitable wheelchair versus a cheaper less suitable option is recommended.

The impact of health service variables on healthcare access in a low resourced urban setting in the Western Cape, South Africa

Background

Health care access is complex and multi-faceted and, as a basic right, equitable access and services should be available to all user groups.

Objectives

The aim of this article is to explore how service delivery impacts on access to healthcare for vulnerable groups in an urban primary health care setting in South Africa.

Methods

A descriptive qualitative study design was used. Data were collected through semi-structured interviews with purposively sampled participants and analysed through thematic content analysis.

Results

Service delivery factors are presented against five dimensions of access according to the ACCESS Framework. From a supplier perspective, the organisation of care in the study setting resulted in available, accessible, affordable and adequate services as measured against the District Health System policies and guidelines. However, service providers experienced significant barriers in provision of services, which impacted on the quality of care, resulting in poor client and provider satisfaction and ultimately compromising acceptability of service delivery. Although users found services to be accessible, the organisation of services presented them with challenges in the domains of availability, affordability and adequacy, resulting in unmet needs, low levels of satisfaction and loss of trust. These challenges fuelled perceptions of unacceptable services.

Conclusion

Well developed systems and organisation of services can create accessible, affordable and available primary healthcare services, but do not automatically translate into adequate and acceptable services. Focussing attention on how services are delivered might restore the balance between supply (services) and demand (user needs) and promote universal and equitable access.

Implementation of the principles of primary health care in a rural area of South Africa

Background

The philosophy of primary healthcare forms the basis of South Africa's health policy and provides guidance for healthcare service delivery in South Africa. Healthcare service provision in South Africa has shown improvement in the past five years. However, it is uncertain as to whether the changes have reached rural areas and if primary healthcare is implemented successfully in these areas.

Objectives

The aim of this article is to explore the extent to which the principles of primary healthcare are implemented in a remote, rural setting in South Africa.

Method

A descriptive, qualitative design was implemented. Data were collected through interviews and case studies with 36 purposively-sampled participants, then analysed through Interpretative Phenomenological Analysis.

Results

Findings indicated challenges with regard to client-centred care, provision of health promotion and rehabilitation, the way care was organised, the role of the doctor, health-worker attitudes, referral services and the management of complex conditions.

Conclusion

The principles of primary healthcare were not implemented successfully. The community was not involved in healthcare management, nor were users involved in their personal health management. The initiation of a community-health forum is recommended. Service providers, users and the community should identify and address the determinants of ill health in the community. Other recommendations include the training of service managers in the logistical management of ensuring a constant supply of drugs, using a Kombi-type vehicle to provide user transport for routine visits to secondary- and tertiary healthcare services and increasing the doctors’ hours.

Policy implementation in wheelchair service delivery in a rural South African setting

BACKGROUND

Wheelchairs allow users to realise basic human rights and improved quality of life. South African and international documents guide rehabilitation service delivery and thus the provision of wheelchairs. Evidence indicates that rehabilitation policy implementation gaps exist in rural South Africa.

OBJECTIVES

The aim of this article was to explore the extent to which wheelchair service delivery in a rural, remote area of South Africa was aligned with the South African National Guidelines on Provision of Assistive Devices, The United Nations Convention on the Rights of Persons with Disabilities and The World Health Organization Guidelines on Provision of Wheelchairs in Less-Resourced Settings.

METHOD

Qualitative methods were used. Data were collected through semi-structured interviews with 22 participants who were identified through purposive sampling. Content analysis of data was preformed around the construct of wheelchair service delivery.

RESULTS

Study findings identified gaps between the guiding documents and wheelchair service delivery. Areas where gaps were identified included service aspects such as referral, assessment, prescription, user and provider training, follow up, maintenance and repair as well as management aspects such as staff support, budget and monitoring. Positive findings related to individual assessments, enthusiastic and caring staff and the provision of wheelchairs at no cost.

CONCLUSION

The gaps in policy implementation can have a negative impact on users and the service provider. Inappropriate or no wheelchairs limit user function, participation and quality of life. In addition, an inappropriate wheelchair will have a shorter lifespan, requiring frequent repairs and replacements with cost implications for the service provider.

Rehabilitation Outcomes of Persons with Complete Paraplegia at a Private Rehabilitation Hospital

In order to overcome activity limitations, prevent secondarycomplications and early death and achieve community integration comprehensiverehabilitation post spinal cord injury (SCI), is essential. The aim ofthe study was to evaluate outcomes of patients with complete paraplegia whoreceived rehabilitation at a private rehabilitation hospital.A quantitative, descriptive methodology was implemented. All patientswith complete, traumatic, thoracic spinal cord injuries, admitted to the studyhospital in the study period, were consecutively sampled. Thirty five patientswere identified of whom16 adhered to the inclusion criteria. The FunctionalIndependence Measure (FIM ) and Needs Assessment Checklist (NAC) wereused as measuring instruments.The mean length of stay was 95 days. Discharge FIM motor scores ranged from 72 to 83 with a mean of 79.3. Themean gain in FIM motor score was 55 and varied from 45 to 61. Discharge NAC scores ranged from 264 to 340 with amean of 300 out of a possible 347. A correlation between length of stay and discharge FIM scores (p = 0.05) were found.Both NAC and FIM scores indicated high levels of physical independence. According to NAC scores patients wereeducated on the prevention of secondary complications and received psychological counselling. Discharge planningand community integration scored lower with means of 80% and 61% respectively. Community based completionof rehabilitation programmes, the incorporation of the NAC, or another participation outcome measure and implementationof on-going programme monitoring and assessment strategies is recommended.

Strain experienced by caregivers of stroke survivors in the Western Cape

Recovery  after  stroke  is  often  incomplete  and  many  stroke  survivors depend on family caregivers. The demands of caring can negatively impact quality  of  life  of  these  carers.  This  study  explores  levels  of strain experienced  by  caregivers  and  the  variables  that  impact  on their strain. A  concurrent,  mixed  method,  descriptive  design  was  utilized. Fifty-seven caregivers  of  stroke  survivors  who  received  rehabilitation at the  Western  Cape  Rehabilitation  Centre  participated  in  the  study.  The Barthel  Index  and Caregiver  Strain  Index  were  utilised  to  collect quantitative  data,  which  was statistically analysed (p <0.05). Qualitative data was collected through semi-structured interviews and thematically analysed.Fifty eight percent of caregivers were experiencing high levels of strain. The following variables significantly impacted on strain namely, caregiver loss of employment (0.04), emotional pressure (0.01), patient residual cognitive and perceptual impairments (0.01), personality changes (0.01) and physical dependency (0.0012).   According to the qualitative data the burden was aggravated by financial problems, patient perceptual problems and patient personality changes. The findings indicate the need for support after discharge, ongoing community support and respite care to enable time off for caregivers.