Browsing by Author "Van Zyl, Chanel"

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    Outlining a "low-resource setting" in the context of rehabilitation to facilitate health equity
    (Stellenbosch : Stellenbosch University, 2020-12) Van Zyl, Chanel; Hanekom, Susan D.; Heine, Martin, 1957-; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
    ENGLISH SUMMARY : Background: Global health systems are under constant pressure due to demographic transitions, epidemiological trends and limited resources. Access to rehabilitation, an acknowledged holistic intervention for anyone with a condition that limits their ability to function, appears most limited in health systems in resource-constrained settings. The resource constraints, specific to the setting, that limit access to and availability of rehabilitation, are unclear. A lack of understanding of what constitutes a “low-resource setting” may limit evidence synthesis, knowledge transfer, and rehabilitation program implementation. The aim of this thesis is to unravel the concept of “low-resource settings”, in the context of rehabilitation, to facilitate health equity. Methods: A systematic scoping review was undertaken to identify published articles in the field of rehabilitation medicine, that were conducted in a self-reported “low-resource setting”. Four electronic databases were accessed and searched from their inception to 24 June 2019: PubMed, Africa Wide, Web of Science and Scopus. Qualitative content analysis through an inductive approach, using in vivo and descriptive coding, was employed to analyse the data. Codes were grouped into content categories, guided by the use of a socio-ecological framework. These content categories were subsequently grouped to identify major themes relating to the term “low-resource setting” in the included studies. The findings informed the development of a case study, detailing the intersection of two methodological approaches to unravel a broad concept in existing, published literature. The case study aims to provide a detailed account and critical reflection on the methods used to answer the research question. Results: A total of 48 studies were included in the systematic scoping review. Following the qualitative content analysis, a total of 410 codes were grouped into 63 content categories, which helped identify nine major themes relating to the term ”low-resource setting” in the context of rehabilitation. These themes include (i) financial pressure, (ii) suboptimal healthcare service delivery, (iii) underdeveloped infrastructure, (iv) paucity of knowledge, (v) research challenges and considerations, (vi) restricted social resources, (vii) geographical and environmental factors, (viii) human resource limitations and (ix) the influence of beliefs and practices. Conclusion: Healthcare administrators, clinicians and researchers now have the opportunity to actively engage with the nine themes developed in this thesis when planning, designing and implementing rehabilitation interventions in “low-resource settings”. Moreover, these themes may provide a breeding ground for future research activities to support greater transparency (e.g. framework development) in reporting of research conducted in “low-resource settings”. Greater transparency may alleviate barriers in knowledge translation, across settings, and assist in reducing the unmet needs for rehabilitation, globally. Using qualitative content analysis as a means to unravel complicated constructs derived from a scoping review of existing literature, relative to the research inquiry, is a valuable intersection of methods that could be utilised more often.
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    Patient-reported outcome measures in key African languages to promote diversity in research and clinical practice (PROUD)—protocol for a systematic review of measurement properties
    (BMC (part of Springer Nature), 2021-06-05) Heine, Martin; Mokkink, Lidwine B.; Van Zyl, Chanel; Derman, Wayne; Hanekom, Susan
    Introduction: Sub-Saharan Africa is a subcontinent with a proud cultural richness and diversity, yet inexplicably also a region with severe health care challenges and inequity. To challenge this health equity gap and reduce the burden of disease, the patient’s voice in monitoring and evaluation of health and health care interventions is paramount. The aim of this two-phased review is to map the availability of patient-reported outcome measures (PROMs) in a selection of non-English, African Languages, and systematically evaluate the measurement properties of the PROMs that were identified. Methods: This systematic review will be conducted in two phases. In phase 1, we will scope the literature for patientreported outcome measures (PROMs), either developed from scratch or through translation and validation in a sub-Saharan African country and a selection of non-English, African languages (n = 31; spoken in > 10 million people and/or a national language). The availability of PROMs will be mapped against the previously reported burden of disease in the respective countries included. Subsequently, in phase 2, we systematically evaluate the measurement properties of these PROMs using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology for systematic reviews on PROMs. To ensure rigour, secondary searches will be developed to specifically locate articles that report on the measurement properties of the PROMs identified during phase 1. The evidence will be graded using the modified GRADE approach. Discussion: This review will provide a comprehensive overview and quality appraisal of PROMs developed in non-English, African languages. Consequently, this review when concluded may be an important first step in promoting access to these PROMs for use in clinical practice and research, as well as facilitate identification and prioritization of key knowledge gaps.