Research Articles (Centre for Disability and Rehabilitation Studies)
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- ItemThe lived experiences of caregivers of stroke survivors in a rural Western Cape Setting(Stellenbosch : Stellenbosch University, 2023-03) Fisher, Mylcka Jade; Visagie, Surona; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.ENGLISH SUMMARY: Introduction: Caregivers play a pivotal role in the community re-integration of stroke survivors. However, they face challenges that they are not always prepared for. This might leave them feeling anxious and uncertain about fulfilling the caregiving role. Caregivers’ emotional, physical, and mental well-being might be affected by the caregiving duties. Few studies have explored caregiver lived experiences specifically and none could be identified that was done in a rural South African setting. Purpose: The aim of the study was to explore the lived experiences of caregivers of stroke survivors discharged from Ceres Hospital, in the Witzenberg sub-district. Methods: A qualitative descriptive phenomenological design underpinned by constructivism was adopted. A pilot study was conducted to practice my interview skills, test the appropriateness of the data collection tool as well as the logistics of the interview. Data was collected by means of face to face, individual interviews with a sample of 5 participants. The interviews were recorded and transcribed verbatim. Inductive thematic analysis guidelines were used. Main findings: Four themes were identified; 1) “It is my duty”. Participants felt obligated to care because of the relationship they had with the stroke survivor. 2) “I don’t make things difficult for him”. Participants neglected their own needs and interests and prioritized their caregiving duties and the needs of the stroke survivor. 3) “God gave me the strength”. Participants found their faith to be a foundation from which they drew strength and 4) “They showed me nothing”. Participants reported anxiety in the initial stages of caring and did not utilize or acknowledge the information provided by healthcare workers. Conclusions: Caregivers find it difficult to adapt to caring for a loved one and are not always equipped with coping strategies. Relationship-specific changes should be considered during stroke rehabilitation and the necessary support should be provided by healthcare workers. Conclusions: Caregivers find it difficult to adapt to caring for a loved one and are not always equipped with coping strategies. Relationship-specific changes should be considered during stroke rehabilitation and the necessary support should be provided by healthcare workers.
- ItemCommunity-based rehabilitation workers’ perspectives of wheelchair provision in Uganda : a qualitative study(AOSIS Publishing, 2019-04-24) Seymour, Nikola; Geiger, Martha; Scheffler, ElsjeBackground: The challenges of wheelchair provision and use in less resourced settings are the focus of global efforts to enhance wheelchair service delivery. The shortage of professional wheelchair service providers in these settings necessitates the collaboration of multiple stakeholders, including community-based rehabilitation (CBR) workers, whose role needs to be further understood. Objectives: The aim of this study was to determine what CBR workers in three areas of Uganda perceived as (1) the challenges with wheelchair provision and use, (2) the factors contributing to these challenges, (3) the role they themselves can potentially play and (4) what facilitators they need to achieve this. Method: This qualitative study in the transformative paradigm comprised focus group discussions to gather perceptions from 21 CBR workers in three areas of Uganda, each with an operational wheelchair service, participant observations and field notes. Thematic analysis of data was implemented. Results: Community-based rehabilitation workers’ perceptions of challenges were similar while perceived causes of challenges differed as influenced by location, historical and current wheelchair availability and the CBR workers’ roles. Their main responsibilities included assistance in overcoming barriers to access the service, transfer of skills and knowledge related to wheelchairs, follow-up of users for wheelchair-related problem-solving, and user and community empowerment. Conclusion: Community-based rehabilitation workers can contribute in various ways to wheelchair service delivery and inclusion of wheelchair users; however, their capabilities are not consistently applied. Considering the diversity of contextual challenges, CBR workers’ range of responsive approaches, knowledge of networks and ability to work in the community make their input valuable. However, to optimise their contribution, specific planning for their training and financial needs and effective engagement in the wheelchair services delivery system are essential.
- ItemParental experiences on the role of wheelchairs in the lives of their children with mobility impairments : a qualitative exploration in Dubai(Taylor and Francis, 2020-06) Liebenberg, Anjanet; Geiger, Martha; Visagie, SuronaPurpose: To explore parental experiences on the role of wheelchairs in the lives of their children with mobility impairments in Dubai. Methods: Seven participants were recruited through purposive sampling and their experiences were explored by conducting semi-structured interviews. The audio recordings were transcribed and thematically analysed. Results: The findings showed that wheelchairs were an essential part of the children`s lives, which enabled their participation in the home, the school and the community. Procurement processes were difficult owing to a lack of assessment and prescription processes as well as insurance companies providing little assistance with payment. The participants described Dubai as a wheelchair friendly city and two overarching themes emerged; firstly, The wheelchair: “It is her life”, and, secondly, Participation: Isolation versus inclusion. Conclusion: The study is the first of its kind in Dubai and indicated that the wheelchair played an important role in the children’s lives and allowed participation in life roles that brought joy and fulfilment. Without wheelchairs, children would be isolated and frustrated. However, some of the participants were not satisfied with their child’s current wheelchair and felt the chair was not appropriate. Recommendations to specific stakeholders included: the development of policies to guide wheelchair service provision by government. In addition, insurance providers could collaborate with the government to adhere to the policy to ensure healthy lives and promote well-being for all. IMPLICATIONS FOR REHABILITATION: The wheelchair provided children the mobility to participate in life roles instead of being isolated. Not all children had appropriate wheelchairs. Service providers and medical insurance did not give sufficient support during wheelchair selection and procurement.
- ItemA 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(Taylor and Francis, 2020-06) Hall, Rehan; Visagie, SuronaPurpose 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 REHABILITATION: The 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.
- ItemExploring the inclusion of teaching and learning on assistive products in undergraduate curricula of health sciences faculties at three South African Universities(Taylor and Francis, 2019-12) Visagie, Surona; Mji, Gubela; Scheffler, Elsje; Ohajunwa, Chioma; Seymour, NickyBackground: 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 rehabilitation: Undergraduate 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.