A participatory evaluation of community-based rehabilitation programme in North Central Vietnam

Information needs of informal caregivers in caring and rehabilitation for dioxin victims in Vietnam

BACKGROUND

Health outcomes among Agent Orange/dioxin (dioxin) victims are significant due to many individuals requiring daily assistance, informal care, and rehabilitation support. This study aimed to identify the information needs of informal caregivers of dioxin victims in Vietnam.

METHODS

A cross-sectional study was conducted in Quynh Phu district, Thai Binh province - an area with a large number of dioxin victims, from June 2019 to June 2020. Quantitative data were collected from 124 caregivers of victims via structured interviews. Qualitative data were collected using semi-structured interview guides with in-depth interviews (IDI) (n = 36) and two focus group discussions (FGD) (n = 12).

RESULTS

The results demonstrated that all caregivers of dioxin victims were family members, predominantly older (71.8%), 61.5 years old on average, living on low incomes (87.9%), and were farmers (80.7%). Almost all participants (96.8%) reported having information needs, particularly concerning dioxin's harms, nutrition, dioxin-related policies and rehabilitation, and psychological support for patients. Caregivers reported that they would like to receive information via health staff counselling (85.0%), television (75.0%), and community loudspeaker (65.8%). Notably, the majority of caregivers reported the need for information regarding psychological support (70.0%). These findings are consistent with qualitative data, which identify an urgent need to provide information, especially through health staff and digital resources.

CONCLUSION

Many families with dioxin victims lived with little support and information, highlighting their high demand for information about care and rehabilitation. Thus, the healthcare system should promote information support, policy, and psychological support for caregivers and victims. An online support system for caregivers and victims is also recommended.

Validation of two scales for measuring participation and perceived stigma in Chinese community-based rehabilitation programs

BACKGROUND

The World Health Organization has asserted the importance of enhancing participation of people with disabilities within the International Classification of Functioning, Disability and Health framework. Participation is regarded as a vital outcome in community-based rehabilitation. The actualization of the right to participate is limited by social stigma and discrimination. To date, there is no validated instrument for use in Chinese communities to measure participation restriction or self-perceived stigma. This study aimed to translate and validate the Participation Scale and the Explanatory Model Interview Catalogue (EMIC) Stigma Scale for use in Chinese communities with people with physical disabilities.

METHODS

The Chinese versions of the Participation Scale and the EMIC stigma scale were administered to 264 adults with physical disabilities. The two scales were examined separately. The reliability analysis was studied in conjunction with the construct validity. Reliability analysis was conducted to assess the internal consistency and item-total correlation. Exploratory factor analysis was conducted to investigate the latent patterns of relationships among variables. A Rasch model analysis was conducted to test the dimensionality, internal validity, item hierarchy, and scoring category structure of the two scales.

RESULTS

Both the Participation Scale and the EMIC stigma scale were confirmed to have good internal consistency and high item-total correlation. Exploratory factor analysis revealed the factor structure of the two scales, which demonstrated the fitting of a pattern of variables within the studied construct. The Participation Scale was found to be multidimensional, whereas the EMIC stigma scale was confirmed to be unidimensional. The item hierarchies of the Participation Scale and the EMIC stigma scale were discussed and were regarded as compatible with the cultural characteristics of Chinese communities.

CONCLUSION

The Chinese versions of the Participation Scale and the EMIC stigma scale were thoroughly tested in this study to demonstrate their robustness and feasibility in measuring the participation restriction and perceived stigma of people with physical disabilities in Chinese communities. This is crucial as it provides valid measurements to enable comprehensive understanding and assessment of the participation and stigma among people with physical disabilities in Chinese communities.

Exploring the emerging profession of speech-language pathology in Vietnam through pioneering eyes

PURPOSE

In September 2012, 18 Vietnamese health professionals graduated as Vietnam's first university qualified speech-language pathologists (SLPs). This study details the reflections of these pioneering health professionals at 12 months following their graduation, drawing attention to their scope of practice as SLPs and to the opportunities and challenges to progressing the practice of speech-language pathology (SLP) in Vietnam.

METHOD

Thirteen graduates participated in small group interviews where they described their work and their perceptions of their emerging practice. Thematic analysis of the interview transcripts was employed to identify key concepts and themes within the data.

RESULT

Four overarching themes were identified-scope of practice, establishing identity, confidence to practise and progressing the profession. Overall analysis revealed evolving professional practice characterised by new learning, fluctuations in confidence and an active forging of professional identity. Mentoring and support by international colleagues and advancing professional recognition were identified as critical to the profession's progression and to the development of context-specific and culturally appropriate services.

CONCLUSION

Participants' reflections draw focus to an important role for the international SLP community as it works in partnership with colleagues to enhance awareness of and services for people with communication disabilities in under-served communities such as Vietnam.

The effectiveness of community-based rehabilitation programmes: an impact evaluation of a quasi-randomised trial

BACKGROUND

Community-based rehabilitation (CBR) programmes have been described as highly effective means of promoting the rights and opportunities of persons with disabilities (PwD). Although CBR is often the main way in which PwD in low-income and middle-income countries access rehabilitation services, there is little literature providing rigorous evaluation of their impact on people's well-being.

METHODS

Data were collected in the Mandya and Ramanagar districts (Karnataka state, India), between December 2009 and May 2010. In total 2540 PwD were interviewed using stratified random sampling: 1919 CBR beneficiaries (who joined the programme between 1997 and 2009) and 621 persons who were living in villages not covered by the programme. We controlled for the systematic differences between people joining and not joining the programme using the propensity score matching method controlling for covariates at individual and village level. We evaluated the impact of the programme on the subgroups of PwD who are disadvantaged on the dimensions of interest: access to pensions, use of aid appliances, access to paid jobs and improvement in personal-practical autonomy after 4 and 7 years of joining the CBR.

RESULTS

We observed a positive and significant impact of the programme on access to services, rights and opportunities of PwD. The results indicate that compared with the control group access to pensions and allowances, aid appliances, access to paid jobs and personal-practical autonomy increased by 29.7%, 9.4%, 12.3% and 36.2%, respectively, after 7 years.

CONCLUSIONS

The CBR programme analysed has a positive impact on access to services and the well-being of PwD who are particularly deprived on outcomes of interest.

Community-based rehabilitation (CBR) monitoring and evaluation methods and tools: a literature review

PURPOSE

To identify and analyse tools and methods that have been reported in the literature for the monitoring and evaluation of community-based rehabilitation (CBR) programmes.

METHOD

A literature review and descriptive analysis were carried out to scope CBR monitoring and evaluation methods and tools. A search was conducted using PubMed and Google Scholar databases, hand searches and reference lists. Reports were retrieved, screened and information was extracted and analysed against research questions.

RESULTS

There were 34 reports which met the inclusion criteria. Analysis of the 34 reports showed that most reports used demographic and programme data. A range of methods were used: interviews, focus groups and questionnaires being the most common. Apart from this, no common standardised procedures or tools were identified and there was not a standard approach to the inclusion of people with disabilities or other CBR stakeholders.

CONCLUSIONS

The findings suggest that there would be value in creating resources such as guidelines, common processes and checklists for monitoring and evaluation of CBR, to facilitate efficient and comparable practices and more comparable data. This needs to be done in partnership with people with disabilities, CBR providers, partners and researchers to ensure that all stakeholders' needs are understood and met. Implications for Rehabilitation While there is broad scope and complexity of CBR programmes, there needs to be consistency and a valid approach in the monitoring and evaluation methods and tools used by CBR programmes. The principles of CBR and CRPD require that monitoring and evaluation involve people with disabilities, CBR managers and staff not only as informants but also in the design and execution of monitoring and evaluation activities. The consistent use of appropriate and valid monitoring and evaluation methods and tools will contribute to developing a stronger evidence base on the efficacy and effectiveness of CBR.

A SWOT analysis of the physiotherapy profession in Kuwait

BACKGROUND AND PURPOSE

Since the end of the Gulf War in 1991, Kuwait has become one of the wealthiest countries in the world and one that has a highly socialized health-care system. This rapid growth and socio-economic development appears to have had a negative impact on the health of its people. As such, the profession of physiotherapy may be in a unique position to address this issue by providing health behaviour interventions and promoting healthy lifestyles. The purpose of this study was to explore the current state of physiotherapy in Kuwait and provide recommendations for future development and growth.

METHOD

Using a qualitative research approach, we conducted 17 key informant interviews (clinicians, administrators and other key stakeholders) in Kuwait. The strengths, weaknesses, opportunities and threats framework was then used to categorize the emerging themes and provide a basis for a strategic direction for the profession.

RESULTS

Informants reported that strengths included funding for services and motivation of professionals. Weaknesses included education and professional resources, marketing/advocacy, standardization and regulation of practice. Opportunities discussed were untapped demand for physiotherapy services, internal development and evolution of the physiotherapy association, along with professional collaboration. Threats addressed included low public awareness of physiotherapy, challenges with inter-professional practice/communication, and cultural perspectives of healthy lifestyles.

CONCLUSIONS

Our research indicates that many unique opportunities exist for physiotherapists in Kuwait. Further development and evolution of Kuwait's physiotherapy professional association could facilitate efforts to advocate for the profession, initiate standards of practice and provide enhanced opportunities for professional collaboration.

Community-based rehabilitation programme as a model for task-shifting

This article explores some of the implications of a non-governmental organisation (NGO) initiated community-based rehabilitation (CBR) programme, for HIV-related task-shifting programmes which have been recommended by the World Health Organisation (WHO) as an important aspect of HIV prevention, treatment and care programmes. The CBR programme is run by multi-skilled community rehabilitation facilitators (CRFs) in a low income, rural context in KwaZulu-Natal, South Africa, and explicitly recognises the multiple facets of disability. As such, the programme focuses on both the physical and social aspects of living with disabilities. A qualitative approach was used to conduct this study, and semi-structured interviews were conducted with beneficiaries of the programme (n = 35), home and community-based care givers (HCBCs) (n = 13), and managers (n = 2). A focus group discussion was conducted with CRFs (n = 5). We found that the CBR programme successfully delivered rehabilitation services at a community level and that multi-skilled CRFs are an effective means of implementing CBR programmes in low-income rural areas. The developmental focus of the programme created a range of benefits for people with disabilities, including: physical rehabilitation, emotional support and counselling, access to grants, social inclusion and accessing assistive devices. Central to the programme's success was the maintenance of relationships and partnerships at different levels in the community, these included relationships between HCBCs and CRFs, between CRFs and therapists, and between the NGO and the various participants in the programme. However, the NGO struggled to maintain a partnership with the relevant government departments and this had important implications for the programmes sustainability. In conclusion, we argue that this programme's use of multi-skilled mid-level workers who have undergone effective training programmes in CBR demonstrates that a wide range of rehabilitation activities can be effectively undertaken at a community level, and that this programme provides an important example of how the WHO's task-shifting guidelines for HIV treatment, care and prevention can be implemented.

Essential actions for caterers to promote healthy eating out among European consumers: results from a participatory stakeholder analysis in the HECTOR project

OBJECTIVE

To identify and assess actions by which the catering sector could be engaged in strategies for healthier eating out in Europe.

DESIGN

A SWOT analysis was used to assess the participation of the catering sector in actions for healthier eating out. Caterers subsequently shortlisted essential actions to overcome threats and weaknesses the sector may face when engaging in implementing these actions.

SETTING

Analysis undertaken in the European Union-supported HECTOR project on 'Eating Out: Habits, Determinants and Recommendations for Consumers and the European Catering Sector'.

SUBJECTS

Thirty-eight participants from sixteen European countries reflecting a broad multi-stakeholder panel on eating out in Europe.

RESULTS

The catering sector possesses strengths that allow direct involvement in health promotion strategies and could well capitalise on the opportunities offered. A focus on healthy eating may necessitate business re-orientations. The sector was perceived as being relatively weak in terms of its dependency on the supply of ingredients and lack of financial means, technical capacity, know-how and human resources. To foster participation in strategies for healthier eating out, caterers noted that guidelines should be simple, food-based and tailored to local culture. The focus could be on seasonal foods, traditional options and alternative dishes rather than just on 'healthy eating'. Small-to-medium-sized enterprises have specific concerns and needs that should be considered in the implementation of such strategies.

CONCLUSIONS

The study highlights a number of possible policy actions that could be instrumental in improving dietary intake in Europe through healthier eating out.

The impact of community based rehabilitation as implemented by community rehabilitation facilitators on people with disabilities, their families and communities within South Africa

PURPOSE

To find out the impact of community based rehabilitation (CBR) as implemented by mid-level rehabilitation workers known as community rehabilitation facilitators (CRFs) on people with disabilities (PWD), their families and the communities in South Africa.

METHOD

A qualitative research design was used with an emphasis on participatory methods with PWD and their family members. Data collection took the form of individual interviews, focus groups and transects walks in both urban and rural settings within six provinces of South Africa.

RESULTS

Although CRFs work with individuals, groups, families and the community, they appear to have had a stronger impact on individuals with disabilities rather than the community at large. Various gaps were also identified and were related to the poor recognition of the scope of practice of CRFs as well as to individual CRFs abilities to carry out certain tasks.

CONCLUSIONS

Although the results suggest that CRFs have had a positive impact, there are still a number of issues that need to be addressed. These include proper support of CRFs and intersectoral collaboration between government departments to ensure the future of CBR in South Africa.

The evidence base for community-based rehabilitation: a literature review

Literature on community-based rehabilitation (CBR) published between 1978 and 2002 is reviewed to assess the evidence base for CBR. There were 128 articles found that met the criteria set by the authors. The articles have been classified according to the methodology used and the key aspects studied. The review showed an ever-increasing number of publications on CBR. Theory papers and descriptive studies are the most common types of papers in CBR literature. Intervention studies and case reports are relatively rare. No systematic review has yet been carried out although reviews on specific aspects of CBR have become available. The key aspects of 'implementation' and 'stakeholders' are relatively well presented but the numbers of articles on 'participation' and 'use of local resources' are noticeably low. This study reveals that there is no real focus of research in CBR and therefore the evidence base for CBR is fragmented and incoherent on almost all aspects of CBR. It is recommended that comprehensive review studies should be carried out on key aspects of CBR projects. This should be supported by systematic research in CBR projects in order to establish evidence-based practices.

Viable methods for evaluation of community-based rehabilitation programmes

PURPOSE

The purpose of this article is to discuss some viable and practically feasible methods for evaluation of community-based rehabilitation (CBR) programmes in developing country settings.

METHOD

Based on review of literature the role of qualitative approaches for evaluation of CBR programmes are analysed.

RESULTS

Aspects of the qualitative paradigm are discussed. The specific qualitative methods of case studies, focus groups, nominal groups, participatory techniques, content analysis, and key informant interviews are deliberated.

CONCLUSIONS

Viable alternatives to the qualitative paradigm offer promise in evaluation of CBR programmes. Issues in qualitative designing, sampling, data collection, analysis, and interpretation are discussed. The classical, quantitative paradigm needs to be complemented with viable qualitative methods for evaluation of CBR programmes.

Reflect before you act: providing structure to the evaluation of rehabilitation programmes

PURPOSE

This paper is concerned with understanding and evaluating potentially diverse rehabilitation programmes. It helps evaluators and programme managers to focus attention on specific aspects of the rehabilitation process and select evaluation questions relevant to each.

METHOD

Distinction is made between the rehabilitation programme itself, the programme environment and the relationships between the two. For each of these areas, evaluation questions have been formulated. For services offered to individual clients, questions address whether the status of clients has improved, what interventions are offered and who benefit from them, the relationships between the service providers and the clients, and who may be involved in the rehabilitation process besides the client. To assess the programme environment, questions address the epidemiology of disability, the resources available to persons with disabilities, the inclusiveness of education and employment and a number of eco-social variables. Relationships between the programme and its environment concern the support of the community for the programme, the way the programme seeks to influence the community, the referral of clients to other services available in the community and the extent to which the programme is a learning organization.

RESULTS

Lists of evaluation questions are presented from which the evaluator can select those most relevant to the programme to be evaluated. This provides a framework for the evaluation and for the information to be gathered. Rather than providing a blue print, this framework permits flexibility to adapt to the specific situation of the programme to be evaluated.

CONCLUSION

This paper presents a useful guideline that stimulates the thinking of those preparing for the evaluation of rehabilitation programmes.