Masters Degrees (Centre for Disability and Rehabilitation Studies)

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Browsing Masters Degrees (Centre for Disability and Rehabilitation Studies) by browse.metadata.advisor "Mji, Gubela"

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    Access to primary care for persons with spinal cord injuries in the greater Gaborone, Botswana
    (Stellenbosch : Stellenbosch University, 2018-03) Paulus-Mokgachane, Thato Michael Moutie; Visagie, Surona; Mji, Gubela; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Centre for Rehabilitation Studies.
    ENGLISH SUMMARY : Introduction: People with SCI often have great need for health care services, but they report access challenges. Primary care access to people with SCI has not been explored in Botswana. Aim: This study aimed to identify barriers and facilitators that users with spinal cord injuries experience in accessing primary care services in the greater Gaborone. Methods: A quantitative, cross sectional, observational study was done. Data was collected with a structured questionnaire from 57 participants with traumatic and non-traumatic SCI. Descriptive analysis was done. Results: The male to female ratio was 2.8:1. The mean age of participants was 40 (SD 9.59). Road traffic accidents caused 85% of the injuries. Most participants visited primary care facilities between 2 to 10 times in the six months before the study. Participants were satisfied with the services (63%) and felt that facilities were clean (95%) and well maintained (73.5%). Preferential treatment, respect, short waiting times and convenient hours facilitated an acceptable and adequate service. Availability was hampered by insufficient provider knowledge on SCI as indicated by 71.9% of participants, and shortage of consumables (80.7%). Structural challenges (42.1% could not enter the facility by themselves and 56.5% could not use the bathroom) and lack of height adjustable examining couches (66.7%) impeded accessibility. Cost was incurred when participants (64.9%) utilised private health services where public services failed to address their needs. Conclusion: Primary care services were mostly affordable, acceptable and adequate. Availability and accessibility aspects created barriers.
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    An exploration and description of rural rehabilitation service model in the Mbhashe Municipality, Amathole district in the Eastern Cape Province of South Africa : a pilot study
    (Stellenbosch : Stellenbosch University, 2020-03) Gysman, Nozipiwo Joyce; Mji, Gubela; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
    ENGLISH SUMMARY : Background: People with disabilities are still disadvantaged in accessing health and rehabilitation services, especially those who reside in rural areas, despite the available policies. Rehabilitation is one of the components of Primary Health Care (PHC) but it remains excluded and poorly understood in PHC programmes. Despite available policies to address rehabilitation for people with disabilities (PWDs), PWDs still have difficulty accessing the rehabilitation services. Rehabilitation remains: •excluded and poorly understood in PHC programmes, •fragmented and uncoordinated with services inaccessible to some parts ofsociety especially in the rural context compared to urban counterparts, •dominated by the medical model and institutionalization of services, and •questionable in terms of relevance of services as there is less involvement,guidance and support from communities where these rehabilitation servicesare being provided. Aim of the study: To explore and describe rehabilitation services rendered in a rural setting of Mbashe municipality in the Eastern Cape Province in South Africa. Study objectives: To describe the rehabilitation and health services in the selected area; to identify the key role players for rehabilitation services in this area (both community-based and institution-based); to describe the rehabilitation pathways available within the health facilities and the community; to explore the challenges experienced by all role players delivering rehabilitation services in the study area; to determine the perceptions of people with disabilities with regards to the current model of rehabilitation in the study area; and, to make recommendations for addressing the challenges with regard to rehabilitation services in the study area and the existing rehabilitation model. Method: A qualitative exploratory and descriptive study design was implemented to describe the rural rehabilitation service model in the Mbashe Municipality in the Amathole District in the Eastern Cape Province of South Africa. Four areas out of nine (Gusi, Hobeni, Nkanya and Xhora) were conveniently selected in the study setting. In-depth interviews were conducted with Health Professionals from the District hospital (Madwaleni). Semi-structured interviews were conducted with the community representatives inclusive of, the Clinic Nurse Practitioner (one from each of the clinics in four selected areas); The Chief/Chieftain (one from each area in four selected areas); and a person with a disability, a representative of persons with disabilities. Focus group discussions (a group from each area) were conducted with persons with disabilities their families and their communities. Instruments used for developing interviewing schedules for data collection were based on Kaplan’s Framework of Organisational Capacity, (1999) and the Wheel of Opportunities (Lorenzo & Sait, 2000). These instruments were used interchangeable to address the objectives of the study. Qualitative methods of data analyses were applied whereby segments of data were broken down into manageable categories which were later grouped and subjected to content analysis to identify emerging themes. Findings: Themes that emerged from interviews conducted with health professionals, communities and focus group discussions with persons with disabilities revealed that the current model of rehabilitation was institution-based. Participants in rehabilitation services, though aware of available health and rehabilitation services, experienced their main challenge in gaining access to these services. One of the main challenges was related to transport to gain access to health and rehabilitation services. Home visits were not part of the rehabilitation services and this limited rehabilitation professionals in understanding about home and cultural situations of their patients. Rehabilitation goals were not fully met with one of the highest goals of rehabilitation – which is community participation – was not met by persons with disabilities in their rehabilitation process. Conclusion: The study findings indicated a need for the development of a rehabilitation model that will be accessible and will provide an opportunity for participation as well as integration of persons with disabilities with their families as well as their communities. Community-based rehabilitation was seen as a suitable rehabilitation service model for this rural community.
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    An exploration of work-related stress and support structures experienced by occupational therapists working at a physical rehabilitation unit
    (Stellenbosch : Stellenbosch University, 2016-03) Clarke, Jennifer; Visagie, Surona; Mji, Gubela; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Centre for Rehabilitation Studies.
    ENGLISH ABSTRACT: Introduction: Work-related stress is experienced in most working environments but can be particularly high in health-care environments. Support structures can help to alleviate the burden of work-related stress, but whether or not these structures are in place and adequate needs exploration. Aim: To explore and describe the work-related stress experienced by occupational therapists working at a physical rehabilitation unit and to determine whether the current support structures are addressing the work-related stress that they experience. Methods: This study was qualitative in nature. A phenomenological approach was used. Seven occupational therapists employed at the study setting were interviewed using semi-structured methods. Data was collected, transcribed and analysed by the researcher, and themes and sub-themes were extracted. Findings: All of the participants were experiencing quite high levels of work-related stress, mainly due to the nature of the work environment and challenges related to management and supervision. Other causes of stress were problems related to caseload, the role of the occupational therapist (OT) in the team, issues related to their colleagues and qualitative versus quantitative care delivery. The study also revealed that the participants were not satisfied with the support structures that were in place and had recommendations as to how the support structures could be improved to reduce work-related stress. Conclusion: The findings of the study confirmed the need for more effective support structures. Participants were quite vocal about the amount of stress and the lack of support they were experiencing – to the extent that they had to find alternative means of support. It was felt that management should show more awareness through acknowledging the therapists’ experiences, and that the organisation should put better support structures in place. Recommendations: Individual counselling, team building and group therapy sessions were recommended, as was decreasing the extent of responsibilities over-and-above the core job requirements or having smaller caseloads or more staff. Stellenbosch University https://scholar.sun.ac.za iv Among the many suggestions regarding managerial improvements were that managers should be more aware of the staff, help with the patients and be more empathetic. Improved communications through all levels of the Centre and a more representative measure of performance was also suggested.
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    Exploring barriers and facilitators to return to work for clients with spinal cord injuries, in Cape Town, South Africa
    (Stellenbosch : Stellenbosch University, 2018-03) Ngemntu, Sharon Nokuzola; Mji, Gubela; Ned, Lieketseng; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Centre for Rehabilitation Studies.
    ENGLISH SUMMARY : Background: Spinal cord injury is a catastrophic event, characterised with loss of function below the level of the lesion and increased dependence on family and societal support. The researcher has been working as an Occupational Therapist in a centre for physical rehabilitation of clients with physical impairments, including those with spinal cord injuries, for more than five years. She has observed that only a small percentage of clients with spinal cord injuries that have completed their rehabilitation programme were able to go back to work after the injury. After examining statistics of the clients seen in the period January-December 2001, when working at a local tertiary Hospital’s Work Assessment Unit in February 2014, the researcher was then further motivated to explore barriers and facilitators to return to work for clients with spinal cord injuries. Hence the aim of this study is to explore barriers and facilitators to return to work for clients with spinal cord injuries. Method: A qualitative study design was implemented to explore views of clients, managers/supervisors of clients with spinal cord injuries and rehabilitation professionals with regard to barriers and facilitators to return to work of clients with spinal cord injuries. Semi-structured interviews were conducted with 13 participants, including clients with spinal cord injuries, a manager of one of the persons with disabilities participating in the study, and Occupational Therapists involved in physical rehabilitation (including rehabilitation of persons with spinal cord injuries) or vocational rehabilitation (work assessment or return to work). Interview schedules were used to conduct interviews, which were recorded and later analysed thematically. Results: The findings highlighted return-to-work barriers related to inaccessible and non-supportive environment, the employers’ attitudes, injury-related issues, the challenging job demands of the previous work as well as transport issues. The facilitators indicated were provision of assistance and support (received from family, friends, church and work); the role of rehabilitation and rehabilitation team members and other role players as well as the necessity of reasonable accommodation in successfully reintegrating persons with spinal cord injuries. Triangulation was done and two common themes emerged amongst the three groups of participants (clients with spinal cord injuries, Occupational Therapists and the Manager) and these indicated the support received by persons with spinal cord injuries and the process of reasonable accommodation which facilitated integration to work. Conclusion: The study findings indicated a need for support for persons with spinal cord injuries, making sure the environment is accessible or conducive for return to work, putting reasonable accommodation measures in place and involvement of all stake holders in the successful reintegration of persons with spinal cord injury to work. These measures could assist all stake holders involved in understanding the needs of persons with spinal cord injury, the responsibility of each of the stakeholders and knowledge about available resources in fostering a smooth transition back to work for spinal cord injury clients.
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    Suitability of ‘Guidelines for screening of prosthetic candidates: lower limb’ for Eastern Cape
    (Stellenbosch : Stellenbosch University, 2017-03) Mduzana, Luphiwo Lakhanya; Visagie, Surona; Mji, Gubela; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
    ENGLISH SUMMARY : Background: Major lower limb amputation has a severe impact on functional mobility. While mobility can be salvaged with a prosthesis, it is not always the most optimal choice. It is often difficult to decide whether to refer someone for a prosthesis. An evidence-based prosthetic screening tool ‘Guidelines for Screening of Prosthetic Candidates: Lower Limb’ is used for prosthetic prescription in the Western Cape Province of South Africa. Objectives: The 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 (n=10), physiotherapists (n=12) and medical orthotists/prosthetists (n=6) in government employment in the Buffalo City Metro Municipality. Participants were trained to use the tool and then used it for four weeks. Their experiences of the tool were assessed through three focus group discussions. Emergent themes were identified during analysis. Findings: Participants indicated that the tool could assist with prosthetic prescription, goal setting, communication and teamwork. They thought the tool was multidisciplinary in nature, comprehensive and practical. Findings showed challenges with regard to teamwork in the study setting. Resistance to change and a lack of time might hamper implementation of the tool. Participants suggested a longer test period, with structured feedback sessions, and supported by hospital management. Conclusion: The tool can assist with managing the backlog for prostheses and to guiding prosthetic prescription in the Eastern Cape Province.