Browsing by Author "Visagie, Surona"
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- ItemThe achievement of community intergration and productivity outcomes by CVA survivors in the Western Cape Metro Health District(Occupational Therapy Association of South Africa, 2012-04) Hassan, Soelaylah A. M.; Visagie, Surona; Mji, GubelaIntroduction: According to the South African National Rehabilitation policy, achieving advanced outcomes such as community integration and productive activity, should be the focus of the rehabilitation services. However, according to the literature, rehabilitation does not often progress beyond basic outcomes such as mobility and self-care. The aim of this study was to describe the achievement of community integration and productive activity outcomes by a group of CVA survivors in the Western Cape Metro Health District. Methods: A descriptive study was carried out. Quantitative data were collected from 57 CVA survivors and caregivers. All these CVA survivors had received in-patient rehabilitation at the Western Cape Rehabilitation Centre (WCRC). Data were collected by means of a medical and demographic questionnaire, the Barthel Index and the Outcome Levels according to Landrum et al. Results: On discharge from in-patient rehabilitation seven (12%) stroke survivors were at level II ie they had achieved only the basic rehabilitation outcomes necessary to preserve long term physiological health, whereas 37 (65%) stroke survivors were discharged at an outcome level III ie ready for residential integration, and 12 (21%) were at level IV ie community integration, and one (2%) at level V (productive activity). Assessment at the time of the study showed a general improvement post discharge, with 21 participants (37%) improving by one or two outcome to achieve community integration and five (9%) achieving the outcome level of productive activity through informal income generating activities. Conclusion: Thirty three (58%) stroke survivors achieved community integration, while six (10%) progressed to employment. One would like to see further progress to employment especially for those participants who were employed before the stroke. Clinicians might be able to assist more stroke survivors to achieve this through using the outcome levels and incorporating the interventions to reach productive activity such as performing work and skills assessments, employer education and assistance with reasonable accommodations in rehabilitation goals.
- ItemCommunity integration of adults with disabilities post discharge from an in-patient rehabilitation unit in the Western Cape(AOSIS Publishing, 2017) Gretschel, Dietlind; Visagie, Surona; Inglis, GakeemahIntroduction: 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.
- ItemDisability and health care access in an isolated quarter of the Karoo(Stellenbosch : Stellenbosch University, 2015-04) Visagie, Surona; Swartz, Leslie; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Centre for Rehabilitation Studies.ENGLISH ABSTRACT: Introduction: High quality comprehensive health care services contribute to community integration and participation of persons with disability. However, persons with disabilities often experience barriers with regard to health care access. Neither these barriers nor the concept of disability have been sufficiently explored in rural Global South settings. This study describes the experience of living with a disability in a remote, rural setting with a specific focus on barriers and facilitators to health care access. Method: A qualitative design utilising case study methodology and interpretative phenomenological analysis was used. The study population consisted of 283 persons with moderate or severe activity limitations, who lived in a rural town in the Northern Cape Province of South Africa. Eight of them were purposively sampled as anchor participants in eight case studies. Their significant others completed each case study. In addition data were collected from six service providers to the study community. Data were collected through 19 in-depth interviews and one focus group discussion, between March and October 2012. The principles of interpretative phenomenological analysis were used to analyse data and identify themes. Similar themes were clustered under superordinate themes. Cases were analysed separately after which patterns across cases were identified. Results: Participants conceptualised disability as an individual problem according to the moral or medical approaches and often interpreted disability as physical in nature. Participants’ level of participation and community integration varied from very little to being employed and well integrated. Self-belief and the attitude and support of significant others, community members and employers played an important role in the level of participation persons with disability achieved. Participants’ primarily utilised public, formal, health care services. These services were found to be mainly curative and preventative in nature. The provision of health promotion and rehabilitation were lacking. Users were not empowered to take control of their own health management and were not included in the health care team. Health system barriers identified included insufficient human and material resources, communication challenges, Stellenbosch University https://scholar.sun.ac.za iv and rigid protocols. The remoteness of the setting hampered health care service delivery. Free health care provision, high quality services at tertiary level, and outreach services to the community were identified as facilitators. A lack of products and technology, poverty, and low levels of education created further barriers to community integration and health care access. Implications: Suboptimal health care together with personal and environmental barriers might have resulted in poor health, functional, community integration, and participation outcomes for participants. Health care was provided reactively to individual users and not according to the principles of primary health care. The little rehabilitation that was provided was not enough to ensure improved functioning or community integration and participation. Recommendations: Since this was an inductive study with few participants recommendations centre on hypotheses for further study. The focus of these theories is on ways to provide health care according to the philosophy of primary health care and on introducing specific rehabilitation programmes in the community.
- ItemEnvironmental factors influencing participation of stroke survivors in a Western Cape setting(AOSIS Publishing, 2015-10) Cawood, Judy; Visagie, SuronaBackground: 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.
- ItemAn exploration of burn survivors’ experiences of pressure garment therapy at a tertiary hospital in South Africa(Occupational Therapy Association of South Africa, 2017) Pillay, Rogini; Visagie, Surona; Mji, GubelaIntroduction: Pressure garment therapy is used to treat hypertrophic scars, but adherence to this intervention presents challenges. The aim of the paper was to explore the pressure garment therapy experiences of adult burn survivors. Methods: The experiences of eight purposively sampled participants were explored in a qualitative, phenomenological study. Data were collected by means of semi-structured interviews. Thematic analysis was conducted. Results: Participants described an improvement in the scars, but struggled with adherence to pressure garment therapy. The emotional impact of the burn injury, physical symptoms, the effort of caring for the garments and aesthetic factors created barriers to adherence. Support, inner strength, knowledge, and seeing an improvement facilitated adherence. Conclusion: The findings of the study show that participants perceived pressure garment therapy as beneficial, but several complex factors impacted adherence. A bigger choice in material colours, a person-centred approach to burn management, digital photos of scars to catalogue improvement and the establishment of a counselling network are recommended.
- ItemExploring the impact of wheelchair design on user function in a rural South African setting(AOSIS Publishing, 2015-06) Visagie, Surona; Duffield, Svenje; Unger, MariaanBackground: 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.
- ItemExploring the impact of wheelchair design on user function in a rural South African setting(AOSIS Publishing, 2015) Visagie, Surona; Duffield, Svenje; Unger, MariaanBackground: 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.
- 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.
- ItemExploring 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(AOSIS Publishing, 2017-02) Mji, Gubela; Braathen, Stine H.; Vergunst, Richard; Scheffler, Elsje; Kritzinger, Janis; Mannan, Hasheem; Schneider, Marguerite; Swartz, Leslie; Visagie, SuronaBackground: 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.
- ItemFactors related to environmental barriers experienced by persons with and without disabilities in diverse African settings(Public Library of Science, 2017-12) Visagie, Surona; Eide, Arne H.; Dyrstad, Karin; Mannan, Hasheem; Swartz, Leslie; Schneider, Marguerite; Mji, Gubela; Munthali, Alister; Khogali, Mustafa; Van Rooy, Gert; Hem, Karl-Gerhard; MacLachlan, MalcolmENGLISH ABSTRACT: 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.
- ItemThe impact of health service variables on healthcare access in a low resourced urban setting in the Western Cape, South Africa(AOSIS Publishing, 2015-06) Scheffler, Elsje; Visagie, Surona; Schneider, MargueriteBackground: 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 DistrictHealth 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.
- ItemImpact of post-stroke impairments on activities and participation as experienced by stroke survivors in a Western Cape setting(Occupational Therapy Association of South Africa, 2016) Cawood, Judy; Visagie, Surona; Mji, GubelaENGLISH SUMMARY : Introduction: This paper explores causal connections between impairments, activity limitations and participation restrictions after stroke. Methods: The study population (N=267) of this descriptive study were public health care users, from the eastern sub-district of the Western Cape Metropole, who had a stroke between 1 January 2009 and 31 December 2010. Fifty-three study participants were selected through stratified, proportional, random sampling. Data was collected using the Stroke Impact Scale-3.0; the Modified Barthel Index; the Loewenstein Occupational Therapy Cognitive Assessment and a language screening test. Spearman correlations were used to determine statistical significance. Results: The mean Stroke Impact Scale participation score was 31.3/100. Limb strength (<0.01), visual perception (<0.01), spatial perception (0.02), motor praxis (<0.01), visuomotor organisation (<0.01), and thinking operations (<0.01), impacted participation scores negatively. The mean Modified Barthel Index score was 70.58/100. Limb strength (<0.01), hand function (<0.01), visual perception (<0.01), motor praxis (<0.01), visuomotor organisation (<0.01), and thinking operations (<0.01) impacted Modified Barthel Index scores negatively. Conclusion: Motor, cognitive and perceptual impairments impacted activities and participation negatively. Stroke survivors should receive routine cognitive, perceptual and motor evaluations. The effect of intervention strategies on cognitive and perceptual impairment post-stroke must be studied.
- ItemImpact of structured wheelchair services on satisfaction and function of wheelchair users in Zimbabwe(AOSIS Publishing, 2016) Visagie, Surona; Mlambo, Tecla; Van der Veen, Judith; Nhunzvi, Clement; Tigere, Deborah; Scheffler, ElsjeENGLISH SUMMARY : 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.
- ItemImplementation of the principles of primary health care in a rural area of South Africa(AOSIS Publishing, 2014-02) Visagie, Surona; Schneider, MargueriteBackground: 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, healthworker 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.
- ItemIs any wheelchair better than no wheelchair? a Zimbabwean perspective(AOSIS Publishing, 2015-11) Visagie, Surona; Mlambo, Tecla; Van der Veen, Judith; Nhunzvi, Clement; Tigere, Deborah; Scheffler, ElsjeBackground: 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.
- 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.
- ItemPolicy implementation in wheelchair service delivery in a rural South African setting(AOSIS Publishing, 2013-09) Visagie, Surona; Scheffler, Elsje; Schneider, MargueriteBackground: 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.
- ItemThe prevalence of burnout amongst therapists working in private physical rehabilitation centers in South Africa : a descriptive study(Occupational Therapy Association of South Africa, 2014-08) Du Plessis, Theresa; Visagie, Surona; Mji, GubelaHealth care service providers are at risk of burnout due to the nature of their jobs and their personalities. No research has been published on the prevalence and causes of burnout in therapists working in physical rehabilitation units in South Africa. This study aimed to determine the prevalence of burnout and identify causes in therapists working in physical rehabilitation in South Africa. A descriptive, quantitative study was done. Study participants comprised 49 therapists (14 occupational therapists, 13 physiotherapists, 7 therapy assistants, 4 social workers, 1 dietician, 5 speech therapists and 5 psychologists) from six private rehabilitation units in South Africa. No sampling was done. The prevalence of burnout was established with the Maslach Burnout Inventory Manual (MBI). Demographic and employment data were gathered through a questionnaire. MBI scores were categorised as high, moderate or low on the subscales of emotional exhaustion, depersonalisation and decreased personal accomplishment. The maximum likelihood and chi-squared tests were used for statistical analysis. A p value of <0.05 was deemed statistically significant. The prevalence of burnout was high: 57.14% suffered from emotional exhaustion, 20.40% from depersonalisation and 38.77% from decreased personal accomplishment. Not having children (p = 0.029), poor coping skills (0.031), an overwhelming workload (0.039),and poor work environment (0.021) had a statistically significant relationship with emotional exhaustion. An overwhelming patient load (0.012), seldom achievable deadlines (0.036), postponing contact with patients (0.02) and poor work environment (0.04) had a statistically significant relationship with depersonalisation. Male gender (0.023), not having children (0.038), less than four years of tertiary education (0.036), low income levels (0.022), high administration load (0.003) and postponing contact with patients (0.011) had a statistically significant relationship with personal accomplishment. Ensuring on-going support emotional support and job satisfaction of therapists is important if an institution is to provide continuing quality rehabilitation services.
- 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.
- ItemThe rehabilitation programme and functional outcomes of persons with lower limb amputations at a primary level rehabilitation centre(Occupational Therapy Association of South Africa, 2013-12) Fredericks, Jerome P.; Visagie, SuronaThe study aimed to evaluate the amputation rehabilitation programme offered at an out-patient rehabilitation centre. Amputations have a severe physical, psychological and socio- economic impact. Effective rehabilitation can assist the individual in dealing with these. A quantitative, descriptive design was implemented. Thirty amputees who received rehabilitation and the therapists working at the centre participated in the study. An International classification of Function, Disability and Health based questionnaire, folder audit form and interview schedules were used for data collection. No programme vision, mission or objectives could be identified. Rehabilitation focused on impairment. The impact of prosthetic rehabilitation on in and outdoor activities requiring mobility was statistically significant, with p values ranging from 0.00069 to 0.037.`No indoor mobility training` had a negative impact on lifting and carrying objects (p 0.011), standing up (p = 0.042), getting around inside the house (p = 0.00023), picking up objects from the floor (p = 0.00068), getting up from the floor (p = 0.0072), getting out of the house (p = 0.0016) and moving around in the yard (0.0013). `Failure to address community mobility` had a statistically significant negative impact on all aspects of community mobility scores except transfers and driving. Recommendations include that a service vision and objectives be developed. In addition services should be evaluated and monitored on an ongoing basis and mentorship provided to therapists.