Masters Degrees (Centre for Disability and Rehabilitation Studies)
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- ItemThe role of wheelchair basketball in enhancing re-integration of people with spinal cord injuries into the community(Stellenbosch : Stellenbosch University, 2024-03) Thobela, Nothemba Siphosakhe; Ned, Lieketseng; Derman, Wayne; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.ENGLISH SUMMARY: Introduction: Participation of people with spinal cord injury in wheelchair basketball has the potential to enhance re-integration back into their community. This can be done by eliminating personal barriers such as, development of secondary complications and improving physical independence, lack of psychosocial and peer support and poor self-confidence and self-esteem associated with self-isolation in people with a spinal cord injury. However, challenges such as lack of access to spinal cord injury rehabilitation facilities, poor access to recreational facilities and resources and poor family support during early rehabilitation continue to hinder their participation. Aim: This study explored the o explore the role wheelchair basketball plays to support community re-integration of people with SCI into their community within the Western Cape Province. Methods: A qualitative, ethnographic design was used to gather in-depth information of lived experiences of wheelchair basketball players with spinal cord injury. There was one local wheelchair basketball club that was actively running and from that club, eighteen participants were identified as eligible for the study. Of the eighteen participants, only five met the criteria of the study, and only five agreed to participate in the full study. The fifth participant withdrew from the study before data collection could commence. Two community integration questionnaires, one subjective and one objective, were completed by the four included participants followed by a semi-structured interview using an interview guide. The questionnaires were scored, and the interviews transcribed in verbatim. Thematic analysis was used to analyse all data. Findings: The data showed that participants expressed that they integrated more into their community when they participated in a wheelchair basketball team. Three themes with sub-themes were identified and included: Theme 1: Improved functional independence. Theme 2: Improved inclusivity and socialization Theme 3: Improved self-esteem and self-confidence Conclusion: The participants experiences provided knowledge on how participating in wheelchair basketball can be used as a medium to bridge the gap between rehabilitation and successful and sustainable community re-integration for those with a spinal cord injury. Wheelchair basketball has the potential to address multiple challenges experienced by those with a spinal cord injury. Unfortunately, the sport itself is under supported by local and national government, local wheelchair basketball clubs are under-resourced and do not have the finances to successfully implement and run multiple clubs or have the platform to create awareness and promote engagement in the clubs. The recommendations propose ideas where the department of health and the department of sports and recreation can improve participation opportunities by providing resources such as safe venues, transportation, and basic equipment to the wheelchair basketball clubs that would make the sport more accessible. This could provide opportunities for awareness, growth, and sustainability of the sport, which could furthermore encourage increased participation. They could also support health and rehabilitation facilities to better create awareness and opportunities to introduce wheelchair basketball and that could be translated to integration as a part of the rehabilitation process.
- ItemWheelchair users’ experiences of access to healthcare in Western Cape Province, South Africa(Stellenbosch : Stellenbosch University, 2024-03) Abrahams, Shaunelia Heidi; Visagie, Surona; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.ENGLISH SUMMARY: Background: Individuals with physical impairments who rely on wheelchairs often face significant difficulties when it comes to accessing healthcare services. There has been limited investigation into the accessibility of healthcare for individuals who use wheelchairs in the Western Cape Province of South Africa. Aim: The focus of this study was to investigate the barriers and facilitators wheelchair user's experience when accessing healthcare facilities in the Western Cape Province of South Africa. Method: An investigation was carried out using a qualitative descriptive study design to explore healthcare access for wheelchair users through the use of the ACCESS Framework. Information was gathered through semi-structured interviews done virtually, telephonically or in-person from a group of 12 individuals who reside across 3 districts in the Western-Cape. An analysis was conducted using thematic methods. Findings: The study revealed that individuals who use wheelchairs encounter various barriers and facilitators when trying to access healthcare services in their local areas. Themes were identified using the ACCESS framework: availability, accessibility, affordability, adequacy, and acceptability. Various obstacles were found, including challenges with travel, steep ramps, inadequate toilets, inefficient patient care, operational system shortcomings, higher out-of-pocket expenses, and a lack of compassion from healthcare professionals. Key facilitators that were identified include the adequacy of infrastructure, a focus on patient-centred care, efficient services, financial support, and supportive health professionals. Conclusion: Despite notable facilitators in addressing the needs of wheelchair users in health spaces, in the Western Cape Province it was evident that more effort is required. Wheelchair users faced numerous obstacles that impeded their access to health care. The availability, affordability, accessibility, acceptability, and adequacy of health care must be improved to serve this population better.
- ItemAn exploration of the need for lower limb prosthetic protocols in the South African private healthcare sector(Stellenbosch : Stellenbosch University, 2024-03-01) Bennie Josephus, Theron; Visagie, Surona; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.ENGLISH SUMMARY: Background: Protocols are informed by evidence and provide guidance during prosthetic component selection and clinical intervention. They help to optimise patient care. If protocols are comprehensive and implemented effectively, they can enhance the quality and consistency of care to prosthetic users. Study aim: To explore and describe the need for a lower limb prosthetic prescription protocol in the private healthcare sector in South Africa. Objectives: ● To critically evaluate existing lower limb prosthetic management frameworks, protocolsand policy in the South African private healthcare sector. ● To explore the experience of lower limb prosthetic users in accessing prosthetic servicesin the private healthcare sector in South Africa. ● To explore perceptions of key informants on the need for lower limb prosthetic protocolsin the South African private healthcare sector. Method: A case study design was used to explore three cases i.e. the Road Accident Fund, Workmen’s Compensation Fund and the Council of Medical Schemes. Data was collected from documents, prosthetic users and key informants. Lower limb prosthetic prescription guidelines; protocols; regulatory frameworks; and policy were sourced and quantitatively evaluated according to the six domains of the Agree II instrument. Seventeen lower limb prosthetic users (beneficiaries from the three cases) sampled through deviant purposive sampling; and seven key informants sampled through expert purposive sampling, participated in online semi-structured interviews. This qualitative data was analysed through inductive thematic analysis. Findings: The AGREE II tool showed that across cases the ‘scope and purpose’ domain scored the highest at 50% (WCA), 47.2% (CMS) and 22.2% (RAF). ‘Editorial independence’ scored 0% for all three cases. Other challenging domains were ‘applicability’ with scores of 16.6%, 6.3% and 6.3% and ‘rigour of development’ (7.5%; 30%; 0%). Four cross case themes emerged: ● Prosthesis as functional enabler. The prosthesis restored mobility, normality and qualityof life. A need for a second prosthesis and advanced components was expressed. ● Prosthetic processes and protocol. Users were dissatisfied and frustrated due to longwaiting times, complex and unclear processes. ● Pre and post prosthetic rehabilitation. Access to rehabilitation services were challenging. ● Role of Certified Prosthetist and Orthotist (CPO). The CPO often provided prosthetic userswith guidance to navigate funder systems and secure funding for prosthetic care. Four further themes emerged from key informant interviews: ● Protocol availability and necessity. There was a need for a protocol. ● Purpose of the protocol. A protocol can support equity, ethical and transparent services,appropriate clinical prescription, fair reimbursement and better access to prostheticservices and rehabilitation. ● Protocol development requirements. Collaboration, facilitated by an independent body,should underscore the development of an evidence-based protocol. ● A Representative regulatory body is needed. Conclusion: A protocol is needed to guide prosthetic service delivery in the South African private healthcare sector. It should provide a set standard and transparency. The protocol should be evidence based and formulated by all relevant stakeholders to increase adoption. A protocol can facilitate optimum clinical care, equity, rehabilitation, fair reimbursement as well as enhancing user satisfaction with funder, device and services.
- ItemA qualitative exploration of the enablers and challenges that mothers of children with disabilities experience in accessing primary healthcare in Lwandle(2023-03) Torres, Marcia; Ohajunwa, ChiomaENGLISH ABSTRACT: Introduction Children with disabilities do need special protection and proper healthcare. The purpose of this study was to gain an insight into the experiences of mothers of children with disabilities on accessing primary healthcare in Lwandle. The main objectives were to identify the enablers and challenges that influenced this healthcare access for their CWD. Methods This study had a qualitative approach to answer the research question. Six mothers of children with disabilities, recruited through total population sampling, participated in the research. In-depth data was gathered by face-to-face interviews which were audio recorded. Data was transcribed and analysed through thematic analysis. Findings Findings of this study highlight six themes which are: Living in the water, Alone and isolated, I am struggling, Spirituality, Helpful healthcare professionals and Family and neighbours. The demands of caring and the mental health challenges that mothers of CWD experience have an impact on accessing PHC for their children. However, spirituality provides mothers with strength and together with caring healthcare professionals and family, these were identified as enablers to PHC access. Conclusion It is critical to also provide the mothers of CWD with optimal care together with their CWD, and the creation of a contextually relevant, multidimensional support system is important going forward to improve health outcomes for CWD.
- ItemHigh-impact chronic pain : barriers and facilitators identified by Western Cape primary healthcare physiotherapists(Stellenbosch : Stellenbosch University, 2023-03) Mason, Brett James Nairn; Geiger, Martha; Parker, Romy; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.ENGLISH SUMMARY: Purpose of the study: The barriers and facilitators to the provision of effective care for individuals with high-impact chronic pain (HICP) identified by physiotherapists working in the Western Cape primary healthcare (PHC) setting were described to inform the development of curricula, policy, and practise of physiotherapists within the South African PHC system. Methods: A qualitative descriptive study was conducted utilising semi-structured interviews of eight purposively selected physiotherapists from Western Cape PHC facilities. Inductive thematic analysis was implemented to interpret the data. Findings: HICP is a complex and disabling condition that adds to physiotherapists’ burden in PHC. Participants identified that patient-centred approaches and collaborative strategies were facilitators to care, while time, patient, systemic, environmental, and physiotherapist factors were barriers. Participant’s identified needs can be summarised as relating to issues of time, knowledge, and support. Conclusion: HICP is a complex and disabling condition that increases the burden on physiotherapists in PHC. Participants recognised that a patient-centred and collaborative approach allows them to better treat these individuals. Multifaceted barriers to offering effective care could be overcome by providing resources such as more physiotherapists, rehabilitation-proficient managers, and pain-specific training in the PHC setting alongside facilitating physiotherapist skills such as innovative practice and networking with existing support structures.