The influence of contextual factors on knee osteoarthritis self-management and education interventions in rural settings of the Western Cape

Coetzee, Marisa (2019-04)

Thesis (MScPhysio)--Stellenbosch University, 2019.

Thesis

ENGLISH SUMMARY : Background: Musculoskeletal (MSK) disorders are a global health concern, and the effect of MSK related disability is amplified in rural areas where the community members are affected by their environmental and social situation. The implementation of a self-management and education programme could improve the health outcomes of individuals in these settings, however, the recommendations in the current evidence-based clinical practice guidelines lack description and contextual information. Understanding the specific context could improve the uptake of these clinical guidelines, and therefore improve patient care and health outcomes. Aim: The aim of this particular study was to describe the contextual factors that could influence the implementation of a self-management and education programme for people with knee OA living in the rural settings of the Western Cape. Method: A descriptive and exploratory qualitative research method with a phenomenological approach was used to conduct this study. In-depth semi-structured individual interviews and focus group discussions were the chosen mode of data collection. Eighteen participants with knee OA were interviewed individually, and 19 community health care workers participated in three area specific focus group, providing collateral information about the community and their health related behaviour. The first two individual interviews were used as pilot interviews, therefore the data of the remaining 16 individual interviews were used along with the focus group data for analysis. The transcribed and translated interviews were coded using the coding software Atlast.ti, after which a deductive data analysis approach was followed. Results: The results showed that the current services offered to individuals with knee OA living in the rural areas of the Western Cape are insufficient in addressing their concerns and managing their symptoms. Various rehabilitation needs have been identified in these areas of which information and exercise needs were the most prominent. The needs identified could be addressed by a self-management and education programme within these communities. However, contextual barriers and facilitators have been identified as possible aspects which could influence the implementation of a self-management and education programme. Personal factors such as ownership, compliance and social isolation as well as environmental factors such as the community attitudes, continuity of care and available transport could have an impact on the uptake and success of a self-management and education programme. Conclusion: This study found that when compared to current clinical practice guidelines, the services offered to people living with knee OA are not sufficient and that there is a need for education and exercise. A self-management programme are the ideal intervention to address the needs of the people living with knee OA in rural areas of the Western Cape. However, this study identified certain contextual factors that has to be considered when planning and implementing such a programme, and a feasibility study should be considered to ascertain the strategy for implementation in these areas.

AFRIKAANSE OPSOMMING : Agtergrond: Muskuloskeletale (MS) kondisies is ‘n globale gesondheids bekommernis en die effek van MS verwante gestremdheid is verhoog in landelike gebiede waar lede van die gemeenskap deur hul omgewing en sosiale omstandighede geaffekteer word. Die implementering van ‘n self-hantering en opvoedingsprogram kan die gesondheidsuitkomstes van individue in hierdie omgewings verbeter. Die aanbevelings in die huidige bewysgesteunde kliniese praktyk riglyne het egter ‘n tekort aan konteks spesifieke inligting. Om die konteks te verstaan kan dit die opname van hierdie riglyne verbeter en dus die pasiëntsorg en gesondheiduitkomstes van hierdie individue verbeter. Doel: Die doel van hierdie studie was om die kontekstuele faktore te beskryf wat ‘n invloed kan hê op die implementering van ‘n self-hantering en opvoedingsprogram vir mense met knie osteoarthritis (OA) wat in landelike gebiede van die Weskaap, Suid Afrika woon. Metode: ‘n Beskrywende en verkennende kwalitatiewe navorsingsmetode is gevolg met ‘n fenomonologiese aanslag om hierdie studie uit te voer. In diepte gedeeltelik gestruktureerde individuele onderhoude asook fokus groep onderhoude is gekies as die metode van data insameling. Onderhoude is gevoer met 18 deelnemers wat knie OA het en 19 gemeenskap gesondheidswerkers, wat kolaterale inligting oor die gemeenskap en hul gesondheidsverwante gedrag kon verskaf. Die eerste twee individuele onderhoude is gebruik as toets onderhoude, dus is die oorblywende 16 individuele onderhoude saam met die fokus groep gesprekke gebruik vir analise. Die transkripsies is vertaal en gekodieer met die Atlas.ti koderings sagteware, waarna ‘n deduktiewe data analise gevolg is. Resultate: Die resultate toon dat die huidige dienslewering aan individue met knie OA wat in landelike gebiede van die Weskaap woon, nie voldoende is om hul kommer aan te spreek of hul simptome te hanteer nie. Verskeie rehabilitasie behoeftes is geidentifiseer in hierdie areas, en die grootste tekortkoming was korrekte inligting en oefen programme. Hierdie behoeftes kan aangespreek word deur ‘n self-hantering en opvoedingsprogram in hierdie gemeenskappe. Kontekstuele hindernisse en fasiliterende aspekte wat ‘n invloed kan hê op die implementering van ‘n self-hantering en opvoedingsprogram is egter geidentifiseer. Persoonlike faktore soos eienaarskap, die volvoering en sosiale isolasie sowel as omgewingsfaktore soos die gemeenskap se instelling, kontinuïteit van sorg asook vervoer kan ‘n impak hê op die opname en sukses van ‘n self-hantering en opvoedingsprogram. Gevolgtrekking: Hierdie studie het gevind dat invergelyking met die huidige kliniese praktyk riglyne, die dienste wat aan mense met knie OA gebied word nie voldoende is nie, en daar steeds ‘n behoefte is aan opvoeding en oefening. ‘n Self-hanterings program is die ideale ingryping om die behoeftes van mense met knie OA wat in landelike gebiede van die Weskaap woon, aan te spreek. Die studie het egter ook kontekstuele faktore geidentifiseer wat in ag geneem sal moet word tydens die beplanning en impementering van so ‘n program. Dus word ‘n haalbaarheidsstudie voorgestel om ‘n strategie te ontwikkel vir die implementering van so ‘n program in hierdie areas.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/105891
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