Outlining a "low-resource setting" in the context of rehabilitation to facilitate health equity

Van Zyl, Chanel (2020-12)

Thesis (MScPhysio)--Stellenbosch University, 2020.

Thesis

ENGLISH SUMMARY : Background: Global health systems are under constant pressure due to demographic transitions, epidemiological trends and limited resources. Access to rehabilitation, an acknowledged holistic intervention for anyone with a condition that limits their ability to function, appears most limited in health systems in resource-constrained settings. The resource constraints, specific to the setting, that limit access to and availability of rehabilitation, are unclear. A lack of understanding of what constitutes a “low-resource setting” may limit evidence synthesis, knowledge transfer, and rehabilitation program implementation. The aim of this thesis is to unravel the concept of “low-resource settings”, in the context of rehabilitation, to facilitate health equity. Methods: A systematic scoping review was undertaken to identify published articles in the field of rehabilitation medicine, that were conducted in a self-reported “low-resource setting”. Four electronic databases were accessed and searched from their inception to 24 June 2019: PubMed, Africa Wide, Web of Science and Scopus. Qualitative content analysis through an inductive approach, using in vivo and descriptive coding, was employed to analyse the data. Codes were grouped into content categories, guided by the use of a socio-ecological framework. These content categories were subsequently grouped to identify major themes relating to the term “low-resource setting” in the included studies. The findings informed the development of a case study, detailing the intersection of two methodological approaches to unravel a broad concept in existing, published literature. The case study aims to provide a detailed account and critical reflection on the methods used to answer the research question. Results: A total of 48 studies were included in the systematic scoping review. Following the qualitative content analysis, a total of 410 codes were grouped into 63 content categories, which helped identify nine major themes relating to the term ”low-resource setting” in the context of rehabilitation. These themes include (i) financial pressure, (ii) suboptimal healthcare service delivery, (iii) underdeveloped infrastructure, (iv) paucity of knowledge, (v) research challenges and considerations, (vi) restricted social resources, (vii) geographical and environmental factors, (viii) human resource limitations and (ix) the influence of beliefs and practices. Conclusion: Healthcare administrators, clinicians and researchers now have the opportunity to actively engage with the nine themes developed in this thesis when planning, designing and implementing rehabilitation interventions in “low-resource settings”. Moreover, these themes may provide a breeding ground for future research activities to support greater transparency (e.g. framework development) in reporting of research conducted in “low-resource settings”. Greater transparency may alleviate barriers in knowledge translation, across settings, and assist in reducing the unmet needs for rehabilitation, globally. Using qualitative content analysis as a means to unravel complicated constructs derived from a scoping review of existing literature, relative to the research inquiry, is a valuable intersection of methods that could be utilised more often.

AFRIKAANSE OPSOMMING : Agtergrond: Wêreldwye gesondheidstelsels is onder konstante druk as gevolg van demografiese oorgange, epidemiologiese tendense en beperkte hulpbronne. Toegang tot rehabilitasie, 'n erkende holistiese ingryping vir enige iemand met 'n toestand wat hul vermoë om te funksioneer beperk, blyk om meer beperkend te wees in gesondheidstelsels met verminderde hulpbronne. Die hulpbronbeperkings, spesifiek tot die omgewing, wat toegang tot en beskikbaarheid van rehabilitasie beperk, is onduidelik. 'n Gebrek aan begrip van wat 'n “verminderde hulpbroninstelling” is, kan die sintese en oordrag van kennis, en implementering van rehabilitasieprogramme beperk. Die doel van hierdie tesis is om die konsep van “verminderde hulpbroninstellings”, in die konteks van rehabilitasie, te ontrafel en om sodoende, gesondheidsgelykheid te verbeter. Metodes: ‘n Stelselmatige literatuuroorsig is uitgevoer om gepubliseerde artikels, in die rehabilitasiegeneeskunde veld, te identifiseer wat uitgevoer is in 'n self-gerapporteerde “verminderde hulpbroninstelling”. Vier elektroniese databasisse is hiervoor gebruik en daar is gesoek vir gepubliseerde artikels vanaf elke databasis se ontstaan tot 24 Junie 2019: PubMed, Africa Wide, Web of Science en Scopus. Kwalitatiewe inhoudsontleding, deur middel van 'n induktiewe benadering, met hulp van “in vivo” en beskrywende kodering, is gebruik om die data te ontleed. 'n Sosio-ekologiese raamwerk is gebruik om kodes in inhoudskategorieë op te deel. Hierdie kategorieë is verder gegroepeer om belangrike temas te identifiseer wat verband hou met die term "verminderde hulpbroninstelling” in die ingeslote studies. Die bevindings het die ontwikkeling van 'n gevallestudie ingelig en die kruising van twee metodologiese benaderings uiteengesit om 'n breë konsep in bestaande, gepubliseerde literatuur te ontrafel. Die gevallestudie het ten doel gehad om gedetailleerde verslag te gee, en krities te besin, oor die metodes wat gebruik word om die navorsingsvraag te beantwoord. Resultate: Altesaam is 48 studies by die stelselmatige literatuuroorsig ingesluit. Na die kwalitatiewe inhoudsanalise is 410 kodes in 63 inhoudskategorieë gegroepeer, wat gehelp het om nege hooftemas te identifiseer wat verband hou met die term “verminderde hulpbroninstelling”, in die konteks van rehabilitasie. Hierdie temas sluit in (i) finansiële druk, (ii) suboptimale gesondheidsorgdienslewering, (iii) onderontwikkelde infrastruktuur, (iv) gebrek aan kennis, (v) navorsingsuitdagings en oorwegings, (vi) beperkte sosiale hulpbronne, (vii) geografiese en omgewingsfaktore, (viii) beperkings op menslike hulpbronne en (ix) die invloed van oortuigings en praktyke. Gevolgtrekking: Administrateurs van gesondheidsorg, klinici en navorsers het nou die geleentheid om aktief betrokke te raak by die nege temas wat in hierdie tesis ontwikkel is, tydens die beplanning, ontwerp en implementering van rehabilitasie-intervensies in "verminderde hulpbroninstellings". Boonop dit, kan hierdie temas 'n teelaarde bied vir toekomstige navorsingsaktiwiteite om groter deursigtigheid (bv. raamwerkontwikkeling) te ondersteun in verslagdoening oor navorsing wat in 'n “verminderde hulpbroninstelling” uitgevoer word. Groter deursigtigheid kan hindernisse in die oordra van kennis, in verskillende instellings, verbeter, en help om wêreldwyd die onvervulde behoeftes vir rehabilitasie te verminder. Die gebruik van kwalitatiewe inhoudsanalise as 'n middel om ingewikkelde konstruksies, afkomstig vanaf 'n stelselmatige literatuurorsig, te ontrafel, relatief tot die navorsingsondersoek, is 'n kragtige kruising van metodes wat meer gereeld gebruik kan word.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/109257
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