The design, development, and evaluation of an appropriate homebased stroke rehabilitation program for a rural primary health care setting in the Western Cape, South Africa

Scheffler, Elsje S. (2020-12)

Thesis (PhD)--Stellenbosch University, 2020.

Thesis

ENGLISH SUMMARY : Background: Little is known of stroke outcomes in low- and middle-income countries with limited formal stroke rehabilitation services and of homebased-stroke services delivered within the primary health care (PHC) context by community health workers (CHWs). Objectives: To describe and analyze the outcomes of patients with stroke from a rural PHC setting in the Western Cape, South Africa. Methods: In a longitudinal survey, 93 stroke patients, referred to home and community-based care services (HCBC) between June 2015 and December 2017, were assessed at baseline, one month and three months. Changes in function (Barthel Index (BI)), caregiver strain (Caregiver Strain Index (CSI)), impact of environmental factors and satisfaction with stroke care were measured. Results: HCBC was delayed, fragmented and brief (median session duration 20 minutes (IQR 15.0-30.0)). Although function improved significantly, dependence remained high: median BI score changed from 40.0 (IQR 15.0-70.0) to 62.5 (IQR 30.0-81.25) (p=0.019). A third (33.0% (30/91)) of caregivers initially experienced strain and the median CSI score remained 3.0 (IQR 0.0-7.0) (p=0.672). Overall, patient and caregiver satisfaction with HCBC was low with only 46.9% (31/66) of caregivers and 17.4% (12/69) of patients satisfied with all aspects of care. Only 47.6% of assistive product needs were met. Environmental factors negatively impacted on patient function and caregiving. Conclusions: Clinical practice pathways and referral guidelines should be developed for the HCBC platform. Specific training of CHWs, focusing on how to educate, support and train family caregivers, provide assistive devices and refer to health services is needed. No abstract available.

AFRIKAANSE OPSOMMING : Beroerte is wêreldwyd ’n leidende oorsaak van mortaliteit en gestremdheid, en hierdie las is besig om toe te neem in lae- en middel-inkomstelande (LMIL’e). Terwyl rehabilitasie ’n basiese reg is en internasionale beste praktyk georganiseerde beroertesorg-modelle met ’n kontinuum van gekoördineerde dienste bevorder, is sulke rehabilitasiedienste swak ontwikkel, gefragmenteerd en beperk in LMIL’e. Beroerte-oorlewendes word dikwels huis toe ontslaan in die sorg van onopgeleide familielede in ’n stadium wanneer hulle die meeste hulp benodig. Versorgers wat swak voorberei is om hierdie verantwoordelikheid oor te neem word oorweldig deur ’n reeks versorgingspligte, finansiële druk, onsekerheid, hul eie emosies, en oorname van die beroerte-oorlewende se rolle en verantwoordelikhede. Die las van sorg kan druk plaas op versorgers se fisieke en emosionele gesondheid, en ’n negatiewe impak hê op hul lewenskwaliteit. Die opleiding en ondersteuning van versorgers word erken as ’n integrale deel van beroertesorg-dienste. Versorgeropleiding moet spesifiek wees tot die konteks, versorgers se behoeftes en die probleme waarmee die beroerte-oorlewende presenteer. In die Kaapse Wynlande bied gemeenskapsgesondheidswerkers (GGW’s) op primêre sorgvlak ondersteuning aan beroerte-oorlewendes en versorgers, ten spyte daarvan dat hulle oor geen beroerte-rehabilitasie-opleiding beskik nie. Daar is baie min bewyse van beroerte-versorgeropleiding op primêre sorgvlak. Hierdie studie het daarom gepoog om by te dra tot die kennis oor die behoeftes van beroerte-oorlewendes en hulle versorgers in die Suid-Afrikaanse konteks, waar rehabilitasiedienste afwesig of ontoeganklik is, en om by te dra tot begrip van hoe om ’n kontekstueel-gepaste opleidingsprogram vir GGW’s te ontwerp en ontwikkel om familieversorgers van beroerte-oorlewendes op te lei. Die opsommings van die vier artikels wat aangebied word vir die doktorale graad, word hier uiteengesit.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/109290
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