Operation Jumpstart Association, 115 Musgrave Road, Durban, KwaZulu-Natal 4094, South Africa
University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, KwaZulu-Natal 4000, South Africa
Rural Remote Health. 2021 Jan;21(1):5855. doi: 10.22605/RRH5855. Epub 2021 Jan 22.
The WHO has estimated that 1% of the world's population need a wheelchair, but few have access. Access to wheelchairs for most of the South African poor population is through accessing rehabilitation services at public health facilities. This study explored access to wheelchair services from the perspective of rehabilitation therapists, within the uMkhanyakude district of KwaZulu-Natal. Therapists' perceptions on access, and its impact on service delivery is under-explored in the literature.
Semi-structured interviews with 11 rehabilitation therapists in the uMkhanyakude district directly involved with wheelchair services were conducted. Levesque et al's conceptual framework of access to health care was used to analyse the data. Themes consistent with these dimensions - approachability, acceptability, availability and accommodation, affordability and appropriateness - were identified from the data.
Access to wheelchairs was perceived to be facilitated by the establishment of meaningful relationships with wheelchairs users, the ability to eventually provide an appropriate wheelchair for all users, the provision of services close to where people live, the training of caregivers and the use of local peer trainers. Perceived barriers were limited outreach by the rehabilitation staff, poor screening of those with mobility impairment by other categories of staff, and limited space and time to provide services. Further barriers linked to the therapists included their uncertainty about their level of competency in the context and lack of peer support for the rehabilitation staff, especially those working alone. Barriers associated with clients were the limited understanding of wheelchairs, and what was perceived to be a lack of responsibility to look after the wheelchairs, which led to poor maintenance.
The aspects of the five dimensions of access of Levesque et al's framework were identified as both facilitators and barriers.The therapists working in this remote rural area have a a strong sense of responsibility about the wheelchair service delivery process and offered clients the best they could with limited human and financial resources. They have a good understanding of the wheelchair users and the environment they function in, which enabled constant adaptation of the services to meet the needs of that specific community.
世界卫生组织估计，全球有 1%的人口需要轮椅，但很少有人能够获得。南非贫困人群获得轮椅的主要途径是在公立医疗机构接受康复服务。本研究从康复治疗师的角度探讨了夸祖鲁-纳塔尔省乌姆坎亚库德地区的轮椅服务获取情况。文献中很少有研究探讨治疗师对服务获取的看法及其对服务提供的影响。
对乌姆坎亚库德地区直接参与轮椅服务的 11 名康复治疗师进行了半结构化访谈。采用莱维塞等人的卫生保健获取概念框架对数据进行分析。从数据中确定了与这些维度一致的主题——可接近性、可接受性、可用性和适应性、可负担性和适宜性。
与轮椅使用者建立有意义的关系、最终为所有使用者提供合适的轮椅、在人们居住的地方附近提供服务、培训照顾者以及使用当地同行培训师，被认为有助于轮椅的获取。治疗师认为存在一些障碍，包括康复工作人员的服务范围有限、其他类别的工作人员对行动不便者的筛查不佳，以及提供服务的空间和时间有限。与治疗师相关的进一步障碍包括他们对自己在特定环境中的能力水平不确定，以及缺乏同行对康复工作人员的支持，特别是那些单独工作的人员。与客户相关的障碍包括对轮椅的有限理解，以及对照顾轮椅的责任的感知不足，这导致轮椅维护不善。
莱维塞等人框架的获取的五个维度的各个方面既被视为促进因素，也被视为障碍。在这个偏远的农村地区工作的治疗师对轮椅服务提供过程有强烈的责任感，他们在有限的人力和财力资源下，尽最大努力为客户提供服务。他们对轮椅使用者及其所处环境有很好的了解，这使他们能够不断调整服务，以满足特定社区的需求。
