Identifying evidence to define community-based rehabilitation practice in China using a case study approach with multiple embedded case study design

Eva Yin-Han Chung

doi:10.1186/s12913-018-3838-7

Abstract

BackgroundThis study examined community-based rehabilitation (CBR) practice in China on the basis of the development of an evaluation system using current evidence in a real context.MethodsA multiple embedded case study design was used to interpret both quantitative and qualitative data. In Part 1, a thematic analysis was conducted to identify the different levels of evidence available in CBR programs in China. Identified themes were then associated with the literature to form a system to code, categorise, and rank the obtained evidence. In Part 2, CBR practice was examined in 12 CBR programs by using the developed evaluation system with the CBR matrix and CBR framework.ResultsSix themes under three categorised levels of evidence for demonstrating quality of practice were found. An evaluation system of program practice, based on existing standards to define levels of evidence, was created and used with the CBR matrix and CBR framework to evaluate the quality of practice in 12 CBR programs. The results of a within-case analysis revealed the strengths and areas for improvement in each program. An across-case analysis by using identified correlations revealed the characteristics of CBR practice in China, as demonstrated in the interaction of core CBR components. The content elements of CBR programs were significantly correlated with health outcomes, social development, education, and empowerment. Empowerment was significantly correlated with participant governance and community ownership.ConclusionThe proposed evaluation system, as developed in a real context, is feasible for monitoring and identifying the strengths of and areas for improvement in CBR programs. This study described the characteristics and interaction of different CBR components in CBR practice in China and is pertinent for enhancing the evidence-based practices and quality of CBR programs in China.

Highlights

This study examined community-based rehabilitation (CBR) practice in China on the basis of the development of an evaluation system using current evidence in a real context
This study proposed that the quality of CBR practice in China could be documented and defined by using the newly developed ranking system on levels of evidence
Use of real evidence to form an audit standard This study identified the use of commonly available evidence in the Chinese CBR context to describe CBR practice in China

Summary

Introduction

This study examined community-based rehabilitation (CBR) practice in China on the basis of the development of an evaluation system using current evidence in a real context. Community-based rehabilitation (CBR) is a multisectoral approach, aiming to equalise opportunities and include people with disabilities, while combating the vicious cycle of poverty and discrimination [1]. Starting in 1991, the State Council approved three national 5-year work programs for people with disabilities, aiming to provide CBR services to all people with disabilities in Mainland China by 2015. Strengthening social support, capacity building in people with disabilities, the provision of a poverty alleviation fund, and the formation of local systems for the provision of services for people with disabilities are factors expected to contribute to the success of CBR in the Chinese context [10]. Evidence of effectiveness can be found in the fact that poverty reduction among people with disabilities in China has declined, with the number of people with disabilities under the poverty line decreasing from 20 million in 1992 to 10.65 million by the end of 2004 [10]

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