Identifying the gap in assessing activities of daily living in resource-constrained rural settings: An integrative review of existing frameworks and instruments

Abstract

Introduction: The non-availability of indoor piped water and electricity results in alternate forms of personal care and domestic tasks in resource-constrained rural settings. This article examines the applicability of existing measures for the contextual assessment of basic and instrumental Activities of Daily Living (bADLs and iADLs) in these settings. Method: An integrative review guided by the approach of Lubbe et al (2020) was conducted. Structured database searches of CINAHL, Scopus and Sabinet identified published articles which were subjected to eligibility criteria. Microsoft Excel was used to synthesize data. Results: The search strategy yielded 591 articles that met the inclusion criteria, from which 187 ADL instruments were identified. Three instruments suited to resource-constrained rural settings were identified. Conclusion: Occupational therapists should consider that existing ADL frameworks and instruments appear silent on the impact of limited access to household amenities in resource-constrained settings. This constitutes epistemic injustice as many rural households globally do not have potable water or adequate household energy supply. Global South occupational therapy curricula must include contextually relevant ADL frameworks and development of contextually relevant instruments should be prioritised. Implications for Practice The findings suggest that existing ADL instruments have limitations when utilised in the Global South, particularly in resource-constrained rural settings. As such, occupational therapists practicing in such settings need to interpret instrument scores with caution and apply contextual clinical reasoning in the best interests of service users. Furthermore, training institutions in the Global South must ensure that the limitations of existing ADL frameworks, models and instruments are made overt within curricula and that research efforts are directed towards the development of contextually relevant ADL instruments.