Community-based Rehabilitation Project Research Articles

The Experience of Involved Individuals From the Implementing Challenges of Community-Based Rehabilitation in Iran: A Qualitative Study

Objectives: One of the prominent vital needs for implementing a community-based rehabilitation (CBR) program is correct perception and we know that CBR is linked to several challenges. The current study was performed to identify the challenges of implementing a CBR program in Iran based on the perceptions of the stakeholders. Methods: This study was qualitative conventional content analysis. In total, 25 participants who were staff of the Welfare Organization at different levels, managers, and experts working in the CBR project and non-governmental organizations (NGOs) were selected according to purposive sampling. Data gathering was performed by semi-structured and in-depth interviews and continued until saturation. The interviews were performed in 2020. To test the trustworthiness of data, the Guba and Lincoln criteria (credibility, dependability, confirmability, and transferability) and MAXQDA were used for data analysis. Results: The challenges of implementing a CBR program were identified. Eight novel categories and 39 subcategories were generated as follows: neglecting the local conditions and role of provinces, poor policymaking, and planning, deviation from the main goals, lack of a comprehensive evaluation system, inefficient resource management, weakness in facilitation, ineffective communication, and the inefficiency of NGOs). Discussion: Policymakers, service providers, and managers must understand the challenges of implementing a CBR program. Also, they are expected to address to this issue. This paper showed evidence for all stakeholders. Paying attention to these challenges can lead to the program’s tremendous success and ultimately, improved service provision and quality of life for people with disabilities and their families. The results support the need for policymakers and managers in the rehabilitation sector to change their vision and address the CBR as an essential part of the rehabilitation system. Also, the collected data could help to reinforce the CBR services.

Change in attitude of ASHAs towards persons with mental illnesses following participation in community based rehabilitation project.

Accredited Social Health Activists (ASHAs) play an important role in health care in rural India. To study the change in attitude of ASHAs towards persons with mental illness (PMI) after involvement in a community-based rehabilitation program. ASHAs (n = 95) were trained to identify and refer PMI. Community Attitudes to Mental Illness scale was administered at baseline and after 18 months of training. Domains of benevolence, social restrictiveness, and community mental health ideology showed significant improvement p < 0.001. There was no change in authoritarianism domain. Engaging ASHAs in identification, referral and treatment positively changes their attitudes towards PMI.

Local Peoples’ Appreciation on and Contribution to Conservation of Peatland Swamp Forests: Experience from Peninsular Malaysia

Peatland swamp forests (PSF) deliver a range of beneficial, but often undervalued ecosystem services. In this paper we examined local peoples’ appreciation on the values of PSF and their contribution to conservation. The study was carried out by interviewing 100 respondents living in adjacent to North Selangor PSF and holding three focus group discussions and a few key-informants’ interviews following participatory rural appraisal and contingent valuation methods. Respondents appreciated PSF for direct values including timber, non-timber forest products, source of fish, and water for agriculture. They reported environmental values of PSF like flood prevention, biodiversity conservation, fresh air, soil fertility, perennial water source, and reduction of storm damages. They also reported several health and cultural benefits including sources of medicinal plants, fresh food, and agro-tourism. The monetary values of some benefits were estimated as USD 128/month/family (for fish), USD 128/month/family (agro-tourism) and USD 159,070/year (irrigation). Although direct benefits from PSF were minimal, respondents sincerely wanted to contribute to PSF conservation through participation in community-based rehabilitation project, patrolling and fire protection, tree planting, cash donation, supplying seedlings, and joining in awareness creation programme. The intrinsic values and peoples’ enthusiasm for PSF conservation suggest a community-based approach for sustainable PSF management.

Participatory Rural Appraisal to Detect Childhood Blindness in Community

International Journal of Medicine and Public Health,2017,7,2,80-82.DOI:10.5530/ijmedph.2017.2.16Published:May 2017Type:Original ArticleParticipatory Rural Appraisal to Detect Childhood Blindness in CommunityAmarendra Deka, Jacqueline S Syiem, S P Saikia, and Valensha Surong Amarendra Deka1, Jacqueline S Syiem2, S P Saikia1, Valensha Surong1 1Department of Ophthalmology, Affiliation Mission Nethralaya, Shillong, Meghalaya, INDIA 2Civil Hospital, Shillong, Meghalaya, INDIAAbstract:Introduction: To evaluate the role of participatory rural appraisal (PRA) in community based rehabilitation (CBR) to detect and manage childhood blindness from rural community. Methods: Fifteen rural project areas with pre-existing CBR project were shortlisted. Main criteria of this selection were pre-existing CBR project with significant number of children with visual impairment. We have adopted PRA methodology to reach the rural community whilst aiming to detect childhood blindness. PRA approaches were also utilized to achieve immunization, spacing between child birth, proper maternal and child health and overall improvement of lifestyle. Information about the villages was collected from villagers by social mapping performed by the villagers themselves. Student’s t test was used to analyze the result. Results: 128 children (CBR program) with visual disability were identified out of which 77.14% were blind and 22.86% had SVI. After adopting PRA approach 84 new cases (p<0.05%) were detected of which 71.43% were blind and 28.57% had SVI. Main causes of blindness were cornea related (31.28%), lens related (21.72%) and buphthalmos (17%). Immunization of child improved from 11% to 81% (p=0.011) over a period of one year. Common practices including food habit, spacing between child births improved. 41% children are mobilized to blind school for rehabilitation. Conclusions: PRA methodology is a new approach in community ophthalmology and is very promising to detect and rehabilitate visually impaired children. PRA is very useful to improve knowledge, to plan rehabilitation as well to treat underlining causes of childhood blindness. Keywords:Childhood blindness, Community, Immunization, Participatory Rural Appraisal, Social mappingView:PDF (614.6 KB) Full Text

Advocacy Campaign for the Rights of People with Disabilities: A Participatory Action Research within a Community-based Rehabilitation Project in Vangani, Maharashtra

Purpose : This paper aimed to demonstrate how participatory action research (PAR) within a Community-based Rehabilitation (CBR) project facilitated community participation to advocate for the rights of people with visual impairment. An advocacy campaign, led by the local people with and without disabilities, was launched for the construction of an accessible foot over- bridge (FOB) at Vangani railway station in Maharashtra, India. Methods : The PAR approach was used to explore the issues faced by the local people with visual impairment. It ensured maximum community consultation, engagement and, consequently, meaningful outcomes for the community. Advocacy tools such as video documentary, online petition, media advocacy, and signature campaign were employed to publicise the issue on a larger platform. Sources for this paper included quantitative data from the survey of Vangani community and documents such as CBR project reports, media coverage articles, minutes of the meeting and correspondence with the Central Railways during the advocacy campaign that was conducted from 2012 - 2015. Results : After 12 months of consistent advocacy, the Ministry of Railways sanctioned INR 15 million for the construction of the foot over-bridge. The construction work on the foot overbridge was completed in December 2016 and now it is open for public use.. Conclusion and Implications : This study illustrates how PAR within a CBR project successfully used an advocacy campaign as a tool for community participation, action and change. Although geographically limited to rural pockets of Maharashtra state, the learning experiences brought out some of the elements crucial for the success of an advocacy intervention within CBR programmes for the rights of people with disability in India.

Development of community based rehabilitation in Thailand: A case study in Samut Sakhon Province

Aims: To set up and conduct a community based rehabilitation (CBR) in urban area based on significant variables and particular conditions of previous meta-analysis studies. Methods: This study is participatory action research (PAR). The one particular community in Samut Sakhon Province, Thailand was purposively selected. The 13 CBR research participants were purposively and voluntarily recruited including officials of local, regional government and community hospital, volunteers, persons with disabilities (PWDs) and their care givers, and researchers. Verbatim of focus groups, participatory observations and field notes were undertaken. Those data were interpreted through thematic coding and analytic induction. Results: Community based rehabilitation project was purposively set up with four significant independent variables including age, education level, occupation or position, and work experience as characteristics of CBR workers suggested by previous meta-analysis. Participatory action research was still contributive strategy for CBR development in terms of mechanism of consciousness raising, understanding collaboration and addressing CBR matrix. However, uncompleted PAR and CBR cycles, no more sectors of stakeholders and particular services with health focus of CBR matrix were limitation and challenges. Conclusion: This study proves that PAR with significant characteristics of participants is important CBR development. It will be more successful should other challenges of CBR will be also addressed.

Effectiveness of a training program for community-based resource workers on cleft lip and palate and cleft speech

Objective: This study evaluated the training module which was developed for resource workers in the community, to impart knowledge about cleft lip and/or palate (CLP) and skill to identify error patterns in speech of individuals with CLP. Design: This was a cross-sectional study. Method: This study is a part of an ongoing community based rehabilitation project conducted in a rural district of South India. A total of 47 resource workers belonging to a rural district served as participants of this study. Pre and post training measures were compared to examine the effectiveness of the training program. Knowledge about CLP and ability to identify error patterns in speech of individuals with CLP by the resource workers were measured pre and post training to examine the effectiveness of the training program. Results: There was a statistically significant improvement in the resource workers' knowledge about CLP. Resource workers were able to identify the abnormal productions but were inconsistent in categorizing the specific error patterns. Conclusions: The post training results revealed improvement in the resource worker's understanding of CLP and ability to identify speech patterns in individuals with CLP. It can be inferred that with periodic retraining, resource workers can be trained to identify speech error patterns in individuals with CLP. Trained resource workers could probably be used to provide speech services under the supervision of speech-language pathologist (SLP) in places where SLPs are not available locally to provide direct therapy.

Teaching Children with Learning Difficulties via Community-Based Rehabilitation Projects in rural Sri Lanka

Teachers in rural Sri Lanka find it challenging to support students with Learning Difficulties (LD) in regular classrooms. As a result, students with LD often quit school early. Community-Based Rehabilitation (CBR) projects located in rural areas sometimes provide learning opportunities for students who are school dropouts. Purpose: The research focussed on identifying an effective teaching approach that Developmental Assistants (DAs) can employ when teaching students with LD. Methods: An action research methodology with two action cycles was selected for this purpose. Each cycle consisted of four stages: analysing, reflecting, planning, and implementing, and monitoring. Data collection involved semi-structured interviews and real-time observations. A combination of qualitative and quantitative methods was adopted for data analysis. Research participants included 11 students aged 8-14 years, their parents and two DAs. Results: Outcomes suggest that students with LD actively engage in learning when an integrated approach that uses thematic units which reflect the students’ world, is in force. They also benefit when some elements of the behavioural approach to teaching-learning: explicit direct instruction, modelling, scheduled practice, reinforcement and feedback, are combined with certain components of the constructivist approach: independent work, group discussions and reflection. Conclusions: The study demonstrates that students with LD can succeed when the teaching-learning process is modified to suit their needs. Hence, CBR project workers ought to be trained to plan and design lessons that meet the needs of students with LD. It further validates the role CBR projects can play in diminishing negative views on disability and in creating inclusive societies. Limitations: The study’s illuminative design was appropriate within a limited sample of students. However, this sample is not wholly representative of the multicultural and multi-religious student population with LD in hard-to-reach areas of Sri Lanka.

Profile of Social, Environmental and Biological Correlates in Intellectual Disability in A Resource-Poor Setting in India.

Background:Intellectual disability (ID) is a major public health issue in India. Social, environmental and biological factors all contribute to the nation's high rate of ID.Objective:We aimed to investigate the distribution, differences and the association of social, environmental and biological factors with different types of ID in a mixed (tribal and non-tribal) population in India.Materials and Methods:Secondary data was collected during a community-based rehabilitation project and analyzed with descriptive statistics: Frequency, percentage and χ2.Results:Poverty, low levels of parental education and a family history of epilepsy and ID were all associated in both tribal and non-tribal populations (P < 0.05).Conclusion:The outcome of this study may be helpful in planning public health initiatives that aim to reduce the burden of ID in mixed populations.

The Prevalence and Characteristics of Patients Diagnosed with Osteogenesis Imperfecta at the Zambia Italian Orthopedics Hospital Community Based Rehabilitation Project

Introduction: Osteogenesis Imperfecta is a rare condition that can be very disabling. It is an inherited disease of the bones, which is characterized by fragility that causes affected individuals to have recurrent fractures that subsequently lead to pain, deformity and disability. The aim of the study was to determine the prevalence of Osteogenesis Imperfecta and identify the common deformities and treatment methods used in managing affected individuals at the Zambia Italian Orthopedics Hospital. Methods: This was a retrospective cross sectional survey. A data capture sheet was used to collect data from records and descriptive trend analysis was done in excel. Results: We identified 18 patients with Osteogenesis Imperfecta out of 8250. The age range was 1 to 17 years. Eighty-three percent (n=15) of these patients had deformities which included; bowed lower limbs, scoliosis and other related complications. All the patients underwent surgery at one point in time and received physiotherapy. Conclusion: The prevalence of Osteogenesis Imperfecta at the Zambia Italian Orthopaedics Hospital Community Based Rehabilitation Project is low. Surgery is the most commonly used method of treatment coupled with physiotherapy. Though uncommon, the condition is expensive to manage for both the institution and affected individuals’ families. This is as a result of repeated surgeries and prolonged physiotherapy.

Knowledge, Attitude and Practice Survey Tool for Intellectual Disability (KAP-ID)

Background: Community based rehabilitation approach is very popular in providing rehabilitation services to the people with intellectual disability in low and middle income countries. It is useful to assess level of knowledge, attitude and practices of parents and relatives of people with intellectual disabilities for strategic planning of the program. Method: series of meetings, focus groups and in-depth interviews with the professionals employed in community based rehabilitation project and workers, and community members were conducted. Common questions around the issues related with intellectual disabilities were collected and discussed. These questions were refined with consultation, references with existing literature and field testing. Result: We have developed and tested a Knowledge, Attitude and Practice survey tool for Intellectual Disability (KAP-ID) in a resource poor setting of a middle income country, India. This tool contains fifteen questions. Conclusion: This brief survey tool is helpful in assessing knowledge, attitude and practices of parents, relatives and also of the community on intellectual disabilities. Information gained through the survey on KAPID found to be useful in designing the behavioral, awareness, educational, health promotional, and interventional program for the population with intellectual disabilities in rural poor settings. Nepal Journal of Medical Sciences | Volume 03 | Number 01 | January-June 2014 | Page 22-25 DOI: http://dx.doi.org/10.3126/njms.v3i1.10345

Opportunity Gap Analysis: Procedures and Methods for Applying the Capability Approach in Development Initiatives

This article explores the importance of and value added by applying the capability approach to strategize, design, monitor or evaluate development initiatives, by operationalizing this agency-oriented (participatory) and opportunity-based perspective and by widening standard methods to deal with new informational spaces. In the first part of the paper a dynamic analytical framework on capabilities expansion/reduction processes—which places at the central stage the opportunity gaps between valuable community functionings and individual capability sets—is presented. These gaps represent the policy area where tailored and appropriate place-specific and people-centred development initiatives can entail the maximum expansion of real freedoms. Then, on the basis of this framework, the paper presents an original participatory methodology—the “O-Gap Analysis”—which can complement standard methods to provide systematized assessments of capabilities within communities to inform policy actions. An empirical case study is also discussed, analysing the application of this methodological procedure regarding a community-based rehabilitation project in Uganda. Applying the capability approach policy interventions cannot be necessarily unique for all individuals or social groups experiencing opportunity gaps for what they have reason to value, as different barriers or mix of barriers and conversion factors, values, desires and aspiration call for tailored people-centred development initiatives.

Social, Environmental and Biological Determinants of Cerebral Palsy in Children with Intellectual Disabilities (ID) in India

Background Cerebral palsy (CP) is a global public health problem affecting 2.12 to 2.45 per 1000 live birth across the world. Cerebral palsy is an upper motor neuron, non-progressive disorder commonly associated with intellectual disability. The presence of cerebral palsy effects person’s overall life. Objectives This study primarily sought predictive capacity of social, environmental and biological determinants of CP in ID. Materials and Methods This is a cross-sectional study design. A total of 262 children, aged 3 to 18 years, with ID were assessed for cerebral palsy and diagnosed on basis of clinical examination in a community based rehabilitation project in Barwani, India. Information was collected by parent interviews, on social, environmental and biological determinants. A logistic regression model has been applied between determinants and CP. Results Logistic regression demonstrated that likelihood of CP in ID children can be predicted on bases of their age (odd ratio = 0.856, CI 95% - 0.76-0.95), intelligence quotients (IQ) (odd ratio = 0.782, CI 95% - 0.73-0.83) and family history of intellectual disabilities (odd ratio = 0.051, CI 95% - 2.36 -0.99) and epilepsy (odd ratio = 0.008, CI 95% - 2.58-1.28). Comorbid conditions of downs syndrome and epilepsy also predicts likelihood of CP in ID. Conclusion Likelihood of CP in ID children can be predicted by their age, IQ, family history of intellectual disability, epilepsy and comorbid conditions of downs syndrome and epilepsy. Gender, socio-economic status and population (tribal versus non-tribal) determinants have no predictive relation with CP in the group. DOI: http://dx.doi.org/10.3126/nje.v3i3.9187 Nepal Journal of Epidemiology 2013;3(3): 262-268

Implementing the World Report on Disability in Malaysia: A student-led service to promote knowledge and innovation

The lead article by puts forward pertinent issues facing the speech-language pathology profession raised by the World Report on Disability. This paper continues the discussion by reporting on a capacity building action research study on the development, implementation, and evaluation of a new approach to early intervention speech-language pathology through clinical education in Malaysia. This research evaluated a student-led service in community-based rehabilitation that supplemented existing and more typical institution-based services. A Malaysian community-based rehabilitation project was chosen due to its emphasis on increasing the equitability and accessibility of services for people with disabilities which was a catalyst for this research. Also, expanding awareness-building, education, and training activities about communication disability was important. The intention was to provide students with experience of working in such settings, and facilitate their development as advocates for broadening the scope of practice of speech-language pathology services in Malaysia. This article focuses on the findings pertaining to the collaborative process and the learning experiences of the adult participants. Through reflection on the positive achievements, as well as some failures, it aims to provide deeper understanding of the use of such a model.

Reliability and Validity of the Korean World Health Organization Quality of Life (WHOQOL)-BREF in People With Physical Impairments

ObjectiveTo identify the validity and reliability of the Korean version World Health Organization Quality of Life Assessment (WHOQOL)-BREF among people with physical impairments living in a community.MethodsParticipants listed in the community-based rehabilitation project were recruited from 45 public health centers. People with brain lesions or physical disabilities were selected. Respondents (n=750) filled out the Korean WHOQOL-BREF questionnaire. Obtained data were analyzed statistically to assess the internal consistency as well as the construct and discriminant validity. An exploratory factor analysis was also performed.ResultsCronbach's α for the total score was 0.839. The value for each domain ranged from 0.746 to 0.849. Pearson correlation coefficient between each domain ranged from 0.539 to 0.717. The highest correlation was between the psychological and physical domain. The item-domain correlation indicated a significant correlation with their original domains. A multiple regression analysis of each domain with two overall questions was performed. The psychological domain made the strongest contribution with the overall quality of life (unstandardized coefficient B=0.065, r2=0.437). When general health satisfaction was considered as a dependent variable, the physical domain most strongly contributed to the variable (unstandardized coefficient B=0.081, r2=0.462). Exploratory factor analysis yielded four factors in the WHOQOL-BREF, accounting for 55.29% of the variability. To assess the discriminant validity, a comparison of each domain with Modified Barthel Index (MBI) was conducted. There were highly significant changes across the MBI scores with the WHOQOL-BREF domains (p<0.001).ConclusionKorean WHOQOL-BREF is a valid and reliable tool to measure the quality of life for people with physical impairments. It has good internal consistency, construct validity and discriminant validity for the population. Further study with a stratified sample is needed.

The WFOT Position Paper on Community-based Rehabilitation: A Call upon the Profession to Engage with People Affected by Occupational Apartheid

The World Federation of Occupational Therapists’ (WFOT’s) position paper on community-based rehabilitation (CBR) was the first of the kind in its 52 year history, a significant indicator of the importance of CBR approaches with the increasing professional interest in social justice and socio-political barriers to participation in dignified and meaningful occupations as a human right. The authors describe the primary health care roots of CBR and critically discuss potential occupational therapy roles in the CBR strategies for inclusive community development. CBR enables the exposition of links between poverty, disability, and other hidden issues. The WFOT CBR project is presented as stemming from the perception that disability can be rethought as a social and development issue incorporating inclusion and individual needs based around occupation. The potential outcomes from the adoption of CBR are explored through the political Activities of Daily Living (pADL) tool, which is used to propose further strategic actions for WFOT, and occupational therapy practitioners, educators and researchers.

Assisting Disabled Chinese Old People through Informal Caring Networks

It has been taken for granted that Chinese communities in Hong Kong would have an extended family or large kinship network to render such ‘care in the community.’ This exploratory study was conducted in a community based rehabilitation project. A great majority of disabled elderly people's informal caring networks were limited. Although they were physically ‘in the community’, they had limited access to timely care from their family members, friends and neighbours. More active roles as ‘brokers’ linking the disabled and elderly to community support services and ‘facilitators’ informal self-help groups are suggested.

Disability and rehabilitation in rural Jamaica: an ethnographic study

The objectives of this work are: (1) an ethnographic description of a community-based rehabilitation project: (2) a description and analysis of the beliefs and behaviors held or exhibited by the families of disabled children as they relate to disability and rehabilitation; and (3) an analysis of the issues and problems associated with a CBR program in a low income environment.