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Whalen Smith CN1, Burger J2, Dusingizimana Z3, Uwamahoro Y3, Nizeyimana JC3, Ndereimana WV3
1The Ohio Colleges of Medicine Government Resource Center, Columbus, United States, 2The Ohio State University, Doctor of Physical Therapy Program, Columbus, United States, 3The Ubumwe Community Center, Gisenyi, Rwanda
Background: The Ubumwe Community Center (UCC) serves people with disabilities (PWDs) in the Western province of Rwanda. The UCC promotes inclusivity, celebration and acceptance of difference, and encourages recognizing one's own capacity and using that to support others. Findings from an epidemiologic review reveal a large concentration of PWDs in the Western province of Rwanda. The UCC currently does not have the capacity to meet all needs of PWDs at their center. Therefore, the UCC requested that colleagues in the U.S. develop a Community-Based Rehabilitation (CBR) program in order to expand their impact in surrounding communities.
Purpose: To train community members associated with the UCC in an adapted CBR model directed by a UCC physiotherapist in order to extend services of the UCC to neighboring communities.
Methods: The CBR program for the UCC was developed utilizing the World Health Organization's CBR guidelines. The Social Cognitive Theory of behavior change and the PRECEDE-PROCEED Model of program planning were the frameworks used to create a sustainable, evidence-based program. Lecture and lab activities were co-taught with UCC physiotherapy staff utilizing a train-the-trainer model. All developed training materials were reviewed and revised by the Rwandan co-instructors for content and cultural appropriateness. Training included 16 hours of lecture and additional practical experiences in the community. Pre/post-tests and practical exams were administered to measure change in knowledge.
Results: Eight males and three females ages 19-27 were trained. Secondary school was the highest level of education for most participants, while four individuals had a bachelor's degree. A significant (p=0.000) increase in scores on a multiple choice post-test was observed. Mean test scores increased from 49.4% to 78.4%. Furthermore, a majority of participant's demonstrated skills rated as 'good' or 'superior' on the practical exam.
Nine of eleven trainees met the established UCC requirements for certification as UCC CBR workers. Following training, the UCC CBR workers visit a nearby village monthly to work with PWDs and their families under the supervision and direction of the CBR physiotherapist.
Rwandan co-instructors independently trained a second cohort after departure of the U.S. instructor. Seven of nine trainees received certification to provide CBR services in a second village.
Conclusion(s): Utilizing theories of behavior change, program development frameworks, and close collaboration with community partners led to the successful adaptation and launch of a CBR program at the UCC in Rwanda. The adapted CBR training program led to demonstrated increases in knowledge and practical skills for community members in addressing the rehabilitation needs of PWDs in communities near the UCC.
Implications: Next steps for the UCC CBR program include ongoing program evaluation to assess CBR worker effectiveness in the community under the supervision and direction of the UCC physiotherapist and retention of knowledge for CBR staff. The UCC will also work to align with other CBR programs in Rwanda as well as to develop continuing education content for current trained CBR staff. Finally, the UCC will partner with the Rwandan Ministry of Health, Rwandan Physiotherapy Association, and University of Rwanda to scale this model throughout the Western province of Rwanda.
Keywords: Community-Based Rehabilitation, Disability, Rwanda
Funding acknowledgements: No current funding source for this project.
Purpose: To train community members associated with the UCC in an adapted CBR model directed by a UCC physiotherapist in order to extend services of the UCC to neighboring communities.
Methods: The CBR program for the UCC was developed utilizing the World Health Organization's CBR guidelines. The Social Cognitive Theory of behavior change and the PRECEDE-PROCEED Model of program planning were the frameworks used to create a sustainable, evidence-based program. Lecture and lab activities were co-taught with UCC physiotherapy staff utilizing a train-the-trainer model. All developed training materials were reviewed and revised by the Rwandan co-instructors for content and cultural appropriateness. Training included 16 hours of lecture and additional practical experiences in the community. Pre/post-tests and practical exams were administered to measure change in knowledge.
Results: Eight males and three females ages 19-27 were trained. Secondary school was the highest level of education for most participants, while four individuals had a bachelor's degree. A significant (p=0.000) increase in scores on a multiple choice post-test was observed. Mean test scores increased from 49.4% to 78.4%. Furthermore, a majority of participant's demonstrated skills rated as 'good' or 'superior' on the practical exam.
Nine of eleven trainees met the established UCC requirements for certification as UCC CBR workers. Following training, the UCC CBR workers visit a nearby village monthly to work with PWDs and their families under the supervision and direction of the CBR physiotherapist.
Rwandan co-instructors independently trained a second cohort after departure of the U.S. instructor. Seven of nine trainees received certification to provide CBR services in a second village.
Conclusion(s): Utilizing theories of behavior change, program development frameworks, and close collaboration with community partners led to the successful adaptation and launch of a CBR program at the UCC in Rwanda. The adapted CBR training program led to demonstrated increases in knowledge and practical skills for community members in addressing the rehabilitation needs of PWDs in communities near the UCC.
Implications: Next steps for the UCC CBR program include ongoing program evaluation to assess CBR worker effectiveness in the community under the supervision and direction of the UCC physiotherapist and retention of knowledge for CBR staff. The UCC will also work to align with other CBR programs in Rwanda as well as to develop continuing education content for current trained CBR staff. Finally, the UCC will partner with the Rwandan Ministry of Health, Rwandan Physiotherapy Association, and University of Rwanda to scale this model throughout the Western province of Rwanda.
Keywords: Community-Based Rehabilitation, Disability, Rwanda
Funding acknowledgements: No current funding source for this project.
Topic: Disability & rehabilitation
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: This project was requested by community partners at the UCC to develop the internal workforce of the UCC. There was no experimental design and all program development tools to create, adapt, and evaluate this CBR training program were based on established methods. The internal program evaluation was not designed to generate generalizable knowledge but to understand the effectiveness of the training program that was created from the established CBR Guidelines and to inform next steps for this program. We believe this project described innovative ways in which established methods have been adapted to meet the needs of practice.
All authors, affiliations and abstracts have been published as submitted.
