BARRIERS AND FACILITATORS TO COMMUNITY REINTEGRATION IN POORLY-RESOURCED COMMUNITIES: THE USE OF PHOTOVOICE METHODOLOGY

J. Phillips¹, T.-L. Williams¹

¹University of the Western Cape, Physiotherapy, Cape Town, South Africa

Background: Sustaining a traumatic spinal cord injury not only causes major changes to an individual’s physical and functional independence but the extended rehabilitation period results in the patient’s personal life style being disrupted. A holistic view of rehabilitation seeks to look beyond the physical impairments of the individual and address the social and environmental factors that create disabling situations.

Purpose: This study aimed to explore the environmental barriers and facilitators to community re-integration for survivors of a traumatic spinal cord injury (TSCI) in a poorly-resourced environment.

Methods: A participatory research approach guided this study. This study was conducted within the Cape Metropolitan area, a part of the Western Cape Province of South Africa. Photovoice methodology was used to explore 12 purposively selected participants’ environmental barriers and facilitators to community reintegration. Information sessions were held with the selected participants at the first meeting. Participants were given details of the project and disposable cameras were distributed. The photo-voice methodology was explained to all the participants. Participants were given the following tasks: Create a photo documentary with the following questions in mind: (1) What keeps you from participating in the community? (2) What helps you to participate in the community more effectively? After participants returned the cameras, and the photographs were developed, sessions were held with all participants individually first, followed by focus group discussions to discuss the top 5 photographs from each participant. The data analysis was guided by the ICF framework.

Results: Most of the challenges experienced by participants related to physical environment and land development; participants had numerous photographs of barriers encountered in the exterior environment such as sidewalks, curbs and lack of ramps. Other challenges were related to services and systems such as public transport and its accessibility. During the focus group discussion, barriers related to the natural environment such as wind and rain also received attention as this restricted mobility. Most of the facilitators were seen in the construction of buildings with certain public areas designed for wheelchair accessibility.

Conclusions: To fulfil the role of advocates for people with disabilities, health professionals such as physiotherapists, need to be aware of the issues faced by these individuals in their respective communities.

Implications: Individuals with a spinal cord injury spent a very short time in the acute-care setting and or rehabilitation. As health professionals attempt to facilitate the transition for individuals who have sustained a SCI from the acute setting back to community life, it becomes critical to be fully aware of the barriers and facilitators to community life.

Funding acknowledgements: University of the Western Cape

Keywords:
Traumatic spinal cord injuries
Rehabilitation
Community reintegration

Topics:
Disability & rehabilitation
Community based rehabilitation
Neurology: spinal cord injury

Did this work require ethics approval? Yes

Institution: University of the Western Cape

Committee: Senate Research Committee

Ethics number: 45060