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Seymour N.1,2, Geiger M.1, Scheffler E.1
1Stellenbosch University, Centre for Rehabilitation Studies, Cape Town, South Africa, 2Motivation Charitable Trust, Bristol, United Kingdom
Background: Wheelchair provision and use in less resourced settings face significant challenges. Global efforts to affect change include the WHO Guidelines on provision of manual wheelchairs in less resourced settings and the WHO wheelchair training resources. Multiple stakeholders are required to collaborate to affect improvement for people with disabilities (PWD). In contexts with shortage of professional wheelchair service providers and where community-based rehabilitation (CBR) is implemented CBR workers have a role to play. The exact nature of their role requires to be further understood.
Purpose: The objectives of the study were to determine what CBR workers in three areas of Uganda perceive as the challenges with wheelchair provision and use; the factors contributing to these challenges; the role they can play and what they need to achieve this.
Methods: This qualitative, participatory study in the transformative paradigm gathered perceptions of twenty one CBR workers through three focus groups, in the three regions of Uganda. Purposive sampling identified CBR workers, connected with community organisations in target areas with access to a wheelchair service.The Freirian approach (1970) provided a framework for each focus group. Data was transcribed and analysed using thematic analysis.
Results: CBR workers provided rich observations of wheelchair users reflecting domains of the International Classification of Functioning, Disability and Health (ICF). Limited availability of appropriate products; financial constraints of PWD and wheelchair services; and particularly historical and societal influences on beliefs are perceived to affect utilisation of wheelchair services and mobility of PWD. Participation is further influenced by inadequate skills in wheelchair use; limited durability of products and environmental factors including physical and attitudinal barriers. CBR workers suggested strategies consistent with the CBR matrix to increase referral, enhance use and care of a wheelchair and increase community inclusion. To strengthen wheelchair provision and support wheelchair users they identified the need for training and closer partnership with wheelchair services. They also pointed out the need for broader issues such as the position and empowerment of CBR workers to be addressed.
Conclusion(s): Contextual challenges to wheelchair provision and use in less-resourced settings would benefit from involvement of CBR workers. Diverse experiences due to historical approaches to wheelchair provision significantly impact attitudes of community, wheelchair users and their family and would benefit from informed CBR input. Further efforts are however required to increase the availability of appropriate wheelchairs and services, and to ensure the financial resources necessary to enhance effectiveness of both wheelchair services and community-based rehabilitation.
Implications: This study demonstrates the need for specific focus on enhancing the role of CBR workers in supporting PWD in accessing and using wheelchairs. In less-resourced settings where professional service providers such as physiotherapists are few with high workloads and where complex barriers to accessing services and participation exist their role is crucial; however unless this is acknowledged and programs developed to include training and closer collaborations with wheelchair services their benefit will not be realized. The study also highlights the need to further explore the training required in order to understand common modules and context specific elements.
Funding acknowledgements: Majority privately funded with contribution by the Stellenbosch university Harry Crossley Foundation
Topic: Disability & rehabilitation
Ethics approval: Ethics approval from Stellenbosch University Health Research Ethics Committee S14/10/210 and from the Uganda National Council for Science and Technology.
All authors, affiliations and abstracts have been published as submitted.
