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Scheffler E.1, Mash B.1
1Stellenbosch University, Division or Family Medicine and Primary Care, Cape Town, South Africa
Background: Stroke is a serious cause of disability in the Western Cape, South Africa and significantly burdens the family, community and health services. The shortage of professional rehabilitation personnel and services in rural areas combined with inappropriate models of care and contextual barriers limit access to rehabilitation services and result in poor functional outcomes after stroke.
Purpose: To develop a home-based stroke rehabilitation programme for a primary health care setting in the Western Cape, South Africa.
Methods: An action research approach was followed. Two cooperative inquiry groups (CIGs) drove the process, one included clinical and management personnel from community-based services (CBS), a disabled-peoples organization and senior community health workers (CHWs) (n=16) whilst the other included CBS- and academic therapy staff (n=7). Through critical analysis and participative problem-solving in iterative cycles of observation, reflection, planning and action the CIGs conceptualised the stroke rehabilitation service model and training programme. Four focus groups each were held with persons with stroke together with their family caregivers and with the CHWs to determine their needs. The draft training programme and content were circulated for comment to CBS personnel and academic staff, as well as clinical experts in stroke rehabilitation. The programme was piloted with three groups of CHWs from different geographic service areas. Individual written feedback was captured after each session and three focus groups were held with CBS staff, CHWs and the district therapy team. All focus groups were digitally recorded and transcribed and the framework approach to data analysis applied to identify and generate themes.
Results: A home-based stroke rehabilitation service model and training programme was designed based through the above iterative processes. Development was done in context of the available best-practice evidence of stroke rehabilitation, and adapted to fit within the primary health care approach and the scope of practice of the CHWs. The content targeted training of the family caregiver and included information about stroke and recovery, patient and family caregiver safety, how to facilitate independence through skills training, adapting the environment and prescribing and using assistive devices, incontinence management, communication, reducing caregiver strain and appropriate referral. Training methodology includes theory, practical skills training, skills transference, observation and monitoring, role play and case studies. The final training package consists of 16 modules delivered over a minimum of 21 hours. It contains a trainers manual, powerpoint presentations, demonstration videos and a participant reference manual.
Conclusion(s): Stroke rehabilitation services at primary level in low resourced settings can be extended by training CHWs in a basic function-oriented home-based stroke rehabilitation programme.
Implications: Physiotherapists based at primary health care level have an important role to play in empowering and supporting CHWs and family caregivers. The availability of standardised training modules for CHWs and family caregivers can assist physiotherapists and the rest of the multi-disciplinary team to extend rehabilitation services to persons with stroke in low resourced settings.
Funding acknowledgements: Stellenbosch University Rural Medical Education Partnership Initiative: President's Emergency Plan for AIDS relief through HRSA under the terms of T84HA21652.
Topic: Neurology: stroke
Ethics approval: This study has been approved by the Stellenbosch University health research ethics committee (reference S13/09/158).
All authors, affiliations and abstracts have been published as submitted.
