EXPLORING THE CONCERNS OF PERSONS WITH DISABILITIES IN WESTERN ZAMBIA: OPPORTUNITIES TO THINK DIFFERENTLY ABOUT PHYSIOTHERAPY IN THE GLOBAL SOUTH

Cleaver S.^1,2, Polatajko H.³, Bond V.^4,5, Magalhães L.⁶, Nixon S.^2,7

¹University of Toronto, Rehabilitation Sciences Institute, Toronto, Canada, ²International Centre for Disability and Rehabilitation, Toronto, Canada, ³University of Toronto, Department of Occupational Science and Occupational Therapy, Toronto, Canada, ⁴University of Zambia, School of Medicine, Zambart, Lusaka, Zambia, ⁵London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, United Kingdom, ⁶Universidade Federal de São Carlos, São Carlos, Brazil, ⁷University of Toronto, Department of Physical Therapy, Toronto, Canada

Background: Physiotherapists improve function by treating people with impairments, activity limitations, and participation restrictions. The functional improvements offered by physiotherapy can be useful to all, but these functional improvements are likely to have the greatest impact for persons with disabilities (PWDs). Although the majority of the world's one billion PWDs live in the countries of the global South, fewer physiotherapy services are available in these countries. Recognizing the lack of services, many physiotherapists from the global North have worked to introduce or increase services in areas of the global South. Although new or increased physiotherapy services could be beneficial for PWDs, it is unknown whether physiotherapy is consistent with the concerns of PWDs in the global South.

Purpose: To collaborate with disabled persons' organizations (DPOs) in Western Zambia to explore their
1) primary concerns related to disability and
2) strategies to address these concerns.

Methods: This study used a constructionist qualitative design informed by critical and participatory approaches to research. The primary investigator of this research was a North American physiotherapist. The participating DPOs included one based in an urban area and another in a rural area of Western Zambia. A total of 81 individual members of the two groups participated in the research. Data were generated through eight focus group discussions and 39 interviews. These data generation activities were semi-structured, designed to stimulate discussion about life with disability and strategies to improve the situation of PWDs. All data were transcribed and analyzed using thematic and reflexive analysis strategies.

Results: The primary concern of the participants of this research was poverty. The strategy that they suggested to address this concern was “help”: a gift or grant of material resources shared in a relationship of expected compassion. In addition to the thematic findings, difficulties in fulfilling the study’s participatory research elements stimulated a reflexive analysis of the research process. This reflexive analysis revealed ways in which power dynamics were likely manifested in the research field. These power dynamics were related to institutional arrangements and the researcher’s position of privilege relative to the study participants.

Conclusion(s): This research was an opportunity to explore concerns, and strategies to address these concerns, without being tied to established service and policy options. Through this process, it was established that the primary concern for two DPOs in Western Zambia, and the strategy to address this concern, was markedly different from the focus of conventional physiotherapy practice and community-based rehabilitation (CBR). Moreover, the difficulties in fulfilling participatory research plans demonstrate the value of reflexivity for physiotherapists aspiring to collaborate with communities.

Implications: There is reason to believe that physiotherapists could be approaching disability differently than PWDs themselves. In resource-constrained settings, physiotherapists should approach service development and expansion in collaboration with PWDs; remaining open to the possibilities that priorities might be different than the focus of established physiotherapy and rehabilitation services. Physiotherapists should approach collaboration with PWDs using reflexivity, while recognizing that institutional arrangements and professional privilege can complicate collaborative aspirations.

Funding acknowledgements: The investigators were supported by the Canadian Institutes for Health Research (CIHR) and the W. Garfield Weston Doctoral Fellowship program.

Topic: Globalisation: health systems, policies & strategies

Ethics approval: Ethics approval was obtained from the University of Toronto Health Science REB and the University of Zambia Social Science REC.

All authors, affiliations and abstracts have been published as submitted.