Solomon P1, Salbach N2, O'Brien KK2, Nixon S2, Baxter L3, Gervais N1
1McMaster University, School of Rehabilitation Science, Hamilton, Canada, 2University of Toronto, Physical Therapy, Toronto, Canada, 3Community HIV Volunteer, Halifax, Canada
Background: For people living with HIV (PLWH) access to rehabilitation, and specifically physiotherapy, is often a challenge. This is despite the dramatic shift from an acutely fatal to a chronic illness whereby many experience disability related to effects of the virus, side effects of medication and natural consequences of aging. Potential barriers include lack of health provider knowledge of the role of rehabilitation. Similarly, PLWH may not be aware of the services and benefits of rehabilitation. Patient activation, or playing an active role in managing one's health, is an important element of chronic disease management.
Purpose: We developed a novel educational program to help PLWH understand the role of rehabilitation, facilitate access to rehabilitation and to promote self-management of health related challenges of living with chronic disease. We evaluated the feasibility and acceptability of the innovation from the perspective of PLWH and program facilitators.
Methods: This was a 2 phase project under the guidance of an advisory committee including PLWH, physiotherapists, and HIV community organizations. In Phase 1 we developed a workshop with evidence-informed pedagogical elements of client-centered care, peer education and problem-based learning. We developed resource materials (online guides and workshop manual) to promote knowledge of rehabilitation and communication and advocacy skills. The workshop emphasized experiential learning and role playing. It consisted of 4 modules designed to be delivered in two, 2 hour sessions in the community. We recruited 3 HIV community organizations and built community capacity by training 3 teams of organization workers and peer volunteers as co-facilitators. In Phase 2 we recruited 27 PLWH to participate in the workshops. Each community organization delivered 2 workshops in small groups ranging from 4 to 8. Participants completed written evaluations post-workshop. Four workshop facilitators and 9 PLWH participants completed an in-depth qualitative interview within one month of workshop completion. We conducted qualitative content analyses of evaluations and transcribed interviews.
Results: Overall feedback was positive from co-facilitators and PLWH who described increased knowledge of the varied role of rehabilitation and improved communication skills. There were divergent views of the length of the workshop. Small groups were important to encourage discussion and promote sharing of experiences and role modelling. The resource materials were viewed as necessary adjuncts for learning. A co-facilitator model was seen as essential to promote PLWH and community involvement. Facilitators experienced challenges with group dynamics and those with more experience were viewed more positively.
Conclusion(s): Delivery of a community-engaged workshop to promote access to rehabilitation for PLWH is feasible and acceptable however, a flexible delivery model is important. While a co-facilitator model promotes the involvement of PLWH and community ownership, additional training may be required for confident and skilled facilitators who can be flexible with workshop delivery.
Implications: It is important for PLWH to be able to identify health challenges that may be amenable to physiotherapy and to be confident in negotiating their needs with their primary health providers. Providing patients with skills to advocate for rehabilitation may be applicable to other chronic diseases.
Keywords: HIV & rehabilitation, patient activation, educational intervention
Funding acknowledgements: This work was funded by a Canadian Institutes of Health Research Knowledge to Action Grant
Purpose: We developed a novel educational program to help PLWH understand the role of rehabilitation, facilitate access to rehabilitation and to promote self-management of health related challenges of living with chronic disease. We evaluated the feasibility and acceptability of the innovation from the perspective of PLWH and program facilitators.
Methods: This was a 2 phase project under the guidance of an advisory committee including PLWH, physiotherapists, and HIV community organizations. In Phase 1 we developed a workshop with evidence-informed pedagogical elements of client-centered care, peer education and problem-based learning. We developed resource materials (online guides and workshop manual) to promote knowledge of rehabilitation and communication and advocacy skills. The workshop emphasized experiential learning and role playing. It consisted of 4 modules designed to be delivered in two, 2 hour sessions in the community. We recruited 3 HIV community organizations and built community capacity by training 3 teams of organization workers and peer volunteers as co-facilitators. In Phase 2 we recruited 27 PLWH to participate in the workshops. Each community organization delivered 2 workshops in small groups ranging from 4 to 8. Participants completed written evaluations post-workshop. Four workshop facilitators and 9 PLWH participants completed an in-depth qualitative interview within one month of workshop completion. We conducted qualitative content analyses of evaluations and transcribed interviews.
Results: Overall feedback was positive from co-facilitators and PLWH who described increased knowledge of the varied role of rehabilitation and improved communication skills. There were divergent views of the length of the workshop. Small groups were important to encourage discussion and promote sharing of experiences and role modelling. The resource materials were viewed as necessary adjuncts for learning. A co-facilitator model was seen as essential to promote PLWH and community involvement. Facilitators experienced challenges with group dynamics and those with more experience were viewed more positively.
Conclusion(s): Delivery of a community-engaged workshop to promote access to rehabilitation for PLWH is feasible and acceptable however, a flexible delivery model is important. While a co-facilitator model promotes the involvement of PLWH and community ownership, additional training may be required for confident and skilled facilitators who can be flexible with workshop delivery.
Implications: It is important for PLWH to be able to identify health challenges that may be amenable to physiotherapy and to be confident in negotiating their needs with their primary health providers. Providing patients with skills to advocate for rehabilitation may be applicable to other chronic diseases.
Keywords: HIV & rehabilitation, patient activation, educational intervention
Funding acknowledgements: This work was funded by a Canadian Institutes of Health Research Knowledge to Action Grant
Topic: Oncology, HIV & palliative care; Health promotion & wellbeing/healthy ageing
Ethics approval required: Yes
Institution: McMaster University
Ethics committee: Hamilton Integrated Research Ethics Board
Ethics number: 14-544
All authors, affiliations and abstracts have been published as submitted.
