AbstractIntroduction Persons with disabilities are among the most vulnerable groups in every society and the World Health Organisation (WHO) has introduced Community Based Rehabilitation (CBR) with the intention of decreasing this vulnerability. In Oaxaca, Mexico, the Piña Palmera CBR program is working with persons with disabilities from rural communities to improve their quality of life.Objective The objectives of this qualitative study were to explore what motivates people to engage in the Piña Palmera CBR program, the expected and perceived benefits of participation, and future hopes and ideas for the program among program participants and their family members.Method Data was collected in the state of Oaxaca in southern Mexico during November-December 2014, in the form of 8 semi-structured interviews. Analysis of the data collected in the interviews was done by using thematic analysis.Findings The analysis of the data resulted in four themes regarding motivations for and perceived benefits of participation: Piña Palmera is a place for learning, You feel part of a group in Piña Palmera, Piña Palmera is improving the situation for persons with disabilities, and No other place works like Piña Palmera.Conclusion That Piña Palmera is a place where you get opportunities to learn, that one feels a part of a group, and that the program is different from other options in the way they work can make them an important resource for persons with disabilities in Oaxaca, decreasing problems with unemployment, discrimination, and lacking governmental support for persons with disabilities.

An ageing population is demanding more of healthcare services worldwide, particularly for long-term conditions. In the UK, the challenge of limited healthcare service resources and the influence of the Equality Act on services have increasingly led to the consideration of people's access to community rehabilitation services. These present a potential opportunity for Inclusive Design. The literature suggests that Inclusive Design and its associated tools have been widely applied to the accessibility of buildings and public transport, as well as consumer products and services, but there is little evidence of their application to healthcare services. A review of the literature highlights the importance of improving people's access to community-based rehabilitation by providing care at or closer to home which has become an increasingly prevalent option to meet the healthcare demand for long-term conditions in an ageing population. Therefore, this thesis investigates how Inclusive Design can be applied to healthcare delivery services to improve patients' experiences of accessing these services. It accomplished this through two case studies: community-based rehabilitation services of back pain and chronic obstructive pulmonary disease (COPD). The case studies involved online surveys and interviews with healthcare professionals and patients in understanding the patients' care journeys and challenges in accessing these services. The impact of services demands on patients' capability and their access to services was analysed using an Inclusive Design tool, the Exclusion Calculator. An inclusive approach integrating tools and procedures was summarised to facilitate the understanding of patients' capability-related needs both for the recipients of care and for the providers of care. This research provides a novel contribution by filling the gaps in the literature on the application of Inclusive Design to healthcare delivery services, i.e., community-based rehabilitation. It demonstrates that an Inclusive Design approach can be used to improve people's access to healthcare services and the tools applied can make a useful contribution to understanding service provision and hence service improvement. The Inclusive Design approach focuses on identifying the demands that healthcare services make of their users' capability and in estimating services' exclusion. The process of applying Inclusive Design in this research may be used to improve other healthcare services.

This thesis research explores the influence of the community-based rehabilitation approach on development programming in Gulu, Uganda. This CBR approach, originally designed to address the multidimensional needs of persons with disabilities living in rural, low-income regions, has been endorsed by many development actors, including the Government of Uganda and the United Nations. It also holds the potential to address the complex intersection of disability, poverty and conflict that resulted from two decades of violent conflict in Northern Uganda. An environmental scan and interviews with development professionals from the local government and non-government organizations was conducted to identify the ways in which this international policy idea has influenced development programming, and the obstacles to implementing community-based rehabilitation in Gulu. This research contributes to the literature on policy transfer, and illustrates how local development actors often lack the capacity to fully implement and sustain international “best practices.” While community-based rehabilitation may be a way to address the nexus of disability, poverty and conflict in places like Gulu, too few resources have been committed to fully implementing it and supporting persons with disabilities.

Masters of Science / Background: Globally the number of people with disabilities (PWDs) is escalating especially in developing countries. Different approaches and strategies have been used to care for PWDs but could not meet their expectations. Community Based Rehabilitation(CBR) is recognised by the World Health Organisation (WHO) as the strategy to address their needs using both the medical and social model. CBR was established and implemented in two areas of Rwanda ten years ago with overall objectives that aim to facilitate accessibility to CBR service and full participation of PWDs in the community.However, the number of PWDs accessing rehabilitation services in Rwanda is still limited.Since the CBR programme started in Rwanda, there has been a lack of information on whether the CBR services provided by these two programmes are meeting the needs of PWDs and whether they facilitated the service providers to deliver the services more easily as intended. The aim of this study was to determine the experiences of PWDs and service providers of the Inkurunziza and Gahini CBR programmes in Rwanda.A qualitative method of data collection used in the study included focus group discussions with the selected PWDs. In-depth interviews were conducted with a purposively selected sample of service providers. This study was carried out at two day centers one from the Inkurunziza CBR programme and the other from Gahini CBR programme. The results revealed that the CBR programmes have increased the number of PWDs accessing CBR services. Services provided at these centres addressed some of the needs of PWDs, which included provision of assistive devices, and rehabilitation services, which were accessible. Most of the participants claimed that the programme is not doing anything to help them with activities that can assist to generate income and facilitate accessibility to schools or vocational training. The study findings indicated that services delivered in both CBR programmes only addressed some of the needs of the PWDs accessing the two CBR programmes. The service providers reported that they found it difficult to reach certain areas to provide CBR services to PWD due to geographical constraints. It is recommended that the CBR services provided by the two programmes need to focus more on education, training and employment of PWDs.

The use of outcome measures by rehabilitation professionals has been advocated for many years; however, routine use is still lacking. Literature on the factors influencing the use of outcome measures locally is limited; therefore, the purpose of this study was to determine the factors that influence the use of outcome measures by community-based physiotherapists in Gauteng Province. While 75 community-based physiotherapists from Gauteng Province invited to participate in the study, 48 community-based physiotherapists responded. A descriptive cross-sectional approach was used in this study. A validated questionnaire was piloted to test its applicability to the South African setting. Thirty-seven per cent of the participants used at least one outcome measure in practice. Support from colleagues and positive attitudes were identified as factors that facilitated the use while lack of knowledge, lack of skills and lack of time were identified as barriers towards the use of outcome measures. The only statistically significant relationship found was between the lack of knowledge and the lower level of use of outcome measures. In conclusion, it was evident that there was poor usage of outcome measures by community-based physiotherapists in Gauteng Province and the barriers identified ranged from individual level to organisational level. Recommendations are made regarding policy for the implementation of policies and guidelines on outcome measures and monitoring thereof in form of audits. Special interest groups could offer courses on outcome measures and physiotherapists be encouraged to undergo postgraduate education. Therefore, the researcher suggests that continuous training be provided within the workplace and outcome measures be adopted. / Dissertation (MPhysiotherapy)--University of Pretoria, 2017. / Physiotherapy / Mphysiotherapy / Unrestricted

Magister Public Health - MPH / Background: Cerebral malaria (CM) kills up to 25% of its patients and about one third of its survivors develop neurological impairments (NIs). With advancements in diagnostic and management techniques for CM, more children are likely to survive. The increase in the number of CM survivors may increase the prevalence of children with NIs. In Malawi, rehabilitation for children with NIs is mostly institution-based with erratic community-outreach services, resulting in poor long-term outcomes. To date, community-based rehabilitation (CBR), a comprehensive rehabilitation approach that also addresses socio-economic impact of NIs and may supplement institution-based rehabilitation services, has not been well explored and documented. Presented here are experiences and perceptions on CBR programmes for NIs following CM in Blantyre, Malawi.

Given the importance placed on participation and empowerment in global health initiatives, the perspective of young people with disabilities has emerged as a vital field of study. This critical ethnographic study gained insight into the perspectives of adolescents with disabilities aged 12 to 18 years who were affiliated with a community-based rehabilitation program in the urban slums of North India. The purpose of this research was to highlight the collective voices of adolescents with disabilities about their rehabilitation challenges, to explore how the culture influenced the rehabilitation challenges faced by adolescents, and to support collaborative work among adolescents with and without disabilities that would inform organizational activities. Fieldwork was conducted from January to May 2005 and October 2006 to March 2007 with 21 adolescents with disabilities, 11 adolescents without disability, and 10 community-based rehabilitation team members. Multiple data collection methods were utilized to ensure that participants could comfortably express their views. A conceptual framework called the ‘Adolescent Group Empowerment Pyramid’ was developed that illustrates one process for empowering adolescents with disabilities and their peers without disabilities within a community setting. Group empowerment involves adolescents with disabilities working towards assuming greater ownership over their rehabilitation while collaborating with their peers. The ‘group’ concept provided the foundation for the framework because adolescents viewed the group setting as enjoyable and effective. Three areas associated with meaningful group empowerment included: group participation, group demonstration, and group recognition. Three external support factors and ten areas for nurturing the group empowerment process are also described. Participants promoted a more liberal approach to empowering adolescents that embraced the notion of collaboration (rather than competition), interdependence (rather than independence), shared benefits (rather than individual gain), and the interaction of community groups. This approach promotes a harmonious balance between empowerment and the community, rather than an aggressive approach to gaining power over or from other marginalized individuals. Group empowerment, achieved through enabling group-centered occupations, encourages adolescents to collectively work for social and occupational justice. To ensure the sustainability of community-based rehabilitation initiatives, programs must be aware of personally meaningful factors that empower and maintain the interest of the target population. / Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2009-08-05 15:30:32.786

Despite our theoretical commitment to community development (CD) approaches in occupational therapy, current practice models focus on individual interventions, rather than identifying how occupational therapists (OTs) can contribute at a community level. Consequently, OTs attempting to work with communities may not have clear guidance on methods of community engagement or strategies for addressing community level issues. This research examined three cases of OTs working in CD in different regions of Canada in order to 1) generate in-depth interpretive case descriptions of CD practice; and 2) conceptualize CD from the perspective and practices of occupational therapy. Data collection in each case occurred over three weeks and included approximately 30 hours of observations, document reviews and 14 interviews with health professionals and program participants. Constructivist grounded theory informed data analysis. The conceptual framework generated from the cross-case analysis describes the context of CD in which the OTs bridged the health and community sectors. The OTs were in community-focused positions located within regional health authorities. The OTs strategically used both professional and personal self to enable more equitable power sharing between health services, community agencies and consumers, creating opportunities for meaningful engagement with and in communities. Four main CD strategies contributed to this power shift: 1) building consumer and community capacity, 2) nurturing community partnerships, 3) influencing the health care system, and 4) linking sectors and resources. These OTs focused on a set of core values while drawing on their professional experiences. Individual, organizational and community-level changes resulted from these CD initiatives. The conceptualizations developed in this study can inform the practice of OTs by identifying potential CD strategies for enabling occupations with communities and sensitizing OTs to historical contextual tensions and power inequities. From this, the applicability of current occupational therapy models to communities can be extended, enhancing reflexive CD practice. / Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2010-03-04 13:35:42.337

In our global world, ideas in general and social work models in particular are spread and implemented in a variety of socioeconomic, political and cultural contexts, generating different outcomes. Many ideas and services launched in different countries by international organisations or governments in order to bring social justice to marginalised and oppressed groups, such as people with disabilities, have been criticised for not reaching or involving those such services aim to serve. Low impact of social programs on the welfare of people and communities has put the effectiveness of such programs into question and can leave people with disabilities dissatisfied with the social services available in their environment. The main purpose of this dissertation is to examine how an international idea for social work practice, as community based rehabilitation (CBR), is implemented in different structures and institutional contexts. To examine how an idea is implemented in different contexts, following research questions have guided the work: “How was the idea of CBR introduced to and implemented in Uganda and Sweden?”, “What contextual factors influenced the implementation of CBR in these countries?”, “What limitations and possibilities affected CBRs chances of continuity and institutionalisation in the two countries?” and finally“Can international ideas and models for social work be successfully used in different structural and institutional contexts?”. The study is based on a qualitative design with a comparative approach using qualitative content analysis for analysing data collected through official documents and interviews with parents to children with disabilities and professionals working in the children’s surrounding. The results show how difficult it is to monitor development through projects in both non-Western and Western countries. International ideas of social work, such as CBR, can make a difference in both Uganda and Sweden for the improvement of the living condition of those in need of services; at least, as long as there are funding for the projects and cooperation between authorities, NGOs and the parents of children with disabilities. The results show also that there are many differences in the process of the implementation of CBR in Uganda and Sweden. The colonial past of Uganda and its weak welfare state make CBR an important project for the improvement of the life conditions of children with disabilities. Meanwhile, the Swedish strong welfare state and legal protection of children with disabilities make CBR much more marginal in Sweden than in Uganda. However, CBRs successes to promote social justice for children with disabilities and their families makes it necessary to integrate the project to the existing organisation of the welfare state in the two countries. Changing existing welfare services requires engagement in political decision-makings, cooperation, and a critical examination of structural and institutional arrangements, in order to include successful projects in the daily functions and duties of the welfare state of every country. This will prevent an international idea for social work to not only be a temporary trend to follow, but also an established working method for helping people in need of proper services.

Community-based rehabilitation (CBR) is an inclusive community development strategy implemented for and by people with disabilities in resource-poor areas. The scarcity of guidelines for CBR program evaluation largely contributes to its insufficient and fragmented evidence base. This thesis aimed to advance knowledge in this field by defining best evaluative practices in CBR and developing guidelines to foster sound CBR program evaluation. To achieve this, the doctoral candidate designed a sequential mixed methods study in three research phases: 1) a systematic literature review to identify potential best practice guidelines, 2) a field study in South Africa to pilot the guidelines, and 3) a Delphi study to generate expert consensus and refine the guidelines. Findings from this doctoral research emphasize the importance of giving a voice and control to those most affected by the program throughout the evaluation process, including people with disabilities. The findings also call for embracing the challenge of diversity by adapting CBR program evaluation to local cultures and languages, and by ensuring that programs leave no one behind. In addition, they indicate that CBR evaluators can foster the use of process and findings by endorsing a rigourous, collaborative and empowering approach. Ten best practice guidelines for CBR program evaluation were systematically developed through the three phases and represent expert consensus. They offer much-needed directions. Three represent features of sound CBR program evaluation processes, six offer indications to facilitate sound methodological decisions, and one recommends using a common framework to situate evaluation findings. The guidelines now need to be piloted in a range of CBR contexts and linked with tools to yield the valid and reliable data necessary to establishing CBR’s evidence base and ensuring that program evaluations lead to positive change in local communities.