Thesis (Ed.M.)--Boston University

Masters of Science - Msc (Physiotherapy) / Rehabilitation services have been described as being necessary to maximize patient independence in order to enable them to participate fully in their communities. The Aim of the study was based on the problem statement and the research question, this study aims at exploring rehabilitation professionals' views on the experiences of patients with physical disabilities accessing CHCs in the Western. The objectives of the study were to explore the views of rehabilitation professionals regarding experiences by patients accessing rehabilitation services at the Community Health Centres (CHCs) in the Western Cape and to reach health experts consensus on how rehabilitation services should be provided at the CHCs based on the outcomes of objective 1. Methodology: This study used an exploratory design that used qualitative methods for data collection (workshops and focus group discussions (FGDs) and a Delphi study. The study was conducted at purposively selected CHCs in the Western Cape. The population in this study included all rehabilitation professionals who provide rehabilitation services in the CHCs, who were invited to participate in the study. Data collection: In the qualitative and the Delphi study, data was collected through workshops, focus group discussions and emails respectively. Data analysis: The workshops and the FGDs were audio recorded and then transcribed verbatim for content analysis.

This work contains a phenomenological analysis of blindness, providing a basis for the evaluation of rehabilitation practice in South Africa and the formulation of future objectives in the field. Stereotypes of blindness associated with the perspectives of consumerism, scientific research, and social casework are analysed. Theories of blindness proposed by Braverman, Carroll, Monbeck, Foulke, Jernigan, and Scott are critically examined. The findings give substance to the claim that professional workers with the blind are guided in their attitudes and actions by images and meanings originating from these sources. All such preconceptions are rejected in favour of a description of blindness in terms of actual experience. An in-depth study of experience reveals how the nature of perception determines the blind person's relationship with the physical environment, with other people, and with the welfare system. In each sphere limitations arise which are overcome by specific responses and appropriate techniques. These observations lead to the formulation of a set of basic principles of rehabilitation, stressing the importance of individualization, self-reliance, assertiveness, versatility, and a personal interpretation of blindness. The relevance of traditional modalities is explained, while the need to expand rehabilitation teaching to include assertive skills training and various types of vocational instruction is emphasized. Current rehabilitation practice in South Africa is evaluated, comparisons being drawn with programmes offered by Beit Halochem in Tel Aviv, Arkansas Enterprises for the Blind, and the Center for Independent Living of the New York Infirmary. South African training is characterized as fostering the independence of the individual. Negative features are the lack of an effective delivery system and failure to meet the priority needs of certain groups. This prepares the way for a case study in which the redevelopment of rehabilitation services for the blind in South Africa .is discussed, beginning with the establishment of a new national rehabilitation centre. Amongst other matters, the study deals with negotiations to circumvent restrictive legislation, funding through a system of corporate sponsorship, and purposeful architectural design. The rehabilitation centre is viewed as the first component of a broader strategy to provide rehabilitation training to all blind people in South Africa, incorporating national, urban, rural, and specialized services. The successful implementation of any action plan will require the participation of blind people themselves by way of a disability rights movement. Finally, attention is focused on the effect of South African racial policies on welfare work. The principle of equal opportunity cannot be practised under present legislation.

Violence against women (VAW) in India reflects encouraged patriarchal notions, societal despotism, and cultural subjugations. The Indian government is continuously striving to bring legal reforms that can deter perpetrators from inflicting violence on women. However, these changes are occurring only on the surface when in fact the issues are deep-seated. Therefore, this thesis addresses two main research questions: 1) What factors contribute to the increase in cases of VAW in India and how the legal system addresses these factors, and 2) What policies and schemes are employed to empower women and provide support services to women victims of violence, and what are the effects of these policies/schemes. To explore each of these questions, the thesis was divided into two parts. In part 1, a legal case analysis strategy was adopted to qualitatively analyze 26 High Court cases from Uttar Pradesh, India. Seven major themes emerged from the thematic analysis of these cases that highlight the reasons for the perpetration of violence, victim-blaming, barriers to report the crime, and legal systemic barriers. In part 2, a policy analysis framework was applied to review and analyze six major schemes and policies focused on VAW. All the schemes and policies were assessed, compared, and prioritized against different criteria which were constructed based on the research findings from part 1. Major results of this study suggest that the schemes and policies focused on VAW are structurally flawed and lack proper monitoring. In conclusion, efforts must be made to deter the act of perpetrating violence on women by implementing suitable community and family interventions, recognizing and eliminating factors that lead to revictimization, providing detailed guidelines to enhance services through local schemes and policies, and acknowledging patterns of patriarchal and cultural norms surrounding VAW.

Due to the growth of the national income and the increases of the medical knowledge of the general population, personal health was much more valued. The medical service market has reached an era of overall competition. One of the most important strategies for improving competitiveness is providing a better service quality. It relies on the realization of the medical demands of the patients. This study examined the major factors affecting patients¡¦ perception of cumulative satisfaction for rehabilitation services. The results show that patients usually get rehabilitation services from local hospitals and clinics. In addition, quality of interaction and quality of processes have significantly positive effect on both patients¡¦ satisfaction and loyalty. Quality infrastructure has significantly negative effect on patients¡¦ loyalty. Quality of object does not affect patients¡¦ satisfaction and behavior intention. The result can be used by the hospitals to reengineer and redesign creatively their quality management processes and the future direction of their more effective health-care quality strategies. Keywords: Service quality, Patient satisfaction, Patient behavior intention, Rehabilitation services

The purpose of this descriptive correlational study was to examine the relationship between admission disability and length of stay obtained from the records of neurological and orthopedic acute rehabilitation adult inpatients. The research question was, "Is there a relationship between the admission disability and length of stay?" Orem's self-care theory was used as the framework of the study. The sample consisted of 118 records of patients dismissed from a freestanding midwestern rehabilitation hospital during July 1, 1996 to November 30, 1996. Admission disability was measured with the Functional Independence Measure (FIM'''*1) instrument that was available in the patient's record. Length of stay was the number of days in the rehabilitation facility. Motor disability was significantly and negatively correlated with length of stay (r= -0.249, p=.006). Implications for practice were discussed. / School of Nursing

Magister Scientiae (Physiotherapy) - MSc(Physio) / Rehabilitation is important for persons living with disabilities as it contributes to their sense of autonomy, self-worth, social participation and improving their quality of life. Improving the quality of rehabilitation services requires the incorporation of patients' perceptions with those of service providers regarding these services. Different studies have revealed that persons with disabilities have experienced inaccessibility of rehabilitation services with regards to inaccessibility and unavailability of transport, inadequate provision of information related to their disability. Lack of staff and skills training are the main experienced challenges encountered by the service providers in the rehabilitation service provision. Hence, the current study aims at exploring the persons with physical disabilities and service providers' experiences regarding the rehabilitation services provided at Bishop Lavis Rehabilitation Centre. A qualitative study design was used for data collection. Eleven participants among patients were conveniently selected for the focus group discussion and three key informants among the service providers participated in the in-depth interviews. The focus group discussion and the interviews were tape-recorded and transcribed verbatim and the data was thematically analysed using pre-determined themes. Permission to conduct the study was sought and granted from the Senate Research Grant and Study Leave Committee at the University of the Western Cape, the Western Cape department of Health as well as the facility manager of Bishop Lavis Rehabilitation Centre. Written informed consent was obtained from the participants prior to the focus group discussion and interviews. The results indicated that patients experienced problems of accessing transport to and from the rehabilitation facility. The taxis and buses were either inaccessible or unavailable for persons with physical disabilities. Poor referral systems, shortage of staff, lack of skills training were among the main challenges that arose in the interviews with the service providers. Due to the workload that service providers encountered, they sometimes lacked time to interact and communicate with patients. Participants in both groups reported positive responses regarding patient participation and involvement in the rehabilitation sessions and interaction between patients and service providers. Though some patients expressed the review that the dissemination of information related to group sessions was inadequate, most of the participants in both the focus group discussion and the in-depth interviews stated that, patients were adequately informed on their conditions and treatment. The study concludes by highlighting the need to improve rehabilitation services in terms of increasing the capacity of service providers, equipment, training of service providers and providing transport services for persons with disabilities. There is a need for those planning the rehabilitation services and policy makers to recognise the challenges encountered by those receiving rehabilitation services as well as those providing these services as discussed in this study. Hence, this will help in developing appropriate, accessible and cost effective rehabilitation services that meet the needs of persons with disabilities.

An Acquired Brain Injury (ABI) can have lasting effects on the self-identity of the injured individual, but also on the self-identity of other family members. Using Contextual Family Stress Theory as a guiding theoretical framework, this qualitative study investigated how mothers experience changes and alterations in their self-identity and family identity, as well as the reconstruction of self-identity and family identity, after a child acquires an ABI. These experiences are important to capture so that clinicians and professionals may better understand the phenomenon of post-ABI self- and family identity and to help inform rehabilitation and professional services. Currently, research has been narrowly focused upon functional gains for individuals and families in rehabilitation while excluding changes in self-identity and family identity. Data were collected via semi-structured interviews and self-report measures of individual mothers' needs and perceptions of the injured child. A constructivist grounded theory analysis was used to analyze the data. Findings reveal the reconstruction processes of mothers' self-identity and family identity after a child receives an ABI, such as internal and external self-identity and intentionality in reconfiguring family identity. Furthermore, results suggest that positive adaptation in self-identity and family identity promote resilience to the changes from the child's ABI. Future research directions, theoretical, and clinical implications are discussed. / Doctor of Philosophy / An Acquired Brain Injury (ABI) can happen in many ways, such as a hard hit to the head or the brain not getting enough oxygen. Children and adolescents are among the age groups that have the highest rates of ABIs. The effects from an ABI are long lasting and impact the injured person in many ways, including their identity or sense of self. When a child receives an ABI, the parents' self-identity and the overall family identity is also affected. The goal of this study was to provide a better understanding of changes in self-identity and family identity for mothers who have a child or adolescent with an ABI. For this study, I recruited 14 mothers of a child with an ABI, and the mothers engaged in interviews and completed several short surveys. The mothers shared important information about changes in self-identity and family identity and made suggestions about how medical and rehabilitation services can better support families affected by ABIs. Findings revealed that families who are intentional about discussing changes to the family, such as role shifts or changes in routine, and expressing emotions adapt more effectively to the consequences from an ABI. Furthermore, the results suggest recommendations for rehabilitation professionals in supporting mothers and families. These include, educating the family about ABIs and involving mothers and families as part of the treatment process. Future directions for further research studies are identified as well as a discussion on best practices for clinicians.

Mental illness is often associated with social isolation, unemployment and limited community participation. Mental health rehabilitation services aim to decrease these psychosocial effects of illness and encourage better community integration for mental health consumers. Volunteer work is one avenue in which consumers can become actively involved with their local communities. However whilst often supported clinically, limited empirical evidence exists which supports the use of volunteer work as a potential mode of rehabilitation for consumers. The overall aim of this study was to document consumer perceptions and experiences with volunteer work and to identify if participation in volunteer work has a positive impact on their mental health. Phase one of this study involved in-depth interviews with nine consumers currently volunteering. Themes identified from these interviews supported the notion that volunteer work is a meaningful occupation for consumers and one which promotes community integration and supports consumer recovery. Findings from the interviews also guided the development of a volunteer scale for later use within the study. Phase two involved the development and pilot testing of a volunteering questionnaire which measured consumer attitudes and experiences with volunteer work. This scale was combined with other standardised tests which measured the mental health variables of personal empowerment and quality of life. Phase three involved the administration of the questionnaire battery developed in phase two. The battery was distributed and completed by thirty consumers, including both those who were and were not volunteering. Analysis conducted identified that overall consumers held a positive view of volunteer work, believing it was a way of developing work skills, friendships and promoting positive mental health. / Analysis comparing the volunteering to the non volunteering group indicated that those volunteering experienced better quality of life, specifically within the psychological health, social relationships and personal environment domains. This provides support for the hypothesis that participation in volunteer work promotes consumer recovery. However, age was identified as a potential confounding variable and so the significant results should be viewed with caution. Cost, stigma and becoming unwell during volunteering were identified as barriers to consumer participation. It is argued that mental health services are in a good position to support consumers not only to access but also to maintain ongoing volunteer participation. To date minimal evidence has existed that supported this intervention. This study has begun to fill this research void, however, small study numbers and the cross-sectional, descriptive design make establishing a cause and effect relationship impossible. It would thus be beneficial to conduct a larger study investigating the impact further, including measuring the influence of any interventions that promote consumer participation in volunteer work, such as supported volunteering.

<p>According to the United Nations, more than half a billion people (about 650 million) worldwide are disabled. Disability can have a vast impact on both the individual and the family. Rehabilitation is therefore a fundamental need for the persons with disability to achieve functional independence and have an improved quality of life. To enhance the effectiveness of rehabilitation, it is important to seek clients&rsquo / perspectives of the rehabilitation services and to incorporate these perspectives into the planning and delivery of rehabilitation services. In areas where rehabilitation services are available in South Africa, minimal research has been done to explore the clients&rsquo / experiences regarding provision of these services. The aim of this study&nbsp / therefore was to explore the persons with physical disabilities&rsquo / experiences of the rehabilitation services they received at community health centres (CHCs) in the Cape Town Metro Health&nbsp / District. Data was collected using a mixed methods design in the form of a sequential exploratory strategy. Qualitative data collection was done using in-depth interviews and this was followed&nbsp / by administration of an interview questionnaire. The questionnaire was developed using results from the in-depth interviews together with information from literature. Ten persons with physical&nbsp / isabilities, who had received rehabilitation services at participated in the in-depth interviews and 95 responded to the interview questionnaire. The interviews were tape-recorded and&nbsp / transcribed verbatim and they were analysed using predetermined themes. The SPSS version 16.0 was used to analyse the quantitative data which was presented in frequencies, medians, quartiles and percentages. The results&nbsp / of the study revealed that the participants experienced problems with getting transport to travel to the community health centres and getting adequate information from the service providers,&nbsp / &nbsp / particularly information regarding disability and support services available for them. Experiences regarding participants&rsquo / involvement in their rehabilitation were generally positive. Generally, the&nbsp / participants reported positive experiences regarding their interaction with service providers and family support and involvement and this study recommends the staff to maintain their standards&nbsp / &nbsp / regarding these two dimensions of rehabilitation. However most of the participants were not concerned about whether the service providers gave them an opportunity to express their preferences or not. The results indicate the need to improve transport services for persons with physical disabilities and to give them more information regarding support services. The service providers&nbsp / should also give the clients more opportunities to get involved in their rehabilitation and educate them about the benefits of them getting involved.</p>