A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Master of Science in Occupational Therapy.
Johannesburg,
May 2019 / Background: Literature shows that access to rehabilitation services for persons with disabilities in South Africa is limited. Recent policy documents by the National Department of Health related to disability and rehabilitation propose integration of occupational therapy services in primary healthcare (PHC) reengineering. However, the implementation strategies are not entirely clear as there is inadequate evidence locally on the occupational therapy service provision in PHC even though there is growing evidence internationally.
Purpose: This study sought to determine the services provided by occupational therapists in PHC. Their perceptions of the integration of occupational therapy services within the PHC reengineering streams was also explored.
Methods: A two-phase explanatory sequential mixed method strategy was utilized in this study with data from the first quantitative phase guiding the second qualitative phase both of equal weights. The first phase was a nationwide cross-sectional quantitative survey strategy using an electronic questionnaire developed on REDCap to establish the extent to which occupational therapy services are delivered in PHC in South Africa. The second phase was an in-depth study using semi structured interviews to comprehensively explore with the occupational therapists practicing in PHC on their perceptions of integrating occupational therapy services in the PHC reengineering streams of the National Health Insurance (NHI). Ethics approval (M180819) was sought and obtained from the University of the Witwatersrand Human Research Ethics Committee (Medical).
Analysis: Descriptive analysis was done for the close-ended questions of the quantitative survey, frequencies and content analysis was done for the open-ended questions in the survey, and thematic content analysis was done for the qualitative data. Trustworthiness procedure such as confirmability, member-checking, dependability and triangulation of data sources (In-depth semi-structured interviews, field notes and survey) was used to ensure credibility of the research findings.
Results: Findings from this study showed there is increasing alignment of occupational therapy services in PHC with the community-based rehabilitation (CBR), the Social Model, the International Classification of Functioning (ICF), and Medical Model using self-management and case-management intervention approaches. The majority of occupational therapists in PHC work on the hospital-based MDT comprising other rehabilitation professionals and nurses. Occupational therapists in PHC have a strong perception of their relevance in the PHC reengineering streams despite the numerous barriers and few facilitators available for the integration of occupational therapy services in PHC reengineering streams of the NHI currently. Their perception is that occupational therapy service integration in the PHC reengineering streams will lead to improved healthcare and the integration will not happen without occupational therapy being adequately supported in PHC.
Conclusion: This study serves to provide evidence to help position occupational therapy and by extension other rehabilitation professions in the PHC reengineering streams of the NHI. The integration of occupational therapy services in the PHC reengineering streams of the NHI is essential to improve the health outcomes of the population and reduce the overall healthcare cost and growing burden of non-communicable diseases in the country / E.K. 2019
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/28217 |
| Date | January 2019 |
| Creators | Jejelaye, Anthony Oluwaseun |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | Online resource (174 leaves), application/pdf |
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