Background Defaulting scheduled rehabilitation therapy may result in increased adverse outcomes such as permanent disability and increased healthcare costs. Concomitantly, there is evidence to suggest that early and continued rehabilitation of children with congenital disabilities can improve outcomes significantly. This study was conducted to determine factors contributing to caregivers' defaulting scheduled rehabilitation therapy sessions. Methods A descriptive cross sectional study was carried out at Chitungwiza Central Hospital, a tertiary facility offering in and outpatient rehabilitation services in Zimbabwe. Caregivers of children who had congenital disabilities (N=40) and who had a history of defaulting treatment but were available during the data collection period responded to an interviewer administered questionnaire. Data were analysed for means and frequencies using STATA 13. ResultsFactors that contributed to caregivers defaulting scheduled therapy included economic constraints (52%), child related factors (43%), caregiver related factors (42%), service centred factors (30%) and psychosocial factors(58%). Majority of the caregivers (98%) were motivated to attend therapy by observable improvements in their children. Other motivators were incentives given in the rehabilitation department (45%), availability of rehabilitation personnel to provide the required services (48%) and psychosocial support from fellow caregivers, families and the rehabilitation staff (68%). Although all the caregivers could not distinguish occupational therapy from physiotherapy services they all reported that therapy was important. Conclusions A combination of psychosocial, economic, child centred and service centred factors contributed to caregivers defaulting scheduled therapy. Interventions that may potentially improve caregiver attendance to scheduled therapy include community outreach services, efficient rehabilitation service provision at the hospitals, and facilitation of income generating programmes for caregivers.
Community-based education (CBE) is a learning approach that enables students to acquire skills by means of applied learning in the community. [1] This learning approach includes elements of primary healthcare, health promotion and disease prevention, and allows students to acquire clinical, research, communication and other professional competencies in a commu nity setting. [2] The goals of CBE include creating knowledge, skills and attitudes among students to ensure the provision of efficient health services to marginalised communities, often in rural areas and communities with significant resource constraints. [3] These goals ultimately increase health professionals' willingness to work in underserved areas. [4] CBE provides opportunities to acquire research, clinical and public health skills through applied learning in a community setting. [1] The objective of CBE is to direct health professionals towards the most important health problems of the community. [5] Despite the several challenges that may affect CBE, lower attrition rates, a greater perceived ability to function in rural communities and high satisfaction, as indicated by students and community members, have been noted as advantages of CBE. [6] Other beneficial aspects of CBE include early contact with the community, improved teamwork of trainees, and improved interpersonal relationships and communication skills. [6] The physiotherapy and occupational therapy students at the University of Zimbabwe, Harare, have been part of CBE attachments since the inception of the programmes in 1987. The University of Zimbabwe has 12 CBE attachment sites, which are shared by all the programmes of the College of Health Sciences. The activities at each of the CBE sites differ, depending on available resources. These activities are mainly sponsored by the Ministry of Health and Child Care and its partners. The University of Zimbabwe provides transport for the students during the CBE attachment. Each of the attachment sites can accommodate a maximum of 10 students; therefore, the number of attachment sites per given year is determined by the number of students registered for their 3rd year in both physiotherapy and occupational therapy. The students who participated in this study had been attached to 5 of these 12 sites. Before their CBE attachment, the students in the Department of Rehabilitation at the University of Zimbabwe receive lectures to prepare them for the attachment. Some of the content covered during the lectures includes the role of rehabilitation professionals in the community, developing, monitoring and evaluating community-based rehabilitation programmes, as well as managing and administering rehabilitation units. These lectures provide the students with the theoretical learning experience, while the CBE attachments provide a practical learning experience. The students are placed at CBE attachment sites for 6 weeks in teams comprising occupational therapy and physiotherapy students. As part of the attachment, the students are expected to visit the loc...
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