Perspectives of basic wheelchair users on improving their access to wheelchair services in Kenya and Philippines: a qualitative study

Williams, Emma; Hurwitz, Elizabeth; Obaga, Immaculate; Onguti, Brenda; Rivera, Adovich S.; Sy, Tyrone Reden; Kirby, R. Lee; Noon, Jamie H.; Tanuku, Deepti; Gichangi, Anthony; Bazant, Eva

doi:10.1186/s12914-017-0130-6

Cited by 32 publications

(29 citation statements)

References 16 publications

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“…Conversely, for those who did access the new wheelchair services, feedback from the CBR workers highlighted benefits to users, similar to recent findings in Kenya and the Philippines (Williams et al 2017).…”

Section: Findings and Discussionsupporting

confidence: 79%

Community-based rehabilitation workers’ perspectives of wheelchair provision in Uganda: A qualitative study

2019

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Background: The challenges of wheelchair provision and use in less resourced settings are the focus of global efforts to enhance wheelchair service delivery. The shortage of professional wheelchair service providers in these settings necessitates the collaboration of multiple stakeholders, including community-based rehabilitation (CBR) workers, whose role needs to be further understood.Objectives: The aim of this study was to determine what CBR workers in three areas of Uganda perceived as (1) the challenges with wheelchair provision and use, (2) the factors contributing to these challenges, (3) the role they themselves can potentially play and (4) what facilitators they need to achieve this.Method: This qualitative study in the transformative paradigm comprised focus group discussions to gather perceptions from 21 CBR workers in three areas of Uganda, each with an operational wheelchair service, participant observations and field notes. Thematic analysis of data was implemented.Results: Community-based rehabilitation workers’ perceptions of challenges were similar while perceived causes of challenges differed as influenced by location, historical and current wheelchair availability and the CBR workers’ roles. Their main responsibilities included assistance in overcoming barriers to access the service, transfer of skills and knowledge related to wheelchairs, follow-up of users for wheelchair-related problem-solving, and user and community empowerment.Conclusion: Community-based rehabilitation workers can contribute in various ways to wheelchair service delivery and inclusion of wheelchair users; however, their capabilities are not consistently applied. Considering the diversity of contextual challenges, CBR workers’ range of responsive approaches, knowledge of networks and ability to work in the community make their input valuable. However, to optimise their contribution, specific planning for their training and financial needs and effective engagement in the wheelchair services delivery system are essential.

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Section: Findings and Discussionsupporting

confidence: 79%

Community-based rehabilitation workers’ perspectives of wheelchair provision in Uganda: A qualitative study

2019

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“…Outwardly oriented users may have sought out information on wheelchair repairs. In Philippines, advice on how to repair wheelchairs or get spare parts may have followed chair breakdowns and falls (Williams et al 2016 ). Possible factors related to this outcome may be fewer accessible environments and more available compatible parts and repair services.…”

Section: Discussionmentioning

confidence: 99%

Wheelchair services and use outcomes: A cross-sectional survey in Kenya and the Philippines

Bazant¹,

Hurwitz²,

Onguti³

et al. 2017

Afr. j. disabil.

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BackgroundThe World Health Organisation recommends that services accompany wheelchair distribution. This study examined the relationship of wheelchair service provision in Kenya and the Philippines and wheelchair-use–related outcomes.MethodWe surveyed 852 adult basic manual wheelchair users. Participants who had received services and those who had not were sought in equal numbers from wheelchair-distribution entities. Outcomes assessed were daily wheelchair use, falls, unassisted outdoor use and performance of activities of daily living (ADL). Descriptive, bivariate and multivariable regression model results are presented.ResultsConditions that led to the need for a basic wheelchair were mainly spinal cord injury, polio/post-polio, and congenital conditions. Most Kenyans reported high daily wheelchair use (60%) and ADL performance (80%), while these practices were less frequent in the Philippine sample (42% and 74%, respectively). Having the wheelchair fit assessed while the user propelled the wheelchair was associated with greater odds of high ADL performance in Kenya (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.6, 5.1) and the Philippines (OR 2.8, 95% CI 1.8, 4.5). Wheelchair-related training was associated with high ADL performance in Kenya (OR 3.2, 95% CI 1.3, 8.4). In the Philippines, training was associated with greater odds of high versus no daily wheelchair use but also odds of serious versus no falls (OR 2.5, 95% CI 1.4, 4.5).ConclusionSelect services that were associated with some better wheelchair use outcomes and should be emphasised in service delivery. Service providers should be aware that increased mobility may lead to serious falls.

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“…Finally, the ability to easily map transfer difficulties in the built environment could also allow WU to share their experiences and provide information about accessibility standards of various establishments (ie, hotel rooms, restaurant toilet). This could also be extended to lower- and middle-income countries, where the majority of disabled people live, who frequently do not have access to rehabilitation programs [39].…”

Section: Discussionmentioning

confidence: 99%

Use of a Low-Cost, Chest-Mounted Accelerometer to Evaluate Transfer Skills of Wheelchair Users During Everyday Activities: Observational Study

Barbareschi¹,

Holloway²,

Bianchi-Berthouze³

et al. 2018

JMIR Rehabil Assist Technol

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BackgroundTransfers are an important skill for many wheelchair users (WU). However, they have also been related to the risk of falling or developing upper limb injuries. Transfer abilities are usually evaluated in clinical settings or biomechanics laboratories, and these methods of assessment are poorly suited to evaluation in real and unconstrained world settings where transfers take place.ObjectiveThe objective of this paper is to test the feasibility of a system based on a wearable low-cost sensor to monitor transfer skills in real-world settings.MethodsWe collected data from 9 WU wearing triaxial accelerometer on their chest while performing transfers to and from car seats and home furniture. We then extracted significant features from accelerometer data based on biomechanical considerations and previous relevant literature and used machine learning algorithms to evaluate the performance of wheelchair transfers and detect their occurrence from a continuous time series of data.ResultsResults show a good predictive accuracy of support vector machine classifiers when determining the use of head-hip relationship (75.9%) and smoothness of landing (79.6%) when the starting and ending of the transfer are known. Automatic transfer detection reaches performances that are similar to state of the art in this context (multinomial logistic regression accuracy 87.8%). However, we achieve these results using only a single sensor and collecting data in a more ecological manner.ConclusionsThe use of a single chest-placed accelerometer shows good predictive accuracy for algorithms applied independently to both transfer evaluation and monitoring. This points to the opportunity for designing ubiquitous-technology based personalized skill development interventions for WU. However, monitoring transfers still require the use of external inputs or extra sensors to identify the start and end of the transfer, which is needed to perform an accurate evaluation.

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Perspectives of basic wheelchair users on improving their access to wheelchair services in Kenya and Philippines: a qualitative study

Cited by 32 publications

References 16 publications

Community-based rehabilitation workers’ perspectives of wheelchair provision in Uganda: A qualitative study

Community-based rehabilitation workers’ perspectives of wheelchair provision in Uganda: A qualitative study

Wheelchair services and use outcomes: A cross-sectional survey in Kenya and the Philippines

Use of a Low-Cost, Chest-Mounted Accelerometer to Evaluate Transfer Skills of Wheelchair Users During Everyday Activities: Observational Study

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