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Recent Submissions

Accessibility of resource constrained urban communities for female wheelchair users in the South African context
(2022) Edwards, Sydney
Background: Wheelchair users living in resource-constrained communities are faced with many physical, social and attitudinal barriers in their environment, which impacts on their access to and participation in their communities and society as a whole. Although legislation regarding access exists in South Africa, poor implementation of appropriate accessibility standards has been noted. Methodology: This study followed a descriptive, explorative qualitative design to guide the exploration of female wheelchair users’ experience of accessibility in the physical and social environment. Purposive sampling was applied, and five participants who matched the inclusion criteria were included in the study. Inductive data analysis was done using descriptive and in vivo codes. Validity strategies of trustworthiness, authenticity and credibility were applied throughout. Results: The following three themes emerged from the data: “Not able to go where I want to go”, “With others, I can go wherever I want to go”, and “Attitude towards disability impacts participation”. Conclusion: The predominant barriers to access for wheelchair users in resourceconstrained communities exist in the physical environment. Structural challenges related to not having enough space for the wheelchair, poor quality of terrain, and the absence of ramps to enter facilities or buildings were found to be some of the main limiting factors to accessibility. The social environment, although not without its own challenges such as negative community attitudes, offers more facilitators to access. Family support was found to be a vital facilitator to overcoming barriers in the physical environment, and to promoting occupational performance. Personal factors of the individual such as coping strategies and level of acceptance of disability was also found to influence the individual’s access and participation.
The influence of interoception on engagement in occupation: a scoping review
(2022) Wijnberg, Meagan Laura
Interoception provides information on internal sensations facilitating awareness of the physiological condition of the body. Interoception is an emergent concept within occupational therapy research and practice due to its impact on occupational performance. Poor interoceptive awareness (IA) may affect occupational engagement through individuals under or over responding to interoceptive cues. Considered a key component in emotional experience, interoception contributes to performance in various occupational areas. This scoping review explored the relationship between interoception and occupational engagement. The Joanna Briggs Institute (JBI) guidelines informed the methodology and involved a three-step search strategy using major scientific and grey literature databases. The search resulted in the extraction of thirteen articles (n=13) that met the inclusion criteria. Data analysis identified a relationship between IA and occupational engagement. Poor IA affects engagement in various occupational areas including activities of daily living, sleep, social participation, and education. The evidence related to interoception within occupational therapy is small but growing and IA appears to play a role in many conditions addressed by the occupational therapy profession. This research study could inform occupational therapy practice and future research related to interoception.
Evidence of determining clinical utility in the development of assessments in occupational therapy: a scoping review
(2022) Dawson, Lindsay
Occupational therapists rely on information gained from standardised assessments, screening instruments, and clinical observations to determine a client’s strengths and weaknesses (American Occupational Therapy Association [AOTA], 2020; Brown, 2010; Foxcroft & Roodt, 2013; Kramer et al., 2009; Richardson, 2010). The information gained from the assessment will be used for planning of intervention and discharge, writing of reports and documentation, as well as applying for funding from medical aids (Alotaibi et al., 2009; Asaba et al., 2017; Benson & Clark, 1982; Scott et al., 2006; Unsworth, 2000). Clinical practice is therefore demanding assessments that are not only psychometrically sound but are appropriate to the context in which they are used (Bossuyt et al., 2012; Foxcroft et al., 2004; Glover & Albers, 2007; Nalder et al., 2017). Clinical utility can be described as how useful and appropriate the assessment is within a specific setting (Benson & Clark, 1982; Lesko et al., 2010; Macy, 2012; Nalder et al., 2017). This is especially important within the South African context, where occupational therapists often use assessments that were developed in the Global North. During assessment development, validity and reliability are often the only factors determined to establish the psychometric properties of an assessment (Benson & Clark, 1982; Salmond, 2008; Switzer et al., 1999). However, it is essential to determine the clinical utility of an assessment during the psychometric testing phase in assessment development. This will allow the developer to adjust the assessment to suit the characteristics and needs of the population and context (Bowyer et al., 2012). A scoping review was conducted to determine whether there is evidence of clinical utility being determined as part of psychometric testing during assessment development in occupational therapy. The study aimed to map the available literature on clinical utility in occupational therapy and identify possible gaps within the existing literature. A comprehensive search of published and unpublished literature between January 2005 and December 2020 was conducted. The search yielded 38 applicable studies. The results of the study indicated an increase in the number of studies done on the clinical utility of assessments within the last 10 years. The majority of the studies were conducted in Global North countries including Australia, the United States of America, and the United Kingdom. The included studies used a variety of study designs, including qualitative, quantitative, and mixed method research designs. The study also included both systematic and literature reviews. However, these designs often did not include the context for which the clinical utility was being determined. A wide variety of components of clinical utility were included within the research, emphasising the lack of a standardised definition as well as a process for establishing the clinical utility. Limited studies on clinical utility were conducted during the assessment development process. Studies were mostly conducted when an already developed assessment was used in a different context to which it was initially developed. None of the included research was conducted in South Africa. Therefore, the results from the Global North cannot be generalised to the diverse context and rich cultural population of South Africa, which forms part of the Global South.
Experiences and perceptions of stroke survivors and occupational therapists on community reintegration post stroke in the Western Cape
(2022) Lindner, Hendrina Cecilia
Worldwide, stroke is one of the leading causes of death and disability. In South Africa, despite numerous policies guiding rehabilitation at different levels of care, stroke survivors show poor levels of community reintegration on returning home. The purpose of this study was to explore the lived experiences of stroke survivors on returning home after having received in-patient rehabilitation as well as their perceptions of the barriers and facilitators to their recovery and process of community reintegration. Furthermore, the study explored the barriers and facilitators to facilitate community reintegration perceived by occupational therapists working in the same area when providing services for stroke survivors. A descriptive, qualitative study design with a phenomenological emphasis was used to conduct this study. Demographic questionnaires and semi-structured key informant interviews were used to conduct interviews with eleven stroke survivors who had received in-patient rehabilitation and were one to three years post stroke as well as two occupational therapists servicing the same area. Three themes emerged from the study. The first theme emerged as the changes in occupational performance experienced by stroke survivors. The second and third theme emerged as the barriers and facilitators to community reintegration as perceived and experienced by stroke survivors living in the Eastern Subdistrict of the Western Cape. Data from the occupational therapy participants were used to triangulate the data that emerged from the stroke survivor participant interviews. Community reintegration continues to be a challenge for stroke survivors living in the Eastern Subdistrict of the Western Cape. Often the barriers are social determinants of health such as the environment, poor coordination of rehabilitation services and poor access to public transport. On the other hand, several facilitators such as stroke survivors’ motivation, drive and social support systems were identified occupational therapists can capitalise on to facilitate the process of community reintegration for stroke survivors. The study highlighted the importance of effective discharge and community-based services to ensure the continuum of rehabilitation for stroke survivors when returning home.
Primary care givers’ experiences of family centred care in a paediatric hospital in Gauteng
(2022) Mashishi, Pretty
Family Centred Care (FCC) is an approach to the planning, delivery and evaluation of health care that is grounded in a mutually beneficial partnership among patients, families and health care professionals (Johnson and Abraham, 2012). When nursing patients their loved ones are involved and a holistic approach is applied. The benefits of FCC are well documented and include shorter hospital stays, improved preparedness for discharge and less emotional stress for both families and patients (Johns Hopkins Children’s Center, 2018).Most nurses acknowledge the importance of FCC and are practising it to some extent however, unsuccessful implementations of FCC are known to exist in various clinical practice settings (Almaze and De Beer, 2017). The experiences of Primary Care Givers (PCGs) in paediatric care are important to understand because according to Hill, Knafl, and Santacroce, 2018 parents are the voice, advocates and care givers for their children including during critical paediatric illness (Hill et al., 2018). Therefore, it is important to know what families actually need as opposed to what healthcare professionals assume they need (Jordan, 2018). The purpose of this research was to determine the primary care givers experience of Family Centred Care in a paediatric hospital in Gauteng. Knowing the positive and negative experiences of FCC by PCGs assists health care providers to gain insight into how to involve PCGs and improve the practice of FCC. A sample of participants was selected using purposeful sampling from Primary Care Givers who were lodging at the hospital. A qualitative descriptive design was used in this research. Interviews with semi-structured questions were used to collect data. Questions were based on four key elements of FCC, as identified by Conway et al(2006) and were used as a template design for the questions. Data was analysed using a latent content analysis approach. The findings were described using themes formed from the interview questions in relation to the core concepts of FCC. The findings of this study reveal that primary caregivers encounter both positive and negative experiences when core concepts of FCC are implemented. Regarding participation, primary caregivers are willing to engage in care with health care professionals as the enabling factor. Respect and dignity are primarily conveyed through human and professional courtesies. These professional and friendly courtesies also facilitate information sharing. The severity of the condition of a child is a key limiting factor for participation but primary caregivers place trust in the knowledge of health care professionals. PCGs place total trust in the knowledge of health care providers.Collaboration was not present in terms of the Institute for Patient and Family-Centred Care (IPFCC) definition as there was no evidence of involvement in policy and program development. Recommendations Health care professionals must be acquainted with the core concepts of FCC and how their actions can impact the experiences of primary caregivers through efforts to act professionally and kindly so that the care environment is conducive for primary caregivers. It is also recommended to educate primary caregivers regarding coping with their hospitalised child and also regarding FCC. Finally, the hospital should develop policies for FCC regarding training, implementation and regular evaluation.