Prevention care for secondary health conditions among people with spinal cord injury in the Tshwane metropolitan area

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2021

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Pilusa, Sonti Imogene

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Promoting health and well-being for people with spinal cord injury is neglected. Spinal cord injury (SCI) is a chronic condition with complex needs and health challenges due to secondary health conditions (SHCs) such as pain, urinary tract infections and pressure sores. Secondary health conditions significantly affect the quality of life, life satisfaction and can decrease life expectancy. The reported high readmission rates due to preventable pressure sores and urinary tract infections sparked the inquiry into the experience of secondary health conditions and factors influencing these conditions' prevention. This study aimed to establish factors influencing prevention care for secondary health conditions among people with spinal cord injury in the Tshwane metropolitan area to develop a prevention model of care. Knowledge on the prevention of secondary health conditions is limited in South Africa. This study used a mixed-method approach with eight studies to address the study objectives. A retrospective study (n=425) was conducted to determine the prevalence of SHCs and the associated risk factors. The results showed a very high prevalence of SHCs (93.7%), and the most common SHCs were pain, bowel and bladder problems. The majority of the participants had multiple SHCs, and the predictors of multiple SHCs were socioeconomic factors, SCI duration and thoracic SCI lesion. These results suggest gaps in SHCs preventive care and that people with SCI need support to prevent SHCs. A qualitative study was conducted with care users (seventeen people with SCI, six caregivers) and care providers (twenty-one therapists) to understand the nuanced experiences of SHCs, prevention thereof, contextual factors influencing the prevention of SHCs and to identify solutions to improve preventive care for SHCs. From the analysis, SHCs impacts functioning, affects mental health, and cause significant disruption in everyday life. People with SCI used self-management, medication, assistive devices, resilience coping strategies and therapeutic approaches to prevent and manage SHCs. However, preventing and managing SHCs is challenging for people with SCI. The results suggest that people with SCI need support to prevent SHCs. Health professionals need to be proactive to empower people with SCI to maintain health and prevent SHCs. The personal factors influencing the prevention of SHCs included knowledge levels, behaviour patterns, socioeconomic factors, patient activation and owning an appropriate assistive device. The environmental factors included social support, inefficient healthcare system, inaccessible built structures and transport system. The healthcare system's inefficiencies were due to a shortage of medical resources (medication, consumables and assistive devices), health workers lacking knowledge of SHCs prevention, and inadequate patient care approach. The factors influencing the prevention of SHCs are multifactorial and complex. The findings emphasise the importance of a whole-person approach to care, understanding personal and environmental factors shaping the experience of prevention of care. If we are to optimise health and prevent the occurrence of SHCs, targeted interventions must address the identified factors To enhance inclusive health and develop a responsive prevention care model, we needed to listen to policymakers', service users' and care providers' views on solutions to improve the prevention of SHCs in people with SCI. The proposed services and interventions to improve the prevention of SHCs include access to adequate health care, patient-centred care, the importance of strengthening rehabilitation care throughout the continuum, promotion of health, skilled healthcare workers and access to resources such as medicine, assistive devices, disability-friendly transport and housing. The study's findings informed the development of a patient-centred prevention care model, highlighting the importance of putting the patient at the centre of care. Understanding the experiences of SHCs and preventive care shed light on the struggle to maintain health and the support needed to minimise the occurrence of SHCs. Prevention care for people with SCI needs to be holistic and empowering with a longitudinal perspective to care.

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A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg, South Africa, April, 2021

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