Peer support as pressure ulcer prevention strategy in special school learners with paraplegia.

Background: Adults with spinal cord injuries perceived peer support as beneficial in preventing secondary health conditions, but the role of peer support among adolescent learners with paraplegia in special schools is still unknown. Objectives: To explore the perspectives of current and previous learners with paraplegia on peer support to prevent pressure ulcers in a special school. Method: A qualitative, exploratory, descriptive study design was used. The authors conducted 12 semi-structured telephonic, audio-recorded interviews and a focus group discussion with current and previous learners with paraplegia attending a special school. The interviews were transcribed verbatim and translated, and data were organised using the Nvivo-12 Pro program. Through conducting an inductive thematic analysis categories, sub-themes and themes were identified from the participants' narratives. Results: The participants' perspectives included positive and challenging aspects of peer support reflected in four sub-themes: group-based support, individual peer mentoring, challenges with peer support and the roles of the school physiotherapist regarding peer support. Conclusion: Learners saw peer support as a crucial strategy in preventing and reducing pressure ulcers. Establishing a peer support system with group and individual components in special schools could be a game-changer to end pressure ulcers among learners with paraplegia and ensure better health and educational outcomes. Clinical implications: Physiotherapists in special schools should support peer support initiatives among learners with paraplegia to ensure successful pressure ulcer prevention.

South African physiotherapists' attitudes to medicine prescription as an extension of practice.

Background: The extension of medicine prescription rights to other healthcare providers was proposed to reduce pharmacotherapeutic service delivery challenges in the South African healthcare sector. The scope of practice of physiotherapists is being reviewed to possibly include prescription rights to promote service delivery. Objectives: Our study assessed the attitudes of registered South African physiotherapists to the inclusion of prescription rights in their scope of practice, including enablers and challenges, and the drug classes they believe to be most relevant. Method: A cross-sectional descriptive survey of South African registered physiotherapists was completed using an online questionnaire. Results: A total of 359 participants completed the questionnaire, where 88.2% agreed that prescribing rights should be introduced, and 87.64% would want to be trained to prescribe. Participants identified several benefits: improved service delivery (91.3%); reduced healthcare delivery costs (89.8%); decreased need for multiple healthcare practitioner consultations (93.2%). Concerns included: inadequate training (55%); increased workload (18.7%); increased insurance premiums against medical liability claims (46.2%). Drugs of relevance included analgesics (95.6%) and bronchodilators (96.0%), while low preference was placed on drugs unrelated to physiotherapy. Chi-square analysis revealed associations between specific drug classes and fields of expertise. Conclusion: South African physiotherapists agree that prescribing and a limited formulary would benefit their scope of practice; however, educational concerns are evident. Clinical implications: Findings support the drive to extend the South African physiotherapy scope of practice, however, investigation will be needed to determine the most appropriate way to capacitate future physiotherapists and current graduates should the extension be approved.

Strategies to integrate physiotherapists into primary health care in South Africa.

Background: Health services are inaccessible in low-income countries. The National Health Insurance (NHI) bill, linked to primary health care (PHC), was introduced in South Africa to improve access to health services. Physiotherapists contribute to healthcare and improve individuals' health status across their lifespan. The South African healthcare system has many challenges: physiotherapists mostly practising at secondary and tertiary levels of care; a shortage of physiotherapists in the public health systems and rural areas; the omission of physiotherapy in health policies. Objectives: To explore strategies to integrate physiotherapy services in PHC settings in South Africa. Method: Our study used a qualitative, exploratory and descriptive approach to collect data from nine doctorate physiotherapists at South African universities. Data were thematically coded. Results: The themes are to (1) improve societal knowledge of physiotherapy, (2) ensure policy representation of the profession, (3) transform physiotherapy education, (4) broaden the role of physiotherapy, (5) eradicate professional hierarchy and (6) increase the physiotherapy workforce. Conclusion: Physiotherapy is not well known in South Africa. Physiotherapy is needed to feature in health policies to transform education focussing on disease prevention, health promotion and functioning in PHC. Broadening physiotherapy roles should consider the regulator's ethical rules. Physiotherapists should proactively collaborate with other health professionals to dismantle professional hierarchies. Without addressing the urban-rural, private-public divide, the physiotherapy workforce cannot improve, to the detriment of PHC. Clinical implication: Implementing the suggested strategies may facilitate physiotherapy integration into PHC in South Africa.

Do physiotherapists have a role to play in the Sustainable Development Goals? A qualitative exploration.

BACKGROUND: While physiotherapists appear to be ideally positioned as key role players in achieving the health- and education-related Sustainable Development Goals (SDGs), few studies have examined the complete scope of physiotherapy practice in addressing the SDGS. Considering the broad scope of physiotherapy practice, physiotherapists are a valuable resource that the South African government can utilise to address their workforce shortages in achieving inclusive primary education, promoting gender equality, reducing child mortality, improving maternal health, and combating HIV and AIDS, and other diseases. OBJECTIVES: The aim of this study was to understand the roles of physiotherapists in the SDGs. METHOD: A qualitative, exploratory and descriptive approach was used. Semi-structured telephonic and Skype interviews were utilised to collect data from nine physiotherapists with PhDs working in academic institutions. Data were transcribed verbatim by the first author and verified by the second author. Data were entered into NVivo® Version 10. An inductive approach to qualitative data analysis was used. In vivo and open coding was used to generate codes and themes. RESULTS: The following roles were highlighted: (1) address HIV and AIDS, tuberculosis and other chronic diseases of lifestyle; (2) improve maternal health; (3) reduce child mortality; (4) empower women and (5) achieve inclusive education for children, especially children with disabilities. CONCLUSIONS: Physiotherapists are well suited to address the SDGs of promoting gender equality and empowering women, reducing child mortality rates, improving maternal health, achieving inclusive primary education and combating HIV and AIDS, tuberculosis and other chronic diseases of lifestyle. Physiotherapists have a valuable role in addressing the quadruple burden of disease in South Africa and assisting the government with the current health resource crisis. CLINICAL IMPLICATIONS: The results of this study will assist to move patient management from a more curative approach to health promotion and prevention. In addition, this study highlights the valuable role of physiotherapists in assisting and supporting the development agenda for 'Transforming our world: the 2030 Agenda for Sustainable Development'.

A qualitative investigation of the role of paediatric rehabilitation professionals in rural South Africa: Rehabilitation professionals' perspectives.

PURPOSE: To investigate the role that rehabilitation professionals play in the rehabilitation of children with disabilities in the rural and under-resourced community of Giyani in South Africa. METHOD: A qualitative, exploratory and descriptive approach was used. Semi-structured face-to-face interviews were used to collect data from a convenient sample of eight rehabilitation professionals. Data were transcribed verbatim by two trained students and verified by the main researcher. An inductive approach to qualitative data analysis was used. In vivo and open coding were used to generate codes. RESULTS: Analysis of data resulted in 21 codes, 9 subcategories, 5 categories and 1 theme. The role of rehabilitation professionals was described in terms of the five categories which are to examine newborn babies and children at risk, support caregivers of children with disabilities, impart skills training for caregivers of children with disabilities, rehabilitate children with disabilities and conduct follow-ups in communities where the children with disabilities reside. CONCLUSION: The role that rehabilitation professionals play in the rural and under-resourced community of Giyani in South Africa is similar to the role played in high-income countries. The role that rehabilitation professionals play is not only focused on the child but also on the family.