ABSTRACT
INTRODUCTION: The WHO has estimated that 1% of the world's population need a wheelchair, but few have access. Access to wheelchairs for most of the South African poor population is through accessing rehabilitation services at public health facilities. This study explored access to wheelchair services from the perspective of rehabilitation therapists, within the uMkhanyakude district of KwaZulu-Natal. Therapists' perceptions on access, and its impact on service delivery is under-explored in the literature. METHODS: Semi-structured interviews with 11 rehabilitation therapists in the uMkhanyakude district directly involved with wheelchair services were conducted. Levesque et al's conceptual framework of access to health care was used to analyse the data. Themes consistent with these dimensions - approachability, acceptability, availability and accommodation, affordability and appropriateness - were identified from the data. RESULTS: Access to wheelchairs was perceived to be facilitated by the establishment of meaningful relationships with wheelchairs users, the ability to eventually provide an appropriate wheelchair for all users, the provision of services close to where people live, the training of caregivers and the use of local peer trainers. Perceived barriers were limited outreach by the rehabilitation staff, poor screening of those with mobility impairment by other categories of staff, and limited space and time to provide services. Further barriers linked to the therapists included their uncertainty about their level of competency in the context and lack of peer support for the rehabilitation staff, especially those working alone. Barriers associated with clients were the limited understanding of wheelchairs, and what was perceived to be a lack of responsibility to look after the wheelchairs, which led to poor maintenance. CONCLUSION: The aspects of the five dimensions of access of Levesque et al's framework were identified as both facilitators and barriers.The therapists working in this remote rural area have a a strong sense of responsibility about the wheelchair service delivery process and offered clients the best they could with limited human and financial resources. They have a good understanding of the wheelchair users and the environment they function in, which enabled constant adaptation of the services to meet the needs of that specific community.
Subject(s)
Disabled Persons , Wheelchairs , Allied Health Personnel , Humans , Rural Population , South AfricaABSTRACT
Introduction: This study investigates the implementation of a new, more automated screening procedure using the ItFits-toolkit in the online clinic, Internet Psychiatry (iPsych) (www.internetpsykiatrien.dk), delivering guided iCBT for mild to moderate anxiety and depressive disorders. The study focuses on how the therapists experienced the process. Methods: Qualitative data were collected from semi-structured individual interviews with seven therapists from iPsych. The interviews were conducted using an interview guide with questions based on the Consolidated Framework for Implementation Research (CFIR). Quantitative data on the perceived level of normalization were collected from iPsych therapists, administrative staff, and off-site professionals in contact with the target demographic at 10-time points throughout the implementation. Results: The therapists experienced an improvement in the intake procedure. They reported having more relevant information about the patients to be used during the assessment and the treatment; they liked the new design better; there was a better alignment of expectations between patients and therapists; the patient group was generally a better fit for treatment after implementation; and more of the assessed patients were included in the program. The quantitative data support the interview data and describe a process of normalization that increases over time. Discussion: The ItFits-toolkit appears to have been an effective mediator of the implementation process. The therapists were aided in the process of change, resulting in an enhanced ability to target the patients who can benefit from the treatment program, less expenditure of time on the wrong population, and more satisfied therapists.
ABSTRACT
BACKGROUND: Challenges to implementating interventions for adolescent depression exist. Exploring the perceptions of key stakeholders in the treatment of adolescent depression is essential for improving implementation . This study aimed to explore psychological therapists' perceptions of, and experiences treating, adolescent depression to identify future avenues for exploration. METHOD: Data were collected opportunistically via a survey integrated within an e-learning package about adolescent depression. RESULTS: Participants believed that adolescent depression was characterised by adolescents' lack of understanding, isolation, and a lack of hope and knowledge. Participants overcame engagement barriers by building trust. Following the e-learning, participants expressed increased understanding of the risk factors associated with adolescent depression and of assessment using different measures. Several key areas for future research to explore were identified and discussed, including (1) whether clinicians of different modalities or at different career stages have difference perceptions, (2) how to meaningfully engage adolescents in treatment and (3) how to train clinicians on different modalities so patients have a choice over their treatment. CONCLUSION: This study demonstrates the value of knowledge gained from understanding psychological therapists' perceptions and illustrates how this can contribute to the improved treatment of adolescent depression.