Factors contributing to defaulting scheduled therapy sessions by caregivers of children with congenital disabilities.

BACKGROUND: Defaulting scheduled rehabilitation therapy may result in increased adverse outcomes such as permanent disability and increased healthcare costs. Concomitantly, there is evidence to suggest that early and continued rehabilitation of children with congenital disabilities can improve outcomes significantly. This study was conducted to determine factors contributing to caregivers' defaulting scheduled rehabilitation therapy sessions. METHODS: A descriptive cross sectional study was carried out at Chitungwiza Central Hospital, a tertiary facility offering in and outpatient rehabilitation services in Zimbabwe. Caregivers of children who had congenital disabilities (N=40) and who had a history of defaulting treatment but were available during the data collection period responded to an interviewer administered questionnaire. Data were analysed for means and frequencies using STATA 13. RESULTS: Factors that contributed to caregivers defaulting scheduled therapy included economic constraints (52%), child related factors (43%), caregiver related factors (42%), service centred factors (30%) and psychosocial factors(58%). Majority of the caregivers (98%) were motivated to attend therapy by observable improvements in their children. Other motivators were incentives given in the rehabilitation department (45%), availability of rehabilitation personnel to provide the required services (48%) and psychosocial support from fellow caregivers, families and the rehabilitation staff (68%). Although all the caregivers could not distinguish occupational therapy from physiotherapy services they all reported that therapy was important. CONCLUSIONS: A combination of psychosocial, economic, child centred and service centred factors contributed to caregivers defaulting scheduled therapy. Interventions that may potentially improve caregiver attendance to scheduled therapy include community outreach services, efficient rehabilitation service provision at the hospitals, and facilitation of income generating programmes for caregivers.

Occupational therapy needs of adolescents and young adults with cerebral palsy in Zimbabwe: caregivers' perspectives.

Objectives: To determine occupational therapy needs of adolescents and young adults with cerebral palsy living in an urban setting, to identify participation levels in activities of daily living and social activities, to identify factors influencing participation and to determine the contribution of occupational therapy in participating in these activities. Design: Descriptive cross-sectional. Setting: Community rehabilitation outreach points in Epworth, Mufakose, Glenview, Dzivarasekwa, Mabvuku and Norton. Participants: Thirty-five randomly selected primary caregivers of adolescents and young adults with cerebral palsy. Data analysis: Data collected on the questionnaires was analysed using SPSS/16.0 for frequencies and means. Results: Fourteen (41%) of the adolescents and young adults were independent in self-care activities such as toileting, grooming, dressing, mobility and bathing. Twenty-one (59%) were totally dependent or needed some assistance in performing activities of daily living. Factors reported to influence participation included upper and lower limb contractures, transport challenges, financial constraints and the home environment. Occupational therapy needs of adolescents and young adults as reported by their caregivers included further training in activities of daily living (74%), home adaptations (66%), vocational skills training (20%) and provision of appropriate assistive devices (6%). Conclusion: In light of these findings performance areas that still needed occupational therapy interventions included activities of daily living, vocational skills training, use of assistive devices and home adaptations. Therefore adolescents and young adults with cerebral palsy living in Zimbabwe still have functional performance deficits that can be addressed by provision of follow-up community occupational therapy interventions.