A review of the framework and strategy for disability and rehabilitation services in South Africa.

Background: Rehabilitation is imperative for the successful integration of persons with disabilities into their social environments. The Framework and strategy for disability and rehabilitation services (FSDR) in South Africa, 2015-2020.was developed to strengthen access to rehabilitation services and ensure the inclusion of persons with disabilities in all aspects of community life. Despite the FSDR being commissioned, access to rehabilitation is a challenge for persons with disabilities and further compounded in rural communities. Objective: The study aimed to describe the barriers and facilitators that influenced the process of development, implementation and monitoring of the FSDR. Method: This qualitative study employed a single case study design. Data was collected through document analysis and in-depth interviews utilising the Walt & Gilson policy analysis framework that outlines the context, content, actors and process of policy development and implementation. In-depth interviews were conducted with twelve key informants (N=12) who were selected purposively for the study. Data obtained from the in-depth interviews were analysed using inductive thematic analysis. Results: We found many factors that influenced the implementation of the framework. Actor dynamics, insufficient resources, the rushed process, poor record-keeping, inappropriate leadership, negative attitudes of staff members and the insufficient monitoring impeded the successful implementation of the framework. While positive attitude, mentorship and support amongst the task team facilitated the implementation process, albeit with challenges. Conclusion: There is a need to address implementation gaps so that the FSDR is responsive to the current rehabilitation needs of persons with disabilities in South Africa. Contribution: This study may inform future disability policy, and can be used as a tool to advocate for the rights for persons with disabilities.

The effects of COVID-19 on the rehabilitation of persons with aphasia: A scoping review.

BACKGROUND:  The impact of the Coronavirus disease 2019 (COVID-19) pandemic was more pronounced on the well-being of persons with disabilities, especially in low- and middle-income countries. There is documented evidence of the rippling effects of COVID-19 on persons with disabilities. However, not much is known about the impact of COVID-19 on the rehabilitation of persons with aphasia. OBJECTIVE:  The scoping review explores how COVID-19 affected the rehabilitation of persons living with aphasia. METHOD:  A scoping review was conducted using Arksey and O'Malley's framework. A search was conducted on Science Direct, PubMed, Medline, Scopus, ProQuest and Google Scholar, to identify relevant studies published between 2019 and 2022. Data were analysed using thematic analysis. RESULTS:  Most studies regarding the effects of COVID-19 on persons living with aphasia were conducted in the United Kingdom. Five themes emerged from the data, namely, (1) negative impact on rehabilitative care, (2) telehealth and its limitations, (3) impact on social participation, (4) compromised caregiver involvement and (5) mental health challenges. CONCLUSIONS:  Findings highlight the need for healthcare professionals to pursue innovative ways in which aphasia rehabilitation and conversational support programmes can be made accessible to persons with aphasia, despite the limitations brought about by a pandemic. Telerehabilitation programmes need to be tailored to the needs of persons with aphasia if they are to be successful. This study highlights the importance and need for the prioritisation of mental health services for persons with aphasia and their caregivers during a pandemic.

Students' experiences of using a writing-intense programme to facilitate critical thinking skills on an online clinical training platform: A pilot study.

BACKGROUND:  Coronavirus disease 2019 (COVID-19) and the subsequent lockdown altered traditional clinical training for speech language pathology students, thus forcing training institutions to implement innovative and responsive clinical training strategies in the midst of the pandemic. As such, a writing-intense programme was piloted in an online clinical training programme with second-year speech language pathology students. OBJECTIVES:  This study explored speech language pathology students' experiences with a writing programme used during an online clinical training programme implemented during the COVID-19 pandemic. METHOD:  The study used a qualitative survey design. Purposive convenient sampling was used to recruit 29 second-year speech language pathology students. Online student reflections guided by 10 open-ended questions were used to elicit responses from students. Data were analysed using deductive thematic analysis. RESULTS:  Findings revealed that the written component of the programme facilitated the acquisition of clinical knowledge and improved clinical processes of writing among students. Feedback that students received on their written tasks improved learning. The clinical component of the course enabled students to learn in a less stressful environment and helped them gain confidence in their knowledge and clinical skills. Connectivity challenges and the lack of motivation from some students negatively impacted the programme. CONCLUSION:  Using a writing programme to clinically train students can have positive effects in applying theory to clinical application because it affords students time to consolidate and process theory with practice as the jump from first year to second year can be cognitively taxing. A writing-intense programme can also improve students' writing skills.

Rehabilitation healthcare professionals' competence and confidence in differentially diagnosing deafblindness from autism spectrum disorders: a cross-sectional survey in South Africa.

BACKGROUND: Early diagnosis and management of children who are deafblind is important to alleviate the effects of deafblindness on the development of the child who is deafblind and their families. However, children who are deafblind are often misdiagnosed or diagnosed late. The misdiagnosis or late diagnosis has been attributed to many factors, one of which is the competence and confidence of healthcare professionals in differentially diagnosing deafblindness from other conditions, in most cases, autism spectrum disorder (ASD). The study therefore aimed to establish the competence and confidence of rehabilitation healthcare professionals in differentially diagnosing deafblindness from ASD in the South African context. METHODS: A cross-sectional survey design was employed for the study. An online questionnaire was distributed to rehabilitation healthcare professionals (N = 78) via Survey Monkey. Data were analyzed using descriptive and inferential statistics. Ethical clearance and permission were obtained from relevant stakeholders prior to the commencement of the study. RESULTS: Regarding the rehabilitation healthcare professionals in this study, 54% were competent in diagnosing ASD, while only 35% could correctly diagnose deafblindness. In some instances, symptoms were classified as associated with both ASD and deafblindness, when they were just those of deafblindness. Of all the rehabilitation healthcare professionals in this study, speech language therapists displayed the most knowledge of deafblindness. Furthermore, healthcare professionals who had between one and nine years of working experience had more knowledge of deafblindness than other professionals with more or less experience. CONCLUSION: Deafblindness is often underdiagnosed or misdiagnosed as ASD. This is due to the lack of competence and confidence of rehabilitation healthcare professionals in diagnosing it. The findings therefore highlight the need for training of rehabilitation healthcare professionals. Training on deafblindness could be included as part of the curriculum in the various undergraduate programs. Deafblindness could also form part of the Continuous Professional Development (CPD) training programs at various healthcare facilities. A team approach to the training would be ideal as it would facilitate peer learning and support. More research is required as it would inform evidence-based assessment, and management and support strategies for children who are deafblind and their families.

A review of the framework and strategy for disability and rehabilitation services in South Africa

Background: Rehabilitation is imperative for the successful integration of persons with disabilities into their social environments. The Framework and strategy for disability and rehabilitation services (FSDR) in South Africa, 2015-2020.was developed to strengthen access to rehabilitation services and ensure the inclusion of persons with disabilities in all aspects of community life. Despite the FSDR being commissioned, access to rehabilitation is a challenge for persons with disabilities and further compounded in rural communities. Objective: The study aimed to describe the barriers and facilitators that influenced the process of development, implementation and monitoring of the FSDR. Method: This qualitative study employed a single case study design. Data was collected through document analysis and in-depth interviews utilising the Walt & Gilson policy analysis framework that outlines the context, content, actors and process of policy development and implementation. In-depth interviews were conducted with twelve key informants (N=12) who were selected purposively for the study. Data obtained from the in-depth interviews were analysed using inductive thematic analysis. Results: We found many factors that influenced the implementation of the framework. Actor dynamics, insufficient resources, the rushed process, poor record-keeping, inappropriate leadership, negative attitudes of staff members and the insufficient monitoring impeded the successful implementation of the framework. While positive attitude, mentorship and support amongst the task team facilitated the implementation process, albeit with challenges. Conclusion: There is a need to address implementation gaps so that the FSDR is responsive to the current rehabilitation needs of persons with disabilities in South Africa. Contribution: This study may inform future disability policy, and can be used as a tool to advocate for the rights for persons with disabilities

'The world is not only for hearing people - It's for all people': The experiences of women who are deaf or hard of hearing in accessing healthcare services in Johannesburg, South Africa.

BACKGROUND: Despite legal and adopted frameworks purporting access to healthcare and rehabilitation services, which are both a human right and key to developmental issues, women who are deaf and/or hard of hearing (HoH) are still excluded and experience barriers when accessing healthcare services. Largely, this is attributed to communication barriers between healthcare professionals and women who are deaf and/or HoH. There have been limited research studies carried out on women with invisible disabilities, such as deafness, especially amongst African women. OBJECTIVES: This study sought to gain insights into the communication experiences of women who are deaf or HoH when accessing public healthcare services in hospitals in Johannesburg. METHODS: A qualitative research study employing semi-structured interviews with 10 African women who are deaf and/or HoH residing in Johannesburg, South Africa and attending government healthcare facilities was conducted. Participants were purposively selected. Data were analysed using thematic analysis. RESULTS: Data revealed the following themes: communication barriers resulting in compromised quality of care and infringement on participants' right to confidentiality; accommodation that is not accommodative and negative attitudes of healthcare professionals. CONCLUSION: The findings of this study confirm the alienating, exclusion, marginalisation, discrimination, invisibility, lack of independence and autonomy of women who are deaf and/or HoH when accessing healthcare services. Therefore, this study argues for a need for the conscientisation of healthcare professionals on communication needs of persons who are deaf and/or HoH. This has implications for the implementation of training programmes that will address communication, reasonable accommodation and attitudes of healthcare professionals.

Factors influencing speech language pathologists' and audiologists' decision to pursue postgraduate studies in South Africa.

BACKGROUND: Factors that influence various professionals to pursue postgraduate studies have been investigated. However, there is a dearth of evidence of factors that influence South African speech language pathologists (SLPs) and audiologists (As) to pursue their postgraduate studies. OBJECTIVE: Therefore, this study aimed to determine factors that influence the decision of South African SLPs and As to pursue postgraduate studies and potential barriers to this pursuit. METHOD: A quantitative survey research methodology with a cross-sectional research design was adopted, where a 21-item web-based survey was used to survey 127 speech therapists, As and speech therapists and As from across the country. All participants were qualified and registered with the Health Professionals Council of South Africa (HPCSA). Ethical clearance and permission from relevant stakeholders were obtained. Data were analysed descriptively. RESULTS: The findings suggested that over half of the participants pursued their postgraduate studies to fulfil a personal goal and improve their knowledge, whilst others did it to develop expertise and for job opportunities. Participants highlighted that a lack of time and funding, heavy workloads and bad experiences during their undergraduate studies were the main barriers to pursuing postgraduate studies. Whilst community service was not a barrier per se, participants felt that it delayed them from beginning their postgraduate studies immediately. CONCLUSION: The findings of this study highlighted the urgent need for institutions of higher learning, government and other stakeholders to provide the necessary support for SLPs and As in South Africa to pursue postgraduate studies.

Challenges of teaching the deaf-blind learner in an education setting in Johannesburg: Experiences of educators and assistant educators.

BACKGROUND: Evidence suggests that educators of deaf-blind students in the South African context have specific challenges in the educational setting because of their lack of adequate knowledge on deaf-blindness and a lack of sufficient training on communication, teaching and learning strategies. OBJECTIVES: The aim of this study was to describe the challenges experienced by educators and assistant educators of children with deaf-blindness. METHOD: Ten educators and assistant educators were selected purposively to participate in the study (Male = 3; Female = 7; age range 31-49 years). Participants were recruited from a school for the deaf-blind in Johannesburg. Participants completed semi-structured interviews on the challenges that they experienced when educating learners who are deaf-blind. RESULTS: Findings from the data after inductive thematic analysis suggested the following: (1) under-preparedness of educators and assistant educators, (2) communication challenges, (3) challenges related to the diversity of deaf-blind learners and (4) lack of support structures for educators and assistant educators. CONCLUSION: There is a need for ongoing educator training on communication strategies, cultural diversity and inclusive strategies. A collaborative model of delivering training and inclusive education that will encompass educators and therapists as a means of supporting both the educator and the learner who is deaf and blind is needed. Such a collaboration may result in positive outcomes for both the educator and the deaf-blind learner.

'I felt pain. Deep pain ': Experiences of primary caregivers of stroke survivors with aphasia in a South African township.

BACKGROUND: Aphasia is an acquired impairment in language and in the cognitive processes that underlie language. Aphasia affects the quality of life of the person with aphasia (PWA) and his or her families in various ways in diverse contexts and cultures. It is therefore important that speech language therapists understand how different contextual and cultural factors may mediate experiences. PURPOSE: The aim of the study was to describe the caregiving experience of female caregivers of PWA residing in Tembisa, a township situated in the east of Johannesburg. METHOD: Qualitative, semi-structured interviews were conducted with primary caregivers of PWA. Purposive sampling was used to recruit 14 primary caregivers of PWA who were daughters, daughters-in-law or wives of the PWA. The interviews were conducted in participants' first language and analysed by the researcher, who is proficient in isiZulu. Data were analysed according to the principles of thematic analysis. RESULTS: Findings indicated that caregivers are unfamiliar with aphasia and the support available to them. Participants experienced frustration and found communication to be challenging owing to their lack of communication strategies. The participants' experiences reflected their context-specific experiences, such as feminisation of caregiving, barriers to healthcare, the influence of low health literacy and contextual perspectives on stroke and aphasia. CONCLUSIONS: Contextual factors of caregivers in Tembisa have an influence on the experiences between caregivers and PWA, the feelings of individuals and families and health-seeking behaviours of individuals and families.