Designing Implementation Strategies for the Inclusion of Lesbian, Gay, Bisexual, Transgender, Intersex, Queer, and Allied and Key Populations' Content in Undergraduate Nursing Curricula in KwaZulu-Natal, South Africa: Protocol for a Multimethods Research Project.

BACKGROUND: Lesbian, gay, bisexual, transgender, intersex, queer, and allied (LGBTQIA+) individuals encounter challenges with access and engagement with health services. Studies have reported that LGBTQIA+ individuals experience stigma, discrimination, and health workers' microaggression when accessing health care. Compelling evidence suggests that the LGBTQIA+ community faces disproportionate rates of HIV infection, mental health disorders, substance abuse, and other noncommunicable diseases. The South African National Strategic Plan for HIV or AIDS, tuberculosis, and sexually transmitted infections, 2023-2028 recognizes the need for providing affirming LGBTQIA+ health care as part of the country's HIV or AIDS response strategy. However, current anecdotal evidence suggests paucity of LGBTQIA+ and key populations' health content in the undergraduate health science curricula in South Africa. Moreover, literature reveals a general lack of health worker training regarding the health needs of LGBTQIA+ persons and other key populations such as sex workers, people who inject drugs, and men who have sex with men. OBJECTIVE: This study aimed to describe the design of a project that aims at facilitating the inclusion of health content related to the LGBTQIA+ community and other key populations in the undergraduate nursing curricula of KwaZulu-Natal, South Africa. METHODS: A multimethods design encompassing collection of primary and secondary data using multiple qualitative designs and quantitative approaches will be used to generate evidence that will inform the co-design, testing, and scale-up of strategies to facilitate the inclusion of LGBTQIA+ and key populations content in the undergraduate nursing curricula in KwaZulu-Natal, South Africa. Data will be collected using a combination of convenience, purposive, and snowball sampling techniques from LGBTQIA+ persons; academic staff; undergraduate nursing students; and other key populations. Primary data will be collected through individual in-depth interviews, focus groups discussions, and surveys guided by semistructured and structured data collection tools. Data collection and analysis will be an iterative process guided by the respective research design to be adopted. The continuous quality improvement process to be adopted during data gathering and analysis will ensure contextual relevance and sustainability of the resultant co-designed strategies that are to be scaled up as part of the overarching objective of this study. RESULTS: The proposed study is designed in response to recent contextual empirical evidence highlighting the multiplicity of health challenges experienced by LGBTQIA+ individuals and key populations in relation to health service delivery and access to health care. The potential findings of the study may be appropriate for contributing to the education of nurses as one of the means to ameliorate these problems. Data collection is anticipated to commence in June 2024. CONCLUSIONS: This research has potential implications for nursing education in South Africa and worldwide as it addresses up-to-date problems in the nursing discipline as it pertains to undergraduate students' preparedness for addressing the unique needs and challenges of the LGBTQIA+ community and other key populations. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52250.

PROTOCOL: Evidence-based frameworks used to promote self-employment with persons with disabilities: A scoping review.

Aim: This scoping review aims to highlight literature on self-employment evidence-based frameworks used to promote self-employment among persons with disabilities. This will be achieved by answering this research question, what evidence-based self-employment frameworks have been successfully used to promote self-employment among persons with disabilities? Methods: To answer the research question, the steps followed will be based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Arksey and O'Malley's sequential stages will be used to guide the scoping review process. An experienced librarian and a second reviewer will assist with this review. A third reviewer will only be involved, when necessary, for example, to help resolve decision conflicts between reviewers one and two. Discussion: This section will discuss the data collected. In line with Tricco et al., this scoping review envisages outlining existing literature, identifying gaps and informing future research in the field of self-employment for persons with disabilities. What evidence-based self-employment frameworks have been successfully used to promote self-employment among persons with disabilities? Is a question that this scoping review seeks to answer. Thus, this research has the potential to add to knowledge and inform or stimulate further research.

Competencies Required to Deliver a Primary Healthcare Approach in the Occupational Therapy: A South African Perspective.

Introduction: The South African government introduced a reengineered primary healthcare approach to promote universal health coverage. The approach was to ensure equitable, efficient, and quality health services for consumers in private and public healthcare sectors. The transition toward a more comprehensive primary healthcare approach to intervention requires occupational therapists who predominantly worked in private and hospital settings to extend their services to clients who previously would have had little access to such services. This study was conducted to identify the key competencies required by occupational therapists to deliver appropriate primary healthcare services to communities from previously disadvantaged periurban and rural areas. Methods: An exploratory, qualitative study design was used. Through the use of policy documents and data from key informants (n = 5), established therapists (n = 14), and novice occupational therapy graduates (n = 39), the study identified and mapped the stakeholders' perspectives of the competencies required by graduates to practice in periurban and rural settings in KwaZulu-Natal in South Africa. Data was collected using semistructured interviews, a focus group discussion, a document review of the university's curriculum, and the local and global regulatory documents. A framework based on the seven roles of the university's competency framework informed the data analysis process. The seven roles are health practitioner, communicator, collaborator, health advocate, leader and management, scholar, and professional. Findings. Participants highlighted the need for graduates to have adequate knowledge and understanding of the impact of the Department of Health policies and social determinants of health on occupation and the client's health. They also needed to be suitably skilled in culturally sensitive communication, negotiating shared goals with the stakeholders, and managing a department. Graduates needed to be socially accountable and develop services to advocate for their clients. Conclusion: The study offered insights into the essential graduate competencies identified by the stakeholders and recommended measures to prepare rehabilitation graduates for service delivery in primary healthcare contexts.

Prevention and early intervention in South African disability claims management: The private insurer perspective.

BACKGROUND: Current available literature lacks a focus on the prevention and early intervention stages of the disability claims management process within the South African context. OBJECTIVE: This study aimed to identify fundamental principles to be applied during the prevention and early intervention stages of the disability claims management process within South Africa. METHODS: A qualitative explorative design with a purposive sampling technique to identify stakeholders. Data were collected fromn = 26 stakeholders using virtual semi-structured interviews. Inductive analysis was used to establish fundamental principles for promoting success in applying a prevention and early intervention approach. RESULTS: Four fundamental principles were identified: stakeholder communication and education, stakeholder collaboration, support, and buy-in, early identification and early intervention. The literature, data and themes were used to inform development of a prevention and early intervention disability model as well as an employee health and productivity continuum. Analysis of the results showed that achieving and maintaining employee health and productivity is a complex goal. However, a prevention and early intervention approach is beneficial in decreasing the likelihood of ill-health progressing to short or long-term disability absence. CONCLUSION: This study has proposed a prevention and early intervention model for a disability that may be applied to the employee health and productivity continuum in an attempt to mitigate the risk of ill-health and disability occurring and if they do occur, to decrease the length of time that the symptoms impact an employee's productivity at work.

"It was like a bad dream": Making sense of violent hand amputation and replantation in South Africa.

BACKGROUND: South Africa is faced with one of the highest rates of violent crime in the world. Accordingly, therapists treat high numbers of deliberate hand injuries. There is, however, a paucity of literature exploring the lived experiences of these survivors. PURPOSE: The aim of this study was to describe and interpret the meaning of living through a violent hand amputation and replantation, the impact on occupational adaptation and to reflect on therapeutic intervention, within the context of South Africa. STUDY DESIGN: An exploratory embedded single case study using a qualitative approach. METHODS: Interpretative phenomenological analysis was used to analyze data from: 8 interviews with the primary participant, over a period of 33 months; an interview with his work colleague; interviews with 5 health professionals; a review of the occupational therapy rehabilitation file and a review of the audio-visuals, recorded over 2-years. RESULTS: This narrative reveals a man who understood his terrifying assault to be part of a southern African ritual of spiritual origin - using human body parts for traditional medicine (muti crime) or witchcraft. He perceived his expensive hand replantation and therapy as surreal and violence as normal. Challenges highlighted the importance of being attentive to the psychosocial sequelae of violence; and the most valuable part of therapy was perceived as occupational engagement. CONCLUSIONS: The perception of attempted muti murder situates this extreme and unusual case study as a novel contribution to the medical and rehabilitation literature. South African therapists are urged to be actively involved in changing the culture of violence, and hand therapists are reminded of the importance of applying holistic and occupation-based intervention.

Clinical and socio-demographic determinants of community reintegration in people with spinal cord injury in eThekwini Municipality, KwaZulu-Natal province.

Background: Community reintegration is a major outcome of rehabilitation after the acute phase in people with spinal cord injury (PWSCI). Objective: To investigated clinical and socio-demographic factors determining community participation in PWSCI, living in the greater eThekwini Municipality, KwaZulu-Natal province. Method: Our quantitative, cross-sectional study had a convenient sample of 41 PWSCI. A trained interviewer obtained socio-demographic information using a structured questionnaire. Participants completed the Reintegration to Normal Living Index (RNLI). Descriptive statistics were used in summarising the data; inferential statistics, -a t-test and analysis of variance (ANOVA) assessed the association of clinical and socio-demographic factors with the extent of community reintegration. A multiple linear regression investigated the determinants of community reintegration with the alpha level set at p = 0.05. Results: Mean age of the participants was 41 years (s.d.: 10, range 25-66), with the majority (n = 32, 78%) being male. The mean RNLI score was 68% (s.d.: 22, range 24-100). Participants scored higher on the RNLI if they were male (mean difference [MD] 18%, 95% confidence interval [CI]: 2-34), were employed (MD 16%, 95% CI: 0-32), had a salary (MD 19%, 95% CI: 5-32) and had no muscle spasms (MD 14%, 95% CI: 1-27. Muscle spasms (p = 0.012, 95% CI: 3.85-29.05) and being female PWSCI (p = 0.010, 95% CI: -35.75 to -5.18) were significant negative predictors of community reintegration. Conclusion: Community reintegration may be influenced by socio-economic factors. Special interventions for muscle spasms and support for women living with spinal cord injuries may enhance community reintegration. Clinical implication: Therapists need to focus on community reintegration with female PWSCI and on returning to PWSCI to work as this was improved community reintegration.

Developmental delay in a resource-constrained environment: An approach to early intervention.

With a reduction in mortality rates of children under 5 years, in low- and middle-income countries, the responsibility to provide quality care to the increased number of surviving children becomes essential. Many of these children present with developmental delay and the onus inevitably rest on the healthcare system. There is, therefore, the need for recognising timely intervention as routine care for these children, who may have potential for a better quality of life with intervention. The authors advocate for early referral and intervention, and provide a brief overview of a holistic approach to developmental delay in low resourced settings from their perspective.

Developmental delay in a resource-constrained environment: Screening, surveillance and diagnostic assessment.

The range and severity of developmental delays vary, and a systematic approach to ensuring early detection for early intervention is essential. The formative years are considered critical for nurturing and maximising developmental potential. In this article, the authors describe a clinical approach to developmental delay within resource-constrained environments of South Africa. The article unpacks the history and examination, developmental screening, surveillance and diagnostic assessment and social determinants of health. For timely interventions to occur, early and accurate assessment is necessary. Medical officers and other health professionals such as nurses, general practitioners and therapists working in low-resourced contexts may use this information in their approach to the assessment of developmental delay.

United Nations Convention on the Rights of Person with Disabilities (UNCRPD) Implementation: Perspectives of Persons with Disabilities in Namibia.

The Namibian government ratified the UNCRPD and its optional protocol in 2007 raising expectations that such a convention would fundamentally improve the lives of persons with disabilities. However, persons with disabilities continue to experience inequalities and violation of dignity. This study explores the impact of the UNCRPD as reflected on the lives of persons with disabilities in Namibia. An exploratory qualitative study with the use of photovoice and in-depth interviews was conducted in Omusati and Khomas regions, Namibia. Persons with disabilities (n = 31) were recruited via purposive sampling, of which n = 25 participants were engaged in three focus group discussions. Participants employed in the disability sector (n = 6) were engaged in in-depth interviews. Data were thematically analysed. The study findings revealed the inadequacy of disability rights information dissemination and continued barriers to inclusivity of persons with disabilities. Stigma, discrimination, limited financial opportunities, weak political support, and limited accessibility to physical infrastructure caused barriers to inclusivity. However, opportunities to advance the UNCRPD were also identified. There is a need for the disability sector to build on identified institutional facilitators to advance disability rights through mobilisation of local resources, communities, and government to redress the challenges identified in Namibia.

Occupational choices of school-going adolescents: a study in the Pitseng Area, Leribe District, Lesotho.

INTRODUCTION: Adolescents require opportunities to engage in occupations and need to have the requisite aptitude and agency to choose the occupations they want or need to engage in. Occupations are defined as the everyday activities that people choose to engage in individually or as groups that bring meaning and purpose to their lives. These occupations can be chosen or enforced. There is a paucity of literature around the occupations that adolescents in rural contexts choose and the meaning underlying their choices. This study explored the occupations of school-going adolescents of Pitseng, Lesotho, to gain insight into adolescent behaviour, and the strategies needed to develop sustainable health promotion programs for adolescents in this area. METHODS: A descriptive qualitative research design was used. Purposive sampling was used to recruit 47 adolescents aged between 13 and 15 years from three high schools in Pitseng, Leribe district, Lesotho. Data was collected using focus group interviews after consent was obtained from the parents or caregivers and assent from the adolescents. Data were analysed thematically using Braun and Clarke's method. RESULTS: Three main themes emerged from the study: realities of customary rural life, facilitators of occupational engagement, and wellbeing versus risky behaviour. Participation in daily routine occupations, cultural norming, resource scarcity, school milieu and leisure engagement were subthemes derived under the first theme. The subthemes identified under the theme facilitators of occupational engagement were intrinsic motivation, and vicarious modelling and peer support. The third theme encompassed the conceptualisation of wellbeing and risky behaviour as subthemes. The adolescents were found to engage in risky behaviour to escape the monotony in their daily lives. This could be attributed to them having fewer choices for recreational activities during their free time. Some adolescents were able to improvise and attempted to enjoy their lives with fewer occupational choices. The natural environment, coupled with creativity, facilitated the engagement of adolescents in fun activities. CONCLUSION: The dominant influences relating to the adolescents' occupational choices and participation in activities were the impoverished rural context and the traditional inherited practices. The protracted timeframes for completing basic activities and household responsibilities and the scarcity of resources for leisure led to a restricted range of leisure activities. The traditional cultural context influenced gender-based differences in the manifestation of occupations. Despite the challenges, the adolescents showed resilience, creativity and a strong desire to improve their futures. Moreover, in this culturally steeped environment, the school and the community chief may be the two best entry points for organisations planning to facilitate health promotion programs. They are recognised and sanctioned power bases in rural communities. Recommendations for education, leisure, health promotion and further study were made for Pitseng.

Clinical educator's experiences of the decentralised training platform for Occupational Therapy students in KwaZulu-Natal, South Africa.

Background: In piloting a shift from traditional practice-based placements to decentralised clinical training (DCT), there was a need to explore the factors that influenced the placement as part of monitoring and evaluation. DCT involves placement to clinical sites away from the higher education institution necessitating changes to supervision strategies utilised. Objective: This study explored the experiences of clinical educators supervising occupational therapy students within this new model during a pilot phase of the DCT programme at one institution in South Africa. Method: The study was located in KwaZulu-Natal province and followed an explorative qualitative design with semi-structured interviews and focus groups with purposively sampled clinical educators (n=11). Data were audio-recorded and d thematically analysed. Findings: Two central themes emerged and included the clinical educators' expectations (organisation factors, role and scope of partners in decentralised training and communication) and experiences (perspectives and value of decentralised training). Conclusion: Decentralised training has considerable potential to contribute to authentic student learning. Improved communication between all stakeholders would assist in enhancing the quality of the learning experiences on such platforms. Students need to be more prepared prior to commencing DCT, and there is a need for more rural placements with a primary health care focus.

Taking hold of hand trauma in KwaZulu-Natal, South Africa.

Background: Trauma in KwaZulu-Natal province in South Africa constitutes at least 17.8% of overall emergency cases, with hand trauma being common. Aim: Based on these statistics, the authors of this study aimed to identify and describe the most common traumatic hand injuries managed in the province including current trends and intervention practices of occupational therapists to inform future intervention. Methods: Using a mixed-method convergent parallel design, 41 therapists completed an online survey, and 12 therapists participated in two focus group discussions. Survey responses were analysed using descriptive statistics, and the audio-recorded and transcribed focus group discussions were analysed deductively using thematic analysis. Findings: Flexor tendon injuries (88%), extensor tendon injuries (73%), fractures (83%) and combined hand injuries (73%) were the most common injuries noted. Sufficient theoretical knowledge (95%), clinical judgement (93%), available resources (88%), relevant practical experience (83%) and surgeon hand therapy protocols (88%) were identified as essential in managing traumatic hand injuries. Challenges included having limited resources, late referrals and poor communication hindering multidisciplinary practice. Conclusion: Therapists face challenges in managing traumatic hand injuries, which inhibits optimal intervention planning. These factors may inevitably negatively influence outcomes achieved through occupational therapy for this group of patients.

Disability management in a public-private health care facility in South Africa: an organisational perspective.

BACKGROUND: Job retention, long-term absenteeism and medical boarding pay-outs are significant concerns for employers within the public health care sector of South Africa. OBJECTIVE: To describe disability management policies, procedures and programmes of employees following impairment and disability in a public-private healthcare facility in South Africa. METHODS: An exploratory qualitative study design was used with key informants in senior management and nursing managers (n=12) selected via purposive sampling. Audio-recorded data from semi-structured interviews and a focus group were thematically analysed using inductive reasoning. RESULTS: There is poor adherence to occupational health and disability management policies and the current referral process is informal with managers using discretion to manage employees with ill health and acquired disability. The procedures prescribed in the policy and procedure on incapacity and ill-health-retirement need to be followed, and an early return to work programme within the health care facility needs to be implemented. CONCLUSIONS: Despite South Africa having many policies on recruitment and reasonable accommodations, there is a lack of implementation of these policies. An integrated disability management policy and programme encompassing health prevention, early return to work strategies, vocational rehabilitation and the implementation of reasonable accommodation is required to ensure that employees who have acquired disabilities or ill health are successful in the workplace.

Occupational Risks in Occupational Therapy Service Learning: A Single-Site "Fear Factor" Study in South Africa.

BACKGROUND: Service-learning constitutes the main practical component of an undergraduate health profession training programme. However, limited exploration of the potential occupational risks that students face during their service-learning placement is noted in the literature. AIM: This study in South Africa explored occupational risk factors as reported by occupational therapy students whilst engaged in service-learning. METHODS: In this explorative qualitative study, purposeful homogenous sampling was used to recruit third and fourth level occupational therapy students who completed a Bachelor of Occupational Therapy degree. Three focus groups were conducted with seventeen students who voluntarily participated. Audio-recorded data were transcribed and analysed thematically using deductive reasoning. RESULTS: Several concerns over potential occupational risks were reported, namely, anxiety over contracting infectious diseases, concerns around musculoskeletal injuries due to manual handling requirements, and inappropriate behaviour of clients, which made the students feel unsafe. Concerns around the implementation of infection control measures, the lack of resources allocated to infection control at some service-learning sites, as well as the coping strategies used during service-learning were highlighted. CONCLUSION: Varied occupational risk factors during service-learning were reported by students. These insights into the perceived occupational risk factors can be translated into actionable strategies to improve the preparation of health science students for service-learning, including coping skills to deal with the demands of service-learning.

'No one prepared me to go home': Cerebrovascular accident survivors' experiences of community reintegration in a peri-urban context.

BACKGROUND: The South African health system has policies and strategies to ensure effective rehabilitation and reintegration of individuals who have survived a cerebrovascular accident into their respective communities. However, implementation of such guidelines remains an issue. AIM: This study sought to explore cerebrovascular accident (CVA) survivors' experiences of community integration. SETTING: The study was located in a peri-urban community within the KwaZulu-Natal Province, South Africa. METHODS: An explorative qualitative study with eight purposively selected CVA survivors was conducted via semi-structured individual interviews. Data were audio-recorded and manually transcribed prior to thematic analysis. Trustworthiness of the study was maintained by strategies such as analyst triangulation, an audit trail and use of thick descriptions. Ethical principles of autonomy, informed consent, confidentiality and privacy were also maintained in the study. RESULTS: Six themes emerged that highlighted (1) loss of autonomy and roles, (2) barriers to community reintegration, (3) social isolation of participants, (4) finding internal strength, (5) enablers of community reintegration including the positive influence of support and the benefits derived from rehabilitation and (6) recommendations for rehabilitation. CONCLUSION: The study revealed both positive and negative influences that impact CVA survivors' ability to effectively reintegrate into their respective communities following a CVA. Recommendations include the need for education and awareness around access to rehabilitation services for CVA survivors, advice on how to improve CVA survivors' ability to mobilise in the community and make environmental adaption to facilitate universal access, provision of home programmes and caregiver training for continuity of care and for inclusion of home-based rehabilitation into current models of care.

Community healthcare worker response to childhood disorders: Inadequacies and needs.

BACKGROUND: Community healthcare workers (CHWs) play a vital role in linking health facilities and communities where there is a high prevalence of childhood disorders. However, there is limited literature on whether this cadre of workers is adequately prepared for this task. AIM: This study explored the training needs of CHWs working in the field of childhood disorders and disabilities to improve the future training of CHWs and service delivery. SETTING: This study was conducted in an urban district in KwaZulu-Natal, South Africa. METHODS: This qualitative study used purposive sampling to recruit 28 CHWs and 4 key informants working in health facilities in one district of the KwaZulu-Natal Province in South Africa. Data were collected via semi-structured interviews and focus groups. Interviews were conducted in the first language (isiZulu) of the CHWs. Data were analysed thematically. Ethical clearance was obtained from a Biomedical Science Research Ethics Committee. RESULTS: There was an evident lack of knowledge and skill in managing childhood disorders and disabilities by CHWs. Enablers and restrictors affecting service delivery were highlighted. Moreover, the training needs of CHWs have raised critical concerns because of the variable nature of training and perceived inadequate preparation for service delivery. The challenges raised were also generic to the holistic role of CHWs and not particularly specific to the CHW role in childhood disorders and disabilities. CONCLUSION: Training of CHWs in childhood disorders may assist in improving CHWs' competence and confidence in the field, which may enhance service delivery and thus may assist in contributing towards improving healthcare for children at this level of care.

Participant incentives in rehabilitation research: a pilot study of researchers' perspectives.

BACKGROUND: Despite the use of research incentives in the recruitment and retention of participants for research studies, there remains debate over the acceptable use of participant incentives in research. There appears to be a paucity of guidelines that can assist researchers in demonstrating practically how incentives may be ethically used in research. OBJECTIVE: This single site pilot study explored the experiences of key stakeholders involved in rehabilitation research to highlight what may constitute acceptable practices for incentives. METHODS: A qualitative inquiry with use of semi-structured interviews with four key informants from a single site was undertaken. Data was audio-recorded and analysed thematically using deductive reasoning. RESULTS: The findings reflect a description of what incentives constitute; the issues around undue inducement and use of incentives in practice. Participants' offered their perceptions on perceived acceptable versus unacceptable practices in the use incentives in research. Participants shared their concern over research incentives being used to sway participation in research rather than reimburse participants for their expenses or offering a token of appreciation. CONCLUSION: There is a need for education of practitioners and researchers to develop skill to aid researchers to evaluate the ethical dilemmas related to the use of incentives in research.

'No one prepared me to go home': Cerebrovascular accident survivors' experiences of community reintegration in a peri-urban context

Background: The South African health system has policies and strategies to ensure effective rehabilitation and reintegration of individuals who have survived a cerebrovascular accident into their respective communities. However, implementation of such guidelines remains an issue. Aim: This study sought to explore cerebrovascular accident (CVA) survivors' experiences of community integration. Setting: The study was located in a peri-urban community within the KwaZulu-Natal Province, South Africa. Methods: An explorative qualitative study with eight purposively selected CVA survivors was conducted via semi-structured individual interviews. Data were audio-recorded and manually transcribed prior to thematic analysis. Trustworthiness of the study was maintained by strategies such as analyst triangulation, an audit trail and use of thick descriptions. Ethical principles of autonomy, informed consent, confidentiality and privacy were also maintained in the study. Results: Six themes emerged that highlighted (1) loss of autonomy and roles, (2) barriers to community reintegration, (3) social isolation of participants, (4) finding internal strength, (5)enablers of community reintegration including the positive influence of support and the benefits derived from rehabilitation and (6) recommendations for rehabilitation. Conclusion: The study revealed both positive and negative influences that impact CVA survivors' ability to effectively reintegrate into their respective communities following a CVA. Recommendations include the need for education and awareness around access to rehabilitation services for CVA survivors, advice on how to improve CVA survivors' ability to mobilise in the community and make environmental adaption to facilitate universal access, provision of home programmes and caregiver training for continuity of care and for inclusion of home-based rehabilitation into current models of care

Community healthcare worker response to childhood disorders: Inadequacies and needs

Background: Community healthcare workers (CHWs) play a vital role in linking health facilities and communities where there is a high prevalence of childhood disorders. However, there is limited literature on whether this cadre of workers is adequately prepared for this task. Aim: This study explored the training needs of CHWs working in the field of childhood disorders and disabilities to improve the future training of CHWs and service delivery. Setting: This study was conducted in an urban district in KwaZulu-Natal, South Africa. Methods: This qualitative study used purposive sampling to recruit 28 CHWs and 4 key informants working in health facilities in one district of the KwaZulu-Natal Province in South Africa. Data were collected via semi-structured interviews and focus groups. Interviews were conducted in the first language (isiZulu) of the CHWs. Data were analysed thematically. Ethical clearance was obtained from a Biomedical Science Research Ethics Committee. Results: There was an evident lack of knowledge and skill in managing childhood disorders and disabilities by CHWs. Enablers and restrictors affecting service delivery were highlighted. Moreover, the training needs of CHWs have raised critical concerns because of the variable nature of training and perceived inadequate preparation for service delivery. The challenges raised werealso generic to the holistic role of CHWs and not particularly specific to the CHW role in childhood disorders and disabilities. Conclusion: Training of CHWs in childhood disorders may assist in improving CHWs' competence and confidence in the field, which may enhance service delivery and thus may assist in contributing towards improving healthcare for children at this level of care