Table 3 The development of a rehabilitation and health information tool (RHIT) [27]
Aims/objectives | AIM: to develop a contextually relevant resource tool to support the community rehabilitation workers in understanding and documenting how the rehabilitation and related health needs of persons with disabilities are met in home- and community-based settings Objectives: (i) to develop the content and domains of the rehabilitation and health information tool; (ii) to establish the validity (face and content) of the rehabilitation and health information tool; and (iii) to test the application of the rehabilitation and health information tool on a sample of persons with disabilities |
Context | The study was conducted in the Mitchells Plain/Klipfontein area, Western Cape, as the community rehabilitation workers were part of the Western Cape Department of Health pilot training project deployed in this substructure. It is a low-income community, with high rates of unemployment linked to low levels of education. It has a high crime rate and alcohol, drug abuse, and gang-related activities are high (City of Cape Town, 2006) |
Problem | The local policies in South Africa such as the National Health Insurance [28] and the Framework and Strategy for Disability and Rehabilitation of the South African Department of Health [29] emphasize the importance of mid-level health workers such as community rehabilitation workers as a key component in primary health care. However, this cadre of worker faces many barriers to providing effective health care, including the lack of resources and supervision structures to support their role in community-based rehabilitation. This study was conducted to develop a rehabilitation and health information tool (RHIT) with community rehabilitation workers |
Study design (include sample size) | The study adopted a sequential mixed methods design. Phase 1: conceptualizing the RHIT Sample size: 6 participants in the focus group discussion (2 persons with disabilities, 2 expert health and rehabilitation practitioners, 2 community rehabilitation workers Methods: document review and focus group discussion with expert panel Phase 2: Pilot test of the applicability of RHIT Sample size: 54 participants (adult persons with a disability requiring home care) Methods: the RHIT was administered face-to-face by 10 trained rehabilitation care workers who provided feedback on the application of the tool |
Findings | Phase 1 identified 12 content domains for the RHIT: overall health, self-care, mobility, communication, relationships, sexual health, general tasks, access to health information, health behaviors, health safety and security, spirituality, and others Presented through 9 close-ended questions and 4 sub-questions Following the focus group with the expert panel, the RHIT was revised further to refine the socio-demographic questions such as living arrangements, type of housing, and living environment; additional questions were added to rehabilitation and health needs, and the wording of the questions was simplified to improve linguistic accessibility for community rehabilitation workers. These processes enhanced the face and content validity of RHIT Phase 2: Field testing of the RHIT indicated that while it was contextually relevant, it covered the content areas and importantly highlighted rehabilitation needs. It was useful for the community rehabilitation workers as it did not require scoring. It assisted in generating a conversation on health needs, intervention planning, and monitoring over time. However, it needed to be shortened and there was a need for further training of workers on the administration of some content areas, e.g., sexuality, as well as on recording information |
What happened after the study | The RHIT requires further refinement, follow-up testing, and validation before it can be formally adopted as part of the rehabilitation care worker’s practice. This process has not yet commenced. However, the lessons learned from this study have been incorporated into the training of these workers specifically in the course that looks into the management and communication of disability-related information |