A stroke rehabilitation training program for community-based primary health care, South Africa

Abstract

Background: With an increasing burden of stroke and a lack of access to rehabilitation services in rural South African settings, stroke survivors rely on untrained family caregivers for support and care. Community health workers (CHWs) support these families but have no stroke-specific training.Objectives: To describe the development of a contextually appropriate stroke training program for CHWs in the Cape Winelands District, South Africa.Method: Twenty-six health professionals and CHWs from the local primary healthcare services participated in action research over a 15-month period from September 2014 to December 2015. The groups participated in two parallel cooperative inquiry (CI) groups. The inquiry followed the cyclical steps of planning, action, observation and reflection. In this article, the planning step and how the CI groups used the first three steps of the analyse, design, develop, implement, evaluate (ADDIE) instructional design model are described.Results: The CHWs’ scope of practice, learning needs, competencies and characteristics, as well as the needs of the caregivers and stroke survivors, were identified in the analysis step. The program design consisted of 16 sessions to be delivered over 20 h. Program resources were developed with appropriate technology, language and instructional methodology.Conclusion: The program aims to equip CHWs to support family caregivers and stroke survivors in their homes as part of their generalist scope of practice. The implementation and initial evaluation will be described in a future article.Contribution: The study developed a unique training program for CHWs to support caregivers and stroke survivors in a resource-constrained, rural, middle-income country setting.

The role of community health workers in non-communicable diseases in Cape Town, South Africa: descriptive exploratory qualitative study

“…CHWs expressed the need for further training, despite having some prior training in rehabilitation, as they felt unequipped for this role. A recent study developed a training programme for CHWs to assist caregivers of stroke survivors during household visits [ 28 ]. CHWs were often the only part of the health services engaging stroke survivors, but without any training in how to assist [ 29 ].…”

Evaluation of a stroke rehabilitation training programme for community-based primary healthcare

“…This article focuses on the action, observation and reflection steps of the inquiry, which corresponds with the implementation and evaluation steps of the ADDIE model ( Figure 1 ). Stages 1 and 2 as well as the planning phase of stage 3, detailing the analysis, design and development steps of ADDIE, were previously published (Scheffler & Mash 2019 , 2020 , 2023 ).…”

“…In consultation with the service managers of the five organisations, 27 key role players involved in stroke-related service delivery at PHC level were invited and all but one agreed to participate (Scheffler & Mash 2023 ). This process is described in detail in a separate article outlining the planning of the inquiry process (Scheffler & Mash 2023 ). Because of practical considerations, two CIGs were formed.…”

“…The first 11 months of planning in 2014–2015 by the two CIGs was described in a separate article (Scheffler & Mash 2023 ). This included an extensive analysis, which informed the consultative coordinated interprofessional design (Harris et al 2016 ) of the training programme (Scheffler & Mash 2019 , 2020 ).…”

“…In this context, the researcher was approached by a district CBS manager to assist in the development of an appropriate home-based stroke rehabilitation training programme to equip these CHWs to train family caregivers. This community-based programme was developed locally through participatory action research and intersectoral collaboration of service providers, in consultation with stroke survivors and their caregivers, as previously published (Scheffler & Mash 2023 ). The aim of this study was to evaluate the implementation and immediate effects of the training programme as part of the same participatory action research process.…”