Community stakeholders’ perspectives on the role of occupational therapy in primary healthcare: Implications for practice

Abstract

BackgroundPrimary healthcare (PHC) is central to increased access and transformation in South African healthcare. There is limited literature about services required by occupational therapists in PHC. Despite policy being in place, the implementation of services at grassroots level does not always occur adequately.ObjectivesThis study aimed at gaining an understanding of the challenges of being disabled and the services required by occupational therapists (OTs) in rural communities in order to better inform the occupational therapy (OT) training curriculum.MethodAn exploratory, descriptive qualitative design was implemented using purposive sampling to recruit 23 community healthcare workers from the uGu district. Snowball sampling was used to recruit 37 members of the uGu community, which included people with disability (PWD) and caregivers of PWDs. Audio-recorded focus groups and semi-structured interviews were used to collect data, which were thematically analysed. Ethical approval was obtained from the Biomedical and Research Ethics Committee of the University of KwaZulu-Natal (BE248/14).ResultsTwo main themes emerged namely: firstly, the challenges faced by the disabled community and secondly appropriate opportunities for intervention in PHC. A snapshot of the social and physical inaccessibility challenges experienced by the community was created. Challenges included physical and sexual abuse, discrimination and marginalisation. Community-based rehabilitation and ideas for health promotion and prevention were identified as possible strategies for OT intervention.ConclusionThe understanding of the intervention required by OT in PHC was enhanced through obtaining the views of various stakeholders’ on the role. This study highlighted the gaps in community-based services that OTs should offer in this context.

Occupational therapy services and perception of integration of these at primary healthcare level in South Africa

“…Community health workers or caregivers are appointed on the PHC level to address outreach, conduct home visits and improve access to health care 58 . Studies in South Africa have called for an increased collaboration between occupational therapists and community health workers or rehabilitation workers 3,49 as this is considered important in achieving these intervention strategies. It is recommended that these health workers be specifically trained to assist with rehabilitation services 40 .…”

“…However, studies still report the predominant use of the medical model 34 including in occupational therapy practice at PHC level in South Africa which is contrary to the CBR approach 3 . The medical model focusses on the underlying impairment(s) suffered by an individual, which differentiates them from other members of society 34 .…”

“…Lastly, a snowball sampling technique was used to recruit participants nationwide by asking therapists who received the survey to forward it on to colleagues who had not received it. With the assumption that less than 10% of the occupational therapists in South Africa are working at the PHC level based on literature 3,49 , a sample size of 75 was needed to represent the population with a 5% margin of error as recommended by Bartlett, et al 50 .…”

“…There are an estimated 4.2 million people with disabilities (PWDs) 1 in South Africa, resulting in a prevalence of 7.5% 2 . Access to occupational therapy and other rehabilitation services for PWDs in South Africa is limited due to factors such as the location of health care services, inadequate rehabilitation workforce, a two-tiered health system (well-funded private-underfunded public health care dichotomy), transportation challenges, as well as poor policy implementation regarding disability and rehabilitation 3,4 . These limiting factors persist despite the existence of recent policy documents published by the National Department of Health (NDoH) related to healthcare, disability, and rehabilitation services 3 .…”

“…Access to occupational therapy and other rehabilitation services for PWDs in South Africa is limited due to factors such as the location of health care services, inadequate rehabilitation workforce, a two-tiered health system (well-funded private-underfunded public health care dichotomy), transportation challenges, as well as poor policy implementation regarding disability and rehabilitation 3,4 . These limiting factors persist despite the existence of recent policy documents published by the National Department of Health (NDoH) related to healthcare, disability, and rehabilitation services 3 . Both the Framework and Strategy for Disability and Rehabilitation Services in South Africa 2015-2020 (FSDRSA) 5 , the National Health Insurance (NHI) White Paper 2017 6 , and the NHI Bill 2019 7 , propose the integration of rehabilitation services within the primary healthcare framework in South Africa in tandem with the primary healthcare (PHC) reengineering process 8 .…”