Sustainable support solutions for community-based rehabilitation workers in refugee camps: piloting telehealth acceptability and implementation

Abstract

Background The lack of training and education of Community-Based Rehabilitation (CBR) workers poses one of the most significant barriers to receiving effective occupational, physical and speech therapy for individuals with disabilities in Low-to-Middle Income Countries (LMIC), especially in countries with significant refugee populations. The aim of this study was to successfully implement a telehealth support system for CBR workers, evaluate the feasibility and acceptability of this intervention’s implementation among CBR workers in the CBR setting, and further identify strategies to address the deficit of skilled rehabilitation workers in LMIC through technological intervention. Methods This pilot study included CBR workers and CBR managers to inform feasibility, acceptability, and sustainable implementation. The RE-AIM and Dynamic Sustainability Framework were incorporated to guide procedural design, survey development, data collection, data evaluation, and increase success of telehealth implementation. CBR workers participate in trainings, telehealth sessions, surveys and focus groups to inform feasibility and acceptability. CBR Managers participated in focus groups to inform feasibility and sustainable implementation. NVIVO 12 Software was utilized to develop themes from CBR worker and CBR manager responses. Results Findings from this study demonstrate the need for additional training support for CBR workers in CBR settings throughout the entire treatment process. The telehealth system demonstrated successful short-term implementation across several domains of feasibility. Telehealth utilization was also proven acceptable, appropriate and necessary. Cultural beliefs, CBR worker training, and CBR Center infrastructure pose the most significant barriers to implementation of telehealth technologies in CBR Centers. CBR workers and managers confirmed the demand for future telehealth-based support systems, strengthening effort towards sustainability and scale-up. Conclusions Telehealth can be utilized to support CBR workers that serve vulnerable and marginalized populations, and in turn improve the global health status among refugee populations by reducing inequitable access to quality health care. The results support the need for further research to rigorously evaluate effectiveness of telehealth interventions to support CBR workers.

Barriers and facilitators for the sustainability of digital health interventions in low and middle-income countries: A systematic review

“…The details of the results related to the project design and implementation factors are as follows. Among the barriers, System usability issues were most cited (20)(21)(22)(23), especially in lower-level health facilities (23). Three studies researched and identified barriers related to internet access: Unavailable and unreliable or expensive Internet access (20,22,24).…”

Remote disability and leprosy services via basic communications technology

“…Current research suggests that in these settings, appropriate communication technology (which this manual seeks to support) can be used to: facilitate caregiver training, 3 support CBR workers, 2 build the individual person's competencies, performance, capacity and participation, 3 and even address inequitable access to quality health care. 2 The people who received remote services via the pilot manual and church volunteer support rated the process and outcomes surprisingly positive, given that these services are intended as a substitute or replacement for face-to-face services where they are unavailable or unaffordable. It was concluded that this is a suitable foundation for further expansion and refinement of the manual and these approaches.…”

“…1 In LMIC, telehealth is increasingly identified as a potential support mechanism for intermediate level workers in rehabilitation and disability services, 2 and to support personal care in the home. 3 Indications are that telehealth approaches are beneficial to support Community Based Rehabilitation (CBR) workers who assist vulnerable and marginalized populations, 2 and when used consistently to guide workers, can improve outcomes for people with disabilities. 3…”

The Implementation of Tele-Health Physiotherapy Services for Musculoskeletal Conditions: A Systematic Review

“…[35] found that using technology in treating patients is beneficial in terms of enabling the self-management, portability of treatment, and allowing the anonymous participation. Finally, in the term of acceptance and satisfaction toward the Tele-Health services, many researchers found that it is acceptable and satisfactory for both patients and clinicians Dynphy et al, 2017, [22], [33]), it could promote better levels of engagement with health care providers [34], and it could provide a solution for remote athlete patients during COVID-19 [26].…”

“…Another article used descriptive report of how to move from in-clinic to Tele-Health care during the COVID-19 pandemic [9]. A pilot study conducted in order to evaluate feasibility and acceptance of implementing Tele-Health by workers of Community-Based Rehabilitation [33]. Master class paper method was used in one article is [7].…”