Understanding how a community-based intervention for people with spinal cord injury in Bangladesh was delivered as part of a randomised controlled trial: a process evaluation

Abstract

Design Mixed methods study Setting Community, Bangladesh Objectives To understand how a community-based intervention for people with spinal cord injury (SCI) in Bangladesh was delivered as part of a randomised controlled trial and to gauge the perceptions of participants and healthcare professionals to the intervention. Methods A community-based intervention was administered to 204 participants as part of a large randomised controlled trial (called the CIVIC trial). Case-managers followed-up participants with regular telephone calls and home visits over the first 2 years after discharge. The following data were collected alongside the trial: (i) chart audit of telephone calls and home visits (ii) recordings of 20 telephone calls (iii) interviews with 14 Intervention participants and four healthcare professionals including three case-managers. Results Participants received the target number of telephone calls and home visits. Pressure injuries were identified as a problem during at least one telephone call by 43% of participants. Participants and case-managers valued regular telephone calls and home visits, and believed that calls and visits prevented complications and alleviated social isolation. Participants trusted case-managers and were confident in the care and advice provided. Case-managers expressed concerns that people with SCI in Bangladesh face many problems impacting on well-being and motivation stemming from poverty, limited employment opportunities, societal attitudes and inaccessible environments. Conclusion A community-based intervention involving regular telephone calls and home visits was administered as intended and was well received by the recipients of the care. Nonetheless, people with SCI in Bangladesh face economic and social problems which cannot be fully addressed by this type of intervention alone.

Secondary health conditions in people with spinal cord injury in South Africa: Prevalence and associated factors

“…Economic vulnerability and the impact on disability and health outcomes must be considered when developing prevention interventions. [37,38] The most prevalent SHCs were pain (78.1%), bladder problems (64.8%) and bowel problems (53.8%). Pain and bladder and bowel problems are the most commonly reported and significant SHCs experienced by people with SCI.…”

A community-based intervention to prevent serious complications and death 2 years after discharge in people with spinal cord injury in Bangladesh (CIVIC): a randomised trial

“…If there was any evidence of a complication, the healthcare professional provided advice to the participant and the participant's family about management of the complication and then more closely monitored the participant until the complication had resolved. Where necessary and possible, the healthcare professionals referred participants to local service providers (although our process evaluation indicated that these services were either not available or difficult to access [18]). The advice provided to participants followed international clinical practice guidelines [19][20][21] modified for the Bangladesh context.…”

“…Participants were also provided with health care products such as wound dressings and urinary catheters to a total of AUD80 (~USD51) if they could not otherwise afford these items (see ref. [18] for more details).…”

“…Participants in the Control group received only usual care (see ref. [18] for details). In brief, usual care did not include routine post-discharge follow-up.…”

The Effectiveness of Community-Based Interventions in Improving Activities of Daily Living and Quality of Life Outcomes in Persons Living with Stroke: a Systematic Review

“…One of these is to bring the treatment strategies into the home or community of people living with stroke; this is known as community-based intervention (CBI). CBI is delivered either to a set place within the community or at the residences of people with disability, with a single person or a group receiving the service at a time (Iemmi et al, 2015;Liu et al, 2020;Ryan, Enderby, & Rigby, 2006). CBI has been developed in both LMICs and HICs to provide people living with stroke continued rehabilitation services after discharge from hospital care, to augment limited healthcare services, and to promote strategies for the prevention of certain conditions (Iemmi et al, 2015;Johnson, Bird, Muthalib, & Teo, 2020;Magwood et al, 2020;Mannan et al, 2012;Yan et al, 2016).…”