Factors influencing the design of an occupational therapy stroke program in primary health care
Naude, Catherina Elizabeth Johanna
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Introduction and background: The ideal of making health care services accessible to all people within South Africa, is envisioned through the implementation of National Health Insurance (NHI). The rendering of Primary Health Care (PHC) services is set to form the heartbeat of NHI and therefore a renewed focus is placed on the re- engineering of PHC services. Occupational therapy plays a vital role in the rendering of rehabilitation services within PHC, especially to stroke survivors. Stroke is one of the leading causes of disability globally and it is furthermore one of the top 10 non- communicable diseases in Thabo-Mofutsanyana Health District (TMHD) in the Free State province. Due to the limited availability of district hospitals in the TMHD, most stroke survivors are dependent on receiving occupational therapy services at the PHC clinics. Due to poor staffing norms, occupational therapy services are, however, often out of reach to the majority of stroke survivors within the TMHD. The need to design and develop renewed service delivery models for occupational therapy was identified to ensure that services are accessible to the stroke survivor. Aim: The aim of this study was to identify the factors that will influence the relevance and feasibility in the design of an occupational therapy program for stroke survivors within a rural PHC setting in the TMHD. Design and methods: A design science research (DSR) methodology was used for this study. Only phase one of DSR was implemented and both qualitative and quantitative research methods were employed. A total of five activities were executed, namely a document review of public health care documentation, structural observations at PHC clinics within the TMHD, structured interviews with community health care workers (CHWs), semi-structured interviews with stroke survivors as well as a focus group with permanently employed occupational therapists within the TMHD. Findings: Four groups of factors were identified that will influence the relevance and feasibility in the design of an occupational therapy stroke program for the PHC setting. Structural factors were identified that included the exclusion of occupational therapy in relevant public health care documentation as well as the inaccessibility of PHC clinics. The second group of factors that were identified are procedural factors and include the lack of outcome measures and standards of practice for occupational therapy services to stroke survivors within PHC, the possible inclusion of CHWs in the presentation of an occupational therapy stroke program as well as the possible design of a group therapy program. The third group of factors identified related to the challenges that stroke survivors experience while seeking occupational therapy services within PHC and include the physical and emotional distress post stroke, a lack of knowledge on the benefits of occupational therapy post stroke as well as transportation challenges. The last group of factors that have been identified is the content factors that might be considered for the future design of an occupational therapy stroke program for the PHC setting. Conclusions: Renewed ways of thinking are needed to overcome the challenges faced within PHC in order to ensure that occupational therapy services are relevant and accessible to stroke survivors. Derived from the factors that have been identified, a framework was designed to assist with the future design of an occupational therapy stroke program for the PHC setting.