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Visagie, Surona (2015-04)
ENGLISH ABSTRACT: Introduction: High quality comprehensive health care services contribute to community integration and participation of persons with disability. However, persons with disabilities often experience barriers with regard to health care access. Neither these barriers nor the concept of disability have been sufficiently explored in rural Global South settings. This study describes the experience of living with a disability in a remote, rural setting with a specific focus on barriers and facilitators to health care access.
Method: A qualitative design utilising case study methodology and interpretative phenomenological analysis was used. The study population consisted of 283 persons with moderate or severe activity limitations, who lived in a rural town in the Northern Cape Province of South Africa. Eight of them were purposively sampled as anchor participants in eight case studies. Their significant others completed each case study. In addition data were collected from six service providers to the study community. Data were collected through 19 in-depth interviews and one focus group discussion, between March and October 2012. The principles of interpretative phenomenological analysis were used to analyse data and identify themes. Similar themes were clustered under superordinate themes. Cases were analysed separately after which patterns across cases were identified.
Results: Participants conceptualised disability as an individual problem according to the moral or medical approaches and often interpreted disability as physical in nature. Participants’ level of participation and community integration varied from very little to being employed and well integrated. Self-belief and the attitude and support of significant others, community members and employers played an important role in the level of participation persons with disability achieved.
Participants’ primarily utilised public, formal, health care services. These services were found to be mainly curative and preventative in nature. The provision of health promotion and rehabilitation were lacking. Users were not empowered to take control of their own health management and were not included in the health care team. Health system barriers identified included insufficient human and material resources, communication challenges,
and rigid protocols. The remoteness of the setting hampered health care service delivery. Free health care provision, high quality services at tertiary level, and outreach services to the community were identified as facilitators. A lack of products and technology, poverty, and low levels of education created further barriers to community integration and health care access.
Implications: Suboptimal health care together with personal and environmental barriers might have resulted in poor health, functional, community integration, and participation outcomes for participants. Health care was provided reactively to individual users and not according to the principles of primary health care. The little rehabilitation that was provided was not enough to ensure improved functioning or community integration and participation.
Recommendations: Since this was an inductive study with few participants recommendations centre on hypotheses for further study. The focus of these theories is on ways to provide health care according to the philosophy of primary health care and on introducing specific rehabilitation programmes in the community.
AFRIKAANSE OPSOMMING: Inleiding: Persone met gestremdhede mag omvattende gesondheidsorg van hoë gehalte benodig om gemeenskapsintegrasie te verseker. Ongelukkig ervaar hulle meermale probleme met toegang tot gesondheidsorg. Kennis oor die aard van hierdie probleme asook in verband met die ervaring van gestremdheid in die globale suide is onvoldoende. Hierdie studie het ten doel om vas te stel hoe persone met gestremdhede in `n afgeleë, landelike omgewing die konsep van ‘gestremdheid’ ervaar en watter faktore toegang tot gesondheidsorg beïnvloed.
Metodes: Hierdie kwalitatiewe studie het gebruik gemaak van gevallestudies en interpreterende fenemonologiese analise. Die studiepopulasie het bestaan uit 283 individue met matige of ernstige aktiwiteitsbeperkinge wat woonagtig was in `n landelike dorp in die Noord Kaap provinsie van Suid Afrika. Ag van hulle is doelbewus geselekteer as anker deelnemers in ag gevallestudies. Persone wat `n belangrike rol in die lewe van hierdie deelnemers gespeel het, het elke gevallestudie voltooi. Verdere data is ingesamel deur onderhoude met ses diensverskaffers. Data is tussen Maart en Oktober 2012, deur middel van 19 in diepte onderhoude en een fokusgroep bespreking ingesamel. Die beginsels van interpreterende fenemonologiese analise is gebruik om temas uit die data te identifiseer. Soortgelyke temas is saam gevoeg onder `n beskrywende tema. Data van elke gevallestudie is eers afsonderlik geanaliseer waarna patrone tussen gevalle geidentifiseer is.
Resultate: Deelnemers het gestremdheid as `n individuele probleem beskou, dit uit `n morele of mediese hoek benader, en dikwels as fisies van aard vertolk. Sommige deelnemers was geïntegreer in die gemeenskap en het gewerk. Andere daarenteen was glad nie geïntegreerd nie. Die resultate dui daarop dat `n geloof in eiewaarde en die houding van familie, die gemeenskap en werkgewers `n belangrike rol gespeel het in suskesevolle gemeenskapsintegrasie en werk.
Deelnemers het meestal van staatsgesubsidieerde, formele, gesondheidsorg gebruik gemaak. Hulle het hoofsaaklik voorkomende en genesende dienste ontvang. Die bevordering van gesondheid en rehabilitasie dienste was onvoldoende. Deelnemers was nie bemagtig om beheer oor hulle eie gesondheid te neem nie en was nie ingesluit in die gesondheidsorgspan nie. Toegang tot gesondheidsorg is belemmer deur `n tekort aan menslike en materiële hulpbronne, kommunikasie probleme en rigiede protokolle. Die afgesonderdheid van die Stellenbosch University https://scholar.sun.ac.za
area het gesondheidsorg verder nadelig beïnvloed. Gemeenskapsintegrasie en toegang tot gesondheidsorg is ook bemoeilik deur `n tekort aan tegnologie en produkte, armoede en beperkte formele skool opleiding. Gratis voorsiening van gesondheidsorg, dienste van hoë gehalte op tersiêre vlak en uitreikdienste na die gemeenskap het toegang tot gesondheidsorg bevorder.
Implikasies: Sub optimale gesondheidsorg tesame met persoonlike en omgewingsbeperkinge het moontlik daartoe bygedra dat deelnemers nie optimale vlakke van gesondheid, funksie, en gemeenskapsintegrasie bereik het nie. Gesondheidsorg is reaktief aan individuele gebruikers voorsien instede van volgens die beginsels van primêre gesondheidsorg. Die rehabilitasie wat gedoen is, was te min om verbetering in funksie en gemeenskapsintegrasie te verseker.
Aanbevelings: Dit was `n induktiewe studie met min deelnemers. Daarom fokus die aanbevelings op die ontwikkeling van hipotesisse vir verdere studie. Hierdie hipotesisse hou meestal verband met die verwesenliking van die filosofie van primêre gesondheidsorg en die ontwikkeling van rehabilitasie programme in die studie gemeenskap.
Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/96695
This item appears in the following collections: Doctoral Degrees (Centre for Rehabilitation Studies)1