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Implementation of the hybrid course on basic wheelchair service provision for Colombian wheelchair service providers.

ABSTRACT: INTRODUCTION:People with mobility impairments often rely on wheelchairs as their primary means of mobility. Untrained wheelchair service providers may provide inappropriate wheelchairs and services which result in negative consequences in wheelchair users' health, quality of life, safety, and social participation. This study aimed to evaluate the influence of the Spanish Hybrid Course on Basic Wheelchair Service Provision, a training based on the World Health Organization's Wheelchair Service Training Program-Basic Level, to increase knowledge in basic level wheelchair service provision among a group of wheelchair service providers from Colombia. In addition, we developed a satisfaction survey which participants completed after the training to understand levels of satisfaction with the training intervention. METHODS:A quasi-experimental study was conducted to evaluate changes in basic level wheelchair knowledge using the Wheelchair Service Provision-Basic Test. Paired sample t tests were used to assess pre-and post-training changes in basic level wheelchair knowledge. The Hybrid Satisfaction Survey was developed in collaboration with a multidisciplinary, international stakeholders' group. The survey's construct of interest was level of satisfaction determined by interaction, instructor, instruction methodology, content, and technology, using a five-point Likert scale (0 = strongly disagree to 4 = strongly agree). The survey was completed anonymously after the training intervention and analyzed using frequencies and percentages. RESULTS:Fifteen wheelchair service providers in Colombia completed the Spanish Hybrid Course. Mean post-scores were significantly higher (Mean (M) = 56.13, Standard Deviation (SD) = 7.8), than pre-assessment scores (M = 50.07, SD = 8.38, t(14) = 4.923, p = <0.0001). Participants who completed the surveys (N = 15) reported that the Spanish Hybrid Course was well received, with 98.66% of responses distributed in favorable levels (>3). CONCLUSIONS:The Spanish Hybrid Course proved to be effective in increasing basic level wheelchair knowledge with a high satisfaction level among participants. Further testing is needed to evaluate the effectiveness of this course across different individuals and countries as a potential tool to build professional capacity in basic level wheelchair provision.

SUBMITTER: Burrola-Mendez Y

PROVIDER: S-EPMC6172015 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Implementation of the hybrid course on basic wheelchair service provision for Colombian wheelchair service providers.

Burrola-Mendez Yohali Y Toro-Hernández Maria Luisa ML Goldberg Mary M Pearlman Jon J

PloS one 20181004 10

<h4>Introduction</h4>People with mobility impairments often rely on wheelchairs as their primary means of mobility. Untrained wheelchair service providers may provide inappropriate wheelchairs and services which result in negative consequences in wheelchair users' health, quality of life, safety, and social participation. This study aimed to evaluate the influence of the Spanish Hybrid Course on Basic Wheelchair Service Provision, a training based on the World Health Organization's Wheelchair Se ...[more]

PMID: 30286127

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Project description:IntroductionWheelchair users worldwide are at high risk of developing secondary health conditions and premature death due to inappropriate wheelchair provision by untrained providers. The International Society of Wheelchair Professionals (ISWP) has developed a Hybrid Course based on the World Health Organization's Wheelchair Service Training Package-Basic Level. The Hybrid Course leverages online modules designed for low-bandwidth internet access that reduces the in-person training exposure from five to three and a half days, making it less expensive and more convenient for both trainees and trainers.MethodsThe Hybrid Course was designed using a systematic approach guided by an international group of stakeholders. The development followed the Quality Matters Higher Educational Rubric, web design guidelines for low bandwidth, experts' opinions, and the best practices for blended course design. A quasi-experimental approach was used to evaluate the effectiveness of the Hybrid Course taken by six graduate students in Rehabilitation Sciences at the University of Pittsburgh by measuring pre- and post knowledge using the validated ISWP Wheelchair Service Provision-Basic Test. The outcome measure was assessed using a paired sample t-test between pretest and posttest scores. The quality of the Hybrid Course was evaluated by three external reviewers using the Quality Matters Higher Educational Rubric who were blind to each others' evaluation and the results of the training intervention.ResultsHybrid Course participants reported significant increases in scores on the ISWP Wheelchair Service Provision-Basic Test after participating in the training, with an average increase of 10.84±5.42, p = 0.004, Cohen's d = 1.99. In addition, the Hybrid Course met the Quality Matters Standards in two out of three evaluations and reported a percentage of agreement between evaluators of 84%.ConclusionsThe Hybrid Course met quality standards and proved to be effective in increasing basic level wheelchair knowledge in a group of Rehabilitation Science graduate students.

Project description:IntroductionValid and reliable scores from measurement tools to test competency in basic manual wheelchair-service-provision are needed to promote good practice and support capacity building. The International Society of Wheelchair Professionals' (ISWP) Basic Test Version 1 in English, launched in 2015, is the most frequently used outcome measure tool to test basic manual wheelchair-service-provision knowledge and is part of an international certification process. Despite the wide acceptance and use of the test, its psychometric properties have not yet been established. The objectives of this study were 1) to evaluate the test's psychometric properties, 2) to develop the test's Version 2, and 3) to evaluate the content validity of the new version.MethodsFor Objective 1, methods from the Classical Test Theory were used to obtain items' difficulty, item discrimination index and domains' reliability. For Objective 2, a team of experts in wheelchair service delivery and education conducted a systematic qualitative review of the questions' text and answers and updated them using evidence-based guidelines. For Objective 3, an external team reviewed the clarity, relevance and domain allocation of the developed items using a 4-point Likert scale. Descriptive statistics were used to describe and characterize the results for each objective. Item-content (I-CVI) and Scale-content (S-CVI) validity indexes were calculated to compute content validity.ResultsFor Objective 1, all domains in the test were below the threshold for acceptable internal consistency reliability; 80% of the total test pool (116 items from the total pool of 145) did not meet the thresholds for item difficulty and index of discrimination suggested in the literature. Of the items in the Test, 78% could be responded to intuitively and 66% did not distinguish between test-takers who were knowledgeable in the content area and those who were not. For Objective 2, experts found concerns such as items being grouped in the wrong domain, being repeated, not using person-first language, and using terms inconsistently. Thirty-four (23.4%) items were dropped and 111 (76.5%) were updated. In addition, 61 new items were developed. Members re-categorized the items and proposed a new classification of subdomains. For Objective 3, good agreement between subject-matter experts was found; the S-CVI calculated using the I-CVIs related to item clarity was 84% while using the I-CVIs related to item relevance was 98%. Only 7 items (4.1%) were deemed to be in the wrong domain and 4 items (2.3%) were considered irrelevant and dropped.ConclusionThe psychometric evidence in support of ISWP Basic Test Version 1 in English is suboptimal. A new set of items developed by experts in the field has shown excellent content validity. Ongoing assessments will be needed as ISWP Basic Test Version 2 is implemented and monitored.

Project description:The World Health Organization (WHO) estimates that only 17-37% of the approximately 77 million people who need a wheelchair have access to one. Many organizations are trying to address this need through varying service delivery approaches. For instance, some adhere to WHO's recommended 8-steps service approach while others provide wheelchairs with little to no service. There is limited and sometimes conflicting evidence of the impact of the WHO's recommendations on the outcomes of wheelchair provision. To help build this evidence, we \explored outcomes of two groups of users who received their wheelchairs through two service models over time. The 8-Steps group (n = 118) received a wheelchair selected from a range of models from service providers trained using the WHO process, and the standard of care (SOC) group (n = 24) received hospital-style wheelchairs and without clinical service. Interviews were conducted at baseline and at follow-up 3 to 6 months after provision, to collect data about wheelchair usage, satisfaction, skills, maintenance and repairs, and life satisfaction. Across-group statistical comparisons were not appropriate due to significant differences between groups. In general, participants used their wheelchairs every day but reported very low mobility levels (<500 meters for the 8-steps group, and <100 meters for the SOC group.) The 8-steps group used their wheelchair for either between 1-3 hours per day, or more than 8 hours per day. The SOC used it between 1 and 3 hours per day. Overall, wheelchair usage and wheelchair skills decreased over the 3- to 6-month data collection timeline. Wheelchair breakdowns were common in both groups emphasizing the need for maintenance, occurring more frequently in the 8-Steps (28.8%) compared to the SOC group (8%), and emphasizing the need for maintenance services. No significant differences were found when comparing device satisfaction across wheelchairs types. Our results emphasize the need for routine maintenance to address frequent wheelchair breakdowns. Our results also demonstrate a large disparity in several outcome variables across groups which motivates future studies where across-group comparisons are possible.

Project description:BackgroundEvidence highlights a global shortage of wheelchair service provision education and training that results in inappropriate wheelchair provision with associated health and economic consequences. Two learning methodologies, a hybrid and an in-person course, based on the World Health Organization Wheelchair Service Training Package Basic Level, currently are available to train wheelchair service providers worldwide. The effectiveness of the in-person methodology, used as the standard of practice, has never been tested. Meanwhile, the Hybrid Course, which combines online and in-person training, was developed to reduce training costs and to scale training interventions and has shown potential effectiveness in increasing basic level wheelchair service provision knowledge. The objective of this study was to compare the effectiveness of both learning methodologies based on knowledge and satisfaction among a group of wheelchair service providers in India and Mexico.MethodsWe conducted a controlled quasi-experimental study to evaluate changes in basic wheelchair knowledge and levels of satisfaction between Hybrid and In-person course learners in India and Mexico. A convenience sampling method guided by local stakeholders' input was used to recruit participants. Outcomes were assessed using self-administered online surveys, the International Society of Wheelchair Professionals Wheelchair Service Provision Basic Test (primary outcome) completed pre- and post- the learning intervention and an anonymous Satisfaction Survey (secondary outcome) completed post- intervention. Baseline characteristics were compared among groups using hypothesis tests based on their assumptions. The primary analysis was intention-to-treat. To address missing values and lost to follow-up, multiple chained imputations were conducted. The primary outcome was analyzed using linear mixed models. The secondary outcome was analyzed using a two-tailed two independent samples t-test.ResultsA total of 81 participants, 43 (53.1%) in the In-person group and 38 (46.9%) in the Hybrid group, participated in the study. Mean baseline knowledge scores were below the passing cutoff of the test (53 points) in both groups. Both study groups experienced statistically significant improvements in the primary outcome when comparing pre- and post-test scores (p<0.0001) with total mean scores above the passing cutoff of the test. The in-person group experienced, on average, larger effects on the primary outcome. The difference in mean change from post-test to pre-tests between In-person groups and Hybrid was 3.6 (95% Confidence Interval: 1.7;5.4), Cohen's d = 0.36, with a small effect size favoring the In-person training. With regards to satisfaction, the difference between the two interventions was 0.23±0.07 in favor of the In-person group (p = 0.0021).ConclusionsBoth learning methodologies had a statistically significant effect in increasing wheelchair service knowledge with overall high levels of satisfaction. However, the In-person group reported overall larger effects when compared with the Hybrid methodology. This study provided recommendations on how organizations can improve blended learning interventions to enhance participants' learning experiences and reduce potential barriers and limitations.

Project description:IntroductionPostpartum intrauterine contraceptive devices (PP-IUCD) are one type of post-partum family planning method, which can be provided to a post-partum woman starting from the placental delivery time (within 10 minutes), or within the first 48 hours of postpartum period. In most developing countries, delivery time is the primary opportunity for women to access post-partum family planning methods, especially for those living in remote areas. Hence, this study assesses providers' knowledge on postpartum intrauterine contraceptive device service provision.MethodsA facility-based cross-sectional study was conducted in Amhara region health center and hospitals. Health providers surveyed included obstetricians, gynecologists, general practitioners, emergency surgical officers, health officers, midwives and nurses from September 18, 2015 to December18, 2016. Simple random sampling was used to select 864 subjects. Data were collected by using a structured self-administered questionnaire and observing the facility. Multilevel analysis was done to see factors associated with outcome.ResultsA total of 197 health facilities and 864 providers are included in the final analysis. Of the total providers 524 (60.6%) were from a health center. The mean age (±SD) of participants was 27.8 years (±5.4). The number of providers with good knowledge accounted for 253 of those surveyed (29.3%). The proportion of good knowledge among trained PP-IUCD providers was 35.7% (those who scored above average), and 27.9% was untrained about PP-IUCD. A considerable heterogeneity was observed between health facilities for each indicator of provider's knowledge. Gender differences were observed as the mean knowledge score deference on PP-IUCD by 0.4 points (β = -0.41; -0.72, -0.10) when the participant was female. Having experience of regular counseling of pregnant women increases PP-IUCD knowledge score by 0.97. (β = 0.97; 95% CI: 0.48, 1.47). Where the health facility requested clients to purchase the IUCD themselves, the mean knowledge score decreased by 0.47 points compared with free of charge at the facility level (β = -0.47; 95%CI: -0.87, -0.07).ConclusionOur findings showed that providers' knowledge about postpartum IUCD was low in the Amhara region public health facility. The lowest knowledge score was noted among nurses, health Officers, midwives, and general practice professionals. Factors associated with providers' knowledge on PP-IUCD are the status of health facility, female sex, training on PP-IUCD, regular counseling of pregnant women, and unavailability of IUCD service.

Project description:Improving access to culturally appropriate mental healthcare has been recognised as a key strategy to address the often greater burden of mental health issues experienced by Indigenous populations. We present data from the evaluation of a national attempt at improving access to culturally appropriate mental healthcare for Indigenous Australians through a mainstream primary mental healthcare program, the Access to Allied Psychological Services program, whilst specifically focusing on the implementation strategies and perspectives of service providers.We conducted semi-structured interviews with 31 service providers (primary care agency staff, referrers, and mental health professionals) that were analysed thematically and descriptively.Agency-level implementation strategies to enhance service access and cultural appropriateness included: the conduct of local service needs assessments; Indigenous stakeholder consultation and partnership development; establishment of clinical governance frameworks; workforce recruitment, clinical/cultural training and supervision; stakeholder and referrer education; and service co-location at Indigenous health organisations. Dedicated provider-level strategies to ensure the cultural appropriateness of services were primarily aimed at the context and process of delivery (involving, flexible referral pathways, suitable locations, adaptation of client engagement and service feedback processes) and, to a lesser extent, the nature and content of interventions (provision of culturally adapted therapy).This study offers insights into key factors underpinning the successful national service implementation approach. Study findings highlight that concerted national attempts to enhance mainstream primary mental healthcare for Indigenous people are critically dependent on effective local agency- and provider-level strategies to optimise the integration, adaptation and broader utility of these services within local Indigenous community and healthcare service contexts. Despite the explicit provider focus, this study was limited by a lack of Indigenous stakeholder perspectives. Key study findings are of direct relevance to inform the future implementation and delivery of culturally appropriate primary mental healthcare programs for Indigenous populations in Australia and internationally.

Project description:ObjectiveThe overall aim of this project was to assess compliance with evidence-based criteria regarding newborn resuscitation among healthcare workers in the maternity units in Maragua District Hospital (a busy district hospital in Kenya).IntroductionGlobally, the majority of deaths under five years are attributable to neonatal causes. Perinatal asphyxia accounts for a significant portion of these deaths, especially in developing countries. These deaths are largely preventable, and interventions geared towards assisting newborns to initiate their first breath within the first minute of life have markedly reduced mortality.MethodsThis implementation project was conducted in the maternity units of a busy district hospital. Evidence-based audit criteria were developed on the basis of an evidence summary developed by the Joanna Briggs Institute (JBI). Using the JBI Practical Application of Clinical Evidence System software (JBI PACES), a baseline audit was conducted including a sample size of 55 healthcare providers and 300 patient case notes followed by an identification of potential barriers and strategies to overcome them. A follow-up audit including a sample size of 55 healthcare providers was conducted by using the same audit criteria.ResultsImprovements in practice were demonstrated in all criteria. The baseline audit demonstrated that three of the five audit criteria were found to be less than 50%, indicating moderate compliance with current evidence with regards to newborn resuscitation. Following implementation of the strategies, which included a six-week education and demonstrative skills training, and updating of the protocols and equipment, there was a significant improvement in all the criteria audited, with the first four criteria achieving 100% compliance, and the fifth criteria achieving 90% compliance.ConclusionOn completion of the project, the participants demonstrated an increase in knowledge and skills on newborn resuscitation, which led to a significant reduction in admission of newborns with birth asphyxia to the newborn unit.

Dataset Information

Implementation of the hybrid course on basic wheelchair service provision for Colombian wheelchair service providers.

Publications

Implementation of the hybrid course on basic wheelchair service provision for Colombian wheelchair service providers.

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