Soraya Maart

Poverty and disability in Eastern and Western Cape Provinces, South Africa

The impact of disability on the living conditions of people living in specifically resource‐poor areas in South Africa has not previously been addressed. This paper presents a comparison of people with a disability and their non‐disabled peers with respect to some key poverty indicators among a sample of Xhosa speaking individuals in resource‐poor areas of Eastern and Western Cape Provinces. A questionnaire on the level of living conditions (household composition and socio‐economic characteristics) and a detailed disability questionnaire that captured more specific details of the disability experience of the individual with a disability were adapted to the South African context and utilised. Despite the improved situation of households with a disabled family member in terms of financial resources (due primarily to the allocation of disability grants), other measures of poverty (education and employment) remain divisive for those with disabilities.

Environmental barriers experienced by urban and rural disabled people in South Africa

Impairments pose a certain degree of difficulty to disabled people, however the impact of the environment is the major cause of disability. Despite the fact that the disabling effect of environmental factors is acknowledged, little research has been done to explore the impact of the environment on varying degrees of disability and different impairments. The aim of this study was to investigate the experience of disabled people with regard to environmental barriers in an urban as opposed to a rural setting. The specific objectives were to identify which items within the International Classification of Functioning, Disability and Health (ICF) checklist of environmental factors presented people with disability with the most barriers and to see whether the barriers were different for those living in a rural as opposed to an urban setting. The study was conducted amongst Xhosa speaking people in the Eastern and Western Cape aresa of South Africa which have, respectively, 5.8% and 4.1% disability prevalences. A descriptive, analytical, cross‐sectional study was used to gather the data. The primary data collection tool was the Xhosa version of the ICF checklist. The sample consisted of 468 respondents, with 375 living in the Eastern Cape and 93 in the Western Cape. Physical problems were reported by 54.6 % of the sample, 14.6% had had an intellectual impairment and 9.9% had visual, hearing or speech problems. Approximately 2% of the sample reported more than one impairment. The prevalence of the different types of impairments between the two areas was similar. Respondents from the urban area reported experiencing more barriers in the categories Products and technology and the Natural and built environment, while respondents from the rural area experienced more barriers with Attitudes. An equivalent number of people in the respective areas identified barriers in the Services category. In this study the face and construct validity of the ICF appeared to be acceptable and it is recommended that further studies be conducted to establish the reliability and content and concurrent validity of the instrument.

The sexual behaviour of physically disabled adolescents

Introduction. Risky sexual behaviour is a major factor contributing to the increasing prevalence of HIV/AIDS in South Africa. A large national survey of adolescents sexual behaviour was undertaken in 2002, however adolescents with disabilities were excluded from this study. The aim of this study is to compare the sexual behaviours of adolescents with physical disabilities to those of their non-disabled peers. Methodology. A cross-sectional sample was drawn from learners with physical disabilities between grades 8 and 9 in Cape Town. Data were collected using the South African youth risk behaviour survey adapted by the medical research council of South Africa. Results. There were responses from 91 participants, of which 56% were males. Approximately, one quarter of the special school sample reported sexual activity compared with one third of the national sample; the difference approached significance. As with the national sample, relatively few adolescents thought they were likely to contract HIV in their lifetime (12%). Fifty percent of the sample claimed that they were able to protect themselves against contracting HIV compared with 66% of the adolescents without disability. The percentage reporting two or more sexual partners in the special schools (27%) was about half that of the national sample (53%). There was little difference in the percentages reporting substance abuse related to sexual activity (14% compared with 15%) and the national sample reported more regularly use of condoms (Special school 18% compared with 25%). Discussion. Disabled adolescents are indulging in risky sexual behaviours, and are at equal risk as their non-disabled peers of developing HIV. Conclusion. Adolescents with disability must not be excluded from main stream research and health promotion activities specifically related to sex education.

The Second Physical Therapy Summit on Global Health: developing an action plan to promote health in daily practice and reduce the burden of non-communicable diseases

Abstract Based on indicators that emerged from The First Physical Therapy Summit on Global Health (2007), the Second Summit (2011) identified themes to inform a global physical therapy action plan to integrate health promotion into practice across the World Confederation for Physical Therapy (WCPT) regions. Working questions were: (1) how well is health promotion implemented within physical therapy practice; and (2) how might this be improved across five target audiences (i.e. physical therapist practitioners, educators, researchers, professional body representatives, and government liaisons/consultants). In structured facilitated sessions, Summit representatives (n = 32) discussed: (1) within WCPT regions, what is working and the challenges; and (2) across WCPT regions, what are potential directions using World CaféTM methodology. Commonalities outweighed differences with respect to strategies to advance health-focused physical therapy as a clinical competency across regions and within target audiences. Participants agreed that health-focused practice is a professional priority, and a strategic action plan was needed to develop it as a clinical competency. The action plan and recommendations largely paralleled the principles and objectives of the World Health Organization’s non-communicable diseases action plan. A third Summit planned for 2015 will provide a mechanism for follow-up to evaluate progress in integrating health-focused physical therapy within the profession.

The impact of an employee wellness programme in clothing/textile manufacturing companies: a randomised controlled trial

BackgroundThe prevalence of health risk behaviours is growing amongst South African employees. Health risk behaviours have been identified as a major contributor to reduced health related quality of life (HRQoL) and the increased prevalence of non-communicable diseases. Worksite wellness programmes promise to promote behaviour changes amongst employees and to improve their HRQoL. The aim of this study was to evaluate the short-term effects of an employee wellness programme on HRQoL, health behaviour change, body mass index (BMI) and absenteeism amongst clothing and textile manufacturing employees.MethodsThe study used a randomised control trial design. The sample consisted of 80 subjects from three clothing manufacturing companies in Cape Town, South Africa. The experimental group was subjected to a wellness programme based on the principles of cognitive behaviour therapy (CBT) as well as weekly supervised exercise classes over six weeks. The control group received a once-off health promotion talk and various educational pamphlets, with no further intervention. Measurements were recorded at baseline and at six weeks post-intervention. Outcome measures included the EQ-5D, Stanford Exercise Behaviours Scale, body mass index and absenteeism.Data was analysed with the Statistica-8 software program. Non-parametric tests were used to evaluate the differences in the medians between the two groups and to determine the level of significance. The Sign test was used to determine the within group changes. The Mann–Whitney U test was used to determine the difference between the two groups.ResultsAt six weeks post intervention the experimental group (39 subjects) demonstrated improvement in almost every parameter. In contrast, apart from an overall decrease in time off work and a reduction in BMI for all study participants, there was no significant change noted in the behaviour of the control group (41 subjects). Seventy percent of the experimental group had improved HRQoL EQ-5D VAS scores post intervention, indicating improved perceived HRQoL. In comparison, only 58% of the control group had improved HRQoL EQ-5D VAS scores post intervention. There was no significant difference between the two groups at baseline or at six weeks post intervention.ConclusionAn employee wellness programme based on the principles of CBT combined with weekly aerobic exercise class was beneficial in improving the perceived HRQoL and changing health-related behaviours of clothing manufacturing employees. However, it cannot be concluded that the EWP was more effective than the once off health promotion talk as no significant changes were noted between the two groups at 6-weeks post intervention.This trial has been registered with ClinicalTrials.gov (trial registration number NCT01625039).

Who gets the disability grant in South Africa? An analysis of the characteristics of recipients in urban and rural areas

Background. This study was to establish whether there was a difference in the characteristics of people who received a disability grant and those who did not in rural and urban samples of isiXhosa-speaking people with disability in South Africa. Sample. The sample was a convenience sample and was identified through a ‘snowballing’ process. Instrumentation. A demographic survey and isiXhosa versions of the International Classification of Functioning , Disability and Health (ICF) and EQ-5D, a health-related quality of life measure were utilized. Results. The sample consisted of 244 rural and 61 urban respondents, demonstrating a preponderance of physical disabilities. The groups who received or did not receive grants were equivalent in terms of age, gender, marital status and employment status. A significantly higher proportion of rural dwellers accessed the grant. The grant holders displayed significantly more problems related to mobility and to technology and policies and services relating to mobility and transport. Those who did not receive grants reported more barriers with regard to the attitudes of health workers but not with regard to any other aspect of social support. Conclusions and recommendations. The majority of men and women with disability identified in this study received the grant, whether or not they lived in remote rural or in urban areas. As there were few differences between the groups, it is likely that several non-grant holders might qualify if they were informed of the grant and applied. The role of medical doctors as ‘gate-keepers’ to the grant might need to be examined.

Disability and access to health care - a community based descriptive study.

Abstract Purpose: The World Disability Report highlighted the need for adequate access to health and medical rehabilitation services for those with disability. Participants in a large community based survey in a low-income area were asked questions relating to their use of health related services. Method: Using random, cluster sampling a representative sample of 1083 households in a deprived area of Cape Town were approached and 152 people with disability were interviewed. Results: Those with disability were more likely to be male (χ2 = 4.24, p = 0.03) and unemployed (χ2 = 66.89, p > 0.001) compared to those without disability. The percentages reporting unmet needs were respectively: 54% for home-based care; 34.5% for assistive devices, 28.9% for medical rehabilitation services; and 2.5% for health services. Those over 65 years of age were less likely to have had the medical rehabilitation that they required (χ2 = 8.00, p = 0.018). There were fewer respondents with sensory and language disorders but these groups reported proportionately more unmet needs. The main problems with accessing services included inadequate finances (71%) and transport problems (72%). Conclusion: It is recommended that all efforts be expended to extend appropriate rehabilitation services, including home based-care and appliances to those identified as having disability, particularly to those older than 65 years. In addition, the services need to be affordable and accessible in terms of suitable transport, particularly in the light of the high unemployment rate and the large number of respondents with mobility problems. Implications for Rehabilitation People with disability may be the most in need of additional health related care and the least able to access it. Transport and financial considerations were found to limit the ability to access appropriate care. Rehabilitation and health services need to reach out through home-based care and appropriate forms of rehabilitation delivery to ensure that those who are most in need of care, such as the elderly and those with more neglected forms of disability, are provided with the services that they require.

Developing Human Rights competencies for South African health professional graduates

Human rights are social or material entitlements which are recognised universally in national and international law and that address fundamental human needs. They inhere in all people by virtue of their humanity, and represent a standard to which governments can be held accountable.

Exploring ICF components in a survey among Xhosa speakers in Eastern & Western Cape, South Africa.

Purpose. To contribute to the testing and development of the ICF model by exploring the relationship between activity limitations, participation restrictions and environmental barriers. Method. Structured questionnaire-based interviews were carried out among a convenience sample of 950 households counting 4917 individuals in Eastern and Western Cape, South Africa. Approximately half of the households had at least one individual with disability, while the other half represented controls in the study. Activity limitations, participation restrictions and environmental barriers were operationalized by means of questions drawn directly from the ICF checklist. Results. Principal component analyses supported a four-component solution for the activity and participation variables, and a two-component solution for the barrier variables. Scales for each sub-component were produced by adding the individual items under each sub-component. Male respondents are more restricted than females when it comes to social activities, individual care, education and mobility barriers. While respondents in Western Cape scored higher (more limitations and restrictions) on the activity and participation sub-scales individual care, daily activities and education, Eastern Cape respondents scored higher on both the environmental barrier sub-scales. Conclusions. A viable structure of sub-components under the broader ICF concepts has been demonstrated. The study has provided some support to viewing activity limitations and participation restrictions as two independent dimensions, but also invites further studies and refinement of the model.

Rehabilitation in Seven Sub-Saharan African Countries: Personnel Education and Training.

This article outlines rehabilitation personnel education and training in seven countries representing a geo-culturally contiguous region of sub-Saharan Africa: Botswana, Cameroon, Rwanda, South Africa, Tanzania, Zambia, and Zimbabwe. It identifies and explicates practices to inform similar or parallel rehabilitation practices in the United States (U.S.). Rehabilitation personnel in the African sub-region have diverse professional preparation backgrounds: physiotherapists, occupational therapists and speech and language therapists. Overlaying this structure of professional cadre are rehabilitation technicians and community health workers with variable levels of formal training; - mostly in-house from public and private-not-for profit organizations serving people with disabilities. Conclusions drawn from this review emphasize implications for rehabilitation counselor education in the U.S., and in particular prospects for internationalizing the rehabilitation counselor education curriculum.