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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 4  |  Issue : 4  |  Page : 259-262

Effectiveness of training community-based rehabilitation workers on multiple disabilities: A pilot study


1 Lecturer, JSS College of Physiotherapy, Mysore, India
2 Krupa Physiotherapy and Rehabilitation Centre, Kollegal, Karnataka, India

Date of Web Publication20-Oct-2015

Correspondence Address:
Vijay Samuel V Raj
Lecturer, JSS College of Physiotherapy, JSS Hopital Campus, MG Road, Mysore - 570 004, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.167654

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  Abstract 

Context: Community-based rehabilitation (CBR) as a developmental strategy addresses the needs of people with disabilities and their family. CBR personals at remote rural play an important role in early detection and prevention of disabilities. The identification with proper guidance can help to overcome the scarcity in early detection. An effective training for rehabilitation workers should contain training program emphasis on multiple disabilities. Aims: The aim of this study was to assess the effectiveness of training CBR personal with relation to knowledge on multiple disabilities. Settings and Design: An experimental design of 12 month's intervention confined to Chamarajanagar district. Subjects and Methods: A total of 20 subjects of trained CBR personals with the age group of 20–45 years were included in this study. The initial baseline evaluation was performed with a pretest questionnaire to assess their knowledge. The training with practical exposure on multiple disabilities was carried out at an interval of 3 months. The posttest at 12 months was analyzed. Statistical Analysis Used: SPSS version 16 for Windows was used for analysis. The results were statistically analyzed using paired test, Chi-square test, and ANOVA for between and within the groups. Results: The results showed significance on effectiveness of training. There was an improvement in outcome measures reflecting on identification and management of disabilities. Conclusions: The knowledge regarding early identification of disabilities plays an important role. Implementation of training methods on a regular interval and as a part in continuing education plays an important source for better outcome.

Keywords: Community-based rehabilitation workers, multiple disabilities, training


How to cite this article:
Raj VV, Thomas M. Effectiveness of training community-based rehabilitation workers on multiple disabilities: A pilot study. Int J Health Allied Sci 2015;4:259-62

How to cite this URL:
Raj VV, Thomas M. Effectiveness of training community-based rehabilitation workers on multiple disabilities: A pilot study. Int J Health Allied Sci [serial online] 2015 [cited 2019 Sep 21];4:259-62. Available from: http://www.ijhas.in/text.asp?2015/4/4/259/167654


  Introduction Top


Community-based rehabilitation (CBR) focuses on enhancing the quality of life for people with disabilities and their families, meeting basic needs, ensuring inclusion and participation.[1] The World Health Organization (WHO) introduced the CBR strategy as part of its goal to accomplish health for all. The Alma-Ata Conference and Declaration of 1978 on primary healthcare creates a new vision for providing promotive, preventive, curative, and rehabilitative services for the main health problems in the community.[2] The human and material limitations of disabled people, their family members, and other community members are identified by the CBR program.[3] The rehabilitation personnel at remote rural plays an important role in early detection of disabilities where the CBR is highly effective and valuable for people with disabilities in the community. It makes possible to deliver the rehabilitation and prevention services to people with disabilities and their families through effective training of generic community workers.[4],[5]

References have revealed that areas are needed to be strengthened in the CBR program and to be successful in achieving objectives of the WHO strategy.[6] Studies have reviewed that CBR personnel acknowledged the benefits of the programme, but summit to a lack of rehabilitation education for them.[7] An effective strategy to achieve the goals is to include a multi-disability training approach in their training curriculum.[8] Multiple disabilities refer to a combination of two or more disabling conditions that have a combined effect on the person's communication, mobility, and performance of day wise tasks.

The literature reviews and studies on CBR workers showed that there is a lack in work experience toward the identification and managing people with disabilities. This has also shown an influence on their education levels [9] and the requirement on the nature and extent of skills, the CBR workers should possess.[7],[10] The CBR service delivery system gives the very importance of training to the workers to improve the skills aiding for early identification of disabilities.[11] There is a much need in the appropriate treatment at a very specific time frame, identification using simple detection techniques may be sometimes handy at rural areas, and may help in early intervention.[12] As there is an arising awareness and supportive program by the government and nongovernmental organizations in India, the need to deliver the program necessitate to be effective. A trained personal must be efficient in the identification, managing the treatment and referrals; thus, educating the differently abled person and family to an early intervention.

It is an important need to evaluate the importance of the training on multiple disabilities taking consideration of education and knowledge as parameters of the rehabilitation workers. Studies on training on CBR personal have stated that training of CBR personnel can progress by exchanging ideas and by evaluating and promoting good practice in a way that will develop rather than restrict the development. The objective of this study was to assess the effectiveness of training the rural CBR workers on multiple disabilities and to evaluating the assessment skills and knowledge of CBR personnel's.


  Subjects and Methods Top


The experimental study was conducted among the CBR workers from various organizations in rural areas in Chamarajanagar district. The subjects were trained in CBR having a basic knowledge on the identification of disabilities. The subjects were randomly selected based on their interest to participate in the training program. A total of 20 subjects volunteered for the study. A written consent was obtained from the subjects with permission from the higher authorities of the institution. The included were of age group between 20 and 45 years and with an educational qualification range from high school to a basic degree with or without special certification.

The subjects were screened through self-administered questionnaire on educational qualification, work experience, and knowledge on disabilities. The questionnaire was formed by the panel of expertise which included the demographic data, work duration, additional training. The questionnaire had a pretrained ability scores and post trained ability under a column of scores. The scores addressed on the component of knowledge, behavior, interpersonal relationship, ability to identify disabilities, ability to refer to specialities.

A pretest at the baseline was obtained prior to the training program. The training on multiple disabilities included the awareness, identification, and the management at the first level was given to all the subjects in three phases. Based on the demographic data, the subjects were grouped for the data analysis based on the years of experience (more than 10 years and <10 years) and the age (20–30 years, 30–40 years and 40–45 years). The training program was similar to all and included all the subjects.

The first phase included training at their work place emphasis on the disabilities was carried on in the first quarter; the second phase was carried out in the second quarter included a practical training by experts on multiple disabilities including musculoskeletal and mental health at a multi-speciality hospital at Mysore. The third phase included a training session with practical exposure at various centers at Mysore in the third quarter.

Posttest at the end of the fourth quarter (12 months) included a collection of data through a questionnaire.


  Results Top


Twenty CBR workers were recruited for the study; of 20 subjects, two CBR workers did not participate to complete the training program. A total of 18 subjects, 2 male and 16 female subjects took part in the study from the baseline to the 12 months period. The age group ranged from 20 to 45 years. 44.4% were qualified at the high school level, 33.3% at higher secondary, and 22.2% were diploma or degree holders. The educational qualification, age distribution is shown in [Table 1] and [Table 2].
Table 1: Education level of CBR workers

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Table 2: Age frequency

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SPSS (Statistical Package for Social Science) version 16 for Windows was used for analysis. The results were analyzed statistically by computing the mean using paired t-test and Chi-square test, one-way ANOVA to analyze between and within groups was used. These were correlated for the significance.

Personal evaluation on post training related to the effectiveness of module was statistically assessed for the significance. The questionnaire was based and classified into knowledge and confidence in identification and management. Basic knowledge and confidence were analyzed using the paired t-test. It was highly significant with t = 21.761 for the knowledge and 11.802 for confidence [Table 3] and [Table 4].
Table 3: The paired t-test for the knowledge†

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Table 4: Paired t-test for the confidence level in assessment and treatment

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The one-way ANOVA tests revealed that there were significant changes with age for the knowledge and behavioral components whereas the confidence gain showed no much change with reference to the age group. The age group between 30 and 40 years showed a higher gain in knowledge [Table 5] and [Table 6].
Table 5: Pre and posttest correlations for knowledge and confidence

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Table 6: One-way ANOVA test for the components

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The test for differences with experience yielded no much difference in knowledge within component groups. The subjects with <10 years of experience showed a significant gain in confidence and behavior when compared with the subjects with more than 10 years of experience [Table 7].
Table 7: Component gains in relation to years of experience

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The training evaluation illustrated that the training was useful and satisfying a lot with>80% on applying learning and on effect on results, some satisfaction and usefulness was>75% for the knowledge and ideas. The test statics showed significance on the maximum total score.


  Discussion Top


The WHO model often fails to recognize the need for training the numerous groups of personnel involved in CBR, and they fall as the first level workers. The training must be aimed to be local and geared to the needs of the project they serve. In this study, the training was based on the work area related and mostly addressed the workers in their local language and type of work. The efficiency of the training post 12 months has shown greater significant changes with respect to the knowledge gained and in their confidence level on the identification. With reference to the analysis, Paterson et al., revealed that CBR workers in South India tend to be young, female and lacking in work experience, and reflecting a lack of educational strategies directed specifically at attitude development, on supporting to the study the results have revealed a proper training in mid or as continuing education can improve the standards of work at rural areas. The study supports the importance of training with relation to the age where younger subjects showed a higher gain in knowledge. The study, to evaluate the importance of training, has shown a significant improvement in improving the knowledge on disability identification and confidence level. Thus, training incorporated at the early entry level of CBR workers would show a greater efficiency and outcome.


  Conclusion Top


The findings reveal that knowledge regarding early identification of disabilities plays an important role as a part of CBR program in the rural areas. Training the CBR personal on multi-disability aspect has a major role in improving the knowledge, confidence, and is an important source for a better outcome.

Acknowledgment

The authors thank Rev. J. Adiss Arnold and Udayshankar for their valuable support in conducting this study. We thank the resource persons for sharing their pearls of wisdom with the subjects at the training during the course of this research. We thank all the participants for their co-operation and interest in learning.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Community Based Rehabilitation; World Health Organization. Programmes. Available from: . [Last retrieved on 2015 Jan 27].  Back to cited text no. 1
    
2.
World Health Organization. Declaration of Alma-Ata. World Health Organization; 1978. Available form: www.who.int/publications/almaata_declaration_en.pdf. [Last accessed on 2015 Jan 26].  Back to cited text no. 2
    
3.
Vanneste G. Editorial: Community Based Rehabilitation: What is it? Disability Word, Issue no.6; January-February, 2001. Available from: .[Last retrieved on 2015 Jan 14].  Back to cited text no. 3
    
4.
Grimby G, Finnstam J, Nelson G, Rashid S. Evaluation of community-based rehabilitation in Punjab, Pakistan: II: The prevalence of diseases, impairments, and handicaps. Int Disabil Stud 1988;10:59-60.  Back to cited text no. 4
    
5.
Mannan H, Turnbull AP. A review of community based rehabilitation evaluations: Quality of life as an outcome measure for future evaluations. Asia Pac Disabil Rehabil J 2007;18:29-35.  Back to cited text no. 5
    
6.
Evans PJ, Zinkin P, Harpham T, Chaudury G. Evaluation of medical rehabilitation in community based rehabilitation. Soc Sci Med 2001;53:333-48.  Back to cited text no. 6
    
7.
Nordholm LA, Lundgren-Lindquist B. Community-based rehabilitation in Moshupa village, Botswana. Disabil Rehabil 1999;21:515-21.  Back to cited text no. 7
    
8.
Rajendra KR, Abraham C, Thomas M. The Sourabha CBR project – An evaluation study. Actionaid Disabil News 1994;5:67-73.  Back to cited text no. 8
    
9.
Paterson J, Boyce W, Jamieson M. The attitudes of community based rehabilitation workers towards people with disabilities in south India. Int J Rehabil Res 1999;22:85-91.  Back to cited text no. 9
    
10.
Campfens D. CBR Evaluation Improving What We Do: A Handbook for Community Based Rehabilitation Programming and Evaluation. Kingston, Canada: International Center for the Advancement of Community-Based Rehabilitation; 1998.  Back to cited text no. 10
    
11.
Mitchell R. Community-based rehabilitation: The generalized model. Disabil Rehabil 1999;21:522-8.  Back to cited text no. 11
    
12.
Rao PH, Venkatesan S, Vepuri VG. Community-based rehabilitation services for people with disabilities: An experimental study. Int J Rehabil Res 1993;16:245-50.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]


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