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1. What evidence do I have (or need) to identify those factors and levels posing the greatest barriers to rehabilitation in my population?
In order to identify the factors and levels that present the greatest barriers to rehabilitation in Kenya, I need to conduct a survey. For example, the rapid Assistive Technology Assessment (rATA) is a population-based household survey conducted in Kenya in 2020. This survey measured the need, demand, supply, user satisfaction, and barriers to accessing assistive technology. To understand the multilevel and intersectional factors associated with barriers to access and the benefits of rehabilitation services, a study will be conducted using the socioecological framework to assess the current situation in Kenya. Additionally, reference can be made to population surveys, census data, and the Rehabilitation and Assistive Technology Strategy of 2022-26 in Kenya.
2. How does my own professional expertise and organizational access suggest where I might be most be effective in developing and launching an intervention?
As rehabilitation focal person, I will collaborate with stakeholders to create an intervention that garners broad support and readiness for implementation. I will foster a culture of collective responsibility for developing, implementing, and embedding the intervention into routine practice. Within the organization, I will prioritize ensuring the availability of resources, enhancing workforce capacity, and cultivating a culture of motivation that supports evidence-informed interventions
3. What formative research might be needed to understand the precise intervention that would be most appropriate and impactful towards overcoming the challenges I identify?
We need to conduct formative research using both qualitative and quantitative methods to understand the specific intervention that would be suitable and effective at multiple levels in addressing the identified challenges. To achieve this, we will use a variety of methods, including telephone interviews, surveys and checklists, semi-structured interviews, and focus group discussions.
4. When considering potential interventions, what factors related to implementation do I need to consider?
In implementation of a potential intervention, there are factors to be considered that include:
a) Acceptability – considering if the intervention is satisfactory, agreeable or palatable to all stakeholders
b) Adoption- The uptake of the intervention by stakeholders
c) Feasibility-consider if the intervention can be successful carried out in my organization
d) Cost- cost of the intervention should be considered
e) Fidelity- whether the intervention will be implemented as per the protocol
f) Penetration- integration of intervention across settings
g) Sustainability-long term maintenance of an intervention in settings and at times integrated in the routine work.
5. What implicit biases may be at work in my culture or context and how do those implicit biases impact an individual’s ability to access and benefit from rehabilitation?
Implicit bias refers to the unconscious attitudes, prejudices, and judgments that we unknowingly hold about people or groups. In my culture or context, various implicit biases may affect individuals’ access to and benefit from rehabilitation, such as gender, socioeconomic status, age, race, ethnicity, disability, employment status, and education level. These biases contribute to health disparities and can significantly hinder individuals from accessing and benefiting from rehabilitation.