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Social Ecological Interventions in Uganda

Rehabilitation is a complex process that requires a multifaceted approach to address the various barriers faced by individuals. This 5th module highlights the importance of considering social ecological factors when designing and implementing interventions, emphasizing the influence of individual characteristics, household dynamics, community norms, institutional policies, and public policy.

Identifying Intervention Levels;

To effectively address rehabilitation barriers in Uganda, it is essential to identify the levels that pose the greatest challenges. This requires gathering evidence through assessments, surveys, and qualitative research to understand the specific factors influencing rehabilitation outcomes. For instance, research in Ugandan communities may reveal that stigma and discrimination at the community level are significant barriers to accessing rehabilitation services, while lack of resources and support within households hinder individuals’ ability to participate in rehabilitation programs.

Leveraging Professional Expertise and Organizational Access

The choice of intervention level also depends on the expertise and organizational access of healthcare professionals and rehabilitation organizations. In Uganda, where mental health services are often limited, partnerships with NGOs can expand the reach of interventions. For example, NGOs can implement community-based awareness campaigns to reduce stigma and discrimination, while rehabilitation centers can provide specialized services for individuals with complex needs.

Formative Research for Intervention Design

Formative research is crucial to tailor interventions to the specific needs of the population. This involves collecting qualitative and quantitative data to understand the perspectives and experiences of individuals with disabilities, their families, and community members. Through formative research, researchers can identify the most appropriate intervention strategies, such as culturally sensitive therapy approaches or community-based support groups.

Implementation Considerations

Implementing social ecological interventions requires careful planning and consideration of various factors. These include resource availability, sustainability, cultural appropriateness, and community engagement. Interventions should be feasible to implement and sustained over time to ensure long-term impact. Engaging communities in the planning and implementation phases is essential to foster ownership and increase the likelihood of success.

Addressing Implicit Biases

Implicit biases, which are unconscious beliefs and attitudes, can significantly impact an individual’s ability to access and benefit from rehabilitation. In Ugandan society, biases related to mental illness, disability, and socioeconomic status may hinder individuals’ opportunities for rehabilitation. Addressing implicit biases through training, community education, and policy changes can create a more inclusive environment for people with disabilities.

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1. Using Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon the fit of Telerehabilitation using the following discussion prompts:

• How does the proposed intervention fit with the priorities of your organizations?

Given that my organization is health research related;
=>Increased Access to Care: Telerehabilitation expands access to care for individuals who may face barriers to traditional in-person services, such as distance, transportation issues, or physical limitations.
=>Improved Efficiency: Telerehabilitation can reduce the time and resources required for delivering rehabilitation services, allowing therapists to see more patients and decrease wait times.
=>Cost-Effectiveness: Telerehabilitation can be more cost-effective than traditional in-person services, as it eliminates the need for travel and reduces the use of physical space and equipment.
=>Enhanced Patient Outcomes: Studies have shown that Telerehabilitation can produce similar or better outcomes than in-person services, particularly for conditions such as stroke

• How does it fit with community values, including the values of diverse cultural groups?

=>Accessibility: Telerehabilitation can be particularly valuable for communities with limited access to rehabilitation services. This includes rural areas, underserved populations, and individuals with mobility impairments or chronic conditions.
=>Cultural Sensitivity: Telerehabilitation providers must be culturally sensitive and understand the beliefs, values, and practices of diverse populations. This may involve providing language interpretation, accommodating religious preferences, and respecting cultural norms regarding physical contact and privacy.
=>Community Engagement: It is important to engage with the community early on in the implementation process to gather input and build support for Telerehabilitation. This can help ensure the intervention is tailored to the community’s needs and values.

2. Using the Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon how to facilitate the Telerehabilitation using the following discussion prompts:

• What strategies could you use to target key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention?
My focus would be on integration strategies such as;
=> Raising Awareness through involvement of stakeholders in public awareness events, webinars, social media campaigns, and targeted media outreach, highlighting the benefits of Telerehabilitation and addressing common misconceptions.
=>Building Knowledge: Conduct educational workshops and training programs specifically designed for each stakeholder group. This ensures tailored content addressing their specific concerns and needs. For instance, training healthcare providers on Telerehabilitation protocols, patient safety, and ethical considerations is essential for building their confidence and competence.
=>A change in mindset through Engaging stakeholders in pilot programs, showcasing success stories, and promoting peer-to-peer learning can help shift negative perceptions and foster a more positive attitude towards Telerehabilitation.
=>Fostering Intention: Addressing concerns, outlining clear benefits, and demonstrating feasibility can help solidify stakeholder intention to integrate Telerehabilitation. This could involve providing financial incentives, streamlining reimbursement processes, and offering practical support during the initial implementation phase.

• What strategies could you use to target the motivation and capability of individuals and organizations to engage in implementation process strategies to integrate the new intervention?
My focus would be on capacity building strategies such as;
=> Building Ownership: Involving stakeholders in the planning and decision-making process promotes a sense of ownership, leading to greater investment and commitment.
=>Highlighting the Value Proposition: Clearly outlining the benefits of Telerehabilitation – improved patient outcomes, increased efficiency, cost savings – can be instrumental in motivating stakeholders to invest their time and resources.
=>Facilitating Collaboration: Encouraging collaboration between healthcare providers, patients, researchers, and technology developers can foster innovation and drive continuous improvement in Telerehabilitation delivery.
=>Providing Training and Resources: Accessible and tailored training programs, technical support, and ongoing educational resources are essential for equipping individuals and organizations with the necessary skills and knowledge to effectively utilize Telerehabilitation.

• This reply was modified 2 months, 2 weeks ago by [email protected].

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The new intervention is “Rehabilitation Needs of City Dwellers: A RE-AIM Framework-Guided Intervention in Uganda”

1. Aspects of the Intervention to guide Planning and eventual success of the project are;
=>Target Population. Focus on vulnerable city dwellers with limited access to rehabilitation services, including the elderly, disabled, and underprivileged.
=>Evidence-Based Practices: Utilize proven rehabilitation techniques and incorporate patient-centered approaches.
=>Community Engagement: Involve community members in all stages of the intervention, from design to implementation and evaluation.
=>Sustainability Plan: Secure funding, build partnerships, and establish mechanisms for long-term operation.
=>Monitoring and Evaluation: Regularly track key indicators to assess progress and make necessary adjustments.

2. Indicators that will be used to monitor the intervention’s success:
=>Reach: Number of community-based rehabilitation centers established and people reached.
=>Effectiveness: Improvement in functional outcomes, quality of life, and patient satisfaction.
=>Adoption: Percentage of healthcare organizations and individuals using the intervention.
=>Implementation: Adherence to protocols, quality of service delivery, and staff training.
=>Maintenance: Continuation of services after the initial project period.

Monitoring and Evaluation Steps
=>Establish a dedicated monitoring and evaluation team.
=>Develop a comprehensive data collection plan and use standardized tools.
=>Conduct regular monitoring visits to track progress.
=>Analyze data and provide timely feedback to stakeholders.
=>Use evaluation findings to inform ongoing adjustments and improve intervention effectiveness.

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4. My country, Uganda can build strong leadership and political support for rehabilitation by:
=>Elevating rehabilitation to a national priority through dedicated budget allocations and policies.
=>Engaging diverse stakeholders including policymakers that is parliament, disability organizations such as CORSU, and community members in advocacy efforts.
=>Investing in training and capacity building for healthcare professionals to ensure quality rehabilitation services, this is being done by ReLAB so far.
=>Promoting data collection and research to demonstrate the impact of rehabilitation on individuals and the economy, Centres such as Makerere university center for health and population research can be of great help.

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3. Google: In 1998, the vision statement was “To organize the world’s information and make it universally accessible and useful” and currently it is, “To organize the world’s information and make it universally accessible and useful, while creating products that are innovative, helpful, and enjoyable to use.”
After incorporating technological innovation and user experience as integral elements in google, ‘innovative, helpful, and enjoyable’ were added to reflect a shift towards prioritizing user satisfaction.
Nike: in 1964, it was “To bring inspiration and innovation to every athlete in the world.” and currently, it’s “To inspire and innovate for a better world.” Nike’s vision statement has broadened from a focus on athletics to a wider commitment to making a positive impact on society.

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2.The Emotional Intelligence Questionnaire has provided valuable insights into my strengths and areas that require attention. I have identified several key areas where I excel and a few that need improvement. These insights have spurred my determination to prioritize development in crucial areas to enhance my overall emotional intelligence. My strengths are self awareness, motivating oneself, Empathy and Social skill. Where as, my managing emotions needs attention. While I am generally good at managing my emotions, there are times when I may struggle to regulate strong emotions, such as anger or frustration. I need to develop strategies to cope with these emotions effectively and prevent them from negatively impacting my behavior or decision-making.

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1. Leadership can arise from both innate characteristics and acquired skills. While some individuals may possess natural leadership abilities, the notion that leaders are solely born with these qualities is very outdated. Leadership behavior can be cultivated through education, mentorship, and experience. A compelling example of a ‘made’ leader is Barack Obama, who, despite not coming from a traditional political background, developed exceptional leadership skills through education, community organizing, and political engagement. On the other hand, natural leaders like Winston Churchill possessed inherent charisma, strategic thinking, and a strong sense of purpose. Therefore, a comprehensive understanding of leadership recognizes the interplay between innate talents and learned behaviors.

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In Uganda, several NGOs are working to meet the rehabilitation needs of the population in Uganda, and the government has made efforts to implement the WHO Guide to Action on NCD prevention and management. However, significant challenges remain in ensuring equitable access to high-quality rehabilitation services for all individuals with disabilities and chronic diseases in Uganda. It is critical that NGOs, government agencies, and other stakeholders continue to work together to address these challenges and improve access to rehabilitation services for all.

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1. NGOs are ;Comprehensive Rehabilitation Services in Uganda (CoRSU), Association of Orthopaedic Prosthetists and Rehabilitation Technicians (AOPRT),CURE Children’s Hospital of Uganda, Humanity & Inclusion (HI) ,etc

2.Yes, the WHO Guide to Action on the Prevention and Management of Non-Communicable Diseases (NCDs) is a comprehensive framework that outlines best practices for preventing and managing NCDs, including rehabilitation services.

3.In Uganda, I know of many people with disabilities and chronic diseases who have faced barriers to accessing healthcare and rehabilitation services, including high costs, limited availability, and stigma.

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According to the data, non-communicable diseases (NCDs) are a significant public health challenge in Uganda. In 2019, the leading NCDs in terms of disability-adjusted life years (DALYs) were cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes. Specifically, the number of people living with cardiovascular diseases was 1,218,000, cancer was 585,000, chronic respiratory diseases were 567,000, and diabetes was 335,000.
Disability:
The data shows that disability is a significant issue in Uganda. In 2019, there were 2,716,000 people living with disabilities, representing 6.3% of the population. The most common types of disability were hearing loss (808,000), vision loss (692,000), and mobility limitations (671,000). Disability intersects with other social determinants of health, such as poverty, education, and employment, creating a vicious cycle that perpetuates inequality and marginalization.
Road Safety Injuries:
Road safety injuries are a significant public health concern in Uganda. In 2019, there were an estimated 3,657 deaths due to road injuries, representing a rate of 14.2 deaths per 100,000 population. This is significantly higher than the global average of 18.2 deaths per 100,000 population. Moreover, there were an estimated 177,000 new cases of non-fatal road injuries in 2019. Road safety injuries not only result in loss of life and disability but also impose a significant economic burden on individuals, families, and society.

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According to the (https://vizhub.healthdata.org/rehabilitation/) and Global Burden of Disease Research initiative, the leading chronic health conditions in Uganda include:

1. Cardiovascular diseases: Approximately 287,000 people live with cardiovascular diseases, such as stroke and ischemic heart disease. These conditions account for a significant proportion of mortality and morbidity in Uganda.
2. Respiratory diseases: An estimated 279,000 individuals live with chronic respiratory conditions such as chronic obstructive pulmonary disease (COPD) and asthma.
3. Musculoskeletal disorders: Approximately 133,000 people suffer from musculoskeletal disorders, including low back pain and osteoarthritis.

Disability:
In Uganda, the overall number of people living with disabilities is approximately 2,046,000, according to the GBD Research initiative. This number represents the challenges faced by individuals with impairments in their daily lives, as well as the need for appropriate rehabilitation services, assistive devices, and social support.

Incidence of Road Safety Injuries:
Road safety injuries present a significant public health concern in Uganda. According to the GBD Research initiative, in 2019, an estimated 7,100 individuals died due to road injuries in the country, reflecting an alarming trend and the need for effective preventive strategies.

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My reflections on these models highlight the need for a multifaceted approach that embraces both individual and social perspectives. Recognizing the strengths and limitations of each model allows for a more nuanced understanding of disability, leading to more inclusive and just societal practices. We must continue to actively challenge the dominant narratives surrounding disability. This involves advocating for accessible environments, policies that promote inclusion, and a shift in societal attitudes towards acceptance and respect. Ultimately, a true understanding of disability requires embracing diversity, recognizing the inherent value of all individuals, and working towards a world where differences are celebrated and everyone can thrive.

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My initial encounters with individuals with disabilities are primarily through the lens of the medical model. Because i see disability as a personal impairment, a biological defect that needs to be cured or managed. Seeing someone with a disability, I often feel a sense of pity or sadness, focusing on their limitations rather than their abilities. My concerns center around their struggles, their need for assistance, and the challenges they might face

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In Uganda,
Moral model Examples;
=>Individuals with disabilities are often perceived as being cursed or possessed by evil spirits.
=>In some rural areas of Uganda, children with disabilities are hidden away from public view or even killed.

Medical Model Examples;
=> In Uganda, some individuals with disabilities are seen as sick or broken and in need of medical intervention or rehabilitation.

Social Model examples;
=>many people with disabilities continue to experience barriers to participation in society e.g some disabled people don’t share plates with general public

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While Uganda has a progressive legal framework for accessibility, its implementation remains a challenge. Many public buildings and facilities are not yet accessible, and individuals with disabilities continue to face discrimination and stigma. Nonetheless, the Disability Act has had a positive impact in raising awareness about disability rights and promoting inclusion.
The NCPD has played a vital role in coordinating efforts to implement the Disability Act. It has developed guidelines for accessibility and has engaged in advocacy campaigns to raise awareness about the rights of persons with disabilities.

However, there are still challenges such as;
*Limited funding for accessibility projects
* Lack of enforcement of accessibility standards
* Persistent discrimination and stigma
* Inefficient health care systems that fail to adequately address the needs of individuals with disabilities

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