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02. . How does my own professional expertise and organizational access suggest where I might be most be effective in developing and launching an intervention?
Given my specialized knowledge and available resources, I am confident in my ability to develop and implement a highly effective telehealth intervention for neuromusculoskeletal disorders. Despite the limited availability of centers in Tanzania, there is significant potential for implementing telehealth for a range of rehabilitation services that include assessment, monitoring, therapy, prevention, supervision, education, consultation, and counselling to reach a larger and growing population.

03. What formative research might be needed to understand the precise intervention that would be most appropriate and impactful towards overcoming the challenges I identify?
The formative research encompasses various methods including interviews, surveys, focus groups, and usability testing. When recruiting participants, it’s crucial to select individuals who accurately represent your target user group. It’s essential to ensure a diverse range of participants to capture various perspectives and insights, and to use the evidence to guide my intervention.

04. When considering potential interventions, what factors related to implementation do I need to consider?

I need to consider the following factors related to implementation:
(I) Acceptability: The satisfaction level of different stakeholders involved in the implementation with various aspects of the intervention, such as content, delivery, and complexity.
(II) Adoption: The rates at which the intervention is being taken up or used at the practitioner and/or healthcare organization level.
(III) Appropriateness: The suitability of the program for healthcare consumers, practitioners, and/or healthcare organizations.
(IV) Feasibility: The practicality of the intervention for everyday use at the practitioner and/or healthcare organization level.
(V) Fidelity: The delivery of the intervention as originally designed.
(VI) Implementation cost: Assessments of the marginal cost, cost-effectiveness, or cost benefit.
(VII) Penetration: The degree to which the intervention is integrated within healthcare organizations.
(VIII) Sustainability: The continued delivery of the intervention beyond the study period, including the characteristics of the implementation context that did or could influence the continuation of intervention delivery.

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Q1. What evidence do I have (or need) to identify those factors and levels posing the greatest barriers to rehabilitation in my population?

To pinpoint the factors and levels that pose the greatest barriers to rehabilitation in a population, it is crucial to have access to rehabilitation data at different levels, including the individual (user level), facility level, and population level. By gathering data at these diverse levels, I will obtain the evidence necessary to identify the barriers to rehabilitation, thus enabling me to pinpoint the specific factors and levels causing these barriers.

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Q2. What strategies could I use to target the motivation and capability of individuals and organizations to engage in implementation process strategies to integrate the new interventions?
To encourage engagement and foster the integration of new interventions, it’s crucial to develop specific strategies that address the motivation and capability of both individuals and organizations. These strategies should be tailored to overcome the particular implementation challenges or obstacles identified during the early stages of implementation. In the specific case we’re examining, the aim is to tackle hurdles at the individual, organizational, and technical levels.
Some potential implementation strategies include organizing educational meetings, utilizing audit and feedback techniques, and incorporating clinical reminders. These strategies show promise in promoting the adoption of evidence-based practices among rehabilitation professionals.

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Q1. What strategies could I use to target key stakeholder’s awareness, knowledge, attitude and intention to integrate the new intervention?

To advance the integration of the new intervention, it is crucial to employ specific strategies that target key stakeholders’ awareness, knowledge, attitude, and intention. Identifying the pertinent stakeholders, such as medical professionals, managers and administrators, clients (Individuals or homes, clinics, schools, residential care homes, and other community facilities ), and external entities (technical groups, policymakers), is an essential initial step. Subsequently, developing tailored programs to address awareness, attitude, and knowledge barriers related to the new interventions can effectively engage these stakeholders.

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From my research, I have discovered a lack of specialized rehabilitation centers and multidisciplinary team members compared to the need. There is a greater need to increase the multidisciplinary rehabilitation workforce at least we will have a Physiatrist, Rehabilitation Engineers, Recreation Therapist, and Vocational Counselors. I would like to suggest more improvement in the education system, at least we will have Universities and put priorities on these areas.

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There is no clear hierarchy and integration of rehabilitation services in the health sector. There are CBRs in a few places and at the District Hospital, and Regional Referral Hospital and Tertiary Hospitals (National Hospitals). Despite of having these services, there is a lack of trained personnel (Few OTs, PTs, PNOs, and Speech Therapist).

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As a physiotherapist, the first word that comes to mind that matches with REHABILITATION is RECOVERY.

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