[Yasmin Garcia Mendez]

What evidence do I have (or need) to identify those factors and levels posing the greatest barriers to rehabilitation in my population?
The is sociodemographic data but no other evidence a part from that as long as I know. I will need to do a literature search on the specific information needed. The STARS, ATA-C and rATA tools may help to collect specific information on factors at each specific level environment. For example, these tools might help to get information at the institutional and superstructural levels, and might proportionate few at the community level. rATA might help to get more information at the individual and household level but might need to be modified to get more information on the knowledge, skills and self-efficacy of the individual as well as the household support and social networks.
For AT intervention, I need to get information on public policy, institutional capacity and functioning, community barriers to access AT services, characteristics of the individual to select best AT intervention, barriers to access and use the AT, etc.

How does my own professional expertise and organizational access suggest where I might be most be effective in developing and launching an intervention?
I will be more effective in developing and launching an intervention at the superstructural level. As we work by providing technical support and cooperation to Ministries of Health in the region of the Americas. We don’t have contact with patients or their families, we can create impact by helping the governments to improve their policies, create their strategic plans on rehab and AT, supporting identifying priority actions to strengthen rehab in health sector, etc.

What formative research might be needed to understand the precise intervention that would be most appropriate and impactful towards overcoming the challenges I identify?
Research on interventions that affect and promote the governments uptake of initiatives to strengthen rehab in health systems and increase financing for AT and rehab. How to increase the governments interest and the political will for AT and rehab. How to increase political support.

When considering potential interventions, what factors related to implementation do I need to consider?
individual factos, household and familial factors, community factors, institutional factors, public policy factors.

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?
There are implicit biases related to the tone of the skin, socioeconomic status, disability, age, gender, and sexual orientations. Those factors impact the individuals ability to access and benefit from rehab in terms of affordability, effectiveness, equity, and time.

[Yasmin Garcia Mendez]

Using Telerehabilitation as a case study, refer to one of the three key determinants of capacity building and reflect on what factors may influence the use of implementation science in Telerehabilitation.
Referring to the workforce capacity, the lack of knowledge, skills and abilities, as well as the involvement in design, conduct and evaluate implementation effors are factors that will influence implementation science in tele-rehabilitation.

Reflect on how the factors that may influence your own organization’s use of implementation science.
The motivations, leadership, trust and culture might not be aligned with implementation science in my unit yet.

[Yasmin Garcia Mendez]

To what extent is there leadership, an evidence-informed practice culture, and a support network that is supporting the sustainment of the intervention?
There is a significant lack of leadership in many countries where we work.

To what extent are there external policy drivers, incentives, or regulatory frameworks that are supporting the sustainment of the intervention?
These are inexistent in most of the countries.

[Yasmin Garcia Mendez]

To what extent have local organizational structures, networks, and culture supported the implementation of the new intervention?
This can be measured from the planning to the implementation processess.
The inner context can prevent or hinder the successful implementation of an EIRI. The organizational structure outlines how rules, roles and responsibilities are directed to achieve the goals for the organization and thereby the rehabilitation interventions provided. The organizational structure, can thereby, facilitate or place barriers to the implementation of an EIRI. Same as the culture of the organization.

To what extent has the implementation of the new intervention been responsive to clients’ group demographics, knowledge, beliefs, and self-efficacy?
This will only be responded after evaluating the outcomes of the intervention implementation.

[Yasmin Garcia Mendez]

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

How does the proposed intervention fit with the priorities of your organizations?
The priority of PAHO regarding rehab and AT is to increase access and strengthen them within health system. So far, systematic assessments of the rehab situation and AT capacity have shown a lack of trained professionals to delver rehab and AT interventions. Tele-rehabilitation would fit with the priorities as it will help to reduce the gaps in access due to lack of rehab workforce.

How does it fit with community values, including the values of diverse cultural groups?
We will need to explore this more in depth as we work with different countries, different communities within countries. This will need to be explored in a case by case scenario. For example, there are some indigenous communities who cannot be photographed or video recorded due to religious and culturural beliefs. But, some larger cities welcome technology innovations.
In some countries of the Americas Region, we have observed that people change phone numbers very often and this hinder the possibility to follow up. We learned about this with a wheelchair study we implemented in El Salvador, we lost to follow up several users due to this factor.

Post your thoughts on the Discussion Board. Look at the posts of your peers. Are there similar thoughts? How do they differ?
They differ in that most of my peers have already experience implementing Tele-rehabilitation whereas we don’t have yet. And other difference is that they mostly come from implementing organizations whereas we, as PAHO do not implement but provide technical support to Ministries of Health in the assessment, planning, and monitoring and evaluating their strategic plans, and so far not in implementing.

What strategies could you use to target key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention?
Dissemination strategies such as social media campaigns for clients, advertising and educational sessions in professional associations meetings, high-level forums for policy/decision makers and org managers/administrators.

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?
Capacity building strategies such as providing training and technical assistance, workshops and round tables, peer networking opportunities such as professional conferences, etc.

[Yasmin Garcia Mendez]

Designing a new intervention.

1. Using your knowledge of the frameworks, what aspects of the intervention will you focus on to guide your planning and eventual success of the intervention?

I will focus on
1) the target population, understand its characteristics, rehabilitation needs and preferences, beliefs and culture, etc.
2) the intervention itself, the evidence supporting the effectiveness of the intervention on the target population, its design and costs, the resources, capacity and expertise needed to implement it, its advantage over other interventions, and indicators or outcome measures are recommended to measure the effectiveness of the intervention and whether outcomes are aceptable and appropriate.
3) the implementation setting characteristics, whether the intervention is feasible and aligned with the organization’s interests, if there is institutional support to implement the intervention, and whether the institution has the capacity, resources, expertise and interest to properly implement it in terms of cost and time.
4) Monitoring and evaluation, would focus also on monitoring the progress of the implementation by collecting data on the above indicators periodically to compare against established targets or goals and to timely identify problems in the implementation process and make adjustments if needed. I would also evaluate if the ultimate goal of the intervention was achieved and if the intervention has become part of routine practice of the organization and make modifications to the project if needed.

What indicators will you use to monitor the success of the intervention on an ongoing basis? What steps will you take to ensure adequate monitoring and evaluation of the intervention?

The indicators will depend on the intervention, but I will try to use indicators in the 3 data domains: health status, health system and determinants of health. The first to collect baseline data on functioning and compared with post-intervention implementation data, outcome measures on the effectiveness of the intervention to achieve its goals; the second set of indicators to measure what was needed for the intervention in terms of inputs (ex. human resources, financing), and what was obtained in terms of outputs and outcomes (ex. quality of the service, utilization) for the intervention; and finally, determinants of health to understand how these impact/affect results.

The steps I would take to ensure adequate monitoring and evaluation would be 1) definition of the research question that will guide the monitoring and evaluation efforts, 2) identification of indicators/data to collect, frequency and source, 3)identification and determination of methods to collect data indicators, analyze, compare and assess results, and 4) making recommendations and modifications/adjustments to the intervention.

[Yasmin Garcia Mendez]

In your opinion, how can your country build strong leadership and increase political support for rehabilitation? Post your comments on the discussion board.

Mexico can build strong leadership and increase political support for rehabilitation by implementing the Guide for action, but before doing that we need to identify what are the barriers for the implementation of the Guide for action. Mexico is not doing anything about implementing these tools and rehabilitation needs to be better integrated into health systems. The first thing I would do is a RCA to identify what are the root causes for Mexico not implementing the Guide for Action and will try to address the root causes. Once addressed these causes and the problem of not implementing the Guide for action, I would follow the 4 steps: STARS, GRASP, FRAME and ACTOR.

[Yasmin Garcia Mendez]

Research some vision statements of various organizations. Post at least two such statements on the discussion forum and explain how these may have evolved.

Save the children: a world in which every child attains the right to survival, protection, development and participation
This may have evolved according to the political, environmental and societal context. Depending on peace or war times, the origin of the organization (UK) and their spread to other countries.

PAHO: To be the major catalyst for ensuring that all the peoples of the Americas enjoy optimal health and contribute to the well-being of their families and communities.
This vision changed with the definition of health over time, from a disease concept to an overall physical and metal health for example.

[Yasmin Garcia Mendez]

Post your reflections on your strengths, areas that need attention, and development priorities as identified by the emotional intelligence questionnaire on the discussion board.

At this point I did not reach scores for strengths. The closer were self-awareness and empathy.
All the areas of the test scored as needed attention.
The lower scored areas were managing emotions and social skills. I am working the managing emotions area and will focus more in my social skills.
I ame becoming more skilled on being aware of my emotions, which I think if the first step towards achieving the management of them, and the rest of the areas. I have being taking therapy and counseling for the past two years and this has helped a lot. Working life is much easier than personal life. Will be paying more attention to myself and to my feelings.

[Yasmin Garcia Mendez]

1. Leadership behavior can be taught vs leaders are born. What do you think? Provide your rationale and an example of a born and made leader.
I believe both. I think some leaders are born, definitely, and with training, learning, life experience, couching, they can hone their skills, for good of for bad. Nelson Mandela is an example of a natural leader.

However, leaders can also be made, again, with learning, training, couching, courses like this, etc. That is why we are here. I consider myself a potential example of a made leader.

[Yasmin Garcia Mendez]

As Mexico is an Upper middle income country, it does not receive a lot of support from international NGOs, we do but rehabilitations services as mostly provided in the public and privare sector, and mostly lead by an NGO regarding pediatric rehabilitation services.
There is no coverage at all for assistive products, some spectacles might be subsidized but it depends on the state entity and the employment status of the person.

Mexico has not employed any of the tools of the WHO Rehab 2030.

[Yasmin Garcia Mendez]

What NGOs are working in your country or district to meet the rehabilitation needs of the population? Teleton Mexico, mostly. Some wheelchair donations from LDS, American Wheelchair Mission, Rotary International. There is on hospital from Shriners.

Is your country using the WHO Guide to Action? No

You may be someone or know someone, or indeed many people, with a chronic disease or disability. What has been their experience in getting health care, rehabilitation, or assistive technology? They usually access health care through the public health system which sometimes does not provide medicines and people has to pay out of pocket. The health care sector is reducing the number of services and treatments being provided. However, people still can access services with waiting times. Assistive products are frequently provided or donated without related services. People have to pay out-of-pocket as these products are not covered by the health system. Other times people wait for donations of wheelchairs, spectacles and hearing aids.

[Yasmin Garcia Mendez]

In Mexico, according to the WHO Rehabilitation Need Estimator, in 2019, about 37 million people experienced conditions that could benefit from rehabilitation. This is 2 in 7 Mexicans. The leading condition was low back pain with 8.2 million prevalent cases in the same year.

According to the National Institute of Statistics and Geography (INEGI) 6,179,890 had some kind of disability in 2020 in Mexico, which represents 4.9 % of the total population.

According to the INEGI, in 2022 there were 91,501 persons injured due to road traffic injuries.

Most prevalent conditions in Mexico in 2019 were musculoskeletal conditions, followed by sensory impairments.

[Yasmin Garcia Mendez]

How many people are living with chronic health conditions? In Mexico, according to the WHO Rehabilitation Need Estimator, in 2019, about 37 million people experienced conditions that could benefit from rehabilitation. This is 2 in 7 Mexicans. The leading condition was low back pain with 8.2 million prevalent cases in the same year.

How many people are living with disability? According to the National Institute of Statistics and Geography (INEGI) 6,179,890 had some kind of disability in 2020 in Mexico, which represents 4.9 % of the total population.

What is the incidence of road safety injuries? According to the INEGI, in 2022 there were 91,501 persons injured due to road traffic injuries.

[Yasmin Garcia Mendez]

There is a huge need on raise awareness on the different models of disability, their causes, responses and meanings. The disability model most predominant in the country will determine the type of responses from authorities and the general population, the actions and strategies to be implemented in terms of rehabilitation services and AT available for persons who needed, the scope of policies and laws, etc. Awareness should be an important component of any effort to strengthen rehab and AT in a country.

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