Development and Validation of the WHO Rehabilitation Competency Framework: A Mixed Methods Study

Abstract

Objectives: To identify the competencies, behaviors, activities, and tasks required by the rehabilitation workforce, and their core values and beliefs, and to validate these among rehabilitation professionals and service users.

Design: Mixed methods study, involving a content analysis of rehabilitation-related competency frameworks, a modified Delphi study, and a consultation-based questionnaire of service users.

Setting: Desk-based research.

Participants: Participants who completed the first (N=77; 47%) and second (N=68; 67%) iterations of the modified Delphi study. Thirty-seven individuals participated in the service user consultation. Collectively, the participants of the mixed methods study represented a significant range of rehabilitation professions from a broad range of countries, as well as both high- and low-income settings.

Interventions: Not applicable.

Main outcome measures: Not applicable.

Results: The mixed methods study resulted in the inclusion of 4 core values, 4 core beliefs, 17 competencies, 56 behaviors, 20 activities, and 62 tasks in the Rehabilitation Competency Framework. The content analysis of rehabilitation-related competency frameworks produced an alpha list of competencies, behaviors, activities and tasks ("statements"), which were categorized into 5 domains. The final iteration of the modified Delphi study revealed an average of 95% agreement with the statements, whereas the service user consultation indicated an average of 87% agreement with the statements included in the questionnaire.

Conclusions: Despite the diverse composition of the rehabilitation workforce, this mixed methods study demonstrated that a strong consensus on competencies and behaviors that are shared across professions, specializations, and settings, and for activities and tasks that collectively capture the scope of rehabilitation practice. The development of the Rehabilitation Competency Framework is a pivotal step toward the twin goals of building workforce capability to improve quality of care and strengthening a common rehabilitation workforce identity that will bolster its visibility and influence at a systems-level.

Keywords: Clinical competence; Competency-based education; Education; Health workforce; Professional competence; Rehabilitation.

Fig 1

The agreed structure and components of the RCF.

Fig 2

Level of participant agreement and number of comments and recommendations in the first and second iterations of the modified Delphi study.

Fig 3

Frequency of health conditions for which the service user sample sought rehabilitation.

Fig 4

Average level of agreement by the rehabilitation service user sample with core values and belief and select Practice and Professionalism competencies.

Fig 5

Average level of agreement by the rehabilitation service user sample with select Practice and Professionalism behaviors.