A stroke rehabilitation training program for community-based primary health care, South Africa

Abstract

Background: With an increasing burden of stroke and a lack of access to rehabilitation services in rural South African settings, stroke survivors rely on untrained family caregivers for support and care. Community health workers (CHWs) support these families but have no stroke-specific training.

Objectives: To describe the development of a contextually appropriate stroke training program for CHWs in the Cape Winelands District, South Africa.

Method: Twenty-six health professionals and CHWs from the local primary healthcare services participated in action research over a 15-month period from September 2014 to December 2015. The groups participated in two parallel cooperative inquiry (CI) groups. The inquiry followed the cyclical steps of planning, action, observation and reflection. In this article, the planning step and how the CI groups used the first three steps of the analyse, design, develop, implement, evaluate (ADDIE) instructional design model are described.

Results: The CHWs' scope of practice, learning needs, competencies and characteristics, as well as the needs of the caregivers and stroke survivors, were identified in the analysis step. The program design consisted of 16 sessions to be delivered over 20 h. Program resources were developed with appropriate technology, language and instructional methodology.

Conclusion: The program aims to equip CHWs to support family caregivers and stroke survivors in their homes as part of their generalist scope of practice. The implementation and initial evaluation will be described in a future article.

Contribution: The study developed a unique training program for CHWs to support caregivers and stroke survivors in a resource-constrained, rural, middle-income country setting.

Keywords: Primary healthcare; community care; education and training; family caregiving; participative methods; stroke rehabilitation.

FIGURE 1

Map of South Africa illustrating the Western Cape province (light grey area), with the Cape Winelands district (darker grey area). The insert shows the Breede Valley subdistrict (black).

FIGURE 2

Diagrammatic representation of the methods. The cycle illustrates the 4 steps of the cooperative inquiry (planning, action, observation and reflection) with the relevant steps of the analyse, design, develop, implement, evaluate model in brackets. This article focuses on the planning step of the cooperative inquiry.