Scielo RSS http://www.scielo.org.za/rss.php?pid=2226-722020230001&lang=en vol. 12 num. lang. en http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100001&lng=en&nrm=iso&tlng=en BACKGROUND: Individuals with spinal cord injury (SCI) in less-resourced settings reported barriers to community integration, including inaccessible rehabilitation services, restricted environments and limited social integration. Peer training and entrepreneurial skills training are provided by Motivation, a nonprofit organisation, and Moshi Cooperative University to enhance occupational engagement of individuals with SCI in less-resourced settings OBJECTIVE: This study aimed to explore the impact of peer training and entrepreneurial skills training on the social participation of individuals with SCI living in Tanzania METHOD: Using a qualitative photovoice approach, 10 participants captured meaningful photos and provided captions according to five standardised questions (PHOTO technique) to convey their messages. Participants selected up to 34 photos that best illustrated their experiences in the community. A mixed inductive-deductive thematic analysis was guided by the International Classification of Functioning, Disability and Health RESULTS: Two interrelated themes emerged: (1) 'influencing factors', which revealed how participants' inclusion in the community was influenced by their activities and personal and environmental factors and (2) 'empowerment', which highlighted participants' desire to advocate and promote awareness of needs and hopes CONCLUSION: Participants emphasised the importance of accessibility and equal opportunities. Whilst some were able to overcome obstacles, others experienced continued inaccessibility that inhibited meaningful occupations. Daily participation challenges of individuals with SCI in rural Tanzania were highlighted. Although the Motivation programmes were perceived to have powerful impacts on social participation, continued efforts and advocacy are needed to overcome accessibility issues and to meet the physical, psychological and social needs of Tanzanians living with SCI CONTRIBUTION: This article highlights the importance of accessibility and equal opportunities for individuals with disability living in rural Tanzania. Peer-training and entrepreneurial programs offer community-based rehabilitation services that were perceived by people with disabilities to have a powerful impact on social participation and vocation. However, continued efforts and advocacy are needed to meet the needs of Tanzanians living with spinal cord injury http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100002&lng=en&nrm=iso&tlng=en BACKGROUND: Community-based inclusive development (CBID) acknowledges society's critical role in supporting the active participation of persons with disabilities. However, research on how this approach relates to the context-sensitive socially situated barriers of disability stigma is underexplored OBJECTIVES: This study aimed to understand the drivers and experiences of disability stigma in Ethiopia, from the perspective of persons with disabilities engaged in CBID programmes, and to establish how disability stigma acts as a barrier to participation METHODS: An inductive methodological approach guided the research design. Mixed methods were used including a narrative review of disabilities studies literature, 16 semi-structured interviews with persons with disabilities, and a quantitative survey of 970 persons with disabilities across three communities in Ethiopia RESULTS: Informed by theories of epistemic justice, this study identified specific indicators of meaningful participation and examined how these relate to experiences of disability stigma. The study found that the participation of adults with disabilities in society is restricted across different areas of life. Misconceptions about the causes of disability and social perceptions regarding the capacities of persons with disabilities are found to exacerbate stigma and act as a barrier to participation CONCLUSION: Targeted efforts to challenge internalised norms and harmful beliefs within CBID approaches are required to address disadvantages arising from embedded disability stigma CONTRIBUTION: This study makes conceptual, empirical and practical contributions that advance insights into the relationship between disability stigma and participation in Ethiopia and the dimensions of epistemic justice relevant to understanding the nature and drivers of disability stigma http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100003&lng=en&nrm=iso&tlng=en BACKGROUND: Access to assistive technology for disabilities is limited in low-resource settings. Therefore, existing research focuses on accessibility challenges. This article focuses on how students with learning disabilities manage learning in the absence of assistive technology, a subject that receives less scholarly attention OBJECTIVES: This article aims to provide insights on how students with learning disabilities manage learning in the face of limited access to assistive technology. It explores conversion factors that influence access to assistive technology METHOD: This qualitative study used semistructured interviews to collect data from students with learning disabilities and respective university staff members who were recruited using convenience and snowballing techniques. Data were analysed thematically and supported by thick descriptions of experiences RESULTS: This study established that students have limited access to assistive technology, and they manage learning through self-devised means that are more socially than technologically or scientifically inspired such as self-affirmation, animal therapy, family support and prayer. Conversion factors, which affect ability by either enabling or constraining access to assistive technology, were identified at personal and institutional or environmental levels CONCLUSION: The article concludes that even though students with learning disabilities devise unconventional assistive ways to manage learning, failure to access assistive technology is a capability deprivation that promotes inequalities CONTRIBUTION: This article provides insights that shift perspectives that students with disabilities are passive recipients of support; rather, they can be active agents who innovate nontechnological ways to manage learning in the absence of assistive technology http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100004&lng=en&nrm=iso&tlng=en BACKGROUND: Third-party disability (TPD) has been studied in multiple patients including those with aphasia and hearing loss. Only one study has been done in relation to caregivers of adults with dysphagia. Third-party disability has been analysed using the International Classification of Function and Disability (ICF) framework. This study, therefore, used the ICF model to explore TPD of caregivers of adults with dysphagia for the context of Johannesburg in South Africa OBJECTIVES: To describe how caregivers experience TPD when caring for adults with a dysphagia in Johannesburg METHODS: Data were collected from five primary adult caregivers, who were all family members, from government clinics in Johannesburg. This article reports the findings from the interviews that were analysed thematically using a top-down analysis approach RESULTS: Caregivers experienced challenges related to TPD mostly related to difficulties of being able to do activities of daily living for themselves, their household chores and attending social engagements. The use of body structure and function from the ICF model was not overtly applicable to the caregiver population. A new visual representation has been suggested to highlight the key themes to augment the social and psychological changes as seen on the ICF framework and demonstrated the specific interaction that these factors had on one another CONCLUSION: Third-party disability is present in caregivers of patients with dysphagia. Healthcare workers need to be aware of the impact that this can have when preparing home management strategies. This newly devised representation can assist in creating a locally relevant patient-centred care approach but requires future input CONTRIBUTION: This article has provided greater insight into TPD in caregivers of adult patients with dysphagia in an urban African context. It has led to new information that can be used as an adjunct to the ICF model when understanding this phenomenon http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100005&lng=en&nrm=iso&tlng=en BACKGROUND: Access to primary health care is a fundamental right for all. However, persons with disabilities are experiencing difficulties when accessing healthcare because of various environmental and personal barriers which may lead to nonuse of such services OBJECTIVES: This study aimed to identify the challenges leading to non-use of healthcare services among persons with mobility impairments in Cofimvaba METHOD: A descriptive qualitative design using snowball sampling was implemented. Semistructured interviews were conducted in isiXhosa with five participants who stopped accessing healthcare, using a self-developed interview guide. Inductive thematic analysis was used to develop codes and themes from the data RESULTS: Study findings revealed major challenges experienced by persons with mobility impairments in accessing healthcare. These included inaccessible roads, geographic inaccessibility, financial accessibility and indirect cost of care, having little or not many health problems, physical infrastructure difficulties within facilities, and attitudinal barriers CONCLUSION: The findings indicated that persons with disabilities are experiencing a combination of structural and environmental challenges which make them stop accessing healthcare CONTRIBUTION: The article shares insights on access challenges that influence non-use of the often-needed healthcare services within the context of rural areas http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100006&lng=en&nrm=iso&tlng=en BACKGROUND: Obuntu bulamu, a peer-to-peer support intervention for children, parents and teachers to improve the participation and inclusion of children with disabilities (CwD), was developed and tested in Uganda. The intervention consisted of disability-inclusive peer-to-peer training and support activities. In this article, parent participation in and evaluation of the intervention are discussed OBJECTIVES: The study aims to evaluate the acceptability and feasibility of the intervention METHODS: A qualitative Afrocentric intervention study was implemented in 10 schools in Wakiso district in Central Uganda. Researchers purposely selected CwD aged 8-14 years, their peers and parents from 10 primary schools with on average three CwD per school. A total of 64 study parents (33 parents of CwD and 31 peers) were interviewed at baseline and endline. Two focus group discussions were held with 14 parents at midline. Parents also participated in a consultative meeting about the intervention design at baseline and two evaluation and feedback workshops at midline and endline. Thematic data analysis was conducted RESULTS: Findings showed that parents found the intervention inspiring, acceptable, culturally appropriate and supportive, as it built on values and practices from their own cultural tradition. Parents reported that the intervention enhanced a sense of togetherness and belonging and helped them to develop more positive attitudes towards CwD and disability inclusion. They felt the intervention increased participation and inclusion of CwD at home, school and in communities CONCLUSION: The Obuntu bulamu peer-to-peer support intervention is an acceptable, culturally appropriate intervention with the potential to improve inclusion of CwD. Further studies are recommended to measure the effectiveness of the intervention CONTRIBUTION: The paper contributes to existing evidence that there is need for more Afrocentric interventions, which built on cultural values and practices. Interventions based on indigenous values have a greater potential to be acceptable, can foster integration and are likely to be more sustainability to achieve disability inclusion. In the article we describe parental perspectives of the Obuntu bulamu intervention, an intervention to improve inclusion of children with disabilities, which was designed by children, parents, teachers, educationalists, and academics from Uganda http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100007&lng=en&nrm=iso&tlng=en BACKGROUND: Participation in activities of daily living (ADL), education, leisure and play in children living with cerebral palsy (CP) may be affected by various factors, as outlined in the International Classification of Functioning, Disability and Health Framework (ICF). The aim of this study was to describe the participation patterns of a group of these children OBJECTIVES: This study aimed to describe participation patterns in ADL, education, leisure and play activities of children living with CP in Modimolle METHOD: An exploratory-descriptive qualitative (EDQ) study design was used. A researcher-constructed bio-demographic data sheet and a semi-structured interview schedule were used to collect data from the primary caregivers of children (5-17 years) living with CP in Modimolle. Interviews were transcribed verbatim, translated from Sepedi to English and analysed using the content analysis approach and NVivo software RESULTS: The findings of this study indicated that children living with CP in Modimolle require set-up and assistance to participate in various ADL such as self-care, family and community activities. They also participate in formal and informal educational programmes as well as active and passive leisure and play activities. However, at the moment, they have limited opportunities to participate because of resource constraints and inaccessible infrastructure CONCLUSION: Although children with CP in Modimolle perform some ADL, and participate in educational, leisure and play activities, they are not fully integrated into their community. Legislative support and policy implementation are required to improve participation and integration of children living with CP. Further studies on community-specific integrative strategies to enhance participation among children living with disabilities are recommended CONTRIBUTION: This paper provides valuable information on the participation patterns of children with CP living in a rural area of South Africa. The findings can assist with development and implementation of community-specific, integrative health and social care strategies to enhance participation among children living with disabilities http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100008&lng=en&nrm=iso&tlng=en BACKGROUND: People with disabilities are a large, disadvantaged minority, comprising approximately 12% of the population. The South African government has ratified international and regional disability treaties but deals with disability rights within general anti-discrimination legislation. There are no specific frameworks to monitor justice for people with disabilities. The study aims to inform further development of disability inclusive mechanisms relating to crises including pandemics OBJECTIVES: This study explored the perceptions of South Africans with disabilities, to understand their experiences during coronavirus disease 2019 (COVID-19), focussing on socioeconomic, well-being and human rights aspects METHOD: An online survey tool generated quantitative and qualitative data. Widespread publicity and broad recruitment were achieved through project partners networks. Participants responded via mobile phone and/or online platforms RESULTS: Nearly 2000 people responded, representing different genders, impairments, races, socio-economic status, education and ages. : (1) negative economic and emotional impacts, (2) a lack of inclusive and accessible information, (3) reduced access to services, (4) uncertainty about government and non-government agencies' support and (5)exacerbation of pre-existing disadvantages. These findings echo international predictions of COVID-19 disproportionally impacting people with disabilities CONCLUSION: The evidence reveals that people with disabilities in South Africa experienced many negative impacts of the pandemic. Strategies to control the virus largely ignored attending to human rights and socioeconomic well-being of this marginalised group CONTRIBUTION: The evidence will inform the development of the national monitoring framework, recognised by the South African Government and emphasised by the United Nations as necessary to ensure the realisation of the rights of people with disabilities during future crises including pandemics http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100009&lng=en&nrm=iso&tlng=en BACKGROUND: The burden of disability because of traumatic limb amputation, particularly transfemoral amputation (TFA) is disproportionately carried by low- and middle-income countries. The need for improved access to prosthesis services in these settings is well-documented, but perspectives on the burden imposed by TFA and the challenges associated with subsequent prosthesis provision vary among patients, caregivers and healthcare providers OBJECTIVES: To examine the burden of TFA and barriers to prosthesis provision as perceived by patient, caregiver and healthcare professional, at a single tertiary referral hospital in Tanzania METHOD: Data were collected from five patients with TFA and four caregivers recruited via convenience sampling, in addition to 11 purposively sampled healthcare providers. All participants participated in in-depth interviews regarding their perceptions of amputation, prostheses and underlying barriers to improving care for persons with TFA in Tanzania. A coding schema and thematic framework were established from interviews using inductive thematic analysis RESULTS: All participants noted financial and psychosocial burdens of amputation, and perceived prostheses as an opportunity for return to normality and independence. Patients worried about prosthesis longevity. Healthcare providers noted significant obstacles to prosthesis provision, including infrastructural and environmental barriers, limited access to prosthetic services, mismatched patient expectations and inadequate coordination of care CONCLUSION: This qualitative analysis identifies factors influencing prosthesis-related care for patients with TFA in Tanzania which are lacking in the literature. Persons with TFA and their caregivers experience numerous hardships exacerbated by limited financial, social and institutional support CONTRIBUTION: This qualitative analysis informs future directions for research into improving prosthesis-related care for patients with TFA in Tanzania http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100010&lng=en&nrm=iso&tlng=en BACKGROUND: Family quality of life (FQOL) is an important outcome for families of children with disabilities globally and provision of support is associated with enhanced FQOL. However, FQOL research primarily focuses on conceptualisation and measurement, and originates from high-income contexts despite the fact that most children with disabilities live in low-income countries. OBJECTIVES: The authors examined how Ethiopian disability support providers practically contribute to meeting the needs of families of children with disabilities to enhance FQOL. METHOD: Building on a previous study exploring Ethiopian families' perspectives on FQOL, the authors used an exploratory descriptive qualitative approach to interview various support providers. Interviews were conducted virtually (because of the coronavirus disease 2019 [COVID-19] pandemic) in English or with interpreting assistance. Audio-recorded interviews were transcribed verbatim and analysed thematically. RESULTS: Support providers affirmed what families had described as important for FQOL - spirituality, relationships, self-sufficiency - and recognised their enormous support needs. They described various ways to support families - emotionally, physically, materially and informationally. They also expressed challenges and their need for support to meet families' needs. CONCLUSION: Ethiopian families of children with disabilities need holistic support that incorporates spirituality, the whole family's needs and disability awareness-raising. Collaborative and committed engagement from all stakeholders is necessary to support Ethiopian families to flourish. CONTRIBUTION: This study contributes to global understandings of FQOL and describes practical approaches to support families of children with disabilities in an African context. The findings of this study highlight the influence of spirituality, relationships, self-sufficiency, poverty and stigma and the need for holistic support and disability awareness-raising to enhance FQOL. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100011&lng=en&nrm=iso&tlng=en BACKGROUND: Caregivers are under enormous pressure in trying to provide for the needs of their children with disabilities in South Africa. The care dependency grant (CDG), an unconditional cash transfer, is the primary state-subsidised intervention for the social protection of low-income caregivers of children with disabilities. OBJECTIVES: The primary objective of this substudy, within a larger multistakeholder qualitative project, was to investigate caregiver perspectives on CDG assessment and application, their beliefs about the purpose of the CDG and how they actually used these funds METHODS: Data for this qualitative research included in-depth individual interviews and one focus group discussion. Six low-income caregivers who were current or previous CDG beneficiaries participated. Deductive thematic analysis was conducted using codes related to the objectives. RESULTS: Access to the CDG was usually too late and over-complicated. Caregivers were grateful for the CDG but it was insufficient to cover the costs of care, in the context of high unemployment and weaknesses in complementary social services. Pressure on these caregivers was intensified by criticism in their social environments and a lack of respite care. CONCLUSION: Caregivers need service providers to be better trained and for systems of referral to available social services to be strengthened. The whole of society ought also to be targeted for increased social inclusion facilitated by improvements in understandings of the lived experience and cost of disability. CONTRIBUTION: The rapid time from data collection to write-up of this study will aid in building the evidence base on the CDG, an urgent priority for South Africa's journey towards comprehensive social protection. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100012&lng=en&nrm=iso&tlng=en BACKGROUND: Healthcare professionals may have a preconceived idea about life after an acquired brain injury (ABI). Understanding lived experiences of individuals with ABI and their significant others, post-hospitalisation, may improve communication between healthcare professionals and individuals directly influenced by the ABI. OBJECTIVE: To describe perceived experiences of individuals with ABI, and their significant others, regarding rehabilitation services and returning to daily activities, one-month post-discharge from acute hospitalisation. METHOD: Semi-structured interviews, via an online platform, expanded on the experiences of six dyads (individuals with an ABI and their significant others). Data were thematically analysed. RESULTS: Six main themes emerged that best described participants' experiences; two of which were shared between individuals with ABI and their significant others (SO). Individuals with an ABI acknowledged recovery as their priority and highlighted the importance of patience. The need for counselling and additional support from healthcare professionals and peers arose. The SO expressed a need for written information, improved communication from healthcare professionals, and education regarding the implications of an ABI. The coronavirus disease 2019 (COVID-19) pandemic negatively influenced all participants' overall experiences, mainly because of termination of visiting hours. Psychosocial intervention would have been beneficial to all participants. Faith influenced most participants' attitudes towards recovery and adapting post-ABI. CONCLUSION: Most participants accepted their new reality but required additional support to cope emotionally. Individuals with an ABI would benefit from opportunities to share experiences with and learn from others in a similar situation. Streamlined services and improved communication may alleviate anxiety among families during this crucial transitional period. CONTRIBUTION: This article provides valuable information on the perspectives and experiences of individuals with ABI and their significant others during the transition from acute hospitalisation. The findings can assist with the continuity of care, integrative health and supportive strategies during the transition period post-ABI. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100013&lng=en&nrm=iso&tlng=en 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. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100014&lng=en&nrm=iso&tlng=en BACKGROUND: While legislation protects persons with disabilities against discrimination, decisions taken in line with institutional policies may still have a negative impact on the lived experience of those individuals. OBJECTIVES: The purpose of the study is to evaluate the efficacy of institutional policies, to describe the unintended psychosocial impact of policies and to identify factors that moderate the impact of the policies. METHOD: The study adopted an autoethnographic approach involving recollecting life experiences, reading archival and policy documents, reflecting on experiences, articulating lived experiences, deep thought, reviewing and repetition. Activities were carried out as and when appropriate, not necessarily sequentially. The aim was to produce a coherent narrative with credibility, authenticity and integrity. RESULTS: The results indicate that decisions based on interpretation of policies did not necessarily result in persons with disabilities being fully included in normal academic activities. A disablist institutional culture substantially moderates the intended consequences of institutional policies on the experiences of persons living with disabilities, particularly those that are nonobvious. CONCLUSIONS: Consideration of persons of all abilities should be no different from recognising the diverse needs of persons of different genders, ages, educational backgrounds, financial means, languages and other demographics. A culture of disability prejudice, even among well-meaning individuals, prevents a progressive policy framework from ensuring inclusivity for persons with disabilities. CONTRIBUTION: The study demonstrates that a supportive institutional culture is necessary to give effect to disability policies and legislation and to optimise the inclusion of persons with disabilities in the workplace. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100015&lng=en&nrm=iso&tlng=en BACKGROUND: People with disabilities in sheltered workshops are disempowered and face many barriers, adversely affecting their income-generating activities and weakening their competitiveness in the labour market. There is limited evidence on how to overcome these barriers. OBJECTIVES: This paper seeks to propose a framework to overcome the barriers experienced by people with disabilities participating in income-generating activities in a sheltered workshop. METHOD: The qualitative exploratory single case study was done with observations and semi-structured interviews as data collection methods. Purposive sampling was used to select 24 participants between ages 22 and 52 years, and content analysis was done of transcribed interviews. Community-based rehabilitation (CBR) guidelines were used to develop the framework. RESULTS: A proposed framework was developed that outlined intervention strategies to address the barriers experienced by sheltered workshop participants to promote increased participation of people with disabilities in income-generation activities, thereby improving their quality of life. CONCLUSION: The participation of people with disabilities in income-generating activities is hindered by several barriers. However, the proposed framework overcomes the barriers to effective participation in income-generating activities. CONTRIBUTION: People with disabilities will benefit from this framework as it will address their challenges and needs for empowerment. It would also inform stakeholders involved about these challenges and strategies. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100016&lng=en&nrm=iso&tlng=en BACKGROUND: There is an emerging body of knowledge on the lived experiences of parenting a child with autism from a maternal perspective. Mothers' reactions to their children's autism diagnoses have been identified as a key factor influencing their children's long-term outcomes. OBJECTIVES: This qualitative study aimed to explore how South African mothers experience their children's autism diagnoses. METHOD: Telephonic interviews were conducted with 12 mothers from KwaZulu-Natal to understand their experiences prior, during and following their children's autism diagnoses. The data were analysed thematically according to the values of ubuntu, social support, culture, tradition, interpersonal relationships, interconnectedness and continuity and compared to the existing scholarship, employing an Afrocentric theoretical lens. RESULTS: The participants held strong cultural and religious beliefs which influenced the entire diagnosis process. Some, who waited a long time, turned to traditional healers or religious leaders. While some reported feeling relieved after the diagnosis, in the sense of at least having a name for their child's condition, they also reported feeling overwhelmed by the realisation that there is no cure for autism. Over time, mothers' feelings of guilt and anxiety declined, and they became increasingly resilient and empowered as their understanding of the meaning of their children's autism diagnosis deepened, but many continued to pray for a miracle. CONCLUSION: Future research should focus on how to enhance support for mothers and their children during each of the three phases of autism diagnosis: prior, during and following their children's autism diagnoses. CONTRIBUTION: The study highlighted the crucial role of community-based religious and cultural organisations in providing appropriate support to mothers and their children diagnosed with autism, aligned to the values of ubuntu, social support, culture, tradition, interpersonal relationships, interconnectedness and continuity. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100017&lng=en&nrm=iso&tlng=en BACKGROUND: Ensuring quality in the structure and process of stroke rehabilitation helps to attain a good outcome. However, knowledge on this is limited in resource-constrained settings such as Ghana. OBJECTIVES: This study aimed to explore healthcare professionals' (HCPs) views and experiences of the structure and process of stroke rehabilitation in three selected hospitals in Ghana. METHOD: A qualitative study was carried out involving 26 HCPs directly involved in stroke rehabilitation from three selected hospitals in the Greater Accra Region of Ghana representing the different levels of healthcare. Interviews were conducted using an interview guide to understand participants' views and experiences of the structure and process of stroke rehabilitation. Interview transcripts were analysed using thematic analysis. RESULTS: HCPs reported limitations with the structure of stroke rehabilitation with regards to the availability of rehabilitation units, bed capacity, approach to care, availability of protocol, staff capacity development and payment systems. With respect to the process of rehabilitation, the primary and secondary level hospitals were found not to have computed tomography (CT) and magnetic resonance imaging (MRI) scanning equipment. Participants also reported limitations with discharge planning, basis for discharge and post-discharge care across all three hospitals. CONCLUSION: This study found limitations in the current structure and process of stroke rehabilitation, which when given some considerations for improvement, can help improve the quality of care and thereby improve the outcome of stroke patients in Ghana CONTRIBUTION: This study provided data which helps to assess the quality of stroke rehabilitation in Ghana. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100018&lng=en&nrm=iso&tlng=en BACKGROUND: Preventing adversity from accelerating among learners with specific learning disabilities (SLD) is imperative. Continuous adversities, such as social-emotional, psychological and academic difficulties, characterise learners with SLD. Prior studies have been conducted on learners with SLD developing a disorder because of the difficulties they face. However, very few studies offer evidence of how learners presenting with SLD cope despite their learning disability. OBJECTIVES: The study sought to investigate what resilience resources are available among learners with SLD in learners with special education needs (LSEN) schools and to provide stakeholders with evidence of resilience enablers for learners with SLD. METHOD: An exploratory quantitative research study was adopted, and 217 respondents with SLD were selected through purposive sampling in four LSEN schools. These learners completed the Child and Youth Resilience Measure (CYRM-28). Data were analysed using the Statistical Package for the Social Sciences (SPSS) and the custom table was used as a statistical technique. RESULTS: Even though the presence of SLD negatively affects an individual's academic, psychological, social and emotional functioning, the results of this study show that individual qualities, relationships with caregivers and peers and contextual resources were resilience-enabling resources for learners with SLD. CONCLUSION: The study's results show that the combination of individual attributes, relational and environmental factors enables the resilience of learners with SLD. When given accessible and meaningful support, learners with SLD can develop resilience CONTRIBUTION: The study contributes to the dearth of knowledge regarding the resilience of learners with SLD in LSEN schools. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100019&lng=en&nrm=iso&tlng=en Research looking into the day-to-day lives of people with intellectual disabilities (ID) is on the increase in Africa. However, not enough is being done to include people with ID as active contributors to this research through inclusive approaches. Inclusive research empowers people with ID as they have the agency and autonomy to speak for themselves and they are given an active voice in the research process and outcomes. This leads to services that cater for what matters to people with ID themselves as opposed to having their needs defined by other people. The common myths and misconceptions attached to ID in Africa, which increase stigma towards people affected by this type of disability can be abated by their visibility in research and evidence of their ability to express themselves. This article makes a call to researchers on the African continent to include people with ID in research as active contributors to the research and not simply as research subjects or respondents. A background is given of global developments that have occurred in inclusive research based on the literature and the author's personal experience, which African researchers can learn from while taking cognizance of the specific needs of their own contexts. This is followed by highlighting the gaps in Africa. The article ends with a discussion of possible reasons for a lack of inclusive research in Africa and suggestions and recommendations to address this gap. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100020&lng=en&nrm=iso&tlng=en BACKGROUND: Identity construction is an integral developmental task for adolescents and young adults (AYA). The intersection of deaf identity and disabling hearing loss (DHL) adds a layer to the complex process of identity construction. AIM: This literature review highlights the self-ascribed deaf identities of AYA and seeks to understand how AYA with DHL forge these identities. Knowledge areas for prospective research and practice are uncovered. METHOD: A traditional literature review of qualitative empirical evidence on AYA's accounts of their deaf identity construction was conducted on seminal literature and peer-reviewed journals in psychology, disability studies and deaf studies. RESULTS: The emerging self-ascribed deaf identities of AYA are diverse. The identities include Deaf, hearing, hard-of-hearing (HOH), bicultural HOH, identities that detach from disability, bicultural DeaF, unresolved and fluid identities. Complex trade-offs exist where the construction of certain identities forgoes certain reasonable accommodations, interventions or relations that are critical for personal development and wellbeing. CONCLUSION: Current literature orients deaf identity formation around hearing status and Deaf-hearing communal dynamics. In-depth research comprising facets of AYA's personal, enacted and relational identities is required to conscientise rehabilitation professionals about the nuances of deaf identity issues and how to develop interventions that are supportive and responsive to the clinical and psychosocial challenges of AYA with DHL. CONTRIBUTION: This paper deviates from the d/Deaf identity dichotomy, revealing a spectrum of deaf identities that AYA forge. The rationales of AYA's deaf identities, underlying processes and possible vulnerable identities are unpacked. Recommendations for prospective .research pertaining to identity construction among deaf AYA are made http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100021&lng=en&nrm=iso&tlng=en BACKGROUND: Identity construction is an integral developmental task for adolescents and young adults (AYA). The intersection of deaf identity and disabling hearing loss (DHL) adds a layer to the complex process of identity construction. AIM: This literature review highlights the self-ascribed deaf identities of AYA and seeks to understand how AYA with DHL forge these identities. Knowledge areas for prospective research and practice are uncovered. METHOD: A traditional literature review of qualitative empirical evidence on AYA's accounts of their deaf identity construction was conducted on seminal literature and peer-reviewed journals in psychology, disability studies and deaf studies. RESULTS: The emerging self-ascribed deaf identities of AYA are diverse. The identities include Deaf, hearing, hard-of-hearing (HOH), bicultural HOH, identities that detach from disability, bicultural DeaF, unresolved and fluid identities. Complex trade-offs exist where the construction of certain identities forgoes certain reasonable accommodations, interventions or relations that are critical for personal development and wellbeing. CONCLUSION: Current literature orients deaf identity formation around hearing status and Deaf-hearing communal dynamics. In-depth research comprising facets of AYA's personal, enacted and relational identities is required to conscientise rehabilitation professionals about the nuances of deaf identity issues and how to develop interventions that are supportive and responsive to the clinical and psychosocial challenges of AYA with DHL. CONTRIBUTION: This paper deviates from the d/Deaf identity dichotomy, revealing a spectrum of deaf identities that AYA forge. The rationales of AYA's deaf identities, underlying processes and possible vulnerable identities are unpacked. Recommendations for prospective .research pertaining to identity construction among deaf AYA are made http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100022&lng=en&nrm=iso&tlng=en BACKGROUND: Access to, and occupational performance in, out-of-home-life-spaces is linked to health, wellbeing and quality of life for older adults. There is little evidence of how this relates to older adults with limited resources in an African urban context OBJECTIVES: To describe the out-of-home-life-spaces accessed and valued by older adults with limited resources, living in an urban South African setting. METHOD: An exploratory concurrent mixed methods study saw 84 rehabilitation clinicians conduct 393 face-to-face interviews with older adults. Clinicians produced reflective field notes and participated in focus groups. Quantitative data were analysed using descriptive statistics with SPSS Version X. Qualitative data were analysed through inductive content analysis. RESULTS: Older adults walked, used mini-bus taxis or private vehicles to get to places of worship, medical facilities, shops, family and friends and special interest gatherings on a weekly or monthly frequency. Lack of funds was the main barrier. Older adults aspired to travel, go on holiday and to visit out-of-town family homes. CONCLUSION: Exploring the daily lived experience of older, urban South Africans with limited resources brought to light the value they attribute to participation in activities that contribute to the wellbeing of their families and communities. Such activities are found in a variety of life spaces. CONTRIBUTION: Results could inform policy makers and service providers in their planning of community mobility, transportation services and health care, for older adults with limited resources. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100023&lng=en&nrm=iso&tlng=en BACKGROUND: Access to, and occupational performance in, out-of-home-life-spaces is linked to health, wellbeing and quality of life for older adults. There is little evidence of how this relates to older adults with limited resources in an African urban context OBJECTIVES: To describe the out-of-home-life-spaces accessed and valued by older adults with limited resources, living in an urban South African setting. METHOD: An exploratory concurrent mixed methods study saw 84 rehabilitation clinicians conduct 393 face-to-face interviews with older adults. Clinicians produced reflective field notes and participated in focus groups. Quantitative data were analysed using descriptive statistics with SPSS Version X. Qualitative data were analysed through inductive content analysis. RESULTS: Older adults walked, used mini-bus taxis or private vehicles to get to places of worship, medical facilities, shops, family and friends and special interest gatherings on a weekly or monthly frequency. Lack of funds was the main barrier. Older adults aspired to travel, go on holiday and to visit out-of-town family homes. CONCLUSION: Exploring the daily lived experience of older, urban South Africans with limited resources brought to light the value they attribute to participation in activities that contribute to the wellbeing of their families and communities. Such activities are found in a variety of life spaces. CONTRIBUTION: Results could inform policy makers and service providers in their planning of community mobility, transportation services and health care, for older adults with limited resources. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100024&lng=en&nrm=iso&tlng=en BACKGROUND: South Africa adopted a policy on inclusive education in 2001 to ensure that all learners are accommodated and accepted in the classrooms despite their differences. OBJECTIVES: This study was aimed at exploring the inclusion of learners with learning disabilities in mainstream primary schools for teaching and learning. METHOD: This study followed a qualitative approach embedded in a descriptive phenomenological design. Data were generated through in-depth interviews with individual participants and were analysed thematically for content. Six teachers from six different mainstream primary school classrooms were purposefully selected for the study. RESULTS: Findings revealed that overcrowding, time constraints and lack of parental involvement impede the inclusion of learners with learning disabilities in mainstream classrooms. However, teachers use: (1) multi-level teaching, (2) concrete teaching and/or learning aids, (3) differentiated instruction and (4) code-switching in accommodating learners with learning disabilities. CONCLUSION: This study argues that for learners with learning disabilities to be more included in mainstream classrooms, the learner population should be reduced to a maximum of 30 learners per class, and collaboration with parents should be enhanced. Also, the arrangement of learners for teaching and learning could be limited to small groups consisting of four to five learners. Multi-level teaching and differentiated instruction should be applied in settings that do not require learners to be separated from their peers without learning disabilities CONTRIBUTION: This study will help improve teachers' inclusive classroom pedagogical practices for all learners including those with learning disabilities. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100025&lng=en&nrm=iso&tlng=en BACKGROUND: Parenting a child with a developmental disability (DD) has a substantial influence on the lives of the parents or caregivers, as well as on how the family operates. This is frequently because of the adjustments in some daily practices that are crucial for parents' or caregivers' human capabilities to provide for childcare. There is not enough research done on human capabilities of parents or children with DD in South Africa. OBJECTIVES: This study investigated the available support in improving the human capabilities of parents or caregivers with children with DD and the bodily health and bodily integrity human capabilities of parents or caregivers with children with DD. METHOD: Qualitative interviews were conducted with 11 parents or caregivers of children aged between 1 and 8 years old with DD. This study used snowball sampling. Thematic data analysis was chosen to analyse the data collected. RESULTS: The results of the study indicate that participants have difficulties bringing up their children because of the emotional strain that goes along with parenting a child with DD. In addition, participants were not able to afford decent and satisfactory shelter and had limited access to good quality food because they could not afford it. CONCLUSION: A lack of social support and care burden influences parents' or caregivers' ability to raise their child with developmental disability. CONTRIBUTION: The study contains helpful information about families of children with DD in under-resourced locations. The information may be of significance to policymakers who are accountable for designing and executing policies that are targeted at assisting parents or caregivers of children with DD. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100026&lng=en&nrm=iso&tlng=en BACKGROUND: Mental disorders are a major health concern across the globe. Schizophrenia, one of the mental disorders, affects approximately 20 million people globally and 5 million people within the African continent. Schizophrenia can affect all areas of life, including participation in instrumental activities of daily living (IADLs). OBJECTIVES: The study aimed to explore personal barriers affecting participation in chosen IADLs among community-dwelling persons with schizophrenia in Kigali city, Rwanda. METHOD: A qualitative, embedded case study design and constructivist epistemology paradigm were used. Purposive sampling and semi-structured interviews were conducted with 20 participants that included 10 persons diagnosed with schizophrenia (case 1) and 10 of their caregivers (case 2). Data were analysed according to the seven steps of Ziebland and Mcpherson. FINDINGS: The two themes identified were community negative attitudes and individual hindrances to participation in IADLs. Theme 1 demonstrated the community's poor support towards persons with schizophrenia due to the stigma attached to mental health illness, which is reported elsewhere. This paper reports on individual hindrances to participation, which revealed limited knowledge and skills, decreased motivation and interest, financial problems, maladaptive behaviours, medication side effects, loss of social interaction and isolation, and disorganised in performing activities to negatively affect persons with schizophrenia's full participation in their chosen IADLs CONCLUSION: Community-dwelling persons with schizophrenia are experiencing various hindrances to participating in their chosen IADLs, which shows a need for support from different stakeholders to improve access and participation of persons with schizophrenia in their daily activities based on their abilities CONTRIBUTION: Different barriers affecting participation of the persons with schizophrenia in their chosen IADLs were highlighted together with the common affected IADLs. It is recommended that when right support is provided, persons with schizophrenia may function at their maximum abilities in their activities of choice and may live at their highest independence level http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100027&lng=en&nrm=iso&tlng=en BACKGROUND: South African public sector efforts to employ people with disabilities (PWDs) in the post-apartheid have been less successful, resulting in a poor transformation record during the past 27 years (1994-2021) due to the failure to integrate PWDs into mainstream employment in government departments. OBJECTIVE: The objective of this article is to identify and highlight some of the barriers to the employability of PWDs in the South African public service. METHOD: The research was framed as a case study within the transformative research paradigm. A typical department in the Western Cape provincial government was selected for the study. In-depth interviews were conducted with selected top managers within the Western Cape provincial government. Convenience sampling technique of the purposive sampling method was adopted to select targeted respondents (n = 10). Thematic analysis was employed to condense the data collected into a small number of significant themes. Atlas.ti version 7 was also used to enhance the analysis. RESULTS: The study found, among others, that there are conceptual, infrastructural, managerial and organisational factors affecting the employability of PWDs in mainstream public service. CONCLUSION: The study concludes that barriers to the socio-economic progression of PWDs, including infrastructural and psychosocial factors, continue to prevail and cause the socio-economic marginalisation of PWDs. CONTRIBUTION: The study contributes towards efforts aimed at the inclusion of PWDs in the workplace by offering both internal and society-wide actions. Internally, successful inclusion of PWDs involves eliminating barriers, removing bureaucracy, initiating management development for disability matters, introducing appropriate talent development measures, and implementing collaborative management of PWDs. External or society-wide measures include campaigns to demystify disability and change attitudes, engage society structures, and improve societal knowledge of disability. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100028&lng=en&nrm=iso&tlng=en BACKGROUND: South African legislation promotes the accommodation of employees with disabilities through enabling modifications and adjustments in the workplace. The literature about the experiences of employees with disabilities in higher education environments regarding accommodation is scant. Filling the gap, this research aimed to explore how employees with disabilities at a South African university cope with disability management practices by means of accommodations. OBJECTIVES: The objectives entailed exploring the encounters of employees with disabilities regarding accommodation in the workplace, their beliefs about these encounters and the meaning that the employees with disabilities attached to them. METHOD: The study design is grounded in the subjectivist epistemology of social constructionism and took on a qualitative approach. The bounded single-case study concerned formative evaluations. The homogeneous purposive sampling strategy amounted to 13 employees with disabilities. Twelve semi-structured interviews were analysed using thematic analysis. RESULTS: The participants relied strongly on self-agency to address splintered or unresponsive disability management practices. To avoid marginalisation, they worked extra hard for securing a rightful place at work. Misconceptions of able-bodied peers or managers triggered psychological stress. CONCLUSION: Coping with the university's disability management practices is mainly a stressful challenge, consequently endangering people's well-being. CONTRIBUTION: Exploring the coping of university employees with disabilities through accommodations filled a gap in the literature. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100029&lng=en&nrm=iso&tlng=en BACKGROUND: The study is conducted to investigate whether curriculum reform for learners with special education needs (SEN) is taking place in Zambia. OBJECTIVES: The study objective were to investigate the extent to which curriculum had been reformed to facilitate the inclusion of children with SEN in Zambia; and determine stakeholders understanding of inclusive education policy, to evaluate the success of an inclusive programme in supporting the full inclusion of learners with SEN. METHOD: This study used a mixed method research design which involved data collection in seven provinces of Zambia. The researchers employed purposive sampling. The largest number of respondents were SEN teachers and administrators. The qualitative data collection tools included semi-structured interviews of individuals and focus groups. The quantitative data came from a questionnaire completed by teachers and supervisors as well as from government documents. The quantitative data were analysed using SOFA Statistics, while the qualitative data were analysed using ATLAS-TI 7. RESULTS: Limited curriculum reform remains one of the main impediments to the implementation of the inclusive policy for children with SEN in Zambia. CONCLUSION: It is concluded that without curriculum reform the implementation of inclusive education in Zambia will be challenging. CONTRIBUTION: There is a dearth of information regarding curriculum reform in Zambia. This is one of the studies that is attempting to plug the information gap on curriculum reform. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100030&lng=en&nrm=iso&tlng=en BACKGROUND: Families are the primary caregivers for persons with intellectual disability (ID), offering informal support to ensure community living. Ensuring families are adequately supported is key to reduce the financial, physical, mental and social toll which long-standing inadequately supported care giving may evoke. Respite care is such a support service offered to caregivers and care-recipients with ID. OBJECTIVE: Part of a larger study aimed at developing a respite care service framework for persons with ID for South Africa, the review aimed to elucidate what principles and practices inform current respite care services for this population globally. METHOD: The Joanna Briggs Institute (JBI) scoping review framework guided the review. Databases were searched using key and surrogate terms for relevant literature published from 2006 to 2021. RESULTS: Thirty-one sources met the inclusion criteria from 417 screened sources of evidence. These were published between 2006 and 2020, and included grey and peer-reviewed articles, the latter mostly mixed design. Information on respite care service characteristics, principles, practices, guidelines, evaluations and impacts were found for high- but not low-and-middle-income countries (LMICs). CONCLUSION: There is an existing knowledge base that can be drawn on to inform the development of quality respite care. The lack of published information on respite care in LMICs necessitates further research to ensure contextually appropriate respite care developments in these settings.. CONTRIBUTION: This study contributes to the knowledge base on respite care for persons with ID and points out the research gap in LMICs http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100031&lng=en&nrm=iso&tlng=en BACKGROUND: Assistive technologies (ATs) enable persons with visual impairment (PwVI) to equitably benefit from public library resources and services as their sighted counterparts. However, the extent to which this facility is available and used at public libraries in less-developed countries remains largely unknown OBJECTIVES: This study reports on the investigation done on the availability and use of ATs by PwVI at public libraries in the cities of Ekurhuleni and Johannesburg in South Africa METHOD: The study used a multimethod and explanatory sequential design in which data were collected through questionnaires administered with 131 librarians and interviews held with 10 PwVI RESULTS: The findings of the study point towards inadequate availability of computers with internet services, audiotapes, screen magnifying and reading software, and these were used for, among others, leisure, research, job searching and communication CONCLUSION: The study concludes that certain ATs were inadequately available and used by PwVI at some libraries in the cities of Ekurhuleni and Johannesburg. The study recommends training for PwVI on how to use ATs, marketing of available ATs, training of staff on how to render AT-based services as well as management availing adequate budget for the development of AT-based collection CONTRIBUTION: The study contributes to the understanding of the types of ATs available and used by PwVI in public libraries http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202023000100032&lng=en&nrm=iso&tlng=en BACKGROUND: Family caregiver training is an integral part of stroke rehabilitation programmes and is associated with improved caregiver and stroke survivor outcomes. In the Cape Winelands District, a low-resourced rural community-based setting in South Africa, stroke survivors and family caregivers mostly rely on assistance from community health workers (CHWs), despite their lack of stroke-specific rehabilitation training OBJECTIVES: To evaluate the implementation and immediate effects of a bespoke, 16 session, 21 h stroke rehabilitation training programme for CHWs to better support family caregivers METHODS: Two cooperative inquiry groups participated in participatory action research to design and develop the programme. This article reports on the implementation of this programme. Inquiry group members directly observed the training, obtained written and verbal feedback, interviewed CHWs and observed them in the community. Consensus on their learning was achieved after reflection on their experience and observations RESULTS: Learning of the cooperative inquiry groups was categorised into the effect on community-based care, the training programme's design and development, how training was delivered and implications for service delivery. Community health workers empowered caregivers and stroke survivors and enabled access to care, continuity, coordination and person-centredness. The need for experiential learning and a spiral curriculum was confirmed. Therapists needed a different set of skills to deliver training. A systems approach and effective leadership were needed to enable community health workers to use their new skills CONCLUSION: The stroke rehabilitation training programme demonstrated potential for integration into service delivery and equipping CHWs to support family caregivers and stroke survivors. Further evaluation of the programme's effectiveness and scale-up is needed CONTRIBUTION: Evidence of an intervention to train CHWs to support stroke survivors and family caregivers