The research base of community-based rehabilitation

This paper provides an overview of the current research on community-based rehabilitation (CBR) which can be found in the public domain. A brief background to the concept of CBR is given, and it is shown how much of this published research reflects the fundamental principles of CBR service delivery, technology transfer, community involvement, and organization and management. Specific research is discussed under these headings. Additional topics reviewed include the target populations of, and disabilities addressed in, CBR research, and the epidemiology of disability. A summary of locations where the research has taken place is also presented. It is concluded that, while there is still a need for additional research and evaluation in the extensive field of CBR, there has been some reluctance to either undertake or permit such activities. However, CBR and ultimately the disabled can only benefit from placing research and evaluation of CBR into the public domain.     

The research base of community-based rehabilitation

This paper provides an overview of the current research on community-based rehabilitation (CBR) which can be found in the public domain. A brief background to the concept of CBR is given, and it is shown how much of this published research reflects the fundamental principles of CBR service delivery, technology transfer, community involvement, and organization and management. Specific research is discussed under these headings. Additional topics reviewed include the target populations of, and disabilities addressed in, CBR research, and the epidemiology of disability. A summary of locations where the research has taken place is also presented. It is concluded that, while there is still a need for additional research and evaluation in the extensive field of CBR, there has been some reluctance to either undertake or permit such activities. However, CBR and ultimately the disabled can only benefit from placing research and evaluation of CBR into the public domain.     

Developing a tool for evaluating community-based rehabilitation in Uganda

Purpose.?The overall purpose of this study is to use the conceptual criteria of the ‘Joint Position Statement (JPS)’ (see http://www.ilo.org/public/english/employment/skills/download/jointpaper.pdf)on Community-based rehabilitation (CBR), together with the data collected from a CBR programme in Uganda (Tororo) to generate a prototype CBR evaluation tool.

Method.?A case study approach is used to examine the Tororo CBR programme. Project documentation was examined to generate base line data which was used to inform sampling for interviews and focus group discussions. These were conducted with a wide range of stakeholders. The interview and focus group data are recorded, translated, transcribed and imported into a computer-assisted analysis programme, NVivo. The data was analysed in two stages: (i) data led development of themes (ii) allocation of the generated themes to the conceptual structure of the ‘JPS’. A third stage uses the data to generate an outcome measurement tool for evaluating CBR programmes.

Results.?Fifty different themes were identified during the analysis and used to construct a questionnaire framed around the concepts of the ‘JPS’. In addition, the questionnaire reflected the words and phrases used by participants. The outcome is a short and feasible tool for evaluating CBR programmes.

Conclusion.?The ‘JPS’ has been used as a framework for the analysis of qualitative data to generate the basis of a prototype evaluative questionnaire which can now be piloted, amended and then used for the evaluation of other CBR programmes.     

Health professional faculty perspectives on community-based research: implications for policy and practice

Community-based research (CBR) has become central to the understanding and elimination of health disparities within the USA and across the globe. The authors sought to determine the perspectives of health professional faculty on the factors affecting their involvement in CBR and the extent of community participation in that research. Faculty from 18 health professional schools in the USA identified by their deans as being leaders in CBR completed a written survey. Respondents reported that between 5-10% of faculty in their schools were involved in CBR. Public perception of the university, familiarity with community-based organization leaders and institutional leadership were cited as the most significant factors contributing to a school's involvement in CBR. Long-term community relationships, recognition in tenure and promotion policies and access to funding were cited as factors that support faculty in conducting CBR. The authors conclude that a more significant investment of public and private funds, the development of interdisciplinary institutional structures for community partnerships and a more inclusive definition of scholarship are needed to achieve a central role for CBR in efforts to understand and eliminate health disparities.     

Health professional faculty perspectives on community-based research: implications for policy and practice

Community-based research (CBR) has become central to the understanding and elimination of health disparities within the USA and across the globe. The authors sought to determine the perspectives of health professional faculty on the factors affecting their involvement in CBR and the extent of community participation in that research. Faculty from 18 health professional schools in the USA identified by their deans as being leaders in CBR completed a written survey. Respondents reported that between 5?-?10% of faculty in their schools were involved in CBR. Public perception of the university, familiarity with community-based organization leaders and institutional leadership were cited as the most significant factors contributing to a school's involvement in CBR. Long-term community relationships, recognition in tenure and promotion policies and access to funding were cited as factors that support faculty in conducting CBR. The authors conclude that a more significant investment of public and private funds, the development of interdisciplinary institutional structures for community partnerships and a more inclusive definition of scholarship are needed to achieve a central role for CBR in efforts to understand and eliminate health disparities.     

A framework for evaluating community-based rehabilitation programmes in Chinese communities

Purpose.?The primary aim of this study was to develop an evaluation framework that could effectively describe the quality of community-based rehabilitation (CBR) practice in Chinese communities.

Method.?This study adopted a case study approach to build and validate a CBR evaluation framework. Core elements of CBR programmes were defined from the literature to form an Initial Framework. Domains and elements of the Initial Framework were then verified with examples of CBR programmes cited in published articles. The revised framework was then further tested for relevance and appropriateness in the real life context through testing in five Chinese CBR programmes.

Results.?A final framework for evaluating CBR programmes was developed. It consists of 5 domains, 25 categorised core elements and 72 indicators.

Conclusion.?A comprehensive CBR evaluation framework was built and initially verified with domains, elements and indicators, and is ready for use in Chinese CBR settings.     

Community-based rehabilitation in South Korea

This paper gives a brief introduction to the geography and demography of the Republic of South Korea. Since 1988 South Korea has been actively legislating and implementing welfare policy for the disabled of the Republic. An overview of these policy changes is presented. The extent to which the policy has been implemented using community-based rehabilitation (CBR) is illustrated using an example from the North Wanju Project. Finally, there is a discussion of the future of CBR in South Korea and the means whereby there can be more social integration of the disabled.     

Community-based rehabilitation in South Korea

This paper gives a brief introduction to the geography and demography of the Republic of South Korea. Since 1988 South Korea has been actively legislating and implementing welfare policy for the disabled of the Republic. An overview of these policy changes is presented. The extent to which the policy has been implemented using community-based rehabilitation (CBR) is illustrated using an example from the North Wanju Project. Finally, there is a discussion of the future of CBR in South Korea and the means whereby there can be more social integration of the disabled.     

Community-based rehabilitation in South Korea

This paper gives a brief introduction to the geography and demography of the Republic of South Korea. Since 1988 South Korea has been actively legislating and implementing welfare policy for the disabled of the Republic. An overview of these policy changes is presented. The extent to which the policy has been implemented using community-based rehabilitation (CBR) is illustrated using an example from the North Wanju Project. Finally, there is a discussion of the future of CBR in South Korea and the means whereby there can be more social integration of the disabled.     

A scoping review of 10 years of published literature on community-based rehabilitation

Abstract

Purpose: To identify the characteristics of peer-reviewed literature on community-based rehabilitation (CBR) in low- and middle-income countries published in English from 2003 to 2012. Methods: This scoping review involved a systematic search of electronic databases using specific keyword/subject heading combinations. Journal articles were included if they were published in English, used “CBR” as related to rehabilitation with persons with disabilities and not limited to high-income countries (HICs). Data were charted according to both pre-determined and emergent categories. A subset of articles was charted by two reviewers to ensure reliability of variables. Results: A total of 114 articles were included. Fifty-two articles presented empirical research and 49 were published in one of two journals. The articles represented CBR activity in 26 specific countries, although only two of these were in Europe and only one was in the Americas. Authors were predominantly affiliated at universities and in HICs. Conclusions: This scoping review identified and characterized a large pool of literature on CBR, facilitating its incorporation into research and practice. Future research should examine the engagement of persons with disabilities in creating CBR literature, and analysis of literature in languages other than English.

• Implications for Rehabilitation

• Community-based rehabilitation (CBR) has been promoted as a rehabilitation strategy of choice in low- and middle-income countries (LMICs), but it has been critiqued for lack of an evidence base.

• A large number (114) of peer-reviewed articles were published on CBR between 2003 and 2012.

• Just under half of these articles (45%) presented empirical research, indicating that the evidence base for CBR is growing but will benefit from continued, rigorous inquiry.

• Furthermore, researchers from LMICs appear to be largely under-represented in published CBR research, flagging the need to support LMIC partners to share their CBR research in peer-reviewed journals.

     

The use of classification models in the evaluation of CBR programmes

Classification models for community-based rehabilitation (CBR) create conceptual order in the many types of rehabilitation programmes that exist in developing countries. Several models have been developed but none of the models appears to be widely accepted or being used in the evaluation process.

Purpose. To review classification models and assess its usability.

Methods. Literature review.

Results. Sixteen documents were found describing 11 different models. These models vary from simply listing different types of CBR to multidimensional configurations encircling principles, methods and outcomes of CBR. The models are only incidentally used in the evaluation of CBR programmes. The more recent models have been used to develop, select and group indicators.

Conclusions. Classification models can indeed structure the evaluation and comparison of CBR programs that are, by nature, very different from each other. Indicators can be developed within a theoretical framework provided by the classification model. In order to be widely accepted the models should be made less complex and focus on outcomes that are meaningful for the people involved in the evaluation as well as for policymakers and researchers.     

Expert consensus on best evaluative practices in community-based rehabilitation

Purpose: The objective of this study was to generate expert consensus on best evaluative practices for community-based rehabilitation (CBR). This consensus includes key features of the evaluation process and methods, and discussion of whether a shared framework should be used to report findings and, if so, which framework should play this role. Method: A Delphi study with two predefined rounds was conducted. Experts in CBR from a wide range of geographical areas and disciplinary backgrounds were recruited to complete the questionnaires. Both quantitative and qualitative analyses were performed to generate the recommendations for best practices in CBR evaluation. Results: A panel of 42 experts reached consensus on 13 recommendations for best evaluative practices in CBR. In regard to the critical qualities of sound CBR evaluation processes, panellists emphasized that these processes should be inclusive, participatory, empowering and respectful of local cultures and languages. The group agreed that evaluators should consider the use of mixed methods and participatory tools, and should combine indicators from a universal list of CBR indicators with locally generated ones. The group also agreed that a common framework should guide CBR evaluations, and that this framework should be a flexible combination between the CBR Matrix and the CBR Principles. Conclusions: An expert panel reached consensus on key features of best evaluative practices in CBR. Knowledge transfer initiatives are now required to develop guidelines, tools and training opportunities to facilitate CBR program evaluations.

• Implications for Rehabilitation

• CBR evaluation processes should strive to be inclusive, participatory, empowering and respectful of local cultures and languages.

• CBR evaluators should strongly consider using mixed methods, participatory tools, a combination of indicators generated with the local community and with others from a bank of CBR indicators.

• CBR evaluations should be situated within a shared, but flexible, framework. This shared framework could combine the CBR Matrix and the CBR Principles.

     

Evaluation of community-based rehabilitation programmes: a search for appropriate indicators

Community-based rehabilitation (CBR) is a common form of service delivery and can provide services for people with disabilities in otherwise underserved areas. Despite a 20-year history of service delivery in many parts of the world by both government and non-government organization sectors, there are few indicators with which to measure the effectiveness of programmes. Among evaluations that have been undertaken there has been a tendency to describe practice rather than the effectiveness of that practice. One reason for this is the lack of robust indicators against which to measure practice. This study examines the activities and outcomes of 10 published evaluations of CBR programmes and proposes indicators for some of CBR practices based upon this examination. Readers are invited to comment upon these indicators or to try using them in their practice.     

Practice guidelines for program evaluation in community-based rehabilitation

Purpose: This paper proposes practice guidelines to evaluate community-based rehabilitation (CBR) programs.

Method: These were developed through a rigorous three-phase research process including a literature review on good practices in CBR program evaluation, a field study during which a South Africa CBR program was evaluated, and a Delphi study to generate consensus among a highly credible panel of CBR experts from a wide range of backgrounds and geographical areas.

Results: The 10 guidelines developed are summarized into a practice model highlighting key features of sound CBR program evaluation. They strongly indicate that sound CBR evaluations are those that give a voice and as much control as possible to the most affected groups, embrace the challenge of diversity, and foster use of evaluation processes and findings through a rigorous, collaborative and empowering approach.

Conclusions: The practice guidelines should facilitate CBR evaluation decisions in respect to facilitating an evaluation process, using frameworks and designing methods.

• Implications for rehabilitation

• Ten practice guidelines provide guidance to facilitate sound community-based rehabilitation (CBR) program evaluation decisions. Key indications of good practice include:

• ??being as participatory and empowering as possible;

• ??ensuring that all, including the most affected, have a real opportunity to share their thoughts;

• ??highly considering mixed methods and participatory tools;

• ??adapting to fit evaluation context, local culture and language(s);

• ??defining evaluation questions and reporting findings using shared CBR language when possible, which the framework offered may facilitate.

     

The use of classification models in the evaluation of CBR programmes

Classification models for community-based rehabilitation (CBR) create conceptual order in the many types of rehabilitation programmes that exist in developing countries. Several models have been developed but none of the models appears to be widely accepted or being used in the evaluation process.

Purpose. To review classification models and assess its usability.

Methods. Literature review.

Results. Sixteen documents were found describing 11 different models. These models vary from simply listing different types of CBR to multidimensional configurations encircling principles, methods and outcomes of CBR. The models are only incidentally used in the evaluation of CBR programmes. The more recent models have been used to develop, select and group indicators.

Conclusions. Classification models can indeed structure the evaluation and comparison of CBR programs that are, by nature, very different from each other. Indicators can be developed within a theoretical framework provided by the classification model. In order to be widely accepted the models should be made less complex and focus on outcomes that are meaningful for the people involved in the evaluation as well as for policymakers and researchers.     

Some ethical issues in community-based rehabilitation initiatives in developing countries

Purpose : This commentary provides both theoretical and practical insights into the concept of community-based rehabilitation (CBR) and its application in developing countries. In doing so it explores current practices in CBR and the debate surrounding them, namely the ethical question and how this may impact on future CBR. The main argument in this account is that disability is a development issue; with widespread poverty, inequality and violation of human rights, and should be addressed within the broader context of community development which may include strategies such as CBR. Method : A review and analysis of recent literature on CBR has been conducted including the review of a number of empirical research documents from various CBR initiatives in developing countries. Results : CBR has increasingly been under scrutiny in terms of the extent to which these have succeeded in delivering rehabilitation services to those in need in the community as well as the permitted level of participation and control of disabled people over the rehabilitation process. Many programmes have been unsustainable and it has been difficult to evaluate their full usefulness to disabled people. These issues raise an ethical question about CBR being an appropriate strategy for the rehabilitation of people with impairments in developing countries. Conclusion : This background emphasizes that new directions in CBR need to be put in place in order to maximize the realization of the ultimate goal: the greatest participation for disabled people in all spheres of life. Effective rehabilitation programmes should allow people with disability to have greater control in the nature of their rehabilitation and that the role of professionals and other stakeholders is one of allies and resources in the rehabilitation process. Moreover, the participation of community members in the rehabilitation policy should be assured.     

Viable methods for evaluation of community-based rehabilitation programmes

PURPOSE: The purpose of this article is to discuss some viable and practically feasible methods for evaluation of community-based rehabilitation (CBR) programmes in developing country settings. METHOD: Based on review of literature the role of qualitative approaches for evaluation of CBR programmes are analysed. RESULTS: Aspects of the qualitative paradigm are discussed. The specific qualitative methods of case studies, focus groups, nominal groups, participatory techniques, content analysis, and key informant interviews are deliberated. CONCLUSIONS: Viable alternatives to the qualitative paradigm offer promise in evaluation of CBR programmes. Issues in qualitative designing, sampling, data collection, analysis, and interpretation are discussed. The classical, quantitative paradigm needs to be complemented with viable qualitative methods for evaluation of CBR programmes.