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A model of home-based care for people with disabilities : Better practice in rural Thailand

- Wanaratwichit, Civilaiz, Hills, Danny, Cruickshank, Mary, Newman, Barbara

  • Authors: Wanaratwichit, Civilaiz , Hills, Danny , Cruickshank, Mary , Newman, Barbara
  • Date: 2015
  • Type: Text , Journal article
  • Relation: Asia Pacific Journal of Health Management Vol. 10, no. 2 (2015), p. 44-51
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  • Description: Background and objective: People with disabilities living in rural areas often require considerable support to meet their complex needs. This study investigated a best practice model in home-based care for people with disabilities in rural Thailand.

    Design and Setting: A case study method was adopted to investigate a best practice model of home-based care for people with disabilities in Nakhonthai District, Phitsanulok Province, Thailand. Data were collected from 30 participants through in-depth interviews, focus groups, direct observation and document analysis. Content and thematic analyses were conducted for qualitative data. The Wilcoxon Signed-Rank test was used for the outcome measurement of activities of daily living (ADL) scores.

    Results: This model of home-based care for people with disabilities, as an integrated network model, brings together the community, health professionals and other organisations. The role of trained community health volunteers was mainly to deliver home-based personal care for people with disabilities, while health professionals focused mainly on controlling the quality of care, managing the knowledge and skills of volunteers, and co-ordinating the network. The difference between ADL scores before and after the implementation of the model (n=20) was statistically significant (p<0.01). Conclusion: This best practice model of home-based care for people with disabilities in rural Thailand shifts responsibility in the main service decisions from professionals to the community and other stakeholders and engages and empowered all stakeholders in the provision, co-ordination and management of care.

Home-based care for people with disabilities : role of registered nurses within the district health system in Thailand

- Wanaratwichit, Civilaiz, Hills, Danny, Cruickshank, Mary

  • Authors: Wanaratwichit, Civilaiz , Hills, Danny , Cruickshank, Mary
  • Date: 2020
  • Type: Text , Journal article
  • Relation: Collegian Vol. 27, no. 1 (2020), p. 18-22
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  • Description: Background: In Thailand, the number of people with physical disabilities (PwD) has been increasing. Following sweeping health care reforms in 2002, efforts were made to improve accessibility to health care by greatly increasing the number of Registered Nurses (RNs) working in local community health centres. Little is known, however, about the role of RNs in improving accessibility to home-based care and the outcomes of care for PwD in Thailand. Aim: To explore the role of RNs in providing high quality home-based services for PwD who have severe limitations in movement. Methods: A case study design was used to explore and describe the role of RNs in home-based care for PwD in one rural and one urban area in lower north Thailand. There were 73 participants, including PwD and their family members, community health volunteers, primary care providers, local government officers and members of the District Health management team. Data were collected from in-depth interviews and focus groups, which were analysed using thematic analysis. Results: The roles of RNs in home-based care for PwD were found in four domains, as case manager, rehabilitation care provider, manager of the community health volunteers and broader care coordinator. Conclusion: The full scope of the RN role in the provision of home-based care for PwD, in the district health system of Thailand, not only involves direct nursing care. The role also encompasses planning and co-ordination of the broad range of professional and non-professional services to meet the needs of PwDs in rural and urban settings. © 2019 Australian College of Nursing Ltd

Implementation science and employer disability practices: Embedding implementation factors in research designs

- Main, Chris, Nicholas, Michael, Shaw, William, Tetrick, Lois, Ehrhart, Mark, Pransky, Glenn, Young, Amanda

  • Authors: Main, Chris , Nicholas, Michael , Shaw, William , Tetrick, Lois , Ehrhart, Mark , Pransky, Glenn , Young, Amanda
  • Date: 2016
  • Type: Text , Journal article
  • Relation: Journal of Occupational Rehabilitation Vol. 26, no. 4 (2016), p. 448-464
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  • Description: Purpose For work disability research to have an impact on employer policies and practices it is important for such research to acknowledge and incorporate relevant aspects of the workplace. The goal of this article is to summarize recent theoretical and methodological advances in the field of Implementation Science, relate these to research of employer disability management practices, and recommend future research priorities. Methods The authors participated in a year-long collaboration culminating in an invited 3-day conference, “Improving Research of Employer Practices to Prevent Disability”, held October 14–16, 2015, in Hopkinton, MA, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with a special panel of knowledge experts with direct employer experience. Results A 4-phase implementation model including both outer and inner contexts was adopted as the most appropriate conceptual framework, and aligned well with the set of process evaluation factors described in both the work disability prevention literature and the grey literature. Innovative interventions involving disability risk screening and psychologically-based interventions have been slow to gain traction among employers and insurers. Research recommendations to address this are : (1) to assess organizational culture and readiness for change in addition to individual factors (2) to conduct process evaluations alongside controlled trials (3) to analyze decision-making factors among stakeholders and (4 ) to solicit input from employers and insurers during early phases of study design. Conclusions Future research interventions involving workplace support and involvement to prevent disability may be more feasible for implementation if organizational decision-making factors are imbedded in research designs and interventions are developed to take account of these influences.

Employer policies and practices to manage and prevent disability: Conclusion to the special issue

- Main, Chris, Shaw, William, Hopkington Conference Working Group on Workplace Disability, Young, Amanda

  • Authors: Main, Chris , Shaw, William , Hopkington Conference Working Group on Workplace Disability , Young, Amanda
  • Date: 2016
  • Type: Text , Journal article
  • Relation: Journal of Occupational Rehabilitation Vol. 26, no. 4 (2016), p. 490-498
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  • Description: Purpose Research of employer policies and practices to manage and prevent disability spans many disciplines and perspectives, and there are many challenges related to stakeholder collaboration, data access, and interventions. The purpose of this article is to synthesize the findings from a conference and year-long collaboration among a group of invited researchers intended to spur new research innovations in this field. Methods A multidisciplinary team of 26 international researchers with published research in employer-based disability management or related fields were invited to attend a 3-day conference in Hopkinton, Massachusetts, USA. The conference goals were to review the status of current research of workplace disability management and prevention, examine its relevance for employer decision-making, compare conceptual frameworks or theoretical perspectives, and recommend future research directions. In this paper, we summarize key points from the 6 resulting papers, compare them with an earlier 2005 conference on improving return-to-work research, and conclude with recommendations for further overarching research directions. Results/Conclusion In comparison with the 2005 conference, a greater emphasis was placed on organizational and social factors, employer roles and responsibilities, methods of implementation, non-clinical approaches, and facilitating stay-at-work as well as return-to-work. A special panel of employer consultants and representatives who were featured at the 2015 conference reinforced the importance of organizational culture, leadership style, and financial decision-making strategies at the employer level. Based on the conference proceedings, we recommend that future research in this area should strive for: (a) broader inclusion of workers and workplaces (b) attention to multilevel influences in the workplace (c) a focus on social as well as physical aspects of work (d) earlier employer collaboration efforts (e) more attention to implementation factors and (f) a broader assessment of possible outcome domains.
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