An exploration of the facilitators and barriers experienced by Rehabilitation Care Workers in the provision of Speech-Language Therapy related services

Master Thesis


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University of Cape Town

Background: South Africa experiences a severe shortage of speech-language therapists (SLTs) which results in individuals requiring Speech-Language Therapy (SLT) services having to travel long distances or being placed on long waiting lists to access services. Rehabilitation Care Workers can assist with bringing this service closer to the communities they serve. It is important to explore the experiences of these individuals to ensure that they are adequately supported and skilled. The University of Cape Town (UCT) has been training Rehabilitation Care Workers (RCWs) since 2012, however to there is currently no empirical data documenting the facilitators and barriers experienced by RCWs in their work. Aim: To explore RCWs (in the Mitchells Plain/Klipfontein sub-structure) perceptions of the facilitators and barriers in providing SLT related activities in their work context. Methods: A descriptive exploratory study was conducted. Eighteen RCWs were approached and 13 participated in 2 focus groups. Data was transcribed and analysed using thematic analysis. An inductive approach was used to develop meaningful themes and sub-themes. Results: The plot of “vital role players” best synthesized the 3 main themes namely scope of practice, RCW position and value as an intrinsic motivator and challenges. : The scope of practice theme included 4 sub-themes namely, RCW activities; awareness of broad scope; understanding family needs; including family as stakeholders in patient management. RCW position and value as an intrinsic motivator - included 4 sub-themes namely, integral members of the team; agents for change; community servants; go between formal structures and the community. Finally the theme challenges –included 4 sub-themes namely, training gaps; safety; lack of resources; feeling undervalued. The facilitators and barriers identified by the RCW’s aligned with perceptions of other mid-level health care workers as reported in the literature. Implications: RCWs work within a family centred care approach and see themselves as community servants who bring vital rehabilitation services into homes by transferring their skills to families and communities through education, support and advocacy. Despite their value and passion, RCWs feel undervalued by those around them, including management structures and the Department of Health (DOH). Conclusion: RCWs can bring much needed rehabilitation services into the homes of communities in Cape Town. For this reason, it is imperative to consider the facilitators and barriers experienced by these individuals in order to harness their natural skills and strengthen the current RCW service and solidify their roles within the Multidisciplinary Team (MDT).