Social participation of individuals with spinal injury using wheelchairs in rural Tanzania after peer training and entrepreneurial skills training

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Abstract

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.

Related collections

Most cited references 78

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Photovoice: a review of the literature in health and public health.

Caricia Catalani, Meredith Minkler (2010)

Although a growing number of projects have been implemented using the community-based participatory research method known as photovoice, no known systematic review of the literature on this approach has been conducted to date. This review draws on the peer-reviewed literature on photovoice in public health and related disciplines conducted before January 2008 to determine (a) what defines the photovoice process, (b) the outcomes associated with photovoice, and (c) how the level of community participation is related to photovoice processes and outcomes. In all, 37 unduplicated articles were identified and reviewed using a descriptive coding scheme and Viswanathan et al.'s quality of participation tool. Findings reveal no relationship between group size and quality of participation but a direct relationship between the latter and project duration as well as with getting to action. More participatory projects also were associated with long-standing relationships between the community and outside researcher partners and an intensive training component. Although vague descriptions of project evaluation practices and a lack of consistent reporting precluded hard conclusions, 60% of projects reported an action component. Particularly among highly participatory projects, photovoice appears to contribute to an enhanced understanding of community assets and needs and to empowerment.

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Inventory and analysis of definitions of social participation found in the aging literature: proposed taxonomy of social activities.

Mélanie Levasseur, Lucie Richard, Lise Gauvin … (2010)

Social participation is a key determinant of successful and healthy aging and therefore an important emerging intervention goal for health professionals. Despite the interest shown in the concept of social participation over the last decade, there is no agreement on its definition and underlying dimensions. This paper provides an inventory and content analysis of definitions of social participation in older adults. Based on these results, a taxonomy of social activities is proposed. Four databases (Medline, CINAHL, AgeLine and PsycInfo) were searched with relevant keywords (Aging OR Ageing OR Elderly OR Older OR Seniors AND Community involvement/participation OR Social engagement/involvement/participation) resulting in the identification of 43 definitions. Using content analysis, definitions were deconstructed as a function of who, how, what, where, with whom, when, and why dimensions. Then, using activity analysis, we explored the typical contexts, demands and potential meanings of activities (main dimension). Content analysis showed that social participation definitions (n = 43) mostly focused on the person's involvement in activities providing interactions with others in society or the community. Depending on the main goal of these social activities, six proximal to distal levels of involvement of the individual with others were identified: 1) doing an activity in preparation for connecting with others, 2) being with others, 3) interacting with others without doing a specific activity with them, 4) doing an activity with others, 5) helping others, and 6) contributing to society. These levels are discussed in a continuum that can help distinguish social participation (levels 3 through 6) from parallel but different concepts such as participation (levels 1 through 6) and social engagement (levels 5 and 6). This taxonomy might be useful in pinpointing the focus of future investigations and clarifying dimensions specific to social participation. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

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Photovoice ethics: perspectives from Flint Photovoice.

C. Wang, Stephanie Jones (2001)

Photovoice is a participatory health promotion strategy in which people use cameras to document their health and work realities. As participants engage in a group process of critical reflection, they may advocate for change in their communities by using the power of their images and stories to communicate with policy makers. In public health initiatives from China to California, community people have used photovoice to carry out participatory needs assessment, conduct participatory evaluation, and reach policy makers to improve community health. This article begins to address ethical issues raised by the use of photovoice: the potential for invasion of privacy and how that may be prevented; issues in recruitment, representation, participation, and advocacy; and specific methodological techniques that should be used to minimize participants' risks and to maximize benefits. The authors describe lessons learned from the large-scale Flint Photovoice involving youth, adults, and policy makers.