A total of 126 (89% of 142) therapists answered the initial questionnaire, 59 (42%) of them completed the exit questionnaire, of which 47 (33%) completed both the questionnaire at the beginning and at the end of the community service. I would like to thank all community service therapists who participated in the study by completing questionnaires.
BACKGROUND
Access to health care would also be improved by a compulsory social service policy (Reid, 2001). The effectiveness of the community service program needs to be improved in order to achieve the Ministry of Health's objective of retaining health workers in the public sector and ultimately improving the health status of the community.
STATEMENT OF THE PROBLEM
Perceptions and attitudes of community service therapists will provide useful information about these factors for all policy makers, provincial rehabilitation program, universities and permanent therapists involved in the Community Service Program. It will facilitate more effective community service planning, implementation, monitoring and change for therapists in KwaZulu-Natal and improve service delivery to patients.
PURPOSE OF THE RESEARCH
There are many factors that influence therapist decisions not to work in rural and underserved areas.
SPECIFIC OBJECTIVES OF THE RESEARCH
ASSUMPTION UNDERLYING THE STUDY
OPERATIONAL DEFINITIONS USED IN THE RESEARCH
SCOPE OF THE STUDY
ORGANIZATION OF THE REPORT The report consists of the following chapters
Purpose of community service internationally
Mandatory programs for doctors and other health care professionals have been initiated in many developing countries, as the shortage of doctors in rural and underserved areas is a problem globally. Historically, various programs have been undertaken to alleviate urban-rural imbalances in the distribution of physicians.
International experience with community service
A number of studies in South Africa have focused on doctors' experiences of community service. The KwaZulu-Natal Rehabilitation Program conducted a qualitative survey at the end of 2003 and 2004 to determine therapists' perceptions of community work.
STRENGTHS AND WEAKNESS OF OTHER STUDIES
FURTHER RESEARCH NEEDED
INTRODUCTION
TYPE OF RESEARCH
STUDY DESIGN
RESEARCH POPULATION
DATA SOURCES
Variables
ReliabilitY of measurement instrument
- Statistical analysis
Internal validity was improved by usmg a census of all rehabilitation therapists who did community service in KwaZulu-Natal in 2005. The questionnaires had to be submitted one month before the completion of community service (end of November 2005).
ETHICS
Biomedical Research Ethics Committee
Potential sources of confounding bias that may affect therapists' attitudes and perceptions of their community service experience include gender, race, occupational category, educational institution, receipt of a rural grant, and where they were placed during their community service years. Data collected at the start and again at the end of community service were compared using frequency tables and cross-tabulation.
Permission to conduct the survey
McNemar's Chi Square tests were used to determine the statistical significance of any differences in proportions of perception and attitude reported from pre to post (with <0.05 as the cutoff for significance) community service. The categorization as a rural placement was made by the therapist indicating that they received a rural allowance.
SUMMARY
4 CHAPTER 4: RESULTS
INTRODUCTION
DEMOGRAPHICS OF THE RESPONDENTS IN THE STUDY
CHANGE IN RESPONSES DURING THE YEAR OF COMMUNITY SERVICE There were 48 respondents who answered both questionnaires. One respondents
- Understanding of the community service policy
- Availability of information on community service policy
- Tertiary education equipping therapists for community service
- Supervision
- Concern regarding personal safety
Four of the therapists' attitudes and perceptions changed from negative or neutral at the beginning to positive at the end, or remained positive from the beginning to the end of the mandatory year of community service (Table 4). Therapists had a statistically significant (p=0.052) change for the better in their understanding of community service. Three therapist attitudes and perceptions changed for the worse during their year of mandatory community service (Table 5).
One of the concerns expressed by community service therapists is that of their personal safety. The intention to remain in the public sector also changed for the worse during the year of compulsory community service for therapists. According to the Department of Health, one of the aims of community service is to retain therapists in the public sector once the year of community service is completed.
ATTITUDES AND PERCEPTIONS OF DIFFERENT OCCUPATIONAL CATERGORIES OF COMMUNITY SERVICE THERAPISTS
- Training
- Support, supervision and mentoring
- Supervision and mentoring
- Assistance by seniors
- Support from hospital management
- Availability of resources
- Future placement
- Working in a rural area in future
Community service therapists were asked about the level of support received from their respective forums. Perceptions of the adequacy of support and supervision had worsened during the year of community service (section 4.3.6). Therapists were asked whether they were given support during their year of community service by the hospital management team.
Housing was available to 25% (2) of the audiologists, 40% (4) of the occupational therapists, 29% (4) of 50% (10) of the physical and speech therapists (Figure 4) on site during their community service years. More than half of the community service therapists felt that they had been successful in their efforts to provide significant community outreach. One of the aims of community service is to attract and retain practitioners in rural areas.
THEMATIC ANALYSIS OF VARIABLES FROM EXIT QUESTIONNAIRE Various questions asked at the end of community service for therapists in KwaZulu-Natal
No significant association was observed between the occupational category of community service therapist and their higher education and training, the supervision and support they experienced, the orientation to the hospital they received, their handling of and attitude towards community service and their long-term career plans. There was no significant difference in the association between where community service therapists were located and higher education, orientation, coping and attitude, and future career plans. In relation to psychological and social coping with the hardships of community service, Indian therapists (10.05) scored better than white therapists (9.07), and the Bonferroni test showed this to be significant (p=0.067).
However, there was a significant difference in the perception of how well the universities oriented their community service therapists for community service. Therapists placed in their 2nd to 5th choices scored the highest average of 8.2, (n=14) and dealt best with language issues. The therapists placed in their 6th or more than sixth choice 7.0, (n=15) and inexplicably therapists placed in their first choice of placements had the lowest score of 6.8, (n=26).
SUMMARY OF STATISTICAL ASSOCIATION BETWEEN DIFFERENT VARIABLES
There was no significant correlation between collection of land allowance and decision to work in a rural area in the future (p=O.782). Therapists located in urban areas (n=21; mean score =3.5) showed a greater willingness to work in rural areas in the future than those working in rural areas collecting rural allowances (n=33; mean score = 3.13). There was also no correlation between collecting rural subsidies and staying at the same institution in the future (p=O.317).
A higher proportion of Indian and White community service therapists perceived that their safety was compromised, in contrast to Black and Colored therapists. The correlation was not statistically significant (p=O.349), however, there were only two black and two colored therapists in the sample.
SUMMARY
5 CHAPTER 5: DISCUSSION
INTRODUCTION
ANALYSIS OF DATA
These findings can be used to motivate future community service therapists to be encouraged about their years of community service. There was also a decrease in doctors' intention to stay in the public sector after the year of community service. Therapists were also asked about the community service orientation received from the university they attended.
When community service began, the majority of rehabilitation therapists (66%) believed that they would have adequate support and supervision to be able to function optimally during the year of community service. Couper (2005) states that a mentoring and support plan should be developed for community service officers. According to the Ministry of Health, one of the purposes of community service is to preserve
LIMITATIONS
It also emphasized the fact that therapists must be well prepared, trained and oriented before commencing community service, especially in rural areas. This study proved useful in identifying areas of need and success in the implementation of community services for therapists in KwaZulu Natal. Because community therapists are directly involved in the program, their input, perceptions, and experiences would be highly valuable.
It is intended that through this consultation and collaboration process, many of the challenges faced by therapists in community care can be addressed. More emphasis should be placed on support, supervision, mentoring, induction and orientation of rehabilitation therapists for community service. The service provision policy was also aimed at attracting and retaining healthcare professionals in the public sector.
SUMMARY
Confronting the role of research in policy development and implementation: A case for community service for doctors in South Africa. An Assessment of Skills Training Needs and Transformation of Community Service Practitioners and Physicians Working in a District Hospital. Factors influencing family physicians to enter rural practice: Does rural or urban background make a difference?
Perception and experiences (?f community service doctors of their mandatory community service at Shongwe Hospital, Mpumalanga, SA World Rural Health. A program to increase the number of Family Doctors in rural and underserved areas impact after 22. Impact of undergraduate study and post Rural graduate training and medical school entry criteria on rural practice among Australian GPs: National study of 2414 GPs.
ONSET QUESTIONNAIRE
- EXIT QUESTIONNAIRE
- GAZETTED SITES FOR COMMUNITY SERVICE 2005
Compulsory community work policy is good for retaining health personnel in rural areas. o I don't know. In last year's allocation process, what was the medical facility number of your choice that you were finally allocated to.. Information about policies and procedures was readily available to me o Strongly disagree o Disagree o Neutral o Agree.
Professional forums were a good source of support. o Strongly Disagree 0 Disagree 0 Neutral 0 Agree COIlliJ.1ent. If you go to work overseas, do you plan to return to work in SA? Please write any further feedback on a separate sheet of paper, including your recommendations for improving the community service.
AUDIOLOGY
J. Crookes Hospital 11 I J.Crookes Hospital
- ETHICS CLEARANCE
UNIVERSITY OF
KWAZULU-NATA
KWAZUlU-NATAt
Disability and Rehabilitation has received and approved an application from Ms N.B.Khan, an MPH student to conduct a community service study for therapists in KwaZulu-Natal. The program recognizes the importance of monitoring and evaluating the community service program for therapists, which was first introduced in 2003. The program strongly believes that Ms. Khan's proposal will contribute significantly to establishing a credible knowledge base to further improve the delivery of the community service program.
Mytopic is "Perceptions and Attitudes towards the Compulsory Community Service Experience: Perspectives of Community Service Occupational Therapists, Audiologists, Physiotherapists and Speech Therapists in KZN". My topic is "Perceptions and Attitudes towards Compulsory Community Service Experiences: Perspectives of Community Service Occupational Therapists, Audiologists, Physiotherapists and Speech Therapists in KZN". The study will be conducted in all hospitals where community service therapists are based, and all therapists will be invited to participate.
