Background This study was instigated in response to the researcher’s own realisation, as a rehabilitation practitioner and educator, that the concept of rehabilitation as identified in the literature may not be culturally sensitive. This view was prompted by the researcher’s interactions with international students undertaking an MSc in Rehabilitation at Oxford Brookes University in the UK. The literature defining and describing rehabilitation generally appears to be from Europe (including the UK), Australia and the USA with an emphasis on concepts and values such as independence, autonomy and individualism, which appears to represent the values the of the Western countries from which the literature originates. This view is supported by Saadah (2002) who identifies autonomy as such a concept, which is identified as the aim of rehabilitation in the literature (Cardol 2002a) and calls for a structural framework for rehabilitation based on understanding of different cultures and culturally sensitive care. Aim and Objectives The main aim of this study was to examine the concept of rehabilitation in the literature in relation to cultural sensitivity in order to gain new interpretations and understandings for rehabilitation practice and education. The objectives being to discover if there is an essence or core of rehabilitation that transcends culture; whether the International Classification of Functioning, Disability and Health (ICF) (WHO 2001) is suitable for use as a cultural framework and to identify implications for practice and education. Methodology and Methods Concept analysis (Morse 1995) was the research approach used as it fits in with the conceptual assumptions of the study and enabled the researcher to analyse the literature in depth in order to explore the concept of rehabilitation in relation to cultural sensitivity. Morse’s approach was followed with the fundamental difference being the addition of qualitative data which were analysed along with the literature. The data were collected from a university and hospital in Manipal, South West India. A literature review was conducted accessing PubMed, CINHAL, AMED, PsycINFO, NARIC and IndMED data bases using inclusion and exclusion criteria. Following management of the literature using the ICF (WHO 2001) categories and critical appraisal a sample of 120 articles was identified. Thirteen patients with neurological or orthopaedic conditions undergoing rehabilitation were interviewed using qualitative interviews, seven focus groups were conducted involving physiotherapy, occupational therapy and nursing students, health care professionals and lecturers and participant observation was conducted. Main Findings The literature and qualitative data were analysed following Morse’s concept analysis approach to establish the level of maturity. This enabled the concept of rehabilitation to be deconstructed in terms of its components (attributes, definitions, attributes, pre-conditions, outcomes and boundaries). As a result the concept of rehabilitation in relation to cultural sensitivity was identified as being mature in relation to pre-requisites, boundaries and outcomes but only partially mature in respect of definitions and attributes. A key finding of this stage is that rehabilitation needs to be meaningful to the person and their family. This then led to the next step of concept analysis: concept clarification, where critical questions were asked of the data in order to advance the concept in relation to cultural sensitivity. As a result, culturally safe rehabilitation, external factors, family centred decision-making and meaningful rehabilitation were all identified as being integral to the concept of rehabilitation being meaningful to the person and their family. Conclusion A key contribution of this study to the body of knowledge on rehabilitation is that, in order for rehabilitation to be culturally sensitive, it needs to be meaningful to the person-in-their-family-in-their-cultural context. This can be seen as the essence of rehabilitation that transcends culture. In order for this to happen, rehabilitation needs to be emergent: responding to the needs of the person in their cultural context with professionals allowing for variation in individual experiences and perspectives. These elements have been combined into a framework with the person-in-their-family-in-their cultural context at the centre. However, the findings and recommendations need to be treated with caution as they are based on a small sample of data representing one area of India with a limited number of participants and literature that is only representative of the country and discipline in which it is written. There are also other limitations in terms of data collection, data analysis and interpretation of results. Future research is required to explore the idea of ‘meaningful rehabilitation’ for patients and their families and to evaluate the framework in practice and in education.
Davis, S
Department of Sport and Health SciencesFaculty of Health and Life Sciences
Year: 2013
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