Date Presented 03/28/20
Limited healthcare in Punta Gorda, Belize, and surrounding villages called for an assessment of needed OT services. Interviews were conducted remotely and with a free healthcare clinic. Four main themes emerged: (1) lack of early intervention, (2) barriers to accessing school for children with developmental disabilities, (3) high caregiver burden, and (4) lack of social-emotional care. Findings support the addition of OT to the available care in rural Belize.
Primary Author and Speaker: Kyra Barillier
Additional Authors and Speakers: Lisa Jaegers
PURPOSE: Within the Southern region of Belize, specifically Punta Gorda in the Toledo District (population 30,500), there are limited resources for health care including one primary care office, one hospital, one eye doctor, various community health workers, and a free health care clinic (HCC). The HCC provides medical care, home health medicine, public health initiatives, and physical therapy. The Belize government offers emergency, primary, and visual medical services, but limited to one hospital and office in this location. Belize is not currently listed as a country participating in the World Federation of Occupational Therapy (1).
Occupational therapy (OT) is not currently offered at the HCC, representing a gap in necessary services to their clients experiencing chronic health conditions and disabilities across the lifespan. The HCC volunteers suggested the use of a needs assessment to examine the need for adding OT to the clinic’s services. An exploratory needs assessment aims to create or adapt services, programs, or policies by highlighting needs of broad groups (2), and is necessary to identify current needs at the HCC to then determine what can be addressed by OT.
DESIGN: This study is a narrative exploration that was completed through one-on-one interviews with Belize HCC volunteers and staff. Study design was informed by initial discussions with key informants at Saint Louis University (SLU) familiar with the region and or healthcare of Belize. Participants were recruited in the first phase through the advice of a member on the board of directors for the clinic. During a visit to the clinic, study participants were recruited for their knowledge of the population served and professional experience working with the general community, in schools, or in the clinic.
METHOD: Semi-structured interviews began in March 2019 at SLU and in person at the HCC in May 2019 to expand the data collected at the remote location. Qualitative in vivo coding (4) is in progress to identify common themes resulting from the data.
RESULTS: In all, 30 interviews were completed in Belize with clinic professionals and 11 at SLU with key informants. Preliminary results indicate several emerging themes including: a) early childhood intervention is rare and negatively affects cognitive, motor, and social-emotional development (3); b) children who have developmental disabilities experience several barriers that could be addressed by OT such as not attending school, despite current advances in care; b) caregiver burden, especially with individuals post injury (e.g. cerebral vascular accident and spinal cord injury) could utilize OT education; c) lack of social-emotional healthcare to address toxic stress and trauma post-injury. Overall, the need for individualized focus on promoting higher levels of independence in the lives of individuals with disabilities was strongly supported and desired.
CONCLUSION: Most of the identified themes of need are within the scope of practice for OT, and they support the addition of OT services to the health care or social services in Belize. This includes mental health care, early intervention, school-based rehabilitation, acute care, caregiver education, and home health. As a continuously developing independent government, Belize has the framework available to support the addition of OT to the national health care system would presents an opportunity to effectively expanding the overall OT practice.
IMPACT STATEMENT: This supports the global expansion of OT and shows the need for OT practitioners in developing countries such as Belize. Expansion should be supported by the clinic, OT associations, and universities with OT programs.
References
World Federation of Occupational Therapy. (2019). Member organizations profiles. Retrieved from https://www.wfot.org/membership/member-organisations/member-organisations-profiles.
Kielhofner, G. (1970). Needs assessment research. In Taylor, R.R., & Finlayson, M. (Eds.) Research in occupational therapy (2nd ed.), 809-839.
Grantham-McGregor, S., Cheung, Y. B., Cueto, S., Glewwe, P., Richter, L., Strupp, B., & International Child Development Steering Group (2007). Developmental potential in the first 5 years for children in developing countries. Lancet, 369(9555), 60–70. doi:10.1016/S0140-6736(07)60032-4
Miles, M. B., Huberman, A. M., & Saldana, J. (2014). Qualitative Data Analysis: A Methods Sourcebook (3rd ed.). Thousand Oaks, CA: Sage Publications.
