Environmental factors influencing the prevention of secondary health conditions among people with spinal cord injury, South Africa

PLOS ONE, 2021 · DOI: https://doi.org/10.1371/journal.pone.0252280 · Published: June 25, 2021

Spinal Cord Injury Participation Accessibility

Simple Explanation

This study explores how the environment affects the prevention of secondary health conditions in people with spinal cord injuries (SCI) in South Africa. It looks at factors like social support, accessibility of buildings and transportation, and the efficiency of the healthcare system. The study found that social support from family and friends, accessible infrastructure, and a well-functioning healthcare system are crucial for preventing these secondary conditions. Lack of these factors can lead to increased health problems and reduced quality of life for people with SCI. The research highlights the need for context-specific interventions that consider these environmental factors to improve the health and well-being of individuals with SCI in South Africa.

Study Duration

July 2018-October 2019

Participants

21 therapists, 17 people with a spinal cord injury and six caregivers

Evidence Level

Not specified

Key Findings

1
Social support from family, caregivers, and peers significantly aids in preventing secondary health conditions by providing emotional encouragement, physical assistance, and financial support.
2
Inaccessible built structures, such as rough terrain and unsuitable public toilets, and a challenging public transport system act as barriers to preventing secondary health conditions for individuals with SCI.
3
An inefficient health care system, characterized by resource shortages, lack of knowledge among health professionals, and an inadequate patient care approach, hampers the prevention of secondary health conditions.

Research Summary

The study aimed to explore environmental factors influencing the prevention of SHCs in people with spinal cord injury by interviewing people with SCI, caregivers and therapists. The environmental factors identified were: the impact of social support, the inaccessibility of built structures and the transport system, and an inefficient health care system. Despite the United Convention on the Rights of Persons with Disabilities (UNCRPD) directive on universal access [27] and the Sustainable Development Goal 11 on the inclusive and accessible environment [28], environmental barriers for people with disabilities persist. In this study, inaccessible public transport systems and built structures were barriers to the prevention of SHCs. The environmental factors influencing the prevention of SHCs are complex and multiple. There are more factors in the healthcare system that influence the prevention of SHCs as stated by Guilcher et al. Understanding local problems and context-specific factors in terms of resources, accessibility, health professional competence and patient care is vital given the high burden of diseases and massive inequality and poverty in South Africa.

Practical Implications

Clinical Practice

Understanding factors preventing secondary health conditions is vital for planning rehabilitation care services. Environmental factors must be considered when developing rehabilitation and prevention programmes.

Educational

Address the lack of awareness of SHCs among community-based health professionals. Training and continuing professional development for health professionals can include disability management and prevention of SHCs.

Research

Explore personal factors influencing the prevention of SHCs in people with SCI, as this study only focused on environmental factors.

Study Limitations

1
The study only looked at environmental factors for the participants at one rehabilitation hospital, limiting generalizability.
2
The sample was purposive, which could imply responder bias.
3
There were very few participants with a higher level of injury.

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