Understanding how a community-based intervention for people with spinal cord injury in Bangladesh was delivered as part of a randomised controlled trial: a process evaluation

Spinal Cord, 2020 · DOI: https://doi.org/10.1038/s41393-020-0495-6 · Published: June 15, 2020

Spinal Cord Injury Research Methodology & Design Public Health

Simple Explanation

This study explores how a community support program for individuals with spinal cord injuries (SCI) in Bangladesh was implemented as part of a clinical trial. The program involved regular check-ins via phone and home visits from case managers during the initial two years post-hospital discharge. The research examined records of phone calls and visits, recordings of phone conversations, and interviews with both participants in the support program and healthcare professionals. The goal was to understand how the program was carried out and what the experiences of those involved were. The findings indicated that the support program was delivered as planned and was generally well-received by the participants. However, the study also highlighted significant economic and social challenges faced by individuals with SCI in Bangladesh, which the support program alone could not fully address.

Study Duration

2 years

Participants

204 Intervention participants, 4 healthcare professionals

Evidence Level

Not specified

Key Findings

1
Pressure injuries were a significant concern, discussed in at least one phone call with 43% of participants. Case-managers provided strategies to treat and prevent them.
2
Home visits, though logistically challenging, were highly valued by both participants and case-managers, enabling better assessment and support.
3
Regular phone calls and home visits helped reduce social isolation and feelings of depression among participants.

Research Summary

This study examined the implementation of a community-based model of care for individuals with SCI in Bangladesh, focusing on the experiences of participants and healthcare professionals. The model of care involved regular telephone calls and home visits by trained case-managers over a 2-year period. The study found that the model of care was feasible, culturally appropriate, and valued by participants. Key themes included the focus on prevention and management of pressure injuries, the value of home visits despite logistical difficulties, and the alleviation of social isolation through regular contact. The study highlighted the importance of the skills and expertise of case-managers, as well as the financial strain faced by participants, which could limit the effectiveness of the support provided. The study also emphasized the need for broader social support programs to address the needs of this marginalized population.

Practical Implications

Reinforce Prior Education

The intervention was more effective when building upon prior education received at a specialized SCI center. Consider prior education levels when implementing similar interventions.

Address Logistical Barriers to Home Visits

Home visits are valuable but face logistical challenges. Decentralizing SCI services and using telehealth can improve accessibility.

Emphasize Behavior Change Skills for Case-Managers

Case-managers need training in behavior change approaches and goal setting to promote patient-centered care effectively.

Study Limitations

1
Potential for positive reporting bias due to involvement of researchers in the intervention design.
2
Recordings of telephone calls were conducted later in the trial, potentially missing early challenges.
3
Lack of interviews with all case-managers or carers of participants with poor outcomes.

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