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Original Research Articles

Anticipated Barriers to Implementation of Community-Based Rehabilitation in Ribeirão Preto, Brazil

Authors:

Regina Celia Fiorati,

Medical School of Ribeirão Preto, University of Sao Paulo, BR
About Regina Celia

Regina Celia Fiorati is a Brazilian Occupational Therapist, professor in Occupational Therapy Undergraduate Course of Heath Science Department at the Medical School of Ribeirão Preto, University of São Paulo - Brazil. She holds a Masters and PhD in Mental Health from the Postgraduate Program in Psychiatric Nursing and Human Sciences at the Ribeirão Preto College of Nursing, University of São Paulo, Brazil, and postdoctoral degree in Public Health from the Faculty of Medicine of the Autonomous University of Madrid, Spain. Currently, Regina Celia Fiorati is professor, researcher and counselor in the Graduate Programs in Psychiatric Nursing and Human Sciences and the Interunit Program of Doctorate in Nursing and Health Sciences at the Ribeirão Preto College of Nursing, University of São Paulo.  Her areas of interest are: Mental Health, Public Health, social determinants of health, social vulnerability, psychosocial rehabilitation and community-based rehabilitation, and social inclusion by work and job, qualitative research and critical hermeneutic method of Jürgen Habermas.

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Regina Y Dakuzaku Carretta,

Medical School of Ribeirão Preto, University of Sao Paulo, BR
About Regina Y Dakuzaku

Regina Yoneko Dakuzaku Carretta is a Brazilian Occupational Therapist, professor in Occupational Therapy Undergraduate Course of Heath Science Department at the Medical School of Ribeirão Preto, University of São Paulo - Brazil. She holds a Masters and PhD in the Postgraduate Program in Production Engineering at the Federal University of São Carlos, Brazil, in the area of Production Management, which comprises the subarea Institutions, Organisations and Work. The subject researched involved people with disabilities and work. Member of the Coordinating Committee of the multiprofessional residency program in integral health care. Her areas of interest are: Public Health, primary health care, social vulnerability, people with disabilities, psychosocial rehabilitation and community-based rehabilitation, and social inclusion by work and job. 

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Karine Pereira Joaquim,

Medical School of Ribeirão Preto, University of Sao Paulo, BR
About Karine Pereira

Occupational therapist graduated from the Faculty of Medicine of Ribeirão Preto at University of São Paulo. Currently she is attending the Multiprofessional Residency in Mental Health with emphasis in Primary Care in the city of Sorocaba - State of São Paulo, Brazil. Her areas of interest are: Public Health, Mental Health, accessibility, people with disabilities, rehabilitation and social vulnerability.

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Aline Ferreira Placeres,

Ribeirão School of Nursing, University of Sao Paulo, BR
About Aline Ferreira

Aline Ferreira Placeres is a Brazilian Occupational Therapist, graduated from University of Araraquara, Brazil. She is a Masters Degree student in Health Sciences from the Nursing School of Ribeirão Preto- University of São Paulo, Brazil. Aline has a postgraduate degree in Physical Rehabilitation from the Multiprofessional Residency Program and Hospital Occupational Therapy from the Improvement Program of the Medical School of São José do Rio Preto, Brazil. Her areas of interest are: rehabilitation; rehabilitation quality improvement; accessibility; social vulnerability;public health; social determinants of health.

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Tiago Silva Jesus

Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Rua da Junqueira 100, Lisbon -1349-008, PT
About Tiago Silva

Tiago Jesus is a Portuguese Occupational Therapist by training, graduated from Oporto Polytechnic Institute, Portugal. He has a European Ph.D. in Health Psychology from the Miguel Hernández University, Elche, Spain. Currently, Tiago is an Associate Post-doctoral Fellow at the Global Health and Tropical Medicine (GHTM), WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine - NOVA University of Lisbon. His areas of interest, research and publication are: rehabilitation; health policy and systems research; methods research; global health; human resources for health; person-centeredness; and rehabilitation quality improvement.

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Abstract

Purpose: Disability is a global health and a global development concern. To address both issues, a community-based rehabilitation (CBR) approach is increasingly recommended to meet a spectrum of needs, especially for people with disabilities. It is first necessary to understand the perceptions of local, frontline providers, in order to design effective measures for implementing CBR programmes. This paper aimed to understand the conceptions of Primary Healthcare Providers (PHPs) - serving a sub-urban, socially-vulnerable territory in Brazil - about: 1) disability, 2) rehabilitation, and 3) the possible local implementation of a CBR strategy, including any anticipated barriers.

Method: Cross-sectional, exploratory qualitative research was based on focus groups conducted between 2013 and 2016. It involved a total of 78 PHPs serving the western region of the Ribeirão Preto municipality in São Paulo, Brazil. Data analysis was based on Habermas’ critical hermeneutics approach.

Results: PHPs understood disability mostly within the biomedical paradigm. Similarly, the predominant conception of rehabilitation was focussed on enabling individuals’ capacity, more than their environment. For local CBR implementation, the barriers that were anticipated were: 1) difficulties in managing and running action across sectors, and 2) the broader socio-political environment that hardly empowers civil society and is affected by power differentials.

Conclusion and Implications: While local PHPs identified important CBR implementation barriers which are contextual in nature, the predominant conceptions of disability and rehabilitation (i.e., biomedical, impairments-based) also act as a barrier. Contextual and cognitive barriers must both be addressed when envisioning a local CBR implementation.

How to Cite: Fiorati, R.C., Carretta, R.Y.D., Joaquim, K.P., Placeres, A.F. and Jesus, T.S., 2018. Anticipated Barriers to Implementation of Community-Based Rehabilitation in Ribeirão Preto, Brazil. Disability, CBR & Inclusive Development, 29(1), pp.5–25. DOI: http://doi.org/10.5463/dcid.v29i1.701
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Published on 17 Jul 2018.

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