Does gender affect access to and utilization of rehabilitation services for persons with amputations in Southern Ethiopia?

Abstract

This study aims to understand the perspectives of healthcare workers who are involved in the care of patients about the factors that impact access to and participation in rehabilitation services for people with amputation in Southern Ethiopia, with a particular focus on gender aspects of both persons with amputation and healthcare workers. A qualitative study was conducted using semi-structured one-to-one, face-to-face interviews with 22 eligible healthcare workers from hospitals and rehabilitation centers in Southern Ethiopia. This study employed a Community-Based Participatory Research (CBPR) approach from 14 October 2022 to 16 January 2023 using consultative workshops with experts and engaged community members as Local Research Advisory Committees (LRACs). Two research assistants conducted interviews, which were recorded, transcribed, and securely stored in a password-protected cloud. The data were then analyzed using reflective thematic analysis. The research team reviewed and agreed upon the themes, sub-themes, and their meanings, using mind-maps to highlight interconnectivity. The study identified five themes with interconnecting sub-themes: Barriers to accessing rehabilitation services (knowledge and awareness of rehabilitation services, fear and violence, culture and belief, long distance, transportation challenges and financial constraints, physical environment and, acceptability and utilization of prosthesis and rehabilitation services related barriers), Resources (quality of materials and physical infrastructure, and workforce), Rehabilitation system (rehabilitation to support independent living, engagement, and service design), Perceptions of patient’s experiences (psychological/emotional, relationships and copings, and physical), and Health outcomes (pain, wound, and prosthetic discomfort). This study provides a unique contribution to understanding access (barriers/ issues) to rehabilitation, particularly highlighting the complex issues faced by women with amputations. The insights of health workers illustrate the multifaceted struggles of women and the reality of compromising their rights to equal and personalized rehabilitation services. It highlights the need for gender-inclusive programs, addressing financial constraints, limited decision-making capacity, and transportation issues. Community-based programs, cultural expectations, and innovative prosthetic design approaches are crucial for empowering women as well as promoting gender diversity in healthcare professionals.