Community perspectives: evaluation of a community-based rehabilitation program in Southern Belize one year post-implementation

Abstract

Purpose: To examine community perspectives regarding the strengths, weaknesses, opportunities, and threats of a community-based rehabilitation (CBR) program in Toledo District, Belize.

Method: A participatory approach was implemented using the CBR Matrix as a conceptual framework. Semi-structured interviews were conducted with CBR community partners and program participants living in Toledo District. Respondents were recruited until thematic saturation was achieved (i.e., no new themes were identified from subsequent interviews). Interviews were recorded and transcribed verbatim. Recurring themes were identified using thematic content analysis.

Results: Eight CBR community partners and 11 program participants completed interviews. Key strengths of the program included engaging CBR program participants as partners in the decision-making process and raising disability awareness. Key weaknesses of the program included lack of a vocational training program and lack of a systematic approach to identify people with disabilities (PWD) or risk factors for disease and disability.

Conclusions: This participatory evaluation provided PWD, their families, and the community the opportunity to express their needs and priorities regarding CBR. Key recommendations included: (1) developing vocational training programs for PWD; (2) expanding collaborations with craftspeople and other community partners throughout Toledo District; (3) continuing the disability awareness program in schools and the broader community; and (4) strengthening community outreach and data collection.

Implications for Rehabilitation

• Persons with disabilities, their families, and community partners should play an active role in the development, implementation, and evaluation of CBR programs to ensure program goals align with community priorities.

• The CBR evaluation process should strive to include diverse perspectives that represent the most marginalized populations (e.g., individuals with significant disabilities living in geographically remote areas).

• The CBR matrix can provide a comprehensive and flexible framework with which to examine community perspectives regarding the strengths, weaknesses, opportunities, and threats of CBR programs.

Keywords:

• Disability
• vocational rehabilitation
• empowerment

Acknowledgements

Sincere thanks to Joyce Lopez, Francisco Cal, Charles Leckie, Melissa Ng, and Hana Main for their support of Hillside Health Care Center and this evaluation, and to the respondents who generously shared their time and perspectives in this ongoing process.

Disclosure statement

Monica Roe served as the Rehabilitation Director for the Hillside CBR program in the year leading up to this program evaluation. Jeff Hartman conducted the initial needs assessment in 2006 and is the former stateside director for Hillside Healthcare International. Dawn Magnusson, Monica Roe and Jeff Hartman serve on various committees for Hillside Healthcare International. Dawn Magnusson is supported by a Health Resources and Services Administration (HRSA), National Research Service Award at the Johns Hopkins School of Medicine from the US Department of Health and Human Services (HHS; under HRSA T32HP10004, Training for Careers in Pediatric Primary Care Research). The content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsement be inferred by HRSA, HHS, the US government, the Belizean government, or Hillside Health Care International.