Parental health literacy in rural Uganda: a qualitative exploratory study

WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426

Purpose: For the past 10 years, community-dwelling the elderly have attended a monthly Preventive Long-Term Care program. The program mainly includes gymnastics and Thera-Band exercises for a duration of approximately 1 h. Furthermore, participants undergo a physical fitness test once a year. This study aimed to investigate changes in motor function in the elderly who attended the program continuously for several years. Methods: The study included 8 subjects (5 females, 3 males), who had attended the program for more than 3 years, had undergone a physical fitness test at least three times and were older than 70 years. Two subjects had mild hemiplegia. Changes in motor function were evaluated by assessing oneleg balancing with open eyes, sitting stepping, grip strength, vertical jump and fast walking speed. Results: The age at the time of the first physical assessment was 74 years for 3 subjects, 75 years for 2 subjects, 76 years for 1 subject and 80 years for 2 subjects. The duration between the first and final assessments was 3–5 years for 4 subjects and 8–10 years for 4 subjects. During this period, the frequency of attendance at the program varied. At the initial measurement, there was a clear difference in the functional level of each parameter among the subjects. However, over time, regardless of the differences in the initial functional level, the subjects had the same level of motor function. At the last measurement, all subjects were independent in activities of daily living and had encountered no problem during social participation activities in the region. Conclusion(s): Regardless of their initial level of motor function, continued participation in the Preventive LongTerm Care program ensured the elderly maintained the same level of motor function over time. Even after temporary interruptions in attendance, there was a high motivation to return, which contributed to continued maintenance of the motor function level. Implications: To ensure a healthy life in the elderly, a high level of motor function is important. However, even in the independent elderly with a low level of motor function, that level of function can be maintained through participation in programs such as the Preventive Long-Term Care program. Keywords: Elderly; Preventive Long-Term Care; Longterm intervention Funding acknowledgements: This work was unfunded. Ethics approval: These subjects were informed consent for the study. http://dx.doi.org/10.1016/j.physio.2015.03.346

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Research Report Poster Presentation Number: RR-PO-05-08-Mon Monday 4 May 2015 13:00 Exhibit halls 401–403 PARENTAL HEALTH LITERACY IN RURAL UGANDA: A QUALITATIVE EXPLORATORY STUDY S. Burke 1 , C. Doody 1 , A. Waugh 2 , S. Garrett 2 , C. O’Sullivan 1 1 University

College Dublin, School of Public Health, Physiotherapy and Population Science, Dublin, Ireland; 2 St. James’s Hospital, Physiotherapy Department, Dublin, Ireland Background: In the Global North, parental health literacy can be assessed using the valid and reliable Parental Health Literacy Activities Test (PHLAT) or its shortened version, the PHLAT-10, both of which examine a parent’s understanding of nutritional information, medical instructions, and common literacy and numeracy skills. However, a suitable tool is not available for the assessment of parental health literacy in countries with high poverty levels and poor literacy rates similar to those in East Africa. To date, no empirical study has reported on the feasibility and utility of the PHLAT in rural Uganda. Purpose: The aim of this exploratory study was to investigate the use of the PHLAT-10 in rural Uganda. A valid and reliable health literacy measure which is sensitive to the cultural nuances of health care in Uganda could prove useful in health promotion and development in this context. This research aimed to present preliminary recommendations on how best the PHLAT-10 could be modified for use in rural Uganda. Methods: Qualitative semi-structured interviews were conducted with a purposive sample of resident health care workers (n = 5) and international health care volunteers (n = 2) at COU Kisiizi Hospital, Uganda. All interviews were led by the primary researcher, a final year undergraduate physiotherapy student from Ireland, who was volunteering at the hospital’s rehabilitation department. The interviews were audio-taped and transcribed. Data analysis was based on an interactive model for qualitative data analysis (Miles & Huberman, 1994). Themes were identified in line with each item of the PHLAT-10. Analysis was completed by the primary researcher and further reviewed by a university lecturer from Ireland. Results: A qualitative analysis of the transcripts suggested that all items of the PHLAT-10 would require considerable modification for use in rural Uganda. The PHLAT-10 was found to show limitations due to local differences in types and availability of infant foods, local differences in the availability of medications for the treatment of childhood illnesses, low parental literacy levels and the existence of a clinician-led model of healthcare in the local area. However, the clinical

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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426

domains and skills assessed by the PHLAT-10 were found to have relevance for this setting. Conclusion(s): The results of this study showed that in its present form, the PHLAT-10 has significant limitations as a tool to assess parental health literacy in a rural Ugandan setting. The need to measure health literacy, however, cannot be disregarded. Without a health literacy measure in developing countries like Uganda, gaps in understanding of common health messages could continue to be overlooked. Implications: The issues examined in this study provide an important first step in the development of a scientifically rigorous health literacy assessment tool. The development of a quick, reliable and valid measure of this construct could prove valuable in moves towards heightened awareness of health related issues in contexts like the one examined in this study. Preliminary recommendations as to how the PHLAT10 could be modified are suggested, which would require further investigation in a larger scale study. Keywords: Parental health literacy; Public health; Uganda Funding acknowledgements: Nil funding associated with this project. Ethics approval: COU Kisiizi Hospital, Research, Ethics and Education Committee. http://dx.doi.org/10.1016/j.physio.2015.03.347 Research Report Platform Rapid 5 Presentation Number: RR-PLR5-3312 Sunday 3 May 2015 13:45 Room 324-326 ASSOCIATION BETWEEN WRIST EXTENSOR MUSCLE ONSET TIMING AND MOTOR CONTROL ACCURACY IN ACUTE AND CHRONIC STROKE PATIENTS R. Turk 1 , W. Srisoparb 1,2 , J.H. Burridge 1 1 University

of Southampton, Faculty of Health Sciences, Southampton, United Kingdom; 2 Naresuan University, Department of Physicaltherapy, Faculty of Health Sciences, Naresuan, Thailand Background: Wrist extension is an essential component for hand function such as grasping and releasing an object (Keenan et al., 1989). Motor control accuracy (MCA) of wrist movement can be measured by tracking performance, and correlates with upper limb functional activity post-stroke (Burridge, 2008). Delayed muscle onset timing has been demonstrated in the paretic upper limb (Chae et al., 2002), which has been shown to improve with recovery of function in the sub-acute phase (Wagner et al., 2007). However, the association between muscle onset timing and wrist MCA has not been demonstrated in acute or chronic stroke patients. Purpose: To investigate the relationship between wrist extensor muscle onset timing and MCA during a discrete

and rhythmic tracking task in acute (less than 4 months) and chronic (more than 6 months) stroke patients. Methods: Participants (28 acute and 21 chronic stroke) were recruited from a University of Southampton research participant database, from Solent and Surrey Community NHS Trusts, UK; and from the Department of Physiotherapy, Buddhachinaraj Hospital, Thailand. After giving informed consent, participants sat in a chair with their arm strapped on a neuromechanical rig. Their forearm was supported with the wrist joint positioned over the pivot point of the rig allowing friction-free flexion-extension movements. The elbow was flexed with the upper arm strapped to a support. Surface electromyography (EMG) electrodes were positioned on the extensor carpi radialis longus and flexor carpi radialis muscles according to SENIAM guidelines (Hermens et al., 1999). Participants performed a discrete step tracking task, with random displacement of the target gradually increasing from 5◦ to 40◦ about the active range of motion (AROM) mid-point. MCA (MCAstep) was calculated as the mean absolute error between target and wrist movement. Wrist extensor onset timing was defined as the interval between the target moving and the detected EMG activation onset where ‘onset’ was 4SD above resting local baseline, recorded for 1 second immediately prior to each target displacement. Participants also performed a sinusoidal tracking task at 0.5 Hz frequency and ±20◦ displacement of the target about the AROM mid-point. MCA (MCAsine) was calculated as the cross-correlation between target and wrist movement (Notley, 2007). Pearson correlation coefficient was used to examine the association between MCA and wrist extensor onset timing in both stroke groups. Results: There were significant moderate to strong correlations between muscle onset timing and MCAstep in both the acute (r = 0.581, p = 0.005) and chronic (r = 0.639, p = 0.002) groups. Muscle onset timing was also moderately and significantly correlated with MCAsine in both the acute (r = −0.451, p = 0.016), and chronic group (r = 0.581, p = 0.001). Conclusion(s): Extensor muscle onset timing is moderately and significantly associated with motor control accuracy of both discrete step and rhythmic sinusoidal tracking in both acute and chronic phase post-stroke. Implications: Considering these results it seems likely that improvement of muscle activation timing may be associated with improved motor control at the wrist; this requires further evaluation in a longitudinal study. Timing of muscle activation should be considered by Physiotherapists when retraining motor control in the upper limb. Keywords: Muscle onset timing; Motor control accuracy; Stroke Funding acknowledgements: This research is funded by Dunhill Medical Trust, England and Naresuan University, Thailand. Ethics approval: Faculty of Health Sciences Ethics Committee, University of Southampton, South West Hampshire